GP surgeries in the UK still use a paper filing system based around manilla packets known as Lloyd George envelopes, which contain patient notes written prior to computerisation.
The quirky name for the files reflects their antique status: these records were first introduced over 100 years ago and named after David Lloyd George, the liberal politician who introduced a national insurance system that was an early element of the welfare state, back in 1911.
But now these envelopes -- or more accurately the files within them -- now represent a significant burden for UK GP practices: a typical GP practice might have over 750,000 pages in Lloyd George envelopes full of detailed health histories.
"It's a legacy that's costing the NHS a significant amount of money," says Martin Kelsall, director of primary care services at the NHS Business Services Authority (NHSBSA), a public body that provides a broad range of central business services to NHS organisations, patients and the public.
"Every patient needs a Lloyd George envelope -- if you move surgery as a patient, the envelope needs to transfer with you," says Kelsall. "There's buildings full of documents that need to be kept. The uniqueness of primary care comes in the fact these documents aren't used frequently. The challenge comes when people need to make use of paper. A huge amount of resource is expended finding and moving records."
The good news is Kelsall and his colleagues at the NHSHSA are meeting that challenge head on. The NHSBSA has spent the past 12 years scanning and processing the nation's paper prescriptions; in 2017, the organisation processed 500 million prescriptions. The NHSBSA is using this experience to begin a process of digitisation that will finally help break the dependence on paper in the NHS, boosting organisational efficiencies.
"Our solution provides cloud-based storage to patient records across healthcare services," says Kelsall. "From an operational point of view, it gives organisations on-demand access to patients' records. It provides a pragmatic solution to a challenging problem. Organisations can save resources and then direct more money towards frontline care."
The NHSBSA wants to create a national and centralised cloud-based storage solution for all Lloyd George records. The system would provide authorised users with browser-based access to patient notes, rather than envelopes being physically shifted around the country when patients change surgeries.
The NHSBSA is using software from CCube Solutions -- a British firm with expertise of implementing electronic document management systems in the NHS. The digitisation of Lloyd George records is part of a broader attempt by the NHSBSA to provide scanning services to all primary care organisations, such as GP surgeries, and secondary care organisations, such as hospitals.
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This transformation in service provision at NHSBSA represents a significant shift for an organisation that has traditionally played a discreet but crucial role in healthcare processes.
"That's the stance we're taking," says Kelsall. "We have the scale and we want to use our capability. We scan 500 million pieces of paper a year, yet in some ways we're still unknown -- I think the fact that we go quietly about our work and achieve great results is proof of our success."
As part of its attempt to provide scanning services to all healthcare organisations, the NHSBSA is offering NHS Trusts and Clinical Commissioning Groups (CCGs) a bespoke document management service that includes document collection, paperwork scanning through intelligent character recognition software, and analytical information.
The NHSBSA plans to reconfigure its existing IBML ImageTrac5 scanners from processing prescriptions, so these systems -- which currently scan about 20,000 prescriptions per hour -- can handle other documents. This work is being managed in tandem with Alaris, IBML's UK service and support partner.
Scanning on behalf of GP surgeries is already underway. The NHSBSA is working with Newcastle Gateshead CCG to digitise the primary care records of 293,602 patients. This process involves collecting and scanning all Lloyd George envelopes from 35 GP practices, processing 25 million documents.
Newcastle Gateshead estimates the approach could help free-up resources and create 6,000 additional sessions at GP surgeries annually.
"We're part of the NHS -- we talk about governance and security in the same way," Kelsall says. "We understand how precious patient records are because we live in that space every day. We have a genuine desire to improve how things work in healthcare."
Kelsall says the NHSBSA is in advanced talks with other CCGs. When it comes to hospitals, the NHSBSA recently agreed a scan-on demand approach with North Bristol NHS Trust. The deal will help one of the largest hospitals in the UK become paper-free at the point of care.
Kelsall says it's not uncommon to hear stories about doctors having to log into different services on the same PC to view patient records. Worse still, some doctors report having to log into other services via a different computer altogether. Kelsall is eager to banish these stories to history -- and to create a new, positive legacy.
"There's a history of everyone in UK healthcare deploying different solutions. But we are actively conscious that the NHS is a moving in a different direction -- and it needs to. Interoperability and open APIs are crucial going forward," he says.
"We think the cloud provides a platform to help doctors access information anywhere. We want to create a blueprint for what scanning should look like. We want to create a legacy, so that documents are digitised and can be used for generations to come."
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