FOI papers reveal more lessons from Bolton NPfIT trials

Papers released by Bolton Primary Care Trust under the Freedom of Information highlight some of the lessons learned from its trial of the NPfIT summary care records system.

We’ve already reported on the Bolton trust’s decision to give healthcare assistants access to a national database of summary care records, although they need no professional qualifications to do so.

The trust has also had difficulties keeping up with “alerts” on its audit trails. Whitehall officials put much faith in the audit trails of national systems to alert NHS staff to unauthorised activity. But there’s a question of whether NHS staff will have the time to police them.

The papers released under the Freedom of Information Act say:

“[Name unknown] is having to put a lot of time into this task and, at the moment, we do not have all that many alerts coming in as the system is not being used to its full potential yet. [Name unknown] felt that the audit trail is ridiculous and asked how they hope to be able to manage it nationally…[Name unknown] informed the group that NHS Connecting for Health had envisaged that this task would take one day per week for each primary care trust which [name unknown] pointed out is still a great deal of time. At the moment it is taking [name unknown] around an hour to look at 10 alerts…”

Other points in the Bolton papers:

– Officials were surprised by the number of leaflets on the summary care records which were returned because the recipients had changed address – which increases the risk of patients having their medical information uploaded to the data “spine” without their knowledge or consent. The papers say that the returned mail was “a lot larger than anticipated” – up to 3%. “There is a risk that patients who have moved address may get a Summary Care Record when they would have chosen not to have one.” Under the “opt-out” regime, patients may have their medical information uploaded to a summary care record once they have been sent leaflets and have not opted out. But if three per cent of 50 million leaflets were returned – the plan is for 50 million people to have records uploaded to the data spine – this would be 1.5 million returned leaflets. So there may be thousands of people whose medical data is uploaded to a central database without their knowledge or consent.

– “If a search is performed for any patient on CSA [the clinical spine application which allows NHS staff controlled access to the national Care Records Service], the software will give consent status as “Implied Consent”. For any patient who [is] not yet part of SCR early adopters, this is incorrect, as implied consent implies they have been informed about SCR.”

– “GP systems continue to be affected by performance issues, and the source of these performance problems is still to be totally identified and resolved.”

– Several GP practices were unable to go live because their data was not up to the required standard. The papers say: “Although an additional eight practices were identified to go live before Christmas, only one was uploaded…” This was because of “issues with their data quality and paper light status”. The papers say the “unknown status of data quality in practices could have large affect on implementation timescales”.

– “Local public reaction is really unpredictable at present [to the summary care record] but is likely to be mixed.”

– “Records for under 16s may be uploaded when they have not been informed of SCR [summary care record].”

– “There are many duplicate records within the Adastra [out-of-hours] system run by Bolton Out of Hours. If OOH continue to generate duplicate records there is a risk that Summary Care Records usage may be impacted as there will not be easy access to NHS number, if original record is not found.”

Separately Bolton has reported “excellent progress” on its trial of the summary care records.


Sir Bobby Robson’s electronic health records viewed illicitly by NHS staff

Pioneering NHS trust reports “excellent progress” with summary care record – part of the NHS IT programme

No qualifications needed to access national database of summary care records

Bolton care records pilot

A computer scientist’s reaction to the NPfIT