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At the heart of general practice since 1960

'My phantom cannabis conviction'

In common with the Guardian, Daily Mail, Times and others, Pulse has been misled by the ambiguous consultation document (www.connectingforhealth.nhs.uk/crdb/docs/

scrrdocument.doc) produced by Professor Mike Pringle and Dr Gillian Braunold on behalf the Government's NHS IT strategy Connecting for Health ('IT reformers unveil plans for shared patient records, News, July 16).

Under the proposals, patients will not be able to limit what goes on to their patient clinical record ­ the national database. Their recommendations are completely consistent with the National Care Records Board policy that 'people should not be offered the choice to opt out of recording their health care data on National Care Records Service'.

Unless proposals are changed, the separate records of the various agencies and professionals in the NHS will all be stored on the national database in their entirety, starting with an unconsented upload of historical data from established GP systems.

The only choice being promoted to patients is the use of unproven software to limit access to that information. The detail of these access criteria is wholly lacking and the review document acknowledges that information will be transferred from existing GP records before all these safeguards are operational.

It is acknowledged that A&E staff, ambulance crews and out-of-hours GP services will have access to a summary, created without patient consent by an as yet undefined methodology.

If it works, this will exclude sexual health, mental health and infectious disease information ­ an explicit acknowledgment that the governance arrangements are flawed.

Other sensitive information will be revealed and the 'hidden' information can anyway be inferred from the medication data which will also be revealed. Mr Jones will not be getting Viagra for an ingrowing toenail.

Even if these safeguards could be wholly successful in the terms described, the proposals are flawed because the patients' instructions can be overridden 'with consent' (often not freely given), 'in an emergency' (determined by who?) or 'when otherwise lawful' (but not necessarily ethical and determined by the Department of Health without consulting the relevant clinician or the patient).

The proposals are contrary to substantial public opinion as demonstrated in opinion polling undertaken previously by the Consumers Association for NPfIT and more recently by You-Gov for the BMA.

It would be naïve for GPs to transfer data to the proposed spine ­ abrogating their responsibilities as data controllers under the Data Protection Act. For a more complete analysis see www.ardenhoe.demon.co.uk/ NHS%20Database%20Privacy.pdf

Pragmatically, despite the expressed intent of the National Care Records Board, health minister Caroline Flint recently confirmed to Parliament that patients can exclude their data from National NHS databases, including the proposed developments.

Readers may wish to take advantage of an off-the-peg instruction to the Health Secretary in respect of their own medical records downloadable from www.fipr.org

This should enhance their privacy without detriment to their health care.

Dr Paul Thornton

Kingsbury

Warwickshire

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