This week’s edition of Pulse, the GP’s magazine, is edited by Dr Dr Gillian Braunold, clinical director for the NHS Summary Care Record Programme. The issue includes an Opinion piece by Dr David Lloyd, medical director of out-of-hours IT at NHS Connecting for Health, discussing how an accurate, reliable record of patients’ medication might improve out-of-hours GP care:
Everyday I come across examples of how the SCR will improve patient care. Take yesterday, and an ordinary four-hour shift in the polyclinic. Two patients came in at either end of the sick spectrum.
A middle aged man with a skin infection arrived who could not get an appointment that day to see his own GP. It seemed minor at the time and I was in two minds whether to treat it. He had already told me about the pills he was taking and I was on the point of sending him away when I commented on his extensive psoriasis-it was then that he told me that the Enbrel (etanercept) injections were not helping very much!
Once I knew that he was on one of those incredibly powerful disease modifying drugs, the whole tenor of the consultation changed and he went out with a bag of pills and stern warnings.
Thirty minutes later and a mother brings in her wheezy three-year-old old. She was worried because the inhalers given to her by her GP did not seem to be working.
What inhalers I asked, she had no idea, so I relied on the usual conversation about the colours of the tubes. I established that he was on a brown one and a blue one but that was it. I had to construct a treatment plan which took into account every possible strength of the brown inhaler that she possessed.
Now even the basic SCR would have changed both of these consultations radically. I would have known about the dangerous drug in the first case straight way and would have been far more suspicious of an infection-I’m sure many of you have seen what terrible things can happen when these new anti-TNF drugs are given. And the second case would have been much quicker and more joined up.
In the comments thread, Trisha Greenhalgh writes:
We need to address the problem of subjuncitivization: the expression of the benefits of the SCR in terms of what WOULD or MIGHT happen. What my team were evaluating was what actually DID happen, and sadly, there was a model-reality gap!