Where is SCR Plan B?

I received my notification that my medications and allergies would be uploaded to my Summary Care Record (SCR) on the same day as the NHS announced that it was putting the whole exercise on hold. Disappointed, I have since watched the farce unfold with a certain amount of wry pleasure. Some primary care trusts in the east of England, who had geared themselves up for the upload, objected and wanted to persevere. Good on them. The NHS said OK, if each GP in the PCT agreed that they were ready, then go ahead. Now the coalition government has decided that SCR data should continue to be uploaded, despite the manifesto pledges to axe the records as it has axed ID cards. I am sure that the enemies of the SCR will fight back. This is the medics' conference season, and already groups of doctors are putting in resolutions calling for the SCR to be scrapped. I have a nasty feeling that they may win in the end. And there is the magisterial report by Dr Trisha Greenhalgh, the "Introduction of shared electronic records: multi-site case study using diffusion of innovation theory" about how the first rolls-outs of the SCR have panned out. This is kinda negative. What you would expect from a practising GP. The report is very intelligent, and could be the basis for many interesting analyses of doctor and patient behaviour. But it misses the main point. Which is: how do you present, to a doctor treating you, all the relevant facts from the past which will help the doctor to give a diagnosis and safe course of treatment? The report says that the SCR is an incomplete answer, but it offers no plan B. So I have been carrying out some private and unscientific research to find out whether the ones who find the SCR so dreadful have developed a coherent Plan B, as to who should hold the record, update it and be legally responsible for its accuracy. And who should define the data standards, so that a million incompatible flowers do not bloom. My initial finding is that nobody with any authority has a Plan B. Most people attacking the SCR are purely negative. There are exceptions. One mate, an experienced IT consultant, argues that the logical holder of records is the PCT. Apparently their equivalents in the States, health maintenance organisations (HMO), are legally responsible for holding any patient records that are aggregated from different clinicians and are liable for the accuracy and use made of such records. Hence instead of the English dream of a single national data spine store, each HMO has its own patient data store. This model has a lot of logical sense to it, as a PCT might be better able to hold a database of GP records than the Spine or GPs themselves. My worry is that gearing up PCTs to be legally responsible for the accuracy of data could be an expensive and time consuming exercise, when expense and time are in short supply right now. One recommendation is that I should forget about any form of an e-care record, and buy myself a Medicalert bracelet (£40), which will have all the details of my allergies and medications. Tempting and radical, but I don't fancy wearing a bracelet. And you are still stuck with a database, albeit a private database, which may or may not be as secure as the Spine. I was greatly encouraged by Roz Foad's response on 14 October 2009 to my previous worries about patient records ( article ). She sees GPs as being the only current holder of a cradle-to-grave record. So, why reinvent the wheel? I couldn't agree with her more. But I have since not heard any support for her ideas. I have a nasty feeling that her colleagues in professional associations have put her firmly in her place while they pursue other agendas. And I can't imagine GPs wanting to shoulder the responsibility. They might be prepared to do it, as is normal for GPs, for a truckload of money. At a session at Smart Healthcare Live last week I was encouraged when I complained that patient records were still in the stone age, and that Trisha Greenhalgh should be careful that her opinions would keep us there. I received a round of applause, which was surprising and gratifying. There are some people who would like to move on. I imagine that coalition ministers are in permanent session in smoke-filled rooms, hammering out the conundrum of whether they can work with the SCR or revert to a Plan B that has yet to emerge. I am on tenterhooks to hear what they come up with.