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GPs told to inform patients of 'state snooping' on sick note records

Exclusive Details around practices’ issuing of Med3 statements for patients are to be extracted by the Government in a move described by GP leaders as amounting to ’state snooping’, Pulse has learnt.

The Department for Work and Pensions (DWP) will extract information from GP records, including the number of Med3s or so-called 'fit notes' issued by each practice and the number of patients recorded as ‘unfit’ or ‘maybe fit’ for work.

As part of the programme beginning next month, GPs will have to inform patients of the extraction, but cannot withhold information unless their patient explicitly objects.

These data will be published anonymously at CCG level, but DWP officials will have access to practice-level data - which they will not be able to pass on to other bodies.

GP experts criticised the decision to obtain practice-level rather than CCG-level data, and warned it could be used to create 'league tables' for practices and have a knock-on effect for other extraction programmes.

The 'fit notes' scheme allows GPs to refer patients who are in employment, but off sick to an occupational health service.

Under the extraction plans, the DWP said that ‘a small number of DWP analysts will have secure password access to the anonymous aggregated data at GP practice level.’

These data - which will be published by the Health and Social Care Information Centre from the spring - will include the duration of fit note, patient gender, type of health condition, their location and whether workplace adaptations were recommended.

The DWP said it will use the data to ‘help provide a better understanding of why people take sickness absence in different areas across the country, so we can make the service as effective as possible for businesses and employees’.

It told Pulse no practice-level information would be shared outside the department, with a spokesperson saying: ‘Only the Department for Work and Pensions will be able to access the data at GP practice level.'

GPs, as data controllers, will be required to tell patients in person, via notices in the practice and on the practice website of the impending extraction.

But GP leaders warned that the scheme is an invasion of privacy.

Family Doctor Association chair Dr Peter Swinyard said: ’I think that is state snooping. Although I am sure some civil servant thought it was a terrific idea somewhere, I am not entirely sure I agree. I don’t know if patients understand that when I write a fit note, some bureaucrat is going to be able to have a look at it.’

GP and data sharing campaigner Dr Neil Bhatia said he was ‘not sure why’ these practice-level data were required, ‘other than to compare practices, create league tables, name and shame’.

He also warned that the extraction could have ‘knock-on effects’ on other secondary use data extraction programmes, such as care.data and the National Diabetes Audit, if it prompts more patients to log 'type 1' objections to data unrelated to direct care being extracted.

Questioning how useful these data would be, he said: ‘I think it would be extremely difficult to make sense of the information out of context of the consultation.’

The GPC was consulted about the plans.

Deputy chair Dr Richard Vautrey said the DWP has ‘responded to the concerns that we raised, not least trying to reduce the workload pressures on GPs that this might create and producing a generic fair processing statement for practices to use’.

Why does the DWP want this data?

‘Fit notes’ form part of the Fit for Work scheme, under which GPs in England and Wales can refer employed patients that are likely to be off sick for four weeks or more to a free occupational health advice service helping them get back into work as quickly as possible. Employers can also refer employees to the service.

The Government’s evaluation of the scheme, rolled out just over a year ago, is still pending.

As reported by Pulse, GPs were unconvinced by the scheme before its launch, and also did not feel equipped for it.

Readers' comments (41)

  • Vinci Ho

    No surprise .
    Send in your comments ,please.

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  • Let's make it fair. I should like to see Jeremy Hunt's entire medical record published online.
    More work and yet another opportunity to be sued.
    Why on Earth would you still want to hold a GP contract?
    Ditch the contract comrades!

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  • Beginning next month? Did I miss the formal notification? Do patients opt out specifically or will it be the standard opt out of all data release?

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  • What code needs to be applied for patients wishing to opt out. We will sink this like we did care.data. Can some one post this to this thread?

    Thanks

    -anonymous salaried!

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  • Maybe we need to protest on the streets as citizens in Poland are currently doing over invasion of privacy by the state. People who move around know that the opinions of Drs re fit noted is varied - that is a worry too

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  • ''but cannot withhold information unless their patient explicitly objects''

    Those manipulating the system will obviously object. Yet another completely time wasting bureaucratic exercise.

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  • ''GP fit note programme has ‘failed to get people back into work’'

    Is there really any surprise here when hard work and dedication are no longer the tenants of British society. Cider, fags and state benefits are.

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  • It seems GP's are allowing themselves to be used by DWP to pursue its punitive welfare to work policies. Islington CCG are piloting Maximus/DWP employment coaches in six surgeries. This is a trend that will corrode people's trust in their GP's. Do you not get it? This is institutionalised violence against people who need our support and care, perpetrated in the name of an ideology of scroungers, the work-shy, the welfare-dependent. These are the policies of a sick society - if we continue to passively go along with it.

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  • Can we just go back to handwriting MED3s and not coding? Problem solved.

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  • It would appear our GPs are going to work for the hated DWP.

    With Work Coaches in GP surgeries able to access patients data via the sick note along with all the psychological profiling for each person off sick with mental health difficulties via the Work and Health Bullying Program, where are they to turn?

    This will blow the trust between doctor patient.

    It will be like the Docs have moved over to the Dark Side.

    Seems this vile government has finely tuned its Psychological attacks. Shock and Awe trauma based Divide and Conquer warfare on the Sick and Disabled continues, along with psychological attacks on any part of society who genuinely want to help. Like most of you GPs.

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  • Would this count as the govermnent forcing us to break our oath of confidentiality? Then after this becomes routein, then everything else will follow under different excuses ....

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  • I think the best way out is stop using the Fit for Work referrals to avoid jeopardising the professional trust we have and to avoid a legal minefield. Surely, if a patient realizes that the State has been snooping on his records the only one held to account will be the GP. Should we be seen as collaborating with the DW&P?
    I don't condone people abusing the system but policing is not our job. Somehow, it always ends up with the shot being fired with the gun resting on GP shoulder.

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  • Maybe consider promoting the following message to patients.

    Dear NHS patient. You will probably be aware that traditionally the information in your medical notes has been held confidentially. Due to recent changes in the law this is no longer the case and the Government now has access to your medical record and is currently able to determine whether you have certain medical conditions and whether you have been issued with fit notes (otherwise known as sick certificates). We expect that the Government may well expand the range of information it obtains from your medical notes in the future and we are powerless to prevent this.
    +/- Should you wish to continue to see your doctor in confidence, we are able to offer a private service.

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  • Peter Swinyard

    It may, of course, be the case that the Special LMCs Conference on Saturday votes that GPs should stop writing sick notes at all...

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  • I'm a bit confused about this. People seem to be very angry about the government looking in our patients notes - but that is not what this is doing is it? It's just finding out how many fit notes we issue?

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  • If nobody does it what can HMG do?

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  • Samuel Lewis

    Looking at practice sicknote records is likely to produce rubbish data. Surely no-one has the time to wade through the free text nightmare that most GPs write! Surely the DWP could get quicker more useful data by looking at its own computerised payout records ? Or is that garbage in garbage out too ?

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  • To 10.40
    This issue is wider than just fit notes. There are other examples of intrusion, in particular the diabetes audit which extracts named patient data. This is the thin end of a very sinister wedge.
    No such thing as "free" healthcare. Data has value. Patients are paying with their privacy.

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  • Neil Bhatia

    the secondary uses opt-out (9Nu0) will prohibit extraction and uploading for individual patients
    so if they have already opted out of care.data, their record is protected from this extraction

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  • There is a Practice somewhere in the home counties that says on its web site if you want to protect your privacy we offer a private GP service too! Yes seriously. I have bookmarked it in case I ever need a GP urgently.

    Could patients pay for a private certificate to protect their privacy if it is for a private employer occy health scheme?

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  • To Helen Wilkinson, the answer to this is at least partly yes. A fit note is simply evidence that you have advised a patient to refrain from work or limit their work etc. It should be considered by employers but they are not legally bound to accept it as evidence of actual fitness to work or not. This function can be achieved by providing a private cert. However, it may not be acceptable to the DWP to claim back SSP.

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  • OK so patients are, in theory able to opt out of these extractions etc. But the organisational turmoil created and the unfunded expense incurred to seek consent/dissent etc makes managing this so unweildy that effectively patients will be denied these opportunities.

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  • It is very worrying and concerning with PIP assessments also looming. I am registered disabled and work but use a motability adapted car to do so, if PIP removed I would not have transport and so could not work. I have not had a day off work due to mobility issues for many years as I have suitable work adaptations etc in place and the ability to work from home if necessary. Certainly DWP wont find anything in fit to work in my records so does that mean I am not disabled any more?

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  • Presumably this relates to their expected 30% reduction in grant in aid. I think in business this is referred to as 'deversification of income streams'. Or getting what the DH can't afford from another dept.

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  • "The GPC was consulted about the plans."
    Could someone - maybe Pulse? - look at the formal consultation processes for consultation between government organisations asking for information, the HSCIC which will be charged with extracting the data, and the part of the GPC responding to such requests? (this is one of many which would have been considered by the GPES IAG before it was abolished on 30th June 2015: AFAIAA there is as yet no replacement of IAG functions)

    "Deputy chair Dr Richard Vautrey said the DWP has ‘responded to the concerns that we raised, not least trying to reduce the workload pressures on GPs that this might create and producing a generic fair processing statement for practices to use’."
    Could we have a full account of the concerns raised, the response to these concerns and the remedies - if any?
    GPES IAG (TOR established *before the HSCA*) published everything - approved application, conditions of approval and minutes of all meetings.
    I'm not clear why this now seems to be regarded as unnecessary.
    Wasn't ther at one stage a 'committment to Transparency'?

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  • @LocumGP 12.33 There is NO law to say you legally have to register with an NHS GP so how does DWP process SSP claims for patients with a private GP and NOT an NHS of which there are number especially in London?

    I am not and would not consent to be an NHS patient due to these privacy issues and ethically objections to the GP Contract.

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  • To Helen. You seem a bit annoyed with me. Maybe I am reading it wrong.
    I was just explaining what I know. What I don't know is the what happens about SSP although having issued a number of private certs myself, I have never had any comebacks or heard of it being a problem. I just didn't want to mislead anyone. Can anyone else add clarity?

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  • Vinci Ho

    (1) I still see this as my old argument in care.data.
    Trust and credibility of this government . Hence , simply, do you believe in IDS running DWP?
    (2) The double edge sword of ensuring people are claiming the benefit of sickness correctly and legitimately with a big- brother snooping , is perhaps 'necessary' but would you trust this big brother swinging the sword. I don't.
    (3) Confidentiallity is always one of our virtues , at least as far as GMC is concerned. This virtue is going to be radically challenged by this newly found freedom of DWP and of course HMOs. If justice is about maintaining the well-being(s) of both the state and individuals , the implementer(s) and operator(s) must be trustworthy...,.

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  • @LocumGP No not at all annoyed just raising the question. I am going to FOIA DWP! There is generally assumption that everyone has an NHS GP someone asked on Mumsnet the other week if was the law!!! I think DWP work to this assumption!

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  • Mary Hawking | GP Partner25 Jan 2016 12:56pm
    Spot on!

    To all - this may be another reason we can justify to our patients our resignations from the NHS.

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  • I agree with all your concerns IF the patient is identified but as I read it, the extracted data is aggregated and unidentifiable for each practice in the same way that GPES data is extracted for QOF
    If this is so, I don't understand your objections,

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  • DPA (1998) schedule 2

    5 The processing is necessary—

    (c)for the exercise of any functions of the Crown, a Minister of the Crown or a government department, or

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  • Surely this is an inevitable progression from computer generated Med3's. There are probably plans for us to send them electronically to the DWP as we do with electronic prescriptions. Then the DWP will have patient identifiable data electronically as the PPA has for prescriptions. - Add the two together, add care.data and summary care record - What have you got?,
    Put the NHS Number in the mix and Hospital records open out.
    Cross reference DOB & address (on the med3) & social service records - where does it end??

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  • Has no one noticed the small delay between pressing OK and it being printed where the data is uploaded to a remote server (I presumed DWP) in order for the 2d bar code and unique ID to be generated before it is printed. The form also asks patient to sign to give the DWP permission to look into it if they are on benefits and it is given to the DWP by the employer for a statutory sick pay claim.

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  • Remember that lovely line uttered by Sharon Stone? 'Waddya gunna do, arrest me for smoking?'
    Just ignore it.

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  • I don't register with an NHS GP due to issues of privacy and lack of trust borne out over last decade yet the number of times I have received a shocked response to this on the few times I have needed a dentist or hospital appointment is worrying - surely there is no obligation to register? Gps are no longer the gatekeepers to all services but now this has been raised it is a mystery

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  • @otherphealthprofessional NO this no obligation to register. I am not registered either for the same reasons plus ethical objections to the GP Contract. I would be interested to chat to you.

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  • Ditch the DWP comrades!!!

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  • I am so glad I am no longer managing a practice in an area of high deprivation. I can see the vultures hovering!

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  • When the 'enhanced service'* arrived my suspicions were triggered (*unpaid work is not an enhanced service).

    If it is lawful for HSCIC to extract the data, why would practices have to 'agree' by signing the enhanced service?

    I checked with ICO as our registration for the DPA is limited to data held for delivering healthcare.

    The primary care challenge for dementia for instance is not delivering healthcare, it is propaganda, just like the sick note is for policing, not for healthcare delivery.

    I challenged ICO for a statement that I would not be breaching my registration if HSCIC used the 'shared' data for purposes other than our registered conditions. ICO did not confirm it was OK to share data with HSCIC.

    I am still waiting for a reply from ICO whether vulnerable patients (E.G. patients with dementia) have had a realistic chance to opt out of the data collection. Opting out involves being aware, finding forms and codes on the internet and then ensuring the GP has added them to the records.

    Lastly, there should be a written agreement if you share data, there is no agreement between HSCIC and our practice so again we would be in breach of the DPA if we 'share' patient data.

    If the GPC agreed to the scheme, I guess they either caught the GPC napping or maybe favours are going to and fro in smoky back rooms?

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  • So, an audit of sick note patterns across the country is "institutionalised violence against people who need our support and care".Are we surprised this sentiment comes from our correspondent in Islington?
    With 35 years experience in GP and Occupational Medicine I can assure Paul that long term sickness absence has serious adverse effects on health.We must ensure that we minister to our patients' needs and not their wants.

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