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Coping with an ageing computer system

GPs can expect to be quizzed by patients about a new leaflet on confidentiality and public health ­ forewarned is forearmed, says Dr Barry Evans

A leaflet informing and reassuring patients about the correct use of patient data in monitoring certain diseases is being circulated to all GP surgeries.

The leaflet, 'Safeguarding the confidentiality of patient information while protecting public health', has been issued by the Health Protection Agency. It informs patients about reporting arrangements for infectious disease and other health threats.

The leaflet is directed to members of the public, but GPs can expect to be asked questions about it and will be better able to answer them if they can take a few minutes to read the leaflet themselves.

The questions GPs are likely to be asked fall into three broad areas.


On learning that identifying information is sometimes made available to doctors to protect the public health, patients may say: 'Why haven't I been told that this is going on?'

The fact that data sharing has been going on for years without breaches in confidentiality should be evidence of the robustness of the systems in place, and GPs can stress this point.

GPs should explain that established and newly-emergent diseases need to be tracked if public health is to be safeguarded. The leaflet is intended to inform, not alarm, at a time when patients have a right to know what is happening to information about them.

The Health Protection Agency has been asked to inform patients by the Patient Information Advisory Group from whom it obtains permission for the voluntary reporting arrangements to enable us to keep within the law, especially the common law duty of confidence.

How do the reporting arrangements work?

Some patients may want more detail on how reporting occurs, what is compulsory (statutory notification) and what voluntary.

Patients can be directed to the Health Protection Agency's website ( for more information but talking through the arrangements of notification and laboratory reporting may also assuage their concerns.

Can patients opt out?

Although patients cannot opt out of the statutory notification of certain infections they can opt out of the voluntary reporting arrangements whether through laboratory reporting or directly from clinicians.

Patients who request such opt-out may be concerned about confidentiality. In this case they could be invited to view the HPA website.

Again, they may be unhappy about the principle of data sharing. It should be explained to patients that effective public health monitoring in the UK is reliant on information on infections and other risks to health.

If significant numbers of people opt-out, health protection will be compromised.

If patients still insist on opt-out and the disease is not statutorily notifiable, the laboratory investigation requests will be marked so that they are not reported for public health purposes with the patients' identifiers present.

Barry Evans is the Caldicott Guardian at the Health Protection Agency


QQuestion: We have had two requests for registration and are unsure whether we are obliged to accept them. Please can you clarify the situation for: ·a German man who intends working here for only three months? ·a man from Iraq working here legally on a highly-skilled migrant workers' programme. His papers state he is legally entitled to stay here for one year only, but are stamped with the words 'no recourse to public funds'?

Answer: We have clarified the situation with the Department of Health. It confirms that acceptance of any patient by a practice is a discretionary matter that hinges on the concept of 'ordinary residence'.

This may be defined as: 'Living lawfully in the UK voluntarily and for settled purposes as part of the regular order of their life for the time being. Also, whether they have an identifiable purpose for their residence here and whether that purpose has a sufficient degree of continuity to be properly described as ''settled''.'

In the absence of any clearer definition, the practice may apply a reasonable interpretation. Many people would consider a six-month period of work in this country as indicating a settled purpose, but this is not a fixed concept.

EEA citizens are not obliged to have any of the official European forms of health care entitlement, such as an E111 or E128.

The practice has an obligation to provide any immediately necessary or emergency treatment to any patient that presents, regardless of the concept of ordinary residence.

·The German patient may legitimately be registered as a permanent or temporary resident, since he is staying here to work for only three months. You may, however, refuse to accept him as an NHS patient if you do not consider him to be 'ordinarily resident'. In that case you may provide treatment for him privately.

·The Iraqi patient may be accepted on your list if you consider him to be 'ordinarily resident'. The fact that his papers are marked as having no recourse to public funds does not apply to NHS entitlement, but only to social security benefits. If, however, you do not regard this patient as being 'ordinarily resident', since he is planning to return to Iraq when his current one-year visa runs out, you may legitimately refuse to accept him on your NHS list as a permanent resident. You would then be entitled to treat him privately.

Under GMS2 you must provide any patient with a written reason for your refusal to register him and you must keep a record of this for the PCT.

You may not refuse to accept either patient on the basis of their racial origin alone, nor must you use any other discriminatory basis for your refusal. You should make it absolutely clear that you have refused acceptance only on the basis of your practice view that they are not 'ordinarily resident' and therefore not entitled to NHS care.

If either patient applies to the PCT, and is in the view of the PCT ordinarily resident, the patient may then be allocated to your list, unless your list has been formally closed.

The consultation document 'Proposals to Exclude Overseas Visitors from Eligibility to Free NHS Primary Medical Services' sets out the Government's proposals for change and also sets out the details of the current regulations.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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