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Q&A: Secure messaging between GPs and patients

Dr Brian Fisher answers your questions on using online messaging in a clinical setting

The Government sees e-messaging as a way to boost productivity and convenience for patients and practices. This may be the case – but we need a lot more experience with this approach before it can become routine.

Q. Is it safe to email my patients?

A. This is too insecure for routine use, even if you use NHS mail. People have described emailing like posting your conversations on the wall of the main square. You should assume that all e-mails are public or could become public.

The only way that you should engage in email with a patient is if there is a written understanding that both recognise the insecurity and are willing to go ahead.

The same really goes for emailing between clinicians, whether between community and the GP or with the hospital, unless using NHS mail.

Q. Could I use secure messaging instead of email?

This is secure because it takes place within the NHS firewall. The following GP systems offer free secure messaging: EMIS offers a specific two-way messaging service; InPS and TPP offer an adapted SMS texting service through NHS Net, but this does not allow patients to reply to practices.

Secure messaging is not as straightforward as email. In EMIS, for instance, the patient message does not come direct to your inbox as does intra-practice communication, or path results. The messages have to be routinely searched for by GP or staff.

Secure messaging must never be used for urgent communication either by you or by the patient. This must be made clear to all who use it. There is a real risk that you may not pick up urgent messages in time.

Q. Does online messaging save GPs time?

Evidence from the US and Denmark suggests that secure messaging saves time and increases productivity, at least at first. A study from Kaiser in California suggests that secure messaging, particularly when combined with patient online record access, saves significant numbers of appointments and telephone calls.

However, there are reports that the messaging traffic can build up and cause workflow problems eventually. Kaiser says that these are not insurmountable, but they do appear to require a change in the way physicians conduct their daily work.

On the other hand, practices with whom I have been in touch who have offered secure messaging in the UK have not experienced increased workload. On the contrary, they feel that it offers a cost-effective approach to care and supplements other means of communication.

Q. How do I start using secure messaging?

This is system dependent and you will need to consult your supplier for details. Naturally, it will help if patients can set up through your practice website. If you don’t have one, suppliers will be able to offer other routes.

The NHS needs more practices to offer messaging as we need to gain more experience with this approach. It appears that, with some forethought, practices should be able to control the traffic and harness these simple tools for mutual benefit.

Dr Brian Fisher is a GP in Lewisham and PPI lead for the NHS Alliance.

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