Progress with demographics in the NHSCRS
since Dr Nowlan's departure
THE PERSONAL
DEMOGRAPHICS SERVICE
The Personal Demographics Service (PDS) is an
essential element of the NHS Care Records Service, underpinning
the creation of an electronic care record for every registered
NHS patient in England. It will serve as a gateway to the clinical
record, enabling authorised healthcare professionals to locate
quickly the clinical record that is uniquely associated with each
demographic record.
Unlike the previous services, this single authoritative
source of demographics is accessible throughout the NHS and is
integrated fully with the other applications and services delivered
as part of the National Programme for IT. These include Choose
and Book, Electronic Prescription Service (EPS), GP to GP and
HealthSpace. It provides more convenience for patients as they
need only notify one authorised healthcare organisation of a change
of address and this change will be available to all healthcare
organisations as and when the patient records are accessed.
Since Dr Nowlan left the organisation significant
progress has been made, resulting in the following incremental
benefits.
The Personal Demographics Service improves the
working lives of healthcare professionals. By using the PDS healthcare
professionals can:
— be confident they have access to
accurate and complete patient demographic information;
— access the most up to date contact
details to ensure that mailings are more likely to reach the intended
recipient;
— find more easily the right record
for the right patient meaning less time chasing records and more
time delivering care;
— where necessary, gain urgent access
to patient's previous clinical history via direct GP to GP contact
as PDS holds patient's previous GP, address and telephone contact
details; and
— access the patient's registered GP
on encounters where a third party patient's (paper) notes had
been incorrectly filed into the notes of a newly registered patient's
notes.
The PDS will replace the following existing
NHS demographics services:
— the NHS Central Register (CHRIS);
— demographic functions of the National
Health Applications and Infrastructure Services (NHAIS);
— the NHS Strategic Tracing Service
(NSTS); and
— NHS Number for Babies (NN4B).
Moving to the PDS becoming the single authoritative
source of demographics will enable the existing national demographic
systems to be shutdown, resulting in reduced operational costs.
Progress on the migration of the above services
has also realised the following benefits to date:
1. Immediate Birth Notifications to PDS
The NHS Numbers for Babies System (NN4B) issues
NHS Numbers on new births. From 1 June 2006, a link between NN4B
and the PDS made information on new births available immediately
in the NHS Care Record Service. Prior to this, it could take up
to eight weeks for a baby's demographics information to be available
to the NHS outside the unit in which the baby was born.
2. Birth Notifications to Office for National
Statistics
In March 2006 an interface was introduced between
the NN4B system and the Office for National Statistics (ONS).
ONS now receives notifications of new births directly, which supports
their statistical analysis and registration of births, deaths
and marriages.
3. NHAIS access to the PDS
The National Health Applications and Infrastructure
Services (NHAIS) comprise a range of legacy IT systems and services
on which the NHS relies. When a patient registers with a GP, NHAIS
now traces the patient through the PDS. This ensures that the
NHS number for the patient is found immediately, reducing the
time necessary for their medical records to be transferred between
GP practices.
The second stage of the NHAIS migration will
commence shortly, enabling new patients to have a NHS number immediately,
rather than being issued with a temporary number.
The PDS also underpins the following services:
1. Electronic Prescription Service
The EPS reduces the need for patients to visit
their GP surgery just to collect a prescription—saving time
for both patients and GP surgery staff, and improving accuracy
and safety because prescription information will not need to be
recorded first by the GP and again by the pharmacist.
2. General Practice to General Practice Service
The benefits to patients include:
— the patient health record being available
to the new GP within 24 hours;
— the new GP will have knowledge of
the patient's current medication, drug interactions, current problems
and key past medical history;
— an improvement in patient safety;
— increased patient confidence that
they will get good continuing care; and
— preventing patients being asked for
information that they have previously reported.
The benefits to practice administrative support
teams include:
— reduced administrative time at the
previous GP practice to find and forward patient records to the
new GP practice;
— reduced administrative and clerical
time at the new GP practice to review and summarise or re-key
the patient record received from the previous GP practice;
— reduced time taken for the practice
to receive the patient record; and
— reduced administrative time to chase
up patient records from health authorities.
3. HealthSpace
HealthSpace will provide the following benefits:
— Information quality will be improved
because patients will be able to check the accuracy of their data
through HealthSpace. They may be able to update some elements
themselves or flag it for the attention of a healthcare professional
— It will provide systematic access
to data held by numerous organisations and will reduce the administrative
burden of those organisations in responding to requests under
the Data Protection Act.
— It will enable patients to update
personal preferences (in PDS)—communicating their wants
and needs to NHS organisations with which they interact. Potentially,
a hospital will already know your dietary requirements, whether
you need an interpreter, whether you need disabled access etc
before you even arrive.
— Patients will be able to enter data
into their own care records. This is especially important for
people with long-terms conditions (often expert patients) who
routinely monitor key metrics themselves. This will open up a
new channel of communication between patients and clinicians.
— Bringing together data and information
to support patient choice in a single, personalised web interface.
It will integrate existing systems (like the Choose and Book on-line
application) with the data on which choice is based (waiting times,
quality assessments, travel times), augmenting this with value-added
services like personalised appointment reminders.
— Providing highly visible proof that
the NHS is modernising and offering on-line services comparable
with other industries.
4. Choose and Book
The PDS underpins the Choose and Book national
service that, for the first time, combines electronic booking
and a choice of place, date and time for first outpatient appointments.
It revolutionises the current booking system, with patients able
to choose their initial hospital appointment, and book it on the
spot in the surgery or later on the phone or via the internet
at a time that is more convenient to them.
Choose and Book provides the following benefits:
— A more flexible and responsive health
service that fits around people's individual lives.
— From 1 January 2006, patients in
England referred by their GP to a specialist will be able to choose
from at least four hospitals (or other healthcare providers) commissioned
by their PCT or practice.
— Enabling patients to choose a convenient
place, date and time for their initial hospital appointment.
— There is less chance that information
will get lost in the post because more correspondence takes place
through computers.
5. Secondary Uses Service—the NHS and
Planning Future Services
The PDS is a comprehensive national system with
a single set of data fields and standards. In conjunction with
the Secondary Uses Service, this allows pseudonymised information
(ie information with all patient-identifying details removed)
to be collated and compared easily across the whole of the NHS
in England, allowing trends to be tracked and analysed more successfully.
In particular the PDS and SUS will enable the provision of improved
migration and patient movement/relocation data, which are seen
as key statistics to aid and identify the continued service development
and improvements to be made to the NHS, both nationally and locally.
The introduction of the PDS has increased the
information governance controls protecting patient information:
— Registration and authentication processes,
allowing systems to identify what actions have been taken by which
healthcare professional;
— Role based access controls, linked
to the identity of each authorised healthcare professional, control
precisely what they are able to see and do when logged on to the
system;
— Search controls constrain how healthcare
professionals are able to view the details of individual patients;
and
— Tools for auditing who has looked
at or amended PDS records and local access to these by "privacy
officers" so as to identify appropriate use.
DEMOGRAPHIC STATISTICS
The PDS is available to 276,899 registered users
at over 7,000 locations (at 3 October 2006). The following table
illustrates the current activity on PDS:
| Transaction type |
Daily average |
Annual average (million) |
| Patient traces | 77,500 |
28 |
| Retrieving patient demographic information |
1,121,500 | 409 |
| Number of data updates | 146,500
| 53 |
It is estimated that these transaction volumes will increase
eight-fold by around the end of 200.
Question 255 (Chairman): Additional costs
The NAO Report estimated the total gross costs of the Programme
over 10 years as £12.4 billion. At the hearing, NAO was asked
whether the extra costs within this figure (ie above the £6.2
billion costs of the core contracts) would fall on the public
sector. NAO replied that they would.
Sir Ian Carruthers wished to put some clarification around
this and was asked for a note.
The key points are that the £12.4 billion is not a budget.
It is an estimate by the NAO of the gross costs of the Programme
(national and local). Its derivation includes a number of calculations
made for convenience, for example extrapolation of costs beyond
the terms of the existing contracts and assumptions of the level
of central expenditure. The NAO Report points out that NHS Connecting
for Health believes that some of these costs will prove to be
lower.
The NAO's estimate also takes no account of anticipated savings
to the NHS, which are already providing substantial offsets to
the gross costs. These include direct savings from improved administrative
systems, direct savings from enterprise wide agreements and indirect
savings such as those arising from improved patient safety.
Some of the benefits are already being realised, for example
savings through the Enterprise Wide Agreements, NHSmail and PACS
total some £1.7 billion over the terms of their contacts.
Also, in response to Question 130, we have provided examples
of savings achieved in an Acute Trust and a Primary Care Trust
following the deployment of the new systems. Extrapolation of
these results across the NHS would produce a net saving for local
organisations, which would be enhanced further by the considerable
savings expected from improvements to patient safety.
For these reasons, the £12.4 billion does not represent
the overall costs of the Programme, but is an estimate of gross
expenditure. We agree with the NAO that, as the IT systems are
implemented, the actual benefits should be assessed. We also accept
the NAO's recommendation that we should provide an annual statement
quantifying the benefits delivered by the Programme. The aim is
to produce the first statement next year.
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