The NHS primary care recovery plan promised ‘interoperable digital solutions’ to support pharmacists to deliver clinical services and ‘significantly improve’ the digital infrastructure between general practice and community pharmacy.

This would include streamlined referral processes, giving community pharmacy additional access to relevant clinical information from GP records, and allowing community pharmacy to update GP records – for instance, following supply of oral contraception or a blood pressure consultation in community pharmacy.

Some of the £645m cash injection promised to the sector would be allocated to the project – but what would need to happen behind the scenes to enable pharmacy teams to deliver clinical services and manage patients’ records appropriately?

The Pharmacist spoke to Dan Ah-Thion, community pharmacy IT policy manager at Community Pharmacy England (formerly PSNC) to find out.

Community Pharmacy England and Mr Ah-Thion help to run the Community Pharmacy IT group, a collaboration which brings together system developers, NHS digital teams, pharmacy teams and all of those within the sector to explore lots of different ways to try to support and streamline pharmacy IT across healthcare.

What needs to change?

Patients often think that pharmacy teams have access to the information they need. ‘But when you’ve got your non-regular patients, you’re delivering a clinical service or there is a more serious situation, it becomes more important to have [information] beyond just your own dispensing record and have it easily available and usable,’ says Mr Ah-Thion.

Alongside their own patient dispensing records, all community pharmacists can access patients’ Summary Care Records – usually via a separate portal, although some system providers have introduced a ‘one-click-integration’. And in some areas pharmacists can access local Shared Care Records, also through a separate portal.

But with the introduction of more clinical services in the community, all community pharmacy professionals will need to be able to read information on patient records and write to GP records – for instance, following supply of oral contraception or a blood pressure consultation in community pharmacy.

‘Where pharmacy systems will update GP systems, we want our GP partners to get this information in a simple straight forward automatic way that is not going to create [added] workload,’ says Mr Ah-Thion.

Although healthcare information systems have come a long way since the days of pen and paper, in the past they have often had to be developed in silos, without an underlying common standard across the NHS records systems.

Even something as simple as a date of birth might not be recognised in the same way across different systems.

‘So you need to create and then use those building blocks,' says Mr Ah-Thion.

The first step in enabling systems to speak to each other is applying agreed common codes to fields that represent the same thing, like a date of birth.

‘Then any time a supplier has [that] code attached to a field, both systems will understand that means the date of birth,' explains Mr Ah-Thion.

To enable streamlined access to patient records, the Community Pharmacy IT group thinks that the NHS should create underlying standards based on the deepest level of information across any type of NHS patients’ record systems.

But while there is a common vison of what IT transformation could look like in the long term, ‘the reality might be about stepping stones along the way, where you get there bit by bit’, Mr Ah-Thion says.

GP Connect: A realistic next step

While the primary care recovery plan has not confirmed what technology would make up its ‘interoperable digital solutions’, an option which is likely to be considered could be linking pharmacy systems via GP Connect, which gives access to information within a patient’s GP record.

Mr Ah-Thion says that the potential use of GP Connect to enable interoperability would be ‘a sensible direction of travel’. ‘There is one national GP Connect programme, so that makes sense in the current environment. There might be an opportunity for a speedier integration with it – a quicker win.’

Rolling out GP Connect to community pharmacies would likely require some work by NHS IT teams, pharmacy IT suppliers and potentially by prescribing IT suppliers – and it is possible that some of the funding announced for IT improvements might be used so that NHS and supplier development teams can carry out any necessary work.

In the past, funding for IT updates has also been paid to pharmacy owners to enable them to buy into a new system or service.

Who will be able to access what – and have patients consented to this?

Pharmacy professionals – that is, pharmacists and pharmacy technicians – regulated under the General Pharmaceutical Council (GPhC) – will be the team members with access to patient records.

Most pharmacy professionals currently have access to Summary Care Records – which is being incorporated into the National Care Records Service. It gives access to information such as medication and allergies, but does not allow pharmacists to add information.

The detail of what changes will be made and what additional access will be given is still to be worked out – but the NHS Long Term Plan provides a ‘clear steer’ that pharmacy professionals need greater access to records, says Mr Ah-Thion.

‘It said the information that the clinician needs should be easily available for the clinician at the time they need it,' he adds.

Patients may need to consent to their health information being shared across different settings, and this will be factored into the development of the model before it is rolled out, says Mr Ah-Thion.

But he thinks it is likely to be well received by patients, who he says often expect their pharmacy clinicians to already have access to and be using the key information needed to carry out their care, and for the pharmacy to be able to update the GP. Patients report wanting to repeat themselves less about their information and wanting to receive safer care.

For instance, when pharmacy teams have to issue an emergency medicine supply to a new patient in the evening or weekend when the GP surgery is closed, they might ask a patient for permission to check their record to ensure the medication is right or see if it has been previously prescribed.

‘The common response is: "what's going on? Why haven’t you got that already?" Because patients are thinking: actually, if you don't have that, how can you care for me in the best way?’ says Mr Ah-Thion.

Any iteration of technological change will be tested to ensure it works for clinicians, patients and providers.

But Mr Ah-Thion says that members of the IT group are ‘excited by the ambition of the plan’ and pleased that digital solutions are being incorporated.

‘The primary care recovery plan seems to have a recognised  the importance of IT, which we welcome,’ he says.

A long-term vision of a common system

One patient record to rule them all

Imagine you’re in a time-pressured situation. You open the record of a patient with diabetes from a single portal, without having to move to a different computer, or scramble for log in details and passwords.

Instantly, you can see all the relevant clinical information you need: the patient’s blood sugars, when they need to test, what their risks are, whether they have been missing doses.

‘The utopia is that in your clinical system, there are no steps, there is no separate login, there is no separate portal – and you might not even know you're looking at a record, it's just part of what you're looking at. You just have the info to hand,’ explains Mr Ah-Thion.

In an ideal system, clinicians would have access to all the relevant information– which in the future could even have a tailored view depending on the patient, immediately pulling up relevant information for patients with diabetes or asthma, for example, in a personalised manner.

Different systems would be able to access and add relevant information from this record via a common infrastructure, and the system would record who changed or added patient information and when. ‘Then there is an audit history of what's gone on and why,’ explains Mr Ah-Thion.

To facilitate this utopia, the Community Pharmacy IT Group thinks that the NHS should create an underlying standard that aligns the IT which sits under al NHS record systems.

‘There would be a bit of work before that could happen, but that needs to be created,’ says Mr Ah-Thion.

Some early work on a common underlying standard is already underway, in the form of the Core Information Standard, created by the Professional Records Standards Body (PRSB) who engage with the pharmacy sector when they develop their standards.

‘That Core Information Standard is supposed to be a starting point, but then really you might want that bigger and you might want that more coded, and you might want common integration methods associated across all records systems and across local Shared Care Record systems.

'At the moment in the event that an IT clinical system provider integrated with one local Shared Care Record so that clinicians with that type of access could better care for their patients, for the IT supplier, integrating with 20 other local Shared Care Record systems would be 20 times the work and take 20 times as long to finish – potentially taking many years,’ says Mr Ah-Thion.

Creating a common code would enable easier flow of information. For example, hospital discharge notes could be seamlessly added to a patient's record, rather than being attached as a PDF (if available at all to a pharmacy professional).

And Mr Ah-Thion says that a common structure and framework would encourage suppliers to work towards interoperable solutions, allowing different systems to begin to integrate bit by bit as updates were developed.

Streamlining referrals

A common patient record could also be aligned with other national standards that are currently being worked on – like the NHS Booking and Referral Standard (BaRS) which aims to enable quick, safe and straightforward referrals across all settings.

Currently, bookings and referrals can be ‘quite ad hoc’, says Mr Ah-Thion.

At the moment, a patient could walk into a pharmacy and be signposted to an appropriate service, ‘but the booking and referral standard would put things through a proper clinical pathway using IT’, says Mr Ah-Thion.

A streamlined process like BaRS could make referrals easier for clinicians and be good for patients. ‘It gives them a more consistent experience, and without things like BaRS as a patient you could be dropping through the gaps. So I think the aspiration of this feature is that it would be used more and more across health and care everywhere,’ says Mr Ah-Thion.

‘We'd hope to be seeing good progress with BaRs in the coming months and years,’ he adds.

And in the future, an expanded 'Community Pharmacy Data Standard', which currently supports information flowing from a community pharmacy to a GP, could be used pharmacy to pharmacy.

Find out more about the Community Pharmacy IT Group’s vision for NHS IT system developments.