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A faulty production line

All patients to view and comment on their full GP record by 2018

The NHS has set out a landmark plan to create a ’21st Century’ IT system, including giving patients the opportunity to access all their medical records through NHS Choices, adding comments to their GP medical records and expanding by 2018.

The Personalised Health and Care 2020 report explains how the NHS will go about giving patients digital access to all their records by 2018, and how the CQC will regulate the quality of record-keeping from April 2016.

Under the 2015/16 GMS contract, GPs are required to provide online access to all coded information in the patient record by 2016 for patients who request it and access to summary care information from April next year.

But the latest report goes further, setting out how patients will have access to all their health records through NHS Choices.

GP leaders warned that the ‘information overload’ could lead to ‘noise problems’ for GPs, making it harder to spot important information.

The landmark report, developed by NHS England, the Department of Health, CQC, Monitor and research organisations among others, sets out how they hope to achieve health secretary Jeremy Hunt’s pledge for a ‘paperless NHS’ by 2018, and explains how all NHS providers will have to develop up-to-date electronic record of patients’ care by 2018.

Among the key lines in the report are:

  • All care records will be digital by 2020, and GPs will not be using paper records by 2018;
  • Patients will be able to access their digital NHS records through NHS Choices by 2018;
  • The CQC will regulate on providers’ record keeping from April 2016;
  • A consultation on how to provide carers with access to patient’s medical records, due to start in April 2016;
  • NHS England will pilot ‘digital care accounts’ where patients hold their care records and personal health budgets, as part of a programme commencing in April 2015;
  • Pilots of a ‘personalised, mobile care record’ which will be held by and editable by patients, but which will be viewable by clinicians;
  • An expansion of NHS England’s delayed flagship GP record sharing scheme,, to join up information from other providers such as care homes for commissioning purposes.
  • This is follow by a pledge that the NHS will move to a ‘whole-system, consent-based’ approach, which respects citizens preferences and objections about how their personal and confidential data is used.
  • Introduction of statutory powers for a new ‘National Data Guardian’ role, which will ‘provide public and transparent scrutiny and challenge about the safe use of personal health and care information.’

The report states: ‘From March 2018 all individuals will be enabled to view their care records and to record their own comments and preferences on their record, with access through multiple routes including NHS Choices.

‘Initially, this will focus on data held by NHS providers (primary care, acute, community and mental health), but it will be progressively extended to cover other care settings,’.

It adds: ‘All patient and care records will be digital, real-time and interoperable by 2020. By 2018 clinicians in primary, urgent and emergency care and other key transitions of care contexts will be operating without needing to use paper records’

Dr Peter Swinyard, chair of the Family Doctor Association told Pulse there was a risk of ‘information overload’ for GPs with the NHS striving to add more and more the record.

He said: ‘You get so much information; about such trivia that you get a signal-to-noise problem, and you don’t always hear the things you ought to hear.

‘I’m absolutely in favour of patients telling me what they feel, and what they think is wrong with them. But that’s what I do, I spend most of my life actually trying to interpret what people are telling me,’.

He added there could be legal ramifications too, saying: ‘There is a risk, of course, that if something is slipped into the patient record and we don’t have time to read the entire record during each consultation … I can see the lawyers making a lot of money out of that.’

Dr Grant Ingrams, deputy chair of the GPC’s IT subcommittee said benefits would depend on the scheme’s implementation.

He told Pulse: ‘You have to treat patients as adults, if they are adults, and to use or abuse their data in the way that they see fit.

‘As long as it’s not doing anything which is going to undermine the effectiveness of the record to provide healthcare, and as long as it’s done with foreknowledge of what they’re doing and why, then that’s up to them.’

He said of the new CQC regulatory powers: ‘Something else for the CQC to bash us with it’s not going to be helpful. And made accessible to carers and patients, what the hell does that mean? And what’s timeliness?’

Mr Hunt said: ‘I want the NHS to be a world class showcase of what innovation can achieve. Today’s plan sets out how we can give patients 21st century, personalised healthcare.’

David Behan, chief executive of the CQC, said: ‘Using information from the public and from other organisations is a crucial part of how we check the care that people receive – it helps us to make decisions about where and when we inspect.’


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Readers' comments (29)

  • "I actually think that this is a great idea - but can we go further? We need to challenge the old fashioned notion that records should be an accurate dispassionate account of facts, recorded by professionals with no agenda."

    Let's at least be honest about the nature of HCP-produced records - they're not always an accurate reflection of reality - the only person who knows what drugs a patient is taking at any time is: the patient.

    Also with regards to "agendas", HCPs aren't robots - they are human beings and as such they will always have agendas and cognitive biases of their own. Agendas and biases might include: QOF targets, profit motive, CCG targets, reputational motives and susceptibility to stereotypes and prejudices about other human beings.

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  • I will make sure I will be gone before this comes in. The practical ramifications are so enormous that it will grind General Practice to a halt, if the Health and Social Care Act does not sink it well before that.

    It means retiring at 55 but the only loss will be to society who will lose my skills. I will gain immensely . Less money but I will have my life back.

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  • perhaps GP's come together and develop our own separate system of recording information away from EMIS, system1 etc.
    or perhaps we even think about going back to paper.

    Is this clinically safe? what is the GMC's view on this?
    I am wandering what the patient's association would have to say about being able to change the recording of the notes. This would not benefit patients. question the notes, yes, but to change them. this is a real danger.
    the change in the notes, who would be responsible for checking authenticity? how many appointments would need to be dropped in order to sign off on these appropriately?
    what does the information commisioner have to say about this?
    who would be the new data controller?

    - anonymous salaried?

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  • The signal to noise bit is a minor point that can be remedied easily by a filter.We have them already in System One whereby you can choose what type of journal entries you want to see.The main issue is whether these so called comments will carry the same legal weight as a consultation and will the GPs be expected to act upon them.So will this become a backdoor way of the "by the way can you sort this out too" multiple request list?

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  • "Anonymous | Other healthcare professional | 13 November 2014 11:29am"

    Firstly chill and try and reflect on the light-hearted nature of the post.
    Secondly consider that your reply contains a degree of guff :
    1) "Let's at least be honest about the nature of HCP-produced records - they're not always an accurate reflection of reality" - I would hope that your records do contain a "reflection of reality" - they should or your regulatory body might want to talk to you.
    2) "the only person who knows what drugs a patient is taking at any time is: the patient" - really? Many of my patients are somewhat vague - this very morning one of my patients did not have a clue what OCP she was taking - only able to articulate that "it was the one with which you have a break". Silly me - I thought that there was a few of them.
    3)"Agendas and biases might include: QOF targets, profit motive, CCG targets" – other than fraudulent entries what part of patient records might include elements of “agenda and biases” in relation to the accuracy of medical records in relation these areas?
    4) In relation to “susceptibility to stereotypes and prejudices about other human beings” – do you think that you are guilty of this in relation to GP’s?

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  • More opportunity here for Industrial Action by refusing to comply but will we ever act in unison??

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  • @11:29

    Have you ever checked your own medical records? I have and mine are full of inaccuracies, as are all of my family members' records - from various different surgeries and many different doctors over the years.

    They list drugs we have never taken at doses we have never taken. They fail to list drugs we do take. They list allergies we have never had and don't list allergies we do have. I even have letters in my records that were about other patients I have never even heard of. Such poor record-keeping may not be intentional but is it clinically safe?

    Do you think HCPs (like all other humans) are not susceptible to stereotyping and prejudicial attitudes towards other human beings? Are you not human?

    If you believe this is not a problem in healthcare provision, I suggest you look at Pubmed and go and read the results of the many studies that have been conducted in this area.

    Some of your patients may be vague - others may know a lot more about their health situation and the drugs they take than you do.

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  • Anon@1.21
    Records list drugs that have been prescribed - whether or not they are taken is another matter.
    Allergies documented will be those diagnosed by doctors or reported by patients.
    Misfiling of letters is not good but down to human error and unlikely to impinge on safety as they will be clearly erroneous.
    Adding to primary care workload in the way suggested will do nothing to relieve the pressure and seems more likely to increase the risk of error as time available is further eroded.
    Ultimately do any of your arguments justify the spending of billions of taxpayers' money?
    What price patient confidentiality if all this happens?

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  • Oh OHP..... 'patient ate sandwich and than farted...' you may have what you want, only thing is no GP will ever take the notes seriously again..... cue anger from OHP.....

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  • Took Early Retirement

    Great fun for hackers I would think. After 34 years in the NHS, and now a "survivor" to use that appalling term, I have no desire to peruse my records at all. I know what Pills I am on and I know I have a Co-Trimoxazole allergy. On System One I can order my drugs online; I did so today in fact, and could see the list. It was correct.

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