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Patient online access to GP record may come to exclude historical notes

NHS England is looking at offering patients online access to GP records from a certain date onwards to avoid ‘an information breach’ in releasing historical notes.

The proposal forms part of talks to realise a Government commitment to make full GP records available online to every patient by 2018, which has yet to materialise.

Patients would still be able to request historical records, as per the current system.

An NHS England official said the health service hasn’t got ‘a smart enough system’ to automatically decide which patient information is suitable for release, meaning GPs would have to manually check patient records ‘on top of everything else’.

Instead, in order to realise the Government's pledge, patients could be given online access prospectively from an agreed date, copying a system used in other countries.

GPs have said prospective access may ‘take more GP time’ and ‘impede communication between doctors and nurses in the patient’s best interest’.

Speaking at a King’s Fund conference earlier this month, Dr Masood Nazir, national clinical lead of primary care digital transformation at NHS England, addressed ‘the challenges’ facing a roll out of full GP record access to patients online.

He said: ‘There are a two things. One is making sure there’s no information in there that is of a third party nature, so that means going through a record, and all the information available, to make sure there’s nothing in there that causes an information breach.

‘Second of all is do no harm to your patients. There are some patients out there where actually making that information available to them may cause them more harm.’

Dr Nazir said a GP might, for example, write ‘has chlamydia same as their partner’ next to test results, or note that they are unknowingly adopted. 

He said: ‘What we haven’t got is a smart enough system, so the only way to do this is to get GPs to sit down and look at those records and actually then say this is fine to make available.

‘What we’re trying to do is get people – organisations – to do that on top of everything else we ask them to do.’

But he added: ‘We’ve had a look at where they’ve rolled it out in the rest of the world where they’re trying to do this. They’ve said, record access from now onwards.

‘So whenever I’m reporting the notes, I now know that record access is available to you, I’m now changing the way I write my notes to make sure that language is appropriate.’

Dr Nazir later told Pulse: ‘We’re collecting thoughts on it at the moment from different organisations, that’s a key thing. I think it’s a discussion that’s been had quite a few times. We’ve just got to look at how that pans out.’ 

His comments came after a question from the audience about the status of the Government’s commitment in 2014 to allow patients full access to GP records through NHS Choices by 2018.

Dr Peter Swinyard, chair of the Family Doctor Association, told Pulse prospective access to records ‘may impede communication between doctors and nurses in the patient’s best interest’.

He said: ‘I think that would be a shame but people who are minded to worry about their health are more likely to be the ones who gain access to their records and look at them.

‘This will actually take more GP time because people will come in and say “but you said I have tuberculosis” and then you’ll have to spend 20 minutes explaining no you don’t have tuberculosis, it’s all under differential diagnosis, and therefore it was written down just in case etc.’ 

But he added: ‘It’s a mixed bag, all this openness. I think the balance is it’s more in the patient’s interest to access their own notes than it is against their best interest.’

NHS England launched a 'national data opt-out' programme inviting patients last month to opt-out of GP record sharing for research and planning purposes.

However, the Government revealed earlier this month that 150,000 patient had their confidential GP records shared over three years, despite opting not to have their data shared for research purposes

Dr Farah Jameel, BMA GP committee executive team IT lead, said: ‘We are aware of informal discussions around providing patients with full access to their medical records, these have been ongoing for many years.

‘The BMA will of course fully engage and provide a detailed response should any formal proposals be put forward, paying close attention to matters of confidentiality, data protection, workload and resources.’

An NHS England spokesperson said: ‘A number of options are being reviewed based on ongoing feedback from patients and GP representatives.

‘We remain committed to ensuring all patients who request or wish to have access to their records will be able to do so as long as there are no safeguarding concerns from making the information available.’

Readers' comments (5)

  • Incomplete records will be 'fake records' and may be misleading...and disrupt the health care of patients in a potentially serious way for patients and doctors.

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  • truthteller. exactly

    the gain for the patient is in seeing the whole record so that they then gain historical context to their problem.

    we have given complete online access at our practice to our patients. has been much appreciated.

    The more you help the patient, the more they can then help us to look after them.

    I think that their is a fear in giving online access to the record.

    I have to say that it is something to embrace.

    it is worse to only give partial access as it makes people think what is being hidden and this can worsen trust between the clinician and patient.

    There has to be safeguards and systems in place before this is released, but once done, away you go!

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  • I think its an interesting debate but as an example that I can share now as the GP and the patient are now both dead was found by myself while summarising.

    Referral to Psychiatry: Please see my Bete Noir

    Full written assessment/response was in French apart form a one line final summary quip in English!

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  • The article refers to ‘informal’ discussions about this. Could I reassure that there have been ‘formal’ discussions over many years that the BMA/GPC has been party to.

    The issue is a legal requirement for GPs as data controllers to ensure that third party data is not shared. Ask the staff in your practice how dedactions they make for each record requested under a SAR to get a feel for the size of the problem.

    Since at least 2010 we have been arguing that access to records must be preceded by improvements in clinical software to allow suppression of third party data easily when it is added to the record, that this work should be funded, and that access should be prospective only until and unless the significant cost of redaction of restrospective records is sorted out

    Older GPs will remember that this was the approach successfully used for access to written records from November 1990

    If the DH etc had followed our advice in 2010 we would be well on the path to implementation

    Personally I am not worried about patients asking for explanations or spotting errors in their records as I feel this will improve healthcare and the doctor patient relationship

    Grant
    DOI ex chair and deputy chair of GPC IT subcommittee who was involved in the formal discussions

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  • In all systems, any practice can set a date before which the patient cannot have access. This is flexible: per patient or for the whole practice. For consultations or for letters, for instance. Also, clinicians can redact consultations if they don't want them seen by a patient.
    So, there's no reason not to offer full access going forward. You have to write notes according to IG requirements. But you'd do that anyway, right?
    Go for full access. Both the practice and the patient gain most.
    Brian Fisher

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