data, just what is relevant to them, and that in order for any system to work properly between service providers it would need to be on some form of cloud-based plat- form and ideally be “government- led”. He said: “We would prob-

ably rather have one system that was upgraded and maintained throughout the whole of the NHS because I think that would make NHS delivery a lot more easy. It has to be government-led. If you leave it down to individual boards they will all do slightly different things in a slightly different way and we will end up with systems not being able to communicate with each other again.”

In the second of two evidence sessions, GPs were able to partici- pate in a similarly wide-ranging discussion on future-proofing health and care in Scotland. How- ever, the session also focused on ICT with an advanced paper from the Royal College of General Prac- titioners Scotland stating: “Urgent investment in IT is required to ensure that systems work more effectively together, improv- ing reliability for clinicians and patients.” Tis was supported by a submission from BMA Scotland, which highlighted “there is a lack of investment in infrastructure to accommodate community care staff – who require good IT connectivity between them – and replace facilities that have outlived their use.” In the session itself, on a fairly

general question from MSPs about the state of IT, Dr Andrew Buist, Chair of the Scottish GP Com- mitee, BMA Scotland, said: “We rely on our computers when we’re in the surgery but when we’re on a home visit we don’t have access to that; we can’t see when they [patients] last had a blood test, we can’t read a hospital letter that arrived the previous week. Te technology exists that we could have access to that information on home visiting and often that makes a huge difference as to what you decide to do. It’s an issue in the out-of-hours period, too, where sometimes the out-of- hours doctors are working with- out access to the patient records.

X x x

Unless we’ve got basic IT that works really well and it’s efficient - and it’s reliable and it’s safe - then none of the other stuff can follow.

Dr Carey Lunan. Chair, the Royal College of General Practitioners Scotland

So we need to do something about this.” Dr Carey Lunan, Chair, the Roy-

al College of General Practitioners Scotland, added that a survey of doctors in 2015 pointed to a need for basic IT systems to work better – over the high-tech telemedicine solutions – and that was still the ongoing priority among general practitioners. She said: “Unless we’ve got

basic IT that works really well and it’s efficient - and it’s reliable and it’s safe - then none of the other


stuff can follow. It’s crucial to safe interface of care to be able to share data across the acute setting and the community setting, and that’s missing. Patients expect us to be able to see what’s happening to them in hospital and they expect teams of consultants and people looking after them in hospital to be able to see what’s happening in the community, and that doesn’t happen. Tey’re always surprised about that.”

Dr Carey also spoke from personal experience as having been a clinical lead for ‘anticipatory care’ – whereby patients with complex needs are catered for by way of a care plan that is shared between different community healthcare providers. She said: “I have a big interest

in this having done this for five years as a clinical lead, so GPs can and other members of the primary care team will create care plans for the patients who have got complex health and social care needs us- ing a piece of IT called the ‘key information summary’, which can then be shared across interfaces,

but it doesn’t work well. So you can see it well in the out-of-hours setting but you can’t always see it in the hospital setting, you can’t see it in the community pharmacy setting; you can’t see it in the care home setting, you can’t see it in the social care setting, so all these very difficult conversations that have been recorded about patients’ beliefs, patients’ desires, wishes about how far they want treatment to go, is not being seen at the time that it needs to be seen.” She added: “It can’t be seen

by ambulance services on the way to an emergency; there are significant issues about being able to communicate patients’ wishes about what they want to happen that are not happening at the moment. Now I know that that there’s work being done in NES [NHS Education for Scotland’s ‘National Digital Service’] around the shared digital platform that will link up health and social care [that will be] much more col- laborative. I’m not sure what the timescales are for that but I think we would all say that it can’t come soon enough.” l

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