The NHS summary care record (SCR) is an electronic summary of key clinical information about each patient registered with the NHS in England.  It is automatically created on registration with a GP practice in England and uses information recorded in the GP clinical system. 

The GP record is known as the ‘source record’.  Information is updated every time a relevant change is recorded in the patient’s GP medical record.

The information held in a summary care record gives registered and regulated healthcare professionals, away from the patient’s usual GP practice, access to information to provide safer care, reduce the risk of prescribing errors, and improve the patient experience.

Putting the right information in the hands of doctors, nurses, and other care professionals at the right time saves lives and improves outcomes.

The SCR can be viewed in:

• general practice clinical systems (SystemOne, EMIS Web and Vision)
• the summary care record application on the Spine portal
• through the summary care record application (SCRa) which is a web-based application

What the SCR includes

There are two types of summary care record:

• core SCR
•  SCR additional information (SCRai, also called enriched SCR)

SCR content is limited to information held in GP systems and contains basic information about allergies and medications and any reactions a patient may have had to medication in the past.  The SCRai may have relevant content recorded by other organisations and shared with the GP practice and can include information about significant medical history (past and present), reasons for medications, care plan information and immunisations.

The table below shows what information may be included in each version.

What the SCR includes

There are two types of summary care record:

• core SCR
• SCR additional information (SCRai, also called enriched SCR)

SCR content is limited to information held in GP systems and contains basic information about allergies and medications and any reactions a patient may have had to medication in the past. The SCRai may have relevant content recorded by other organisations and shared with the GP practice and can include information about significant medical history (past and present), reasons for medications, care plan information and immunisations.

The table below shows what information may be included in each version:

Information such as carers’ details, communication needs, etc, often originates outside the GP practice with input from the patient/patient’s family.  It is important for any specific support needs to be included in the clinical record and for these needs/details to be updated when changes are made.

Levels of detail

The level of detail in an SCR depends on how information is collated and coded by the registered practice.  The record can be added to with more coded data and associated free text, subject to the decisions of the patient and responsible clinician.

Data recording varies according to:

• the clinical system in use
• local data quality
• the recording practices preferences
• patient preferences

Additional information will, therefore, vary from one record to another but will follow a broadly consistent format.

It is very important that additional information in the source record is coded appropriately, maintained, and updated in a timely manner, ideally at the point of care.  Most coded data will be available in the SCRai but will only be included in core SCR if the patient consents.

Sensitive information

In all versions of the SCR, sensitive information such as fertility treatment, pregnancy terminations, gender reassignment and sexually transmitted diseases is excluded through the Royal College of General Practitioners’ (RCGP) sensitive dataset.

Patients can, however, opt to have sensitive information included.  The information must be added to the record manually.  Guidance on including additional information in the SCR can be found on the NHS Digitial website.

For a comprehensive SCR/SCRai there is a reliance on correct coding within the clinical record.  There may be a small number of patients with historic coding issues, such as a problem being incorrectly identified as minor/major, and instances of codes relating to the same problem not being linked.  This serves to highlight the importance of correct use of coding within GP practices.  

Summarising patient records supports this, and it remains a contractual requirement for practices to summarise patient records.  Future development will see plans to digitise paper-based medical records, to provide more informed care decisions and patient outcomes, and deliver the NHS Long Term Plan vision.

Recording medicines prescribed outside general practice

Not all medications are prescribed within a general practice.  Other care settings, such as accident and emergency departments, community pharmacies, and by other clinical professionals like paramedics and dentists, can also prescribe medication to patients, including repeat medication.

If these medications are not recorded back into the GP practice record, this could result in healthcare professionals not having enough information to make an informed clinical decision about a patient’s care and may put patients at risk of medication errors.

Recording medicines prescribed elsewhere into the GP practice record explains why medicines prescribed outside a patient’s GP practice must be recorded into their GP practice record as soon as the practice is made aware, and the implications to the SCR when this is not done.  It also explains what steps GP practices can take to ensure that this information is recorded correctly.

Where SCR is used

When patients are at their most vulnerable, giving health and care professionals access to their SCR enables them to better understand the patient’s needs and make the best decisions with and for them. 

SCR can be accessed in a wide range of settings, subject to access controls:

• acute trusts (both unscheduled and scheduled care)
• GP practices
• GP out of hours services
• NHS 111
• walk-in centres
• urgent treatment centres
• minor injury units
• mental health
• community pharmacy
• custody suites
• prisons
• hospices
• community care
• district nursing
• ambulance services
• drug and alcohol service
• smoking cessation clinics
• private healthcare
• social services
• child protection

The following settings and use cases are currently not in scope for SCR viewing and will not be approved for rollout:

• research purposes, including clinical trials
• police and other government departments
• non-clinical cosmetic service providers

Two exceptions were granted under an urgent public health need for COVID-19 clinical trials. These were the Principle and Panoramic trials.

Note | Where the patient cannot give their permission, the clinician treating them can still access the SCR without their consent where it is deemed in the best interests of the patient.

SCR/SCRai in pharmacies

Being able to view the SCR in community pharmacies has clear benefits for patients and staff.  Community pharmacies have an increasing role in providing primary care services, including vaccinations, minor injuries, medicines reviews, etc.  Every time a pharmacy professional accesses an SCR /SCRai, they will be asked to confirm that they have a legitimate relationship with the patient, that is, they have a good reason to view it based on clinical need.  The following can be checked, with 24-hour access:

• allergies to prevent prescribing errors
• current medications prescribed for emergency supply purposes
• eligibility for services such as a free flu jab, COVID-19 vaccination etc.

Access is via a secure web-based viewer, SCR 1-click, or the Spine portal.

Information created by the pharmacy will integrate with the GP record and if coded and relevant will then be included in the SCRai.

Patient choice | Opting in and opting out

It is good practice to provide all patients with information about the benefits of opting in, and risks of opting out of the SCR, so that they can make informed choices, especially when registering with a GP practice (see important points to note below).

The health and social care system faced significant pressures during the COVID-19 pandemic.  As part of the response the Department of Health and Social Care removed the requirement for a patient’s prior explicit consent to share additional information as part of the SCR.  The current (April 2023) protocol is, therefore, for core and additional information to be included in a patient’s SCR by default unless the patient has explicitly opted out.  This will be reviewed following the coronavirus (COVID-19) pandemic. 

Further information on the use of confidential patient information without consent (COPI) for COVID-19 purposes can be found on the Health Research Authority website.

NOTE | patients can continue to express an SCR consent preference and can change their mind at any time.  

Patients can inform the practice of their choice or complete the SCR patient consent preference form and return it to the GP practice. Practices should publicise this as an option and offer the link on their website.

Patients can inform thepractice of their choice or complete the SCR patient consent preference form and return it to the GP practice.  Practices should publicise this as an option and offer the link on their website.

In some circumstances practices can also amend SCR opt-out decisions.  Often at the point of care from another provider, patients realise the limitations of not sharing their SCR.  A change of mind at this point can result in other care providers then requesting access to view the SCR, through the Spine portal, with the patient’s consent.  If a difficulty arises because of the patient’s preference to opt out, practices should ideally contact the patient and review the decision together.

Patients should understand that opting out of SCR also prevents the use of national applications like the electronic prescription service (EPS) and electronic referral system (eRS).

Patients on the frailty register

Identifying frailty in patients can help predict who is likely to have a fall, become dependent on other people to help with basic care tasks, experience an unplanned admission to hospital or a care home, or die within the next year.  Frailty is also associated with anxiety, depression, and a poorer quality of life.

Practice computer systems have an algorithm that identifies patients with multiple co-morbidities and a high number of medications.  The risk stratification tool Electronic Frailty Index (eFI), rates patients 65 and over as having severe, moderate, and mild frailty.  It is intended as a guide for practices to identify the small percentage of patients who could benefit from greater input into the management of their care.

Previous contract specifications for the management of patients with frailty recognised the importance of having detailed SCRai for this cohort.  If any of the practice’s patients identified with severe frailty have opted out, then the practice needs to address this on an individual basis.  

Viewing the SCR

There are strict rules about viewing a patient’s care records set out in national SCR information governance guidance.

SCR uses the following controls to make sure access is in line with all information governance (IG) requirements:

• authentication and role-based access control (RBAC) using NHS smartcards (Smartcard authentication needs a Health and Social Care Network (HSCN) connection, previously known as N3)

• NHS Care Identity Service 2 (NHS CIS2) works with modern browser technology, allowing access via secure internet services) legitimate relationships (LR) meaning the viewer has a good reason to view the patient’s SCR as they are involved in their care

• permission to view (PTV) when the patient is asked for their consent before the SCR is viewed (emergency access is allowed if it’s in the patient’s best interest, if they are unconscious or can’t communicate)

• patients can access a summary of some of their details, though not the full SCR through web-based services such as the NHS App

• patients will potentially have full future records access in the through the Accelerating patient access to their record programme

• patients can update and correct the information held on their GP record, but cannot exclude or remove information

Further guidance on access to a patient record by a third party (with or without the consent of the patient) which is known as subject access requests (SARs) can be found another article in these Guidelines.

Permission to view

Permission to view can be gained each time there is a need, or it may cover future use, if the question asked makes this clear to the patient and there is a clear system for recording this.

Legitimate relationships and permission to view (or emergency access, with explanation noted) can be recorded by a member of staff such as a receptionist, or by the clinician themselves.  Self-claiming a legitimate relationship, or selecting emergency access, will generate an alert on the patient record.  Each organisation’s privacy officer will audit these alerts to make sure there was a valid reason for the view.

SCR permission to view is available for patients with one of the following registration types:

• registered for GP services in England

• temporary residents (can be registered for treatment for between 15 days to 6 months)

• walk-in patient (can be treated as a temporary or private registration)

• immediately necessary (registered for immediate treatment)

• private registration (will pay for treatment)

Benefits of the SCR

The benefits of the SCR/SCRai include:

• providing relevant information for emergency or out-of-hours providers, making unwanted admissions less likely and avoiding delays in urgent care
• health and care professionals providing care in any setting have key clinical information, reducing the risk of prescribing and other errors 
• for patients with a disability, information such as communication needs, carers’ details, likes, and dislikes, and specific care preferences can all be included.  (It is widely acknowledged that carers benefit from ‘contingency planning’ conversations and have these recorded in SCRs so that care professionals know when and how to action such plans when needed)
• awareness of health problems like diabetes or dementia
• identifying patients eligible for flu or other vaccinations
• end of life preferences, lasting power of attorney details and advance decisions are available to care professionals
• non-English speakers’ clinical information is available immediately

SCRai is simple and effective in supporting clinical management, helping to make clinical engagement with new and unfamiliar patients safer.  

It is also particularly helpful in supporting clinicians treating the most complex and vulnerable patients.

NHS digital provides with some expert views on the benefits of additional information in summary care records including a useful case study.

Risks of opting out of SCR

The risks of opting out of SCR include:

• medication and prescribing errors
• potential delays in providing emergency care

NOTE | Where a patient has opted out of SCR, there may be occasions when a practice needs to contact an individual to suggest they consider opting back in.  An example would be following referral to community services or secondary care, where access to SCR could reduce any risks involved, improve patient safety, and enhance the care they receive.

Important points to note

The following are key things for practices to be aware of:

• Check the date the SCR was last updated. It may not be current.  If this is the case, when the patient attends an appointment, their SCR will be updated.  This is important particularly, but not exclusively, for those patients who are, for whatever reason, classed as vulnerable.
• If a patient has recently changed GP, the SCR may not be created or fully updated.  Checks should always be made to ensure the patient consents to an SCR by using the patient consent preference form.  Consent is enduring, so the SCR is kept up to date in real time as the GP record is updated.  It is good practice for new patient registrations to be screened and any important information such as current medication, ongoing problems, carers details etc to be updated at that initial consultation.
• A screen message may inform that certain entries (sensitive information) have been deliberately withheld from the summary.  Once full record access is granted to patients through the accelerating patient access to their record programme, it is important that clinicians consider the impact of each entry, including documents and test results, as they add them to a patient’s record.
• Practices should record medicines prescribed elsewhere into the GP practice record to ensure records are accurate and up to date.
• If a patient’s GP record is updated with some SCR-relevant information by a user who has logged on with username and password rather than a smartcard, the information sits in the background until the next smartcard user in that practice logs on, opening the gateway to allow the information to flow to the SCR.
• If there is a break in the GP record, for example because a patient moved away from England or joined the armed forces, the record must be reviewed and updated on their return.

SCR data

At the time of writing (April 2023) 98% of GP practices in England are using SCR. Data indicates that more than 96% of the population in England have a SCR, 81.9% have an SCRai and 1.3% have opted out.  

On average, there are 270,000 SCR views per week across the different clinical systems.  

You can access up-to-date information on usage in the NHS Digital dashboards.

Summary

• The content of the SCR/SCRai may differ from patient to patient according to a range of factors.
• Patients can opt not to share their SCR.  They can opt in and opt out at any time by using the patient consent preference form.
• Authorised clinicians can override an opt out decision where they deem this to be in the best interests of the patient.
• There are of clinical, safety and quality benefits to patients of sharing their SCR.
• Patients need to be made aware of the risks associated with not sharing their SCR

The National Care Records Service (NCRS) is the new and improved successor to the Summary Care Record Application (SCRa).  It provides access to an ever-increasing number of national NHS digital service, in different health and care settings.

Related GPG content

• Subject access requests
• Smartcards and role-based access
• NHS CIS2
• Electronic Prescription Service (EPS)
• eReferrals
• Consent to record sharing
• Shared care records
• NHS App
• Digitisation of Lloyd George records

Other helpful resources

• NHS Digital, Why and how we process data in the Summary Care Record system, and patient’s rights Summary Care Record (SCR): GDPR information.
• NHS Digital, SCR coronavirus (COVID-19) supplementary privacy notice
• NHS England, Accessible information Standard and Summary Care records
• UK, About the NHS App
• NHS England, Subject access requests