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Independents' Day

Soaring costs for copying patient records ‘should be a national scandal’

The recent surge in third-party requests for free copies of patient records is sucking tens of millions of pounds out of NHS general practice, writes practice business partner Clive Elliott

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When practices first became aware of the General Data Protection Regulations (GDPR) there was a wave of anxiety amongst practice managers. I tried to explain to those managers who were worried that GDPR is not really aimed at us, as we should be operating good practice already.

Under GDPR, we are not allowed to charge a fee for patient information and, in principle, I support that idea. However, the legislation does not allow us to recover our costs either. Where a solicitor used to pay £50, they now get to keep that money while the whole cost centre has shifted to an already struggling NHS.

In a practice of our size, with 6,000 patients, we have in the past received approximately £10,000 per year in fees from solicitors and firms who collate records on their behalf under the Data Protection Act – a large contribution towards staff costs.

Only last week, a set of medical records for a long-term chronically ill patient took one person an entire day to find, copy, collate, redact, print and post – meaning costs of nearly £100 (taking into account we pay at least the Living Wages Foundation wage rate, plus on-costs including paper and copying charges). This is an extreme example but, on average, I estimate it costs us £60 per subject access request. It just isn’t sustainable if we can no longer charge fees for this work.

The law could easily be changed if there is the political will to do so

From my basic research, I estimate there are 8,550 GP practices in England and Wales with an average list size of 7,800. If £10,000 of income is the norm for a practice of our size, then it is not difficult to extrapolate the figures and see that this is now costing the NHS in England and Wales over £85 million.

That’s also £85 million in higher profits for solicitors and this just at primary care level. God alone knows what it is now costing hospitals and other NHS bodies but it must be into the hundreds of millions. Why this isn’t a national scandal fails me.

When I became business partner, I introduced a voluntary £7.50 charge for solicitors and others to have their client’s sensitive information sent by tracked delivery. Every solicitors firm and every company that collates information for solicitors refused to pay. Every other organisation agreed. It was then that it dawned on me that solicitors don’t work for free, but they expect the NHS to.

As highlighted by Pulse's story about the call for GPs to write to their MP about excessive third-party patient data requests, I am sure I am not alone in seeing the change that has taken place since 25 May. Solicitors are much more aggressive with their demands and collation companies act with a sense of entitlement which beggars belief. By way of example, last week I proposed to a firm of solicitors that I would give the requested medical records to our patient as the solicitors refused to pay for secure postage (despite not now even having to pay for the records). The partner in the firm threatened to ‘come down there and sort [me] out’. ‘Well, if you’re down here anyway,’ I said, ‘you may as well collect the notes yourself.’

He swore at me. While I am past being intimidated by bullies, this is increasingly what practices are having to deal with.

The law could easily be changed to allow practices to cover their costs if there is the political will to do so. If there isn’t, then the Government is effectively removing £85 million from already tight primary care budgets and giving it to solicitors.

Personally, I would like to see some understanding between professionals. Solicitors can afford to pay a reasonable charge. They don’t work for free so why should the NHS?

The BMA and LMCs need to lobby the new Health Secretary hard about this. CCGs should also be up in arms because it hands precious NHS resources to solicitor’s firms.

Patients should be furious because, in the end, they are the ones that will suffer.

At the moment, this is not a national scandal. But it should be!

Clive Elliott is business partner at Court Street Medical Practice in Telford

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Readers' comments (16)

  • Nhsfatcat

    Report the partner to the law society.

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  • I have a solution, donot deny the information, as “it is patients right”. Just advise that they need to come to surgery to access it. Are we breaking any law?

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  • doctordog.

    If we insist the note requesters attend surgery, could we charge them for the use of the room / computer?
    I simply cannot believe we are expected to supply FREE photocopies either.

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  • When they attend we can also insist they bring a copy of the police check for our records,as well as charging them of course.

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  • Actually have tried some of those things, getting patient in , making sure they are on patient access, copying the redacted notes they want. However, we are still getting similar crap from solicitors like in the article, demanding the records and threateningly GMC or that we are breeching the rules of the new Law. !!!!

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  • This is total Boll,,,,, I will defy this unethical act, and only give summaries in the first instance, or get the patient to sort it out themselves. I do not care for the consequences as i have had enough of this crap day after day of abusive behaviour towards our profession.

    It will never end, and as soon as the whole GP community wakes up to this the more likely we are to act as a unit and fight everything that is so bloody obviously abusive against our profession from the government.

    I bet you they are laughing at all our comments now revelling in the distress and dismay it is causing us!!

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  • Someone gave me an idea re this. Ask the patient to provide a USB stick, download the record to this, give to the patient and it is their responsibility to get the thing to the solicitor. Would this be legally OK? We are currently sitting on a request that would be 1000 pages of notes, largely irrelevant to the issue at hand.

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  • And folks still want to be GPs. More and more bonkers. Stuff the lot and leave ASAP.

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  • I know leave ASAP is a reality for me also, but believe it or not after 25 years I feel institutionalised, I know nothing else, so i want to fight on and I want compensation for the sheer mess they have caused in my work life balance due to obstacles i cannot jump and neither pull out of, cornered rat with nowhere to go !!! Bast...s

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  • perhaps that should say Like a cornered rat - oops

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  • I think that it would be reasonable to assume that solicitors passed on the cost of obtains copies of medical records to their clients prior to GDPR. So, one would presume that they will now reduced their fees. Will they heck!

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  • Socialism

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  • What is everybody worried about? Brexit is on the horizon and GDPR can be disregarded - just a question of months. The problem may arise from the fact that the lawmakers and the legal profession as such is profiting at our expense they just might want to keep this regulation in place even after 31.03.2019.

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  • David Banner

    Yes, it should be a national scandal.
    But nobody cares.
    So it isn’t.

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  • Since 2012 we are not dealing with solicitors, we deal with patient direct, so all records are collect from base.

    GDPR states you cannot charge for access (the £10 access fee) and it states you have to give information that you have in writing you should supply in writing (i.e. not verbally only) but it does not specify you have to give it printed (emails and files are written), and it does not oblige you to deliver it by golden coach to Timbuktu either.

    So we now offer patients to come down with their camera, this was always an option under DPA, or offer to make copies for the copying charge.

    It has not been tested in courts, and any complaint would have to go through ICO, who are snowed under and take a year to reply. Solicitors know this so will happily pay so far.

    If you enter into a contract with solicitors a far way from home (same for mail order companies) and you have to recover costs, you have to travel to their local court, same vice versa. Any dispute with your patient can be dealt with in the local court for both parties.

    I had a dispute over £50 and had to travel to Manchester for the case from Kent (2012, and then still lost as it is a civil case and it matters who sounds the most plausible not what is true.

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  • Clarify, you are not charging for access, but to recover your copying costs, so your invoice should reflect this.

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