Refat Hussain
PFD Report
All Responded
Ref: 2014-0061
All 1 response received
· Deadline: 9 Apr 2014
Coroner's Concerns (AI summary)
Out-of-hours GPs working for Harmoni lack access to patients' full medical records, compromising their ability to make accurate diagnoses.
View full coroner's concerns
(1) The lack of access to the patients GP medical records reduces the ability of out of hours GPs working for Harmoni to make accurate diagnoses
Responses
Noted
Care UK acknowledges the coroner's concerns regarding access to patient information and describes existing systems for receiving information from GPs, including post-event messages, Special Patient Notes, Summary Care Records, and Coordinate My Care in London. They emphasize that the onus is on the registered GP practice to enable access. (AI summary)
Care UK acknowledges the coroner's concerns regarding access to patient information and describes existing systems for receiving information from GPs, including post-event messages, Special Patient Notes, Summary Care Records, and Coordinate My Care in London. They emphasize that the onus is on the registered GP practice to enable access. (AI summary)
View full response
Dear Dr Wilcox INQUEST TOUCHING ON THE DEATH OF MS. REFAT HUSSEIN ("MS HUSSEIN") AND YOUR REGULATION 28: REPORT TO PREVENT FUTURE DEATHS DATED 12 FEBRUARY 2014 (THE "REPORT") I am writing this letter in response to the Report. I am the Medical Director for Urgent Care within Care UK which, since November 2012 Harmoni has been wholly owned by Care UK. We fully appreciate that in providing high quality Out of Hours ("OOH") medical care it is highly desirable to have access to information from the patient's registered General Practitioner ("GP"). During his review of GP OOH services in 2000,
emphasised this very point and at the time of his review, he was confident that a national programme to deliver electronic records would address this. Regrettably, this project did not deliver. As you may appreciate, there are a number of GP IT systems that necessarily underpin consultations and the organisation of In Hours care in General Practice. Whilst there is increasing interoperability between these systems, we are not yet at the stage where records are easily shareable between GP practices and OOH providers. Our OOH information system, called Adastra, does communicate with daytime GP practices in the sense that, after an OOH consultation has taken place the GP practice receives a "post event message" ("PEM") detailing the consultation that has taken place in OOH period. The PEM contains a summary of the consultation notes. As such, our OOH service is able to communicate with GP practices. However, the reverse (i.e. an information flow from a GP practice to OOH as a matter of routine) is simply not possible under current NHS protocols. Our clinicians are not routinely able to see records from daytime GP computer systems. This situation applies generally to OOH services and is not specific to Harmoni/Care UK. At its most basic level, this means our OOH clinicians have to ensure that they take a careful history from patients and their carers and/or family to ensure that they can deliver a high quality medical assessment and appropriate treatment. To us, this is not satisfactory and we are aiming to exert what influence we can to change the current state of affairs for the benefit of patients As such, we have not been complacent about this concern and have taken, and continue to press GPs to submit information to us about patients who have long term conditions, are very poorly or vulnerable. This is achieved through a system called Special Patient Notes Care UK Clinical Services Limited Registered Office :, Connaught House, 850 The Crescent, Colchester Business Park, Colchester, Essex, CO4 9QB Registered company number: 03462881
("SPN"). GPs can submit SPNs in either written form that we can transcribe into our records or preferably, can use a web portal to submit the SPN directly into our systems. We provide templates of the most common forms of SPN to try to ensure that the correct data is captured and the system we have implemented reminds GPs when SPNs that have been placed on the system by that GP are due for review. In addition to this, we are working closely with the Health and Social Care Information Service ("HSCIS") to ensure that systems are in place to ensure that we can see patients' Summary Care Records ("SCRs"). The SCR is a direct element of GP patient records and has the potential to be enormously helpful in ensuring that we have access to important information extracted from the patient's registered GP. Together with HSCIS, we are promoting this nationally as SCRs will only become truly useful when more GPs have uploaded them and the content of the SCR is expanded. I should also add that in London, we also work closely with NHS England to ensure that our OOH (and other) services can access patient records on a system called Coordinate My Care ("CMC"). CMC is widely used across London to try and integrate the daytime medical care, community nursing care, hospital care and OOH care. An important factor applying to all of the above developments is that the onus is on the registered GP practice to enable us to access information. I hope that this letter illustrates that this is an issue that we take extremely seriously and are working diligently to resolve. I am happy to provide any further information or clarification that you may require.
emphasised this very point and at the time of his review, he was confident that a national programme to deliver electronic records would address this. Regrettably, this project did not deliver. As you may appreciate, there are a number of GP IT systems that necessarily underpin consultations and the organisation of In Hours care in General Practice. Whilst there is increasing interoperability between these systems, we are not yet at the stage where records are easily shareable between GP practices and OOH providers. Our OOH information system, called Adastra, does communicate with daytime GP practices in the sense that, after an OOH consultation has taken place the GP practice receives a "post event message" ("PEM") detailing the consultation that has taken place in OOH period. The PEM contains a summary of the consultation notes. As such, our OOH service is able to communicate with GP practices. However, the reverse (i.e. an information flow from a GP practice to OOH as a matter of routine) is simply not possible under current NHS protocols. Our clinicians are not routinely able to see records from daytime GP computer systems. This situation applies generally to OOH services and is not specific to Harmoni/Care UK. At its most basic level, this means our OOH clinicians have to ensure that they take a careful history from patients and their carers and/or family to ensure that they can deliver a high quality medical assessment and appropriate treatment. To us, this is not satisfactory and we are aiming to exert what influence we can to change the current state of affairs for the benefit of patients As such, we have not been complacent about this concern and have taken, and continue to press GPs to submit information to us about patients who have long term conditions, are very poorly or vulnerable. This is achieved through a system called Special Patient Notes Care UK Clinical Services Limited Registered Office :, Connaught House, 850 The Crescent, Colchester Business Park, Colchester, Essex, CO4 9QB Registered company number: 03462881
("SPN"). GPs can submit SPNs in either written form that we can transcribe into our records or preferably, can use a web portal to submit the SPN directly into our systems. We provide templates of the most common forms of SPN to try to ensure that the correct data is captured and the system we have implemented reminds GPs when SPNs that have been placed on the system by that GP are due for review. In addition to this, we are working closely with the Health and Social Care Information Service ("HSCIS") to ensure that systems are in place to ensure that we can see patients' Summary Care Records ("SCRs"). The SCR is a direct element of GP patient records and has the potential to be enormously helpful in ensuring that we have access to important information extracted from the patient's registered GP. Together with HSCIS, we are promoting this nationally as SCRs will only become truly useful when more GPs have uploaded them and the content of the SCR is expanded. I should also add that in London, we also work closely with NHS England to ensure that our OOH (and other) services can access patient records on a system called Coordinate My Care ("CMC"). CMC is widely used across London to try and integrate the daytime medical care, community nursing care, hospital care and OOH care. An important factor applying to all of the above developments is that the onus is on the registered GP practice to enable us to access information. I hope that this letter illustrates that this is an issue that we take extremely seriously and are working diligently to resolve. I am happy to provide any further information or clarification that you may require.
Sent To
- Harmoni HS
Response Status
Linked responses
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56-Day Deadline
9 Apr 2014
All responses received
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Report Sections
Investigation and Inquest
On 12/h June 2013 commenced an investigation into the death of Refat Hussain aged 25 years The investigation concluded at the end of the inquest on 17lh December 2013. The conclusion of the inquest was Medical Cause of death: 1a Multi-organ failure: b In hospital cardiac arrest Pulmonary Tuberculosis and pneumonia II Rubenstein Taybi Syndrome: Conclusion of the Coroner as to the Death: On 15/4/2013 Ms Refat Hussain was admitted to St Georges Hospital. She was initially diagnosed with bilateral community acquired pneumonia, was treated and improved a little. However, she developed haemoptysis on 21/4/2013 and suffered a cardiac arrest on 22/4/2013. She was confirmed the same day as suffering form pulmonary TB. Despite all active treatment she deteriorated and died on ITU on 11/5/2013. She had developed active signs of TB in February 2013. If she had been diagnosed and treated appropriately at that time then on the balance of probabilities the death would have been averted:
Circumstances of the Death
Ms Hussain was part of an extended family most of whom developed either open TB or latent TB at the material time.Refat herself had been diagnosed with latent TB but had 125, not received treatment for this. In the early of February 2013, she had developed symptoms consistent with active TB, which for various reasons went unrecognised: On 30h March 2013, she was visited at home by a Harmoni who based upon the history given at the time and the examination of Ms Hussain, diagnosed chest infection and prescribed antibiotics had no access to Ms Hussain's usual GP records, nor that of her family members which may have assisted him to make the diagnosis of TB and arrange appropriate treatment: It is possible that had hhad such background information this death may have been averted Based upon the information available to him) diagnosis and treatment was reasonable and appropriate. This situation was further complicated as Ms Hussain was unable to give & clear history herself due to her Rubenstein Taybi syndrome:
Action Should Be Taken
In my opinion action should be taken to prevent future deaths and believe you [ANDIOR your organisation] have the power to take such action.
Copies Sent To
Consultant Medical Microbiologist , St Georges Hospital, Blackshaw Road; London; SW17 have also sent it to The Care Quality Commission
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.