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No mandate for grab

The Government’s flagship data-sharing initiative will almost certainly save lives, but the argument doesn’t end there, writes Pulse editor Steve Nowottny

Here’s a question. Do you really understand how the scheme works? Are you aware of what data will be extracted, who will be given access to it and what it will be used for? And could you explain all that to a patient?

How about your practice staff? How would you rate your receptionists’ understanding? What about your family, and friends? How many of them, hand on heart, would you say have even heard of the scheme?

With its Byzantine information-governance set-up, low-key publicity campaign and decidedly clunky name, it’s hardly surprising has largely failed to capture the public imagination. But with one GP close to the process describing it as ‘possibly the biggest-ever culture change in general practice’, the profession should be in no doubt about the significance of surrendering guardianship of patients’ records.

The pros and cons sit along a familiar fault line of medical-political debate; it’s about weighing up the benefits for the many versus the rights of the individual. will almost certainly save lives, with suppliers adamant it will improve first commissioning decisions, then medical research and ultimately patient care. So you would expect doctors as a group to be fully behind it – and yet many are not.

Sceptics fear confidentiality breaches and mission creep, with enough wiggle room in the ‘guarantees’ to leave room for doubt. As for the argument will save lives? Well, so would a total smoking ban or a 50mph speed limit but, as ever, utilitarian benefits must be balanced against other considerations.

In any event, it’s an important debate – but unfortunately, it’s not one the country is having. Pulse’s survey suggests just half of GPs and practice staff and as few as 15% of patients understand how works, and NHS England’s efforts to alert patients – sending out one unaddressed leaflet easily mistaken as junk mail – seem half-hearted at best.

Where GPs have gone above and beyond to set out the options to patients, the effect has been startling. Manchester GP Dr Amir Hannan found 372 of his patients opted out within a week after he publicised an opt-out form on his website. Whether similar numbers follow suit elsewhere remains to be seen, but the fear is many patients are sleepwalking into having their data shared.

GPs are again left in an impossible position – pay out of your own pocket to inform patients proactively, or risk sanctions and legal claims if patients complain they were not properly informed.

To share widely the most private medical details of millions of patients without consent is an astonishingly presumptuous move, even given the purported safeguard of so-called ‘pseudonymisation’. NHS England’s own analysis warns the ‘extraction of personal confidential data without consent carries the risk that patients may lose trust in the confidential nature of the health service’.

The current opt-out model came about because of fears patients might not get round to signing up to even if they supported its aims. But there can be no justification for the NHS sharing potentially identifiable information, disclosed confidentially to a GP, if the patients concerned are not even aware of it.

Until the Government proves most patients have not only heard of but have a reasonable understanding of its implications, it has no mandate to assume control of their records by default.

Readers' comments (5)

  • It is clear they are going to sell this data, why do they need my name and postcode unless they want to make money out of it. I can understand sharing information about disease, treatments etc, but my name and where I live is a joke. They will sell this information to companies who will the hound us with junk mail and bring undesirables to our doors.

    I feel this is what most folk are concerned about. who has what illness, issues around medication, what treatments are available in what area, is fine, but very personal information about me is an abuse of the DPA system.
    The NHS we are told belong to us, patient information belongs to the patient!

    This is just a money making scam fro the NHS and it is about time the public were made aware who sells what to whom!

    I will never consent to share simple because the NHS cannot be trusted!
    I have also reached the point that I limit the information I give to my GP just in case that gets shared!

    It is very a very damaging exercise and it will greatly affect the trust patients have in their GP's!

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  • First, the hyperbole from NHS England and some supplicant medical charities: there are existing Big Data databases in the US from the likes of Kaiser and UnitedHealth, so if those charities want Big Data, why aren't they already using US data? has always been about performance management (and by extension, commissioning). It will allow NHS England to produce league tables of GP practices and when you consider their latest wheeze of allowing patients to change practices with a few mouse clicks, you start to see the real reason for the programme.

    For those arguing from a public health perspective, I would say that far more valuable data is currently tied up in the huge databases held by the likes of Tesco Clubcard, Nektar and Experian. There is a bigger argument to open that data up to public health researchers than GP records because those databases will cover people who do not use GP services. (One could argue that GP records cover the "horse already bolted" people, whereas Tesco has the data about people where intervention really could have an effect.)

    Of course, making data held by private companies available to researchers does not fit into the politics of a government intent on shrinking the state and outsourcing everything.

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  • Vinci Ho

    What is the difference between this and automatic removal of organs from people's dead bodies for research purposes. Remember the Alder Hey scandal?? All about 'extraction ' behind your back.

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  • Great article thank you. I have been trying to explain to my patients and family and almost always met with initial total disbelief that this is actually happening. Good to see the RCGP list of demands today and the possibility that tide may be turning….
    Please keep reporting on this it badly needs straightening out

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  • no surprise
    no mandate either for health and social care act etc etc etc etc
    parliament is unfit for purpose

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