SCR Expert Advisory Committee

Contents Contents 2 1. Background and Strategic Justification 3 2. Scope 4 3. Mode of operation and period of review 5 4. Membership 6 5. Processes and Procedures 8 2 Copyright 2015, Health and Social Care Information Centre.

1. Background and Strategic Justification The purpose of the Summary Care Record (SCR) is to provide key essential medical information for clinicians in urgent or unscheduled care to support patient safety, preference and care quality. It is derived from the patient s GP record and initially consists of a core dataset of medication, allergies and adverse reactions. The SCR may be optionally supplemented with additional relevant clinical information such as diagnoses, past medical history and patient preferences, added by the GP with express patient consent. As of August 2015, approximately 55 million patients in England have a SCR: over 96%. This is projected to reach 100% during 2015. Nearly 50,000 SCRs are currently being viewed per week across a range of care settings including: 92 GP Out of Hours care settings (60%), Pharmacists in 217 hospitals (85%), 63 hospital Emergency Departments (34%), Acute Admissions wards in 61 hospitals (29%), 177 Community and Intermediate Care teams (41%), 107 Walk in Centres and Minor Injury Units(39%). GP system suppliers and HSCIC have developed a more efficient mechanism to support GPs in populating SCRs with additional, relevant information, with the express consent of the patient. This is being deployed during 2015; and over time it is expected that GPs will create SCRs with Additional information for the most vulnerable and frail patients those that need them most. The ministerial review of SCR in 2010, concluded: We should only consider expanding the content of the Summary Care Record when we have built trust in the system and when patients request that we do so. We therefore recommend that new governance be established, for the content of the Summary Care Record. [more below] The current scope of the SCR is summarised in the SCR scope document 1. This states: In defining the scope of the SCR, there are two distinct components that should be considered: Content and use: a. Content: describes the information contained within the SCR and from where that information is derived. b. Use or purpose: describes how, by whom and in what care settings the SCR is used. The SCR fulfils a specific role and should not be confused with other electronic patient record (EPR) initiatives. Appendix D contains links to further information on the SCR and defines the SCR in relation to other shared health information. Summary Care Record Content Governance The ministerial review also recommended that new governance arrangements are introduced to oversee the evolution of the record: These new governance arrangements will: assume responsibility for the clinical content of the NHS Summary Care Record; be responsible for decisions about the introduction of any new content to the record; be driven by patients and citizens in partnership with the professions, tempered by knowledge of the IT capability; and, 1 http://webarchive.nationalarchives.gov.uk/20130502102046/http://www.connectingforhealth.nhs.uk/systemsand services/scr/documents/scrscope.pdf 3 Copyright 2015, Health and Social Care Information Centre.

only consider expanding the content of the record when we have built trust in the system and patients request that we do. It is planned that the chair, membership and Terms of Reference for the new SCR content governance will be in place by early 2011 and this SCR Scope document will be updated to reflect this at this point. This update will include how the new governance arrangements will link to the SCR Programme Board and the detailed process for changing the scope of the record Created to support the findings of the Ministerial Review; the Expert Advisory Committee (EAC) - is an expert reference group to advise the SCR programme board on proposals to change the scope of the content and usage of the NHS Summary Care Record. 2. Scope The NHS Summary Care Record EAC will make recommendations to the SCR programme on proposals to change the scope of the content and use of the NHS Summary Care Record. Membership of the committee will include representatives of patients and the public, clinical professional bodies and Royal Colleges. The committee will ensure all proposals received to expand the scope of the NHS Summary Care Record are subjected to debate and analysis by representatives of patients and the public and the clinical professional bodies and that any relevant recommendations to expand the scope of the NHS Summary Care Record from non-gp settings are made to the Minister of State for Health for approval. Committee members will be experienced communicators, able to work constructively and effectively with other members of the EAC, and be able to grasp and evaluate complex issues. They will usually represent a key constituency, and have efficient and effective mechanisms routinely to engage that constituency and bring that balanced perspective to committee discussions. There will be at least one meeting each year (in London or Leeds), with the main business during the year being conducted by email, with a telecom/videoconference from time to time. The NHS SCR Programme may refer issues to the EAC for advice (using email or other methods). The EAC will give consideration as to how it will secure a wider perspective than committee members on some of the key issues it will need to advise on. To this end, the committee will seek advice from relevant stakeholders and expert opinion where appropriate, including relevant experts, and a planned Volunteer Reference Panel (see Section 4 below). Principal roles and responsibilities: Content To make relevant recommendations to the Minister of State for Health on proposals received to expand the scope of the content of the SCR from non-gp settings. To make recommendations to the SCR Programme Board on proposals received to expand the scope of the content of the SCR from GP practices. To oversee the clinical content of the NHS Summary Care Record. 4 Copyright 2015, Health and Social Care Information Centre.

Implementation To provide practical implementation advice on issues referred to the board by the SCR Programme Board, with expert/specialist input where appropriate. To advise the SCR Programme on potential business process implications of additional information being added from GP practices. To advise the SCR Programme on the potential business process implications for the non-gp care settings involved in adding this new content to the SCR. To identify any issues for consideration in non NHS care settings viewing the new content proposed for the Summary Care Record. To identify the need for future clinical standards in the NHS Summary Care Record and, where necessary, the need for development of specific NHS standards or sub-sets of other standards for NHS usage. These will need to be considered by the appropriate Standards Boards. E.g. SCR alignment with emerging national (Royal College of Physicians) standards for records. Patient and public and clinician involvement To advise the SCR Programme on the patient and clinical consent requirements which would result from proposals to add new content to the SCR and the practical implications associated with obtaining this consent in the care setting involved. In reviewing all proposals to expand the scope of the SCR, to ensure that the following considerations have been fully addressed: i. The impact on health outcomes, patient care, experience and safety; ii. iii. iv. patient and public understanding and perception of the SCR; the utility of the information to clinicians working in urgent and emergency care settings; the technical capability of the systems to add the new content to the SCR subject to the associated patient consent; and, v. the technical capability of existing SCR systems to store and view the new content and any associated patient consent requirements. 3. Mode of operation and period of review The committee will report to the NHS Summary Care Record Programme Board [the Programme Board ]. The SCR Programme will refer proposals to change the scope of the Summary Care Record to the EAC for review and recommendation. A recommendation made by the EAC to change the scope of the Summary Care Record may in some circumstances require the approval of the Minister of State for Health, as the sponsoring department for the Summary Care Record Programme. The SCR Programme may also refer other issues to the EAC for advice and guidance. 5 Copyright 2015, Health and Social Care Information Centre.

Papers will usually be circulated to EAC members two months ahead of a Programme Board, to allow sufficient time for members to be able to engage with and represent the view of their constituency (if applicable), and for their responses and feedback to be collated. Members will generally formally represent their organisation or constituency. For continuity, and where possible and relevant, organisations are asked to maintain consistency of the representatives attending the meetings. Where necessary, the EAC will advise by correspondence (including email/virtual exchange) on issues raised by the SCR Programme between meetings which require advice urgently. The EAC is not accountable for the successful delivery of the SCR Programme, which is the responsibility of the SCR Programme Board. The EAC will work to a quarterly schedule feeding into the Programme Board, with additional consultations if needed. There will be an annual meeting of its members to review progress, learn, develop and improve. Records will be kept of the recommendations, decisions and advice of the EAC. Conflict of Interest All members of the committee and those asked to comment on work produced by the committee will be asked to declare any conflicts of interest. Any action to be taken on the basis of these declarations will be at the discretion of the Chair. Openness and Confidentiality Transparency is a guiding principle. The HSCIC will make documents available to the public unless there is a compelling reason not to do so in accordance with the law and its published policy on openness. Where appropriate, an agreed summary of the meeting minutes will be published on the SCR website. For reasons of probity and commercial sensitivity, members are required to treat documents as confidential where appropriate and lawful. The status of all documents circulated will be clearly indicated. Duration The role and membership of the committee will be reviewed annually. 4. Membership The EAC shall have a non-clinical chair who will serve a term of office of 24 months. That appointment has been made, and is Judith Brodie (Appendix C). Membership of the committee will comprise patient representatives and representatives of clinical professional bodies. The Senior Responsible Owner for the Summary Care Record Programme will also attend the meeting. Depending on the particular type of content and care setting to be considered, additional appropriate representatives may be invited. Members of the Summary Care Record Programme team and HSCIC tech office will be asked to advise the board on issues of information technology capability. The initial membership of the Expert Advisory Committee comprises: 1. British Medical Association - BMA 2. Royal College of GPs - RCGP 6 Copyright 2015, Health and Social Care Information Centre.

3. Royal College of Physicians - RCP 4. Royal Pharmaceutical Society - RPS 5. College of Emergency medicine 6. Royal College of Nursing - RCN 7. Richmond group (coalition of major charities) 8. National Voices (umbrella group for health and social care charities) 9. Age UK 10. Children s services NSPCC 11. Adult Social services - ADASS The following diagram shows the proposed initial membership of the committee with related constituencies: More information on the current proposed membership can be found at Appendix C below. A planned volunteer reference panel will be engaged as required, but not be part of the formal EAC mechanisms or process: 7 Copyright 2015, Health and Social Care Information Centre.

5. Processes and Procedures The overall high level process flow for consideration of proposals by the SCR Expert Advisory Committee (EAC) is: Proposals for change may come from patients, carers or the public as well as professionals The process will incorporate a period within which proposals for change cannot be resubmitted (unless there are suitable mitigating circumstances) The EAC will review and endorse criteria against which proposals for change will be assessed The approval process for the committee specific element will comprise: 1. The assessed and quality checked proposal is circulated to members of EAC with a comments response sheet (Appendix A), which may include a cost-benefit analysis. 2. Chair of EAC reviews and collates comments returned from the board members 3. Chair completes response section of proposal form 4. Chair circulates summary response to the EAC members for approval 5. Response is provided with confirmation of status and next steps 6. Proposal tracker is updated accordingly 7. If successful, proposal is incorporated into SCR roadmap Appendix A below includes a draft example of a proposal template Appendix B below shows a draft example of a committee member response sheet 8 Copyright 2015, Health and Social Care Information Centre.

Appendix A SCR Development Proposal Template App A EAC Dev Proposal v0.1.docx Appendix B Comments Response Sheet App B EAC Comments v0.1.docx Appendix C Recruitment and membership information July 2014 1. Non clinical chair Judith Brodie (see member specification below) 2. Example recruitment letter App C EAC Letter v0.2.docx 3. Example member specification App C EAC Rec pack v0.1.docx 4. Example initial membership of the committee including key potential constituencies App C EAC Member list v0.21.docx 9 Copyright 2015, Health and Social Care Information Centre.

Appendix D SCR and other electronic sharing mechanisms The following table summarises the SCR in relation to other data sharing mechanisms. Scheme Use Data Shared Notes Summary Care Record (SCR) Direct Individual Care Detailed Care Record Sharing Care.Data and other secondary uses Direct Individual Care Secondary use collective datasets Derived from the GP detailed care record. Repeat and recent acute medication. Allergies and drug sensitivities. Additional information can be added in conjunction with the patient. Elements of the patients detailed records from GPs, hospitals and other health locations shared to relevant health professionals treating the patient. Specific Read coded entries mainly QOF codes Referral codes Medication NHS No, DOB, Gender, postcode National record provided by all GP systems and available across the NHS to relevant health professionals treating the patient in urgent or unscheduled care. Created and viewable with patient consent. Sharing of detailed records within existing clinical systems such as TPP SystmOne and Emis Web. A variation of detailed care record sharing is where clinical information is shared between systems such as through interoperability gateways or clinical portals. Referrals and discharge letters are included in this scheme. care.data is where selected, specific information from GP records is shared with the Health and Social Care Information Centre (HSCIC) to help the NHS plan and improve patient care nationally. Direct Care care provided by clinical staff for the direct treatment of individual patients. Data is shared with relevant clinical professionals to directly support the treatment. Secondary Use Collective datasets: When patients are treated or cared for, information is recorded, collated and shared to support relevant organisations with: Healthcare planning, commissioning of services, payments, improvement of public health and development of national policies. Further information regarding SCR: For patients: http://www.nhscarerecords.nhs.uk/ For healthcare staff: http://systems.hscic.gov.uk/scr/staff http://systems.hscic.gov.uk/scr/staff/scrbasics 10 Copyright 2015, Health and Social Care Information Centre.