Dear Ms Sumeray Re: Regulation 28: Report to Prevent Future Deaths (2) Investigation in to the death of Mr John William Day Thank you for your correspondence dated 4 June 2014 in which you raised concerns about access to medical records GPs working out of hours_ understand that you will also be receiving a reply fron] who is the medical director for the GP out of hours service His reply deals in some detail to explain the limitations of accessing information from patient records. As chair of the organisation responsible for commissioning out of hours GP services and as practicing GP am familiar with the severe limitations of the current information systems available to out of hours doctors _ There have been various attempts to improve clinical information sharing through IT developments, nationally, regionally and locally: Results have been variable and often of limited functionality. In particular difficulties relating to consent and information governance have resulted in incomplete access The technical problems mean that even the system on the Island [Vision 360] is not easy to access and not always reliable. As such when consulting with patient who is deemed to have adequate capacity it would be normal practice to ask that patient whether were aware of any allergies and act solely on that information. Current working practices and systems would not allow routine checking with the patient record: Commissioning high quality; sustainable and integrated services for they

The Island CCG, along with all other CCGs, is developing a system-wide IT strategy: The aim is to move towards universal, integrated and readily accessible health care record_ This would have considerable benefits to delivery of care in a range of ways of which out of hours access is only one Frustratingly the practical problems to progress this are considerable and wide ranging: Ast explains the Island is making significant advances with the introduction 0 an overarching system [ISIS] but we have long way to go before there is a fully operational shared information system.

The 3 | JUL 20" Beac n Health at St Marys Centre Hospital Response to matters of concern raised in the Regulation 28: Report to Prevent Future Deaths (2) in relation to the death of Mr John Day The concerns raised in section 5 are about access to a patient'$ records out of hours and, although it did not apply in this case, the potential risk to a patient who lacks capacity, if this is not available: It is unfortunately the case that there is no system currently available to GP out-of hours services that has the capacity and capability to provide a clinician with all the patients GP clinical records although previous contacts with the out of hours service are accessible, locally, via the dedicated out of hours system, Adastra. Whilst all UK residents, unless they opt out, can be checked against the National (NHS) spine, this only gives the demographics of that patient and not any clinical record, sO this not provide information about allergies Whilst it is planned that there will be access to the Summary Care Record through the National Spine this does not function fully yet and we have not succeeded when attempted by the Beacon services: We are fortunate in that all the GPs on the island have the same primary care computer system which should allow some limited sharing of clinical information locally, through a system called Vision 360 but this has largely failed to function, is cumbersome and could not be accessed by the mobile GP because the limited ability to transfer data to the laptops in the cars due to the band width. In the case of a patient who lacks capacity, it would be possible, although time consuming, for a GP in the community to contact a GP colleague at the base to see if Vision 360 is functioning and then to check for allergies or other serious and appropriately important conditions that might have any impact on the treatment being considered. This, even then, does rely on the information being correct and complete on the GP system and would not be possible to access in the case of non island residents_ In this case the patient was deemed to have capacity firstly by the paramedic; as they accepted his refusal to go to hospital, and then bYL IMr Day denied any allergies to both of these clinicians so there was no reason to check the veracity of the patient's response even if access to Vision 360 were more reliable_ All the GPs working in the out of hours service are aware of the potential, but unreliable, access to Vision 360 and, as a matter of normal clinical practice, would attempt to access it if they significant concerns about initiating a treatment with a potential serious allergic response in a patient without capacity: NHS 0 SMOKEFREE Isle of Wight RECEIVE would good Quality Care ) rone

The Beac" 0 Health at St Marys Centre Hospital There is no integrated health care record system in the UK that we could adopt that would deliver a comprehensive and mobile health care record across all systems but we are leading the way on the development of that integration on the island: The Beacon out of hours service is working closely primary care, the ambulance service and secondary care. We have already integrated the Adastra system into the overarching hospital system ISIS. Better links between this and the primary care system (Vision) are limited by the unreliability of Vision 360 which is a problem nationally and not within our control. it is more likely to be resolved by a change it the islands primary care system_ Actions taken Reminder sent to all out of hours GPs to consider trying to access to Vision 360 if clinically indicated. To continue to press for improvements in the IT systems to be able to deliver mobile access to patients clinical record. Beacon Medical Director NHS SMOKEFREE Isle of Wight get Quality Car ) 3 one