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The waiting game

GP records to be shared without patient permission to tackle 'high cost' patients

Exclusive Identifiable information from GP records will be shared without patient permission under a new local scheme to intervene in the care of ‘high cost individuals’.

Pulse has learnt that NHS Southend CCG hopes to start extracting identifiable data from GP records next month, with the aim of identifying ‘high cost’ patients and reviewing their care.

The CCG says it is the first scheme of its kind to extract, link and share identifiable information in GP records for use other than direct patient care.

But GP leaders have questioned the focus on cost, rather than the quality, of patient care and Pulse has learnt that patients will also not be informed about the data extraction in advance and will have to ask their GP to opt out if they are not comfortable with identifiable information from their medical record being shared.

The model is similar to that of the troubled scheme that NHS England was forced to delay indefinitely after a furore over the scheme that would have seen identifiable data from GP records routinely extracted and used by the health service unless patients asked to opt out.

Pilots of have yet to begin, but health managers have already admitted they have been unable to implement 700,000 patient opt-outs to GP data being shared, with GP leaders claiming that their admission demonstrates the ‘mess’ that the Government has created.

The NHS Southend scheme will identify patients with complex care needs though their NHS number, age and post code, with the aim of ‘reviewing’ their care. The scheme will also extract data including the number of appointments with the GP or practice nurse, prescribed medications, and unplanned admissions for individual patients.

The CCG will not send letters to patients to let them know of the record sharing scheme, instead, a CCG spokesperson told Pulse that its ‘comprehensive communications plan’ included informing patients via local and social media, public events and signposting in GP practices.

NHS Southend CCG’s governing body minutes state that over the last 12 months, the CCG and Southend-on-Sea Borough Council have been applying to share data for the purposes of ‘identify[ing] high-cost individuals whose care may need to be reviewed by a multidisciplinary team with whom they have a legitimate relationship’.

Other reasons included identifying those with ‘abnormal or perceived abnormal outcomes, for example emergency admissions’, ‘commissioning best value, new services by identifying populations of patients’ and ‘assess[ing] whether new services are having the desired outcomes’.

When asked about the cost cutting objective, a spokesperson for the CCG told Pulse: ‘Our main aim, through data sharing, is to improve services and the quality of care to patients with multiple care needs.’

‘Quite often the reason an individual’s care is high cost is because they are receiving multiple services but all delivered separately. By reviewing data across the system we will be better placed to see opportunities to join up health and social care services and provide patients with a single package of care.’

But the record sharing scheme has yet to receive approval from Essex LMCs, who told Pulse they had consulted the GPC and sent a letter to the CCG raising concerns over how the information would be used.

The letter - seen by Pulse says: ‘What is the exact purpose of this over and above risk stratification? And specifically, which non-practice personnel will access the data?’

Dr Andrew Mimnagh, vice chair of NHS Sefton CCG, said his CCG also undertakes risk stratification but questioned the emphasis on cost in the Southend scheme.

He said: ‘The ethos for the ones we’re doing is optimising patient care, getting it closer to home. It makes you sit up and think, when you see it put so baldly: “we will be looking at the money”. I wonder how much of that is a product of the area, whether it’s all about he money in that area.’

Readers' comments (24)

  • I am a patient in Southend and at a recent meeting with the CCG was told only basic information will be available, so who can trust the NHS?

    In future I will withhold personal information and only tell my GP what I want him to know and will never trust a GP again.

    This is via the back door.

    So what if some patients are high cost, having worked and paid into the NHS all my life, what are they going to do now, tell me I am too old for treatment and to go away quietly and die!

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  • This is part of Risk Assesment.
    I'm not clear about social care involvement but I gather that requires specific consent
    Identifying high risk/expens/usage patients isn't really a problem: practices will know who they are, and concentrating more resources on them has to be good for the individual, their carers - and the system.
    What about all of the others?

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  • So what do they plan to do with 'high cost' patients, have them 'put down'l?
    Severely disabled fol are high cost, they needs specialised equipment on ongoing care and of course this government always targets the most vulnerable!

    Why not look at stopping the issue of low cost drugs on prescription, patients get paracetamol, on script because they get it free, many other low cost medicines are 'prescribed' and are not POM's.
    Anything costing less than a script the patient should be made to pay for.
    Walk around any boot fair and see the vast amount of aids available for sale, items issued by the NHS but not returned, wheelchairs, walking sticks, trolleys etc.

    If patients are on high cot medications, it is because they need them and they are only obtainable via the GP ... so is this CCG targeting vulnerable patients or GP's?

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  • I've already had my medical records violated against my wishes, for no just reason. It has destroyed my trust in the professionals who should have been treating me. It makes a mockery of justice and human rights in this country.
    I have a longterm condition which I am trying to manage on my own, because I no longer trust those who are supposed to be helping me.
    And yes, you can still feel like this when you work for the NHS.
    I think the only way to not have your records violated is to not see the doctor...

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