The NHS Summary Care Record (SCR) is a national database that holds electronic records of important patient information such as current medication, allergies and details of any previous bad reactions to medicines, created from GP medical records. It can be seen and used by authorised staff in other areas of the health and care system involved in the patient’s direct care.

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 health and care professionals at the right time saves lives and improves outcomes.

The SCR can be viewed in:

• The National Care Records Service (NCRS), which is a web-based application, and is the successor to the Summary Care Record application (SCRa)
• General practice clinical systems (TPP SystmOne, EMIS Web, and newer GP Systems joining the English estate)
• Some local point-of-care applications for health and care workers, such as an Electronic Patient Record (EPR) system in a hospital

What the SCR includes

There are two types of Summary Care Record:

• Core SCR
• SCR with Additional Information (also known as SCR AI)

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. 

At a minimum, the Core SCR contains important information about:

• current medication
• allergies and details of any previous reactions to medicines
• the name, address, date of birth and NHS number of the patient

Summary Care Records with Additional Information, may include details of long-term conditions, significant medical history, or specific communications needs. In response to the COVID-19 Pandemic, SCR with Additional Information is now included by default for patients with an SCR, unless they have previously told the NHS that they did not want this information to be shared. For more information, see Additional Information in the SCR.

An SCR 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.  

The Additional Information will be presented in the SCR under the following headings:

• Risks To Patient
• Risks to Care Professional or Third Party
• Diagnoses
• Problems and Issues
• Clinical Observations and Findings
• Treatments
• Investigations
• Investigation Results
• Family History
• Care Events
• Administrative Procedures
• Provision of Advice and Information to Patients and Carers
• Personal Preferences
• Services, Care Professionals and Carers
• Care Professional Documentation
• Patient/Carer Correspondence
• Third Party Correspondence
• Social and Personal Circumstances
• Lifestyle

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 foundGuidance 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 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. 

The original scope of the Summary Care Record (SCR) was to provide access to key information in Urgent and Emergency Care settings. Overtime through close consultation with the Expert Advisory Committee, NHS England have progressed a number of proof of concepts to see whether there are benefits, both for patients and health care professionals, for other care settings to access the SCR.

The following care settings are approved for national rollout to view the SCR where a legitimate relationship exists:

• 111
• accident and emergency
• acute assessment
• ambulance
• community care
• GP out of hours
• GP (for temporary or non-registered patients)
• hospital pharmacy
• minor injury units/walk in centres/urgent treatment centres
• scheduled care
• mental health
• health and justice (custody suites)
• hospices
• primary care
• community pharmacy
• substance misuse

The following care settings are currently either being discussed or there is an active proof of concept but are not approved for further rollout:

• dentistry (minor oral surgery and community dental providers)
• domiciliary care and care homes
• optometry
• private GP providers
• private hospitals and privately funded healthcare services
• adult social care
• sexual, contraceptive and reproductive healthcare services. 

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

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. This is known as Emergency Access.

For users viewing SCRs within NCRS, SCR is available using mobile or desktop devices connected to the internet using WiFi, mobile data or an existing Health and Social Care Network (HSCN) connection.

NCRS offers multiple access options including biometric authentication, smartcards and multifactor authentication (MFA).

User authentication is provided by NHS Care Identity Service 2 (NHS CIS2), the products and services require NHS Credential Management to authenticate in secure modern browsers. 

SCR in Community Pharmacy

Being able to view the SCR in community pharmacies has clear benefits for patients and staff.  Community 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, 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 through the Spine Portal, or via NCRS Integration.

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

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 (June 2024) 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 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 and as part of their new patient registration pack.

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 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 an SCR with Additional Information 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) or other alternative authentication methods such as biometrics and Multi Factor Authentication (MFA).

• 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 GP Record, though not the full SCR, through patient facing 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. Please note this is not the Summary Care Record.

• Patients can update and correct the information held on their GP record by contacting their GP practice.

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 in 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.

Permission to View Guidelines are available on the NHS England website and covers five key areas:

1. Organisations viewing SCRs should define the scope of the permission being sought i.e. who is being given permission and for how long.

2. The explanation to a patient, as part of seeking permission to view, should be simple, straightforward, honest, and appropriately communicated.

3. A patient’s permission to view should be sought at the most appropriate point in the patient’s care pathway.

4. The scope of permission obtained should be appropriately recorded.

5. On those occasions when it is not possible to ask for permission to view, care professionals may act in the patient’s best interests.

Benefits of the SCR

The benefits of the SCR 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

SCR 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 England 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, all GP practices in England are creating SCRs for their registered patients. Data indicates that more than 96% of the population in England have a SCR, 88.3% have an SCR with Additional Information, and 1.4% have opted out.  

On average, there are 320,000+ SCR views per week across the different clinical systems.  

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

Summary

• The content of the SCR 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 England, 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