The NHS Care Records Service (NHS CRS) is the key component of the new systems and services being delivered through the national programme for information technology. It has a number of applications, including:
personal demographics service (PDS), which holds nationally demographic information for every patient covered by the national health service in England, accessible through local systems, and is currently processing message transactions at a rate of over 9 million per month;
spine directory services, which holds reference data such as users and locations. Over 260,000 users are now registered, around 50,000 currently access the system on any given day;
access control framework, which registers and authenticates users, including patients, and provides a single log-in and a record of each professional accessing a NHS care record; and
transaction messaging system, which processes and routes data messages, for example from a GP to a hospital or from one general practitioner to another.
Introduction of the NHS CRS has not been delayed. These four elements went live on time and to budget in July 2004 to support choose and book. Among other planned applications, the first stage of the secondary uses service went live in June 2005 to support payment by results. Other core modules are scheduled for release over the course of 2006 and 2007. However, ambitious initial targets were set to drive the programme, and some individual components have been delayed.
In general implementation is being achieved in carefully managed stages, via incremental rollout both geographically, and by increasing functionality over time to build the care record. The programme is about patient and clinician benefit and improved safety. We believe it is best to get things right in the long term rather than to push on regardless against a rigid timetable and risk getting things wrong in the short term. In the context of a 10-year programme the impact of this is limited.
When fully deployed, the NHS CRS will be made up of records of individual clinicians recording episodes of care, key aspects of which will be placed in the detailed care record for sharing with others as their roles allow within local health communities, and a summary care record. The national programme’s national clinical leads, working with NHS Connecting for Health, have undertaken work with a wide range of groups including the British Medical Association and the royal colleges to consider the best way of populating and launching the summary care record.
As a result, a limited amount of clinical information will be automatically uploaded, such as prescriptions and allergies. More detailed information would then be added on a case by case basis. This approach is supported by the BMA on the basis that as it takes full account of the views of patients.