Evidence submitted by South East Health
Ltd (EPR 13)
1. EXECUTIVE
SUMMARY
We are a not-for profit limited company, providing
out of hours primary care services to a population of over 900,000,
covering parts of East Kent, together with the East Sussex coast
including Brighton. Our services are commissioned by four Primary
Care Trusts (Eastern & Coastal Kent PCT, East Sussex Downs
and Weald PCT, Hastings & Rother PCT and Brighton & Hove
City PCT.)
We note the focus of this new inquiry and our
written evidence relates to three of the five areas given in Press
Notice No. 12, namely:
(a) Who will have access to locally and
nationally held information and under what circumstances.
Our submission below stresses the importance
of our out of hours primary care service having access to "in-hours"
patient records, and in particular, those held by the patient's
GP Practice.
(b) What patient information will be held
on the new local and national electronic record systems
Our submission below indicates that generic patient
details should be accessible for matching and verification. We
also advocate that a patient summary should be made accessible
to the clinicians of our out of hours service, compiled from information
stored in the computerised GP Practice patient record.
(c) Current progress on the development
of the NHS Care Records Service and the National Data Spine and
why delivery of the new systems is up to 2 years behind schedule.
Our submission below stresses the importance
of delivering the new systems in the out of hours context. We
mention some previous complaints concerning the out of hours service
which have highlighted the problems which can arise when continuity
of patient care is jeopardized by lack of access to previous medical
history.
2. SUBMISSION
(a) Who will have access to locally and nationally
held information and under what circumstances.
South East Health Ltd welcomes the interest
of the Committee in this area of focus. Our organisation is commissioned
by a group of Primary Care Trusts (PCTs) to provide an out of
hours primary care service to their combined populations in East
Kent and East Sussex. The total population served is around 900,000.
The demography is diverse in terms of age ratios,
population distribution and culture. Large parts of the Romney
Marshes and the Rother Levels are rural, thinly populated areas.
In contrast Brighton is densely populated, multi-cultural and
cosmopolitan.
As a result of the new General Medical Services
Contract 2003, GP practices were no longer obliged to provide
patient services in the evenings, or at weekends or Bank Holidays.
The responsibility for such provision, which had previously been
handled by groups of practices working together as GP Co-ops,
was now passed to the local PCT. The PCT then commissioned the
service from out of hours provider organisations such as South
East Health Ltd.
The Department of Health and indeed HMG, have
been concerned to stress the importance of a 24/7 Health Service.
This cannot work effectively without continuity of care.
South East Health Ltd employs doctors on a sessional
basis, to cover its evening/overnight and weekend shifts. The
likelihood of a GP seeing one of his/her practice patients when
the GP is working for South East Health Ltd as an out of hours
duty doctor, is remote.
The out of hours duty doctor will have the following
patient information available to him/her when a telephone advice
consultation or a face to face patient consultation is about to
be made:
(i) generic details of the patient—name,
date of birth, address, own GP
(ii) current symptoms/health problem(s) (as
described by the patient or their carer, to the South East Health
Ltd call operator)
(iii) references to previous calls, if any,
made to South East health Ltd.
(iv) special Notes if any—essentially,
attention flags for the information of the clinician, provided
by and at the discretion of, the GP practice or other healthcare
provider, eg if the patient has been removed from a practice list
and is subject to a local violent patient scheme.
It follows therefore that medical history details,
including operations, illnesses, allergies, allergic reactions
to medications, etc, etc, could be of significance in the context
of the out of hours consultation, and under existing arrangements,
may well not be known to the out of hours clinician.
At best this situation compromises continuity
of health care—at worst it is dangerous and might be life
threatening.
We would therefore strongly urge the Committee
to be mindful of the need for access to GP practice patient information
by the out of hours service.
(b) What patient information will be held
on the new local and national electronic record systems
We hope that we have justified our need for
access to patient records out of hours, as in 2a) above.
The out of hours clinician needs to have historic
details of the patients and details of recent healthcare events
or episodes. The natural source of this information will be the
patient's computerised GP notes. For example, a patient who has
contacted the out of hours service for advice/treatment might
have had a recent hospital episode.
The patient or carer may not be fully aware
of the details of this episode. However, a discharge summary will
have been sent by the acute hospital to the GP practice, and the
details will have been captured and stored within the GP patient
record.
We would advocate that an extract summary of
the patient's GP record should be routinely posted on the National
Data Spine so that it can be made available to the out of hours
clinician.
An extract summary could include:
— Generic patient details
— History of other significant events
eg pregnancies
— History of medical treatments
— List of current medication (Repeat
and Acute)
— Recorded reactions to medication
— Medications contra-indicated
— Summary of hospital episode(s)
— Existing Special Notes / Management
protocols
(c) Current progress on the development of
the NHS Care Records Service and the National Data Spine and why
delivery of the new systems is up to 2 years behind schedule
In common with other out of hours providers,
South East Health Ltd (formerly Seadoc Ltd and Brightdoc Ltd)
has file records of a number of complaint cases in which the continuity
of care had been compromised by the lack of access to previous
medical history. In a minority of cases the complaint had escalated
to the Healthcare Commission and in two instances, to the Parliamentary
& Health Service Ombudsman.
In such cases we have been at pains to point
out that we have promoted and implemented upgrades to our out
of hours database software to go as far as we can in minimising
the risk of repetition. For example the system now alerts clinicians
to previous out of hours contacts (last six calls).
However we have also respectfully pointed out
that the lack of access to GP practice summary patient extracts
is outside our control.
Ron Owttrim
Chief Executive, South East Health Ltd
March 2007
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