Why the NHS Summary Care Record is and will be worse than useless.

A recent consult with a new patient led to some interesting insights into how p*ss poor, sorry for the naughty grunt word, the NHS Summary Care Record (SCR) scheme is given the fact that it has been at least 7 years in the making.

The instigator of this idea was a public school educated Scot with shiny teeth and not much else who is currently earning loads of wads doing nothing useful and has a track record in computing equivalent to Pol Pot's in providing better modern healthcare to the masses. Come to think of it the former did something similar in the UK too. We digress.

 

A new patient came to ask in an appointment with a doctor that involved nothing medical and 10 + years ago would never have happened before NHS Party Care was introduced via QOF (Quality and Outcomes Framework) in 2004. In doing so they denied an appointment to anyone with a true medical need which would appear to be the point of current Tripartite NHS care as opposed to what doctors were trained to do. Appointments in general practice are now needed for most people for Party Care (QOF et al) = GP tick a box to ensure they get paid as opposed to true medical care and treatment. Could this be one factor in the rise in A&E attendances? 

The patient had a chronic illness and so needed medication to sustain life and we here at ND Central ask all new patients to see us with regard to their medication. Most of the time this is routine and we merely place the patient's previous medication onto our computer system and print off a repeat prescription and advise them how to get another. 

Sometimes this is useful for we have had "diabetics" on treatment whose previous GPs had diagnosed them with diabetes with a random blood sugar of 8 or whose previous medication was lethal or whose previous GPs had got it completely wrong or who had failed to investigate what they were treating their patient for. For most patients this is an inconvenience but sometimes seeing a new doctor with a clean sheet can be to your benefit in contrast to the Party's view that your SCR is completely right.

 

Of course the SCR will always be right for if a non Party card carrying professional enters a child at risk it will never appear in any SCR seen anywhere else and clearly protects those it was meant to help (the politicians) who need access to all patients' healthcare records in an emergency in order to suppress leaks via blackmail.

Our new patient asked to be excluded from their QOF (Quality and Outcome Framework) defined illnesses which if we were true Party players would immediately suggest severe mental illness in our patient and automatic inclusion on another Party defined register but we had no problem with individual freedom and so we "excepted" our patient at their request and with their fully informed consent. 

This will no doubt incur the wrath of the local Soviet for GPs in the UK are only allowed a certain percentage of informed dissenters. Go above that and even if you have a highly intelligent well read practice population who see through the Party you will receive a visit from one of the Senator McCarthy QOF tsars at the local Soviet to ask you about your above target dissent rate. (These McCarthys think that high dissent rates = work avoidance rather than patients exercising NHS Choice). 

We know our patient will get far better care from our local excellent consultants at the local teaching hospital for they have been providing this for the patient long before QOF was even thought of.

 

We can see why they wanted it as for almost 50 years they had been looked after by the local consultants who had kept them well with a once a year one stop clinic appointment for one part of their illness and a once every 6 months for another part of their all body affecting illness. This care was completely free at the point of delivery to the patient and more importantly free from NHS Party Care and completely free for the patient of tick box duplication of completely patient useless care (QOF).

Our new patient also had another request. They wanted to know if their request to have their medical records withheld from the SCR had been transferred from their previous GP to us and would their medically confidential data be safe from widespread viewing via the NHS super secure sieve called the SCR? 

The answer was that their GP electronic record had not been transferred to us. 

Only their Lloyd George paper GP records which are probably still the most complete patient record in the UK and somewhere in it amongst realms and realms and realms of computer printouts maybe the patient's request to be excluded from the SCR might be found. Their last 2 years of medical records printed off from NHS Party Care records will outweigh the succinct 50 years of hand written records. To our patient's disgust we showed them their (blank) medical record on the computer screen, which in contrast to some GPs is always viewable by our patients. 

The computer screen on a little hidden drop down box told the patient that they had given their implied consent to the creation of a full SCR despite them never have been consulted and despite them previously and actively opted out of this scheme many years before at their previous doctors. 

So in true Soviet style the current Tripartite NHS confidentiality position is that all patients give implied consent to the disclosure of their medical records in the same way that MPs all gave their implied consent to disclosure of their expenses and did not object at all to their disclosure. 

And yet we as GPs have to respect any corrupt MPs medical confidentiality as they are allowed not even to appear on the SCR or the NHS spine something you will have great trouble with if you wished to do so as a private citizen or were even allowed to do so as a private citizen which you are not comrade patient. 

Remember Comrade Andrew and his sound bite no decision about me without me quote? 

Praise be to the Party for its assumption that all patients want a Stasi record in the same way that East Germans gave their consent for the same. Our patient was not impressed with this arrogant assumption having already opted out once and we are now all making completely unnecessary appointments with our GPs to check if their computer systems do the same for some have changed supplier.

 

So if you happen to be ill and cannot see a GP it will be because QOF care and SCR opt outs take priority for a patient.

Tales from the Darkside - the start.

Those of our regular readership (thank you and a happy New Year) will know that in the Northernshire province of Shiteton Soviet we are so well served by our local Harvard and Yale educated commissars with years of private sector involvement in highflying companies that GPs are completely unnecessary in providing local healthcare.

The current Tripartite coalition on NHS healthcare privatization has been so warmly received that here in Shiteton PCT, Northernshire GPs have been throwing themselves anywhere else than to be involved with clinical commissioning for there are so many GPs here that we daily have to draw lots to see who is unfortunate enough to be sent to the golf course rather than provide patient care. Not all parts of the UK are that lucky.

The plethora of Harvard and Yale MBAs we have at our local Soviet means that our patients enjoy first world care the whole time from their cradle to their grave given their extended life expectancy due to the excellent local NHS commissars.

The Party however via its local organs are concerned about the lack of golf playing GPs involved in local NHS commissioning and clearly have a quota to meet and as GP after GP declines to be involved due to the Party's excellent local Soviet they have been looking for "volunteers" to start as GP commissioners in the New Year. As a result one of the team here at ND Central has, under duress, been seconded to the darkside.

The volunteer was selected at the infamous café Michelle using the time honoured tradition of playing Russian roulette albeit with a blank round in the revolver. Those familiar with the scenes from the Deer Hunter will know what the particpants felt as someone from the team would have to, gulp, do commissioning if they "won" at roulette after a heavy evening of Resistance work.

Given that the Parties all feel that "clinical" commissioning is fully supported by the(ir) medical profession (gong hunter friends at the Royal Colleges) you would have thought there would be no problem locally with "volunteers".

So at last one of the Resistence has been turned to the darkside not through NHS "Choice®™" but through the need for survival and we hope to provide some insights from a dark merky world that needs to be brought to light.

This may lead to a few articles about how NHS commissioning both past and present have been delivered for the benefit of the comrade patient. It will also show how the force of the dark Lord Vadar of the NCB operates to ensure true Soviet style "local" (GP led?) healthcare commissioning via Central Party diktat and control.

Remember comrade GPs the command centre is no longer in Moscow, or Whitehall, or in the dark world of the NCB formerly known as the Department of Health, but "The headquarters will be in the consulting room and the clinic."

Praise be to the Party for ensuring that each NHS reform will lead to nothing useful in healthcare bar an increase in costs and administration coupled with decreased quality and quantity of healthcare. Both of which benefit not the private sector or administrators but the patient and their healthcare . . . you have been warned.

Oh no it won't!

Some of the team have been in communicado by virtue of no internet access while the rest are with their families and cannot be bothered to blog. However a grainy TV picture in some of the more remote outposts of the world enabled us to see this latest government initiative from a far.

Well given every child protection report written says the information was there but not shared can you see how much this will achieve? If professionals police, social services, doctors, nurses etc. do not talk under current freedom of speech will a computer allow us as GPs to detect Johnny or Joanna Scrot child abuser or their abusees?

I'll just plug my Smartcard in and it will allow me to instantly access the police National Computer System, John and Jo's DNA that I just slipped off them when I shook their hands while telling them of their child's unexplained fracture and allow us to access all the local social services' children at risk registers?

Just look at some of the problems we have as GPs dealing with child protection issues at present. Our first port of call used to be our practice attached health visitors but the Party in its infinite retardation took them away from GPs under their TCS policy. Officially it was Transforming Community Services (TCS) although most use Transferring (to the private sector) as the T word as it reflects reality more accurately.

Social services keep a record of children at risk or of concern but cannot for some reason give us a list of children on its register that are patients at ND Central because "it is on paper". They nonetheless expect a GP to attend a case conference when rung late in the afternoon before the meeting to be held next morning with full surgeries already booked. The GMC say we should attend these because Mr. Hodges says so or else.

This is akin to our experiences of working in A&E when asking if a child was on an at risk register meant getting more senior hospital administrators to open safes then it would take to get a nuclear missile's launch codes. And that was in hours if you were lucky and before Data Protection Acts and EU legislation.

Some local intel from CQC and Ofsted inspections from nearby Soviets suggests that communication failures are to blame so will we get our health visitors back? Oh no comrades the communication failures are because computer does not talk onto computer and so this must be addressed immediately.

So we have a local system where the health visitors and social services enter their information on a computer system which does not speak to any GP or hospital clinical system. Add to this the "quality" of the national summary care record noted here and ask yourself do social workers, police officers, neighbours, family members etc. carry the Party card?

One can see the problems looming large like the visible tip of an iceberg miles across. This iceberg is huge and unsinkable due to political diktats and a computer system will not stop it for these problems have existed for years.

Remember the ice breaker here will be produced by British Medical Computing (BMC) which has a superb track record of failure to deliver, failure to deliver on time and failure to provide frontline clinical staff with anything useful.

If professionals now are finding it harder to talk to each other as a result of Party policy (TCS) and computers don't talk to each other now how will this work? The data is sitting in various sources but data in isolation is useless.

You cannot interrogate a computer but "search" a health visitor about little Tom Smith and you won't just get name, rank and serial number you will get a whole lot more. Similarly with social workers, school nurses, police officers et al you get pieces of a jigsaw which sometimes just one piece or person holds the missing link and one might be able to connect all the pieces together. Computers can't do jigsaws.

And will this be delivered by 2015? Dream on guys yet another NHS IT initiative that will deliver nothing but costs.

And will never help those it should. Ever.

Praise be to the Party for giving us yet another IT failure so big it will be seen galaxies away as an information black hole sucking everything into it but giving sod all back out in return.

Until the next one.

Writer's cramp.

At this time of year we suspect a lot of GPs will be doing something they don't do very often nowadays and that is to write legibly.

With the increasing use of computers to hold medical information most of the time we spend typing away on computers. We only rarely write letters by hand usually only on home visits when admitting patients to hospital and if we write in surgery it is usually only a few words on a post it or instructions to staff on hospital letters etc.

We do still sign prescriptions but the signatures we use are usually a squiggle that over time becomes less and less recognizable as having any letters in it due to the need to repeat it quickly and often several hundred times a day.

Indeed some of the team have 2 signatures one for prescriptions the other for cheques and credit card transactions but these are becoming less often used as PINs replace signatures.

So when one of the team sat down to write a few Christmas cards they experienced something they had last experienced at school - writer's cramp. Writing prescisely involves fine muscle movements and we realized that we don't use these muscles as often as we used to and so after just a few smartly and legibly written and addressed cards our dominant hand hurt.

The last time we experienced this was in our English Literature exam when the grade you got was dependant on the weight of paper you wrote on that the examiner could read and so writing legibly at speed was a must do.

Praise be to the Party for deskilling the muscles in our hands that are needed to do things not dependant on a working computer system. It was surprisingly painful and unexpected and brought back painful memories of English Lit. as well!