The RCGP’s decision to advocate prospective rather than retrospective access to medical records is a reasonable compromise. It’s wise, it’s safe and it reduces workload for practices.
There’s a concern over coercion - that an abusive partner, controlling parent or bullying parent might put pressure on a patient to share personal information - but we don’t know whether it’s likely to be a frequent issue. American research shows it doesn’t frequently occur, but then again we know coercion is dramatically underreported.
Another concern is that patients will be alarmed by things they read, or won’t understand what is in their record. This does happen, but it’s not very common. Patients understand about 75% of what they read, so understanding is not a big problem. We also know that the group of people most alarmed have psychiatric problems- but that’s counterbalanced by the number of people with psychiatric problems delighted by access to helpful information.
There are concerns over workload but the number of people who want record access is currently small, so practices won’t be inundated. There will be initial implementation and training costs, but for each piece of work, they’re likely to save time.
Probably most patients would understand why access is restricted. If they wanted to see something in the past they can still ask to see their paper records through a data subject request. There is no simple technological fix, so the best way to mitigate it is to inform people about it when they sign up, and make sure they know they can switch off access.
The GPC’s response to the report - that online access to records by 2015 should not be compulsory - is not a sensible position. The Government wants to fund this - the problem is that they are bullying the profession into taking the money.
The Government has irritated the profession because of the contract imposition and the record access has been bound into that. It’s taken on a bad odour as a result. I’m pleased the College have taken the position that patient access should go ahead.
It does have its risks, but it does make care safer.
Dr Brian Fisher is a GP in South East London and patient and public involvement network lead at NHS Alliance
