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RCGP advises practices delay NHS app records access

RCGP advises practices delay NHS app records access

The RCGP has advised GP practices to consider delaying automatic access to records via the NHS app on the grounds of patient safety.

From next week, patients will automatically be able to read new entries – including free text, letters and documents – in their GP health record through the NHS app. 

But the RCGP said that some GPs ‘do not feel ready to implement automatic access safely for patients’ by the planned go-live date of 1 November.

It added that this is ‘despite their best efforts to prepare and despite the College’s work to support them in this’.

The RCGP advised practices to consider whether they can allow records access ‘safely’ and if not, ‘delay access in order to prepare further’. 

It said: ‘It is appropriate that practices that feel ready to do so proceed with expanding record access, but the College would never encourage practices to go ahead with a course of action that they feel would jeopardise patient safety. 

‘Practices must consider the benefits of providing record access against their own level of preparedness and capacity to redact sensitive information safely, and decide whether to delay access in order to prepare further.’

It added that its GP online services toolkit outlines ‘how to apply opt-out codes to prevent automatic access for patients for whom it is considered unsafe’.

And the RCGP urged NHS England to ‘carefully consider’ whether the rollout should go ahead as planned.

It said: ‘Practices should not be left to address these risks alone and before confirming go-live, NHS England must carefully consider the timescale in the light of the latest information about the situation on the ground.’

It added: ‘The College has always supported the principle of expanded record access and the benefits that patient access to records offers in terms of self-management, health outcomes and patient satisfaction. 

‘However, we have also recognised the additional risks that automation brings and over the past year we have consistently highlighted the importance of practice preparedness, safe redaction technology and consideration of the most vulnerable patients.’

The RCGP raised concerns that:

  • The ‘workload and workforce crisis’ facing GPs ‘severely limits the ability of GPs to engage with any additional programmes of work, with priority rightly given to providing direct care for patients’
  • Despite ‘some improvements’ to redaction functionality, NHS England ‘has not yet delivered on all of the technical solutions the College proposed last year’
  • Other parts of the healthcare system are ‘not sufficiently informed’ about what the rollout means for their communications with general practice and the implications of automation for the role of GPs as data controllers

It said: ‘The College has communicated these concerns to NHS England on a regular basis and highlighted NHS England’s responsibility to fully consider the risks associated with this programme and the legal basis under which it is implemented.’

An NHS England spokesperson said: ‘Giving patients greater access to their health data gives them the tools they need to better manage their own health and reduces pressure on practices, with patients able to access information such as test results at a touch of a button without having to contact their GP.

‘The NHS wrote to general practices in July outlining the actions needed to safeguard their patients during this move, alongside a package of support developed in partnership with the RCGP and patient groups to help them prepare, and this support will continue to be available to all practices.’

They stressed that NHS England continues to engage with the professional bodies, patient groups, safeguarding leads and early adopter sites to prepare for 1 November 2022, when the automatic rollout will go ahead.

And they said that there is a range of tools and technical capabilities available to support the safe management of patient records, which have been successfully applied in early adopter sites.

Practices should contact their commissioner if they see challenges with providing the necessary safeguards so that commissioners can continue to work supportively to help practices be ready, they added.

The BMA has also called for the change to be delayed again and said it is having ‘urgent discussions’ around the new requirements, with guidance set to be issued imminently.

NHS Digital had first intended for patients whose practices use TPP to be first to have access to new entries in their GP notes through the NHS app from December 2021 – with EMIS practices to follow this year.

But the launch date was delayed until April 2022 for both systems, after the BMA wrote to NHSX expressing its concerns about the timing of the rollout.

It was then delayed again, with NHS England recognising concerns around ‘safeguarding’.

Meanwhile, it was last week revealed that GP practices registering new patients will have to repeat the work already done by the previous practice of redacting their record.

As well as prospective records access, Pulse revealed earlier this month that NHS England plans to enable patients to request their historic GP records through the NHS App from next year.


          

READERS' COMMENTS [5]

Please note, only GPs are permitted to add comments to articles

Michael Mullineux 25 October, 2022 12:01 pm

And what about IT systems capability? EMIS often cluncky and slow as it is, how will servers cope with additional access requests from patients?

Simon Hodes 25 October, 2022 12:20 pm

Default opt in Vs opt out for patients
Why?

Also where are the resources to deal with all the associated queries that will doubtless arise?

Richard Greenway 25 October, 2022 12:45 pm

Please delay this -we are considering opting out all of our patients until we can do this safety.
GPs are the data controller (not NHS digital) and are liable for unlimited fines for data breach when (not if) these occur.

– The suggestion that we should automatically opt-out all patients with learning disability or any other protected condition is a likely breach of the equalities act, so not feasible.
– “Wrong patient” data -as soon as we file incorrect data on the wrong patient, it becomes potentially live – even if we subsequently correct this. This is much more serious/ sensitive /personal where free text is revealed. How can we mitigate?
– What it the process for pts challenging 104 opt outs -if the patient disagrees with GP judgement. (no advice nationally)
– Coercion a risk to vulnerable patients/ DV/ Safeguarding. We don’t know who they are -so cannot mitigate.
– We have lost the GP 2nd check on identity when records access sought through NHS app. How difficult is it to open account of a household member on their behalf. Previously only basic data was available -this increases risks. As data controller we have to be sure that identificatoin process is bullet proof -but have no control over this.

Patrufini Duffy 25 October, 2022 3:54 pm

Should could won’t can’t…

Ian Jacobs 25 October, 2022 7:12 pm

Most hospitals and secondary care have not computerised their clinical records. Some patients with long term conditions and disabilities have over 6 stuffed full folders of paper records- have you seen them in the trolleys for notes taken to and from OP clinics ?

Ok- many results of Ix and tests are computerised – and admission/discharge letters are usually accessible.

But the nearest that hospital records get to having a clinical summary is by using the GP summary – which is often included with a referral ( especially. emergency admissions ).

GP record summaries have been painstakingly created ( and paid for by GP practices employing notes summarisers ) over the last 30 + years- with training practices needing to have well summarised notes before being approved as a training practice.

This is an extraordinarily valuable database . The consequences of allowing patients free access to these records is asking for ” trouble ” as many patients are going to question and dispute info. that has been entered on their record ( either with their ” approval ” or without their knowledge ).

This is not the right time to be exposing your practice to the inevitable workload ( much of it controversial and confrontational )- when day to day praising is so fraught and under resourced .

Opt out . Opt out . Who knows when a better time may emerge but at the moment it looks a very long way off- if ever.