Summary Care Record
Viewer Guidance
Including Additional Information
Version 0.37 – June 2015
For further information or to request support: scr.comms@hscic.gov.uk
The Summary Care Record and Additional Information
1. What is the Summary Care Record (SCR)?
1.1.
The SCR is an electronic patient record containing up to date key information from the
patient’s GP record. It is available throughout England and as of June 2015 over 96% of
people in England have an SCR.
1.2.
Currently, most patients have an SCR containing the core dataset SCR (medication,
allergies and adverse reactions as a minimum) - see Fig.1. SCRs can also contain
Additional Information over and above the core dataset where patients provide their
explicit consent for this to happen.
2. Interpreting the SCR (Fig.1)
2.1.
The core SCR dataset present in all records is:
 Allergies and adverse reactions to medication;
 Current repeat medication;
 12 months of acute medication (or 6 months if stated);
 6 months of discontinued repeat medication (unless otherwise stated).
2.2.
The SCR is sourced from the patient’s GP record only. Therefore, it may not include the
entire list of the patient’s over the counter medications or items prescribed outside of the
GP practice, unless the practice has manually entered these items into their GP system
or the information is part of a wider shared record from another organisation. These
items will be labelled on the SCR (under Type) as ‘Prescribed Elsewhere’.
2.3.
The SCR is marked with the last date and time that an update was sent by the GP
practice. Viewers should check this to ensure that they understand when the record was
last updated – see Fig. 1 – Note 1.2.
2.4.
A message will be displayed if a patient has recently changed their GP practice, as this
could indicate that the SCR content is not yet fully up to date – see Fig.1 – Note 1.1. This
message will be displayed if the SCR has been newly created or has not yet been
created by the patient’s new GP practice; either because the new GP practice does not
yet hold information to overwrite the existing SCR, or because they have not yet started
uploading SCRs. These messages, in conjunction with the date and time stamp, should
be used to assess how current the SCR information is (see Fig. 1).
2.5.
A message will be displayed when items have been withheld from the SCR. This may be
because GP system privacy settings have been used to restrict the sharing of certain
information from the patient’s GP record.
3. Additional Information Content in the Summary Care Record (Fig. 2)
3.1.
Functionality is being enabled in GP systems during spring and summer 2015 to provide
an improved mechanism for Additional Information to be added. This will include:
 Reason for medication
 Significant medical history (past and present)
 Significant procedures (past and present)
 Anticipatory care information – such as information about the management of
long term conditions
 Communication preferences – as per the ISB-1605 dataset
 End of life care information – as per the ISB-1580 dataset
 Immunisations
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Items are identified for inclusion due to their presence above either as part of a key
dataset (e.g. End of Life care) or because they appear in a relevant section of the GP
record, e.g. items appearing as ‘significant problems’ within the GP system are likely to
be automatically included. GP practices may also manually add further information, in
accordance with patient wishes.
3.2.
As this improved functionality is enabled and utilised, Additional Information will slowly
become more widespread – particularly for those patients who will benefit most – such as
patients approaching the end of life, the “frailest 2%” and those with long term conditions
and/or communication problems such as patients with learning disabilities or dementia.
3.3.
There are differences in the underlying GP record format, supplier implementation, local
data quality and patient preferences. As a result, the content of SCRs with Additional
Information will vary from record to record but will follow a broadly consistent
presentation format explained below.
3.4.
SCR content is limited to information held in GP systems but may include information
from shared records. Therefore, the SCR Additional Information may include relevant
content recorded by other organisations and shared with the GP practice.
3.5.
The data included in the SCR consists of coded items from the GP system together with
any supporting free text. The codes are translated to SNOMED terminology1 and
presented to the SCR viewer. Some of the primary care terminology may not be familiar
to emergency and other secondary care clinicians – see 3.22 below. There is no
standard for the recording of supporting free text and its quality will vary, but when
present in the SCR it generally provides additional useful detail to supplement the coded
information. This may also include information that may be considered sensitive or relate
to un-necessary third party information – see sensitive information below (3.14 and 3.15).
3.6.
The SCR with Additional Information is generally larger - typically 2-3 times the size of
the core SCR (3-16 pages).
3.7.
The SCR with Additional Information follows the existing SCR format with the core
dataset of the record containing medications, allergies and adverse reactions remaining
at the top of the SCR. When Additional Information has been added, Reason for
Medication will appear against relevant medication if this has been recorded by the GP
practice.
3.8.
Additional Information will appear below the core SCR, grouped under the following Care
Record Element (CRE) headings:
1
For further information on SNOMED CT see the SNOMED CT GP user guide:
http://systems.hscic.gov.uk/data/uktc/training/snmdct_gp_userg.pdf
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3.9.
The headings are determined by the UK Terminology Centre (UKTC) and are a
mechanism to group SCR items within individual patient records. A heading will only
appear in an individual SCR if there is relevant information available from the patients GP
record for inclusion under that heading. Some headings are only likely to be used in
limited circumstances e.g. ’Third Party Correspondence’ will not generally be present, as
this information cannot currently be attached to the SCR – although the existence of
correspondence in the GP record could be signposted.
3.10. When headings are shown, they always appear in the order above.
3.11. There is no specific ‘End of Life’ heading but End of Life care information will appear
under relevant headings e.g. the Resuscitation status (see section 3.12) will always
appear under Personal Preferences and diagnoses will appear under Diagnoses.
3.12. Resuscitation Information in the SCR:
Resuscitation Codes in the Summary Care Record
Only the most recent instance of the Resuscitation (Do Not Attempt Cardio-pulmonary
Resuscitation - DNACPR) codes from the GP system is displayed in an SCR with
Additional Information (if this information is recorded in the GP system).
This always appears under the Personal Preferences heading along with other End
of Life preferences such as preferred place of care or death. If the code has been
marked in the GP record as an active problem, then it may also appear under the SCR
Problems and Issues heading.
Resuscitation status in the SCR is only to be treated as a signpost to information
that is fully recorded elsewhere and viewers and clinicians are advised to
continue to follow their existing processes according to local and national
standards
3.13. The quality and completeness of the Additional Information included in an SCR is
dependent on a number of factors including the underlying clinical record, data quality
and confidentiality issues. As a result, SCR viewers should be aware that the SCR
potentially may not be complete and should be seen as an additional clinical tool to
support current practices.
3.14. Items defined in the Royal College of GP’s (RCGP) sensitive dataset, found at:
http://systems.hscic.gov.uk/scr/gppractices/additional/rcgpexc2015aprv1.xls which
specifically relate to in-vitro fertilisation, sexually transmitted diseases, terminations of
pregnancy and gender re-assignment are automatically excluded from Additional
Information, but can be manually added by the patient’s GP practice, if the patient
wishes. However, there may be other items deemed as sensitive which may have been
included as codes or referenced in free text i.e. details of abuse or un-necessary
information related to third parties. Viewers are reminded to treat the SCR information
with sensitivity as for any other clinical records and to take steps to avoid inappropriate
disclosure when discussing information with patients, family and carers.
3.15. When an item is excluded from SCR Additional Information because it is in the RCGP
sensitive dataset, a message is included in the SCR. As per section 2.4 above a general
message is included at the top of the SCR indicating that one or more items have been
withheld from the SCR. See Fig. 3.
3.16. There are a number of known causes of duplication and repetition within the SCR with
Additional Information. These include duplication of codes from the underlying system,
data quality issues, inclusion of repeated vaccinations or different instances of similar
information from shared records. Means for filtering these out are being considered.
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3.17. SCRs may contain auto generated text defining problem detail from the GP system. This
may be of less relevance for non GP viewers. Examples include Significant Active,
Significant Past, Minor Active, Minor Past, End Date, Problem; New – see Fig.2.
3.18. Problems and Issues is a special section that may contain the patient’s active
problems, where they have been identified as such in the GP system. Some systems
may also include significant past or inactive problems. Any items that appear under this
heading will also appear under their respective defined headings as well e.g. heart failure
in Figure 3 appears in Diagnoses and also Problems and Issues.
3.19. Immunisations / vaccinations currently appear under Treatments. The placement of
these items is being reviewed.
3.20. Clinical Observations and Findings may include some observation values – such as
blood pressure – but only if the GP system adds them systematically (which not all do) or
if the GP practice mark the items for inclusion or because they were recorded in a
relevant section of the GP record for inclusion in SCR.
3.21. Investigations and Investigation Results only contain items manually added by the GP
practice or because they were recorded in a relevant section of the GP record for
inclusion in SCR.
3.22. GP systems use different versions of codes to record clinical information1. The
information included in the SCR is converted to SNOMED CT codes for display. Some
codes may include terminology unfamiliar to non-primary care SCR viewers. Examples of
these include:
 [D]= codes for working diagnoses when a specific diagnosis is not yet ascertained.
 [M]= related to morphology of neoplasms
 [EC]= Classified elsewhere in a code, usually referring to an underlying cause of a
particular disorder.
 [NEC]= not elsewhere classified
 [HFQ]= however further classified
 [OS]= otherwise specified - only used when a definitive code is not available.
 [NOS]= not otherwise specified - only used when a definitive code is not available.
 [SO]= Site of
 [V]= Supplementary factors influencing health status, but not including illness
 [X][Q] relate to cross-reference and qualifier information - not important for viewing
Other clinical notation that may also be encountered includes:
 O/E = On examination
 C/O = Complaining of
 H/O = History of
 P/H = Personal history of
 F/H = Family history of
 CXR = Chest x-ray
 NAD = No abnormality detected
3.23. The SCR examples shown in this guidance are screenshots of the SCRa web
application. There are some presentation differences between the SCRa and printouts.
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Figure 1: Viewing the core SCR
1.1 If the patient is no longer registered with this GP practice (see 3.4), or if items
have been deliberately withheld from the SCR (see 3.4) the relevant message
below will be clearly displayed in the SCR:
Patient registration ended [date]. GP Summary no longer being updated
One or more entries have been deliberately withheld from this GP Summary
1.2. Date
and time
when the
SCR was
last
updated
(see 2.3)
1.3. Items
prescribed
outside the
GP practice
will only
appear if
entered by
the GP
practice.
Their Type
will be
labelled as
Prescribed
Elsewhere
(See section
3.2)
1.4. Last issued
date may not
appear for current
repeat medication
on every SCR. In
this case the Date
First Added will
appear
1.6. If Discontinued Repeat Medications are not being
sent by the patient’s GP practice the following
message will appear in this section:
The Discontinued Repeat Medications are not
included in this summary
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1.5. If an SCR contains
Additional Information it
will appear under relevant
headings beneath the
core data (see section
4.7)
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Figure 2: Viewing Additional Information in the core SCR
2.1. If the patient
consents to
Additional
Information,
Reason for
Medication will
be included if
recorded in the
GP record
2.2. If the Reason
for Medication is
recorded in the
GP system but is
excluded from
the SCR, then
this is indicated
2.3. Additional
Information
appears below
the core SCR
grouped under
SNOMED
headings. In this
example,
Diagnoses are
the first
information to be
included in the
SCR
.
2.4. Additional Information appears as individual rows (in reverse date order), comprising:
1. Date of the event (Date)
2. The SNOMED equivalent of the coded item included from the GP system (Description)
3. Supporting free text (Additional Information sub-heading)
In this example, the supporting text includes auto-generated information from the GP system
indicating the problem detail of the coded item e.g. it is a Problem and this is the First Episode.
The auto-generated information is system specific and will vary depending on which GP system
produced that individual SCR. The successive text “end stage” is the supporting free text
recorded by the GP practice when this information was recorded
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Figure 3: Viewing Additional Information below the core SCR
3.1 The
Diagnoses
heading includes
the patient’s
diagnoses that
have been
automatically
included in the
SCR Additional
Information.
3.2 Problems and Issues
is a special section that
contains the patient’s Active
and significant past
Problem items if they have
been identified as
Problems in the patient’s
GP record. These items
also appear elsewhere in
the SCR under their own
relevant defined headings.
3.3 The
supporting free
text provides
additional
useful detail to
supplement the
coded
information. It
may include
sensitive or
third party
information –
see 3.14 and
3.15
3.4. Clinical Observations and Findings may include some observation values – such as blood
pressure – but only if the GP system adds them systematically (which not all do) or if the GP
practice mark the items for inclusion or because they were recorded in a relevant section of the GP
record for inclusion in SCR.
In the example above, some information has been marked as confidential or private in the GP
system and is therefore not included in the SCR. When this occurs in the SCR, a message is
included indicating that one or more items have been withheld from this SCR.
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Figure 4: Viewing Additional Information below the core SCR
4.1. The Treatments
heading includes
vaccinations. The
example here shows
the annual influenza
vaccination which can
contribute to repetitive
information in the
SCR.
4.2 Investigations
and Investigation
Results will only
contain items
specifically identified in
the GP system for
inclusion. More
detailed information
may be available in the
GP record but not
present in the SCR
4.3. The Personal
Preferences section
contains patient
preferences such as
those regarding End of
Life care and
Resuscitation status
– see section 3.12
4.4. This section can
include details of Next
of Kin
Further information can be found at http://systems.hscic.gov.uk/scr/gppractices/additional and any
questions can be sent to the Health and Social Care Information Centre (HSCIC) SCR team at
scr.comms@hscic.gov.uk.
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