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One in five GPs already self-censoring what they record in patients’ notes because of concerns about online access



Exclusive One in five GPs have already changed the amount of information they routinely record in patients’ notes because of concerns about patients being given access to their full record online, a Pulse survey reveals.

A snapshot poll of 365 GPs also found 56% would not welcome online access to their own full patient record, despite the Department of Health’s plans to roll out online access for all patients by 2015.

A fifth (19%) of respondents said they had begun to change what information they enter into GP records over the past year due to concerns over online access. GPs reported excluding information about child safeguarding, possible diagnoses and information on end-of-life care in order to not distress patients or destabilise the doctor-patient relationship.

They also said they had begun to omit information about third parties, negative examination findings, information on mental health issues and concerns over fabrication of symptoms for similar reasons.

The Government is planning a DES to incentivise GPs to offer full online access to patient records next year, a policy the GPC has said should be scrapped due to concerns over workload, safety and confidentiality.

Dr Wendy Fletcher, a GP in Banwell, Somerset, said she was ‘not interested’ in routinely accessing her medical record as it would not benefit her, and said she was now routinely excluding information from patient records which she would have previously included.

She said: ‘People come in with vague symptoms that could be something or it could be nothing. Usually you’d note that down in the notes, but now it’s more difficult because you don’t want every patient with a tummy ache to be worrying they have cancer.’

‘I also jot things down to remind myself about things going on with family or work that might be impacting on the illness, but that’ll be difficult now.’

‘It’ll be the most anxious people who want to see their notes, and so they are the people you don’t want to upset the most.’

Dr John Etherton, a GP in East Haven, Sussex, said GPs would now be wary of writing certain details in records due to the risk of complaints.

He said: ‘GPs will be reluctant to write down their concerns as they could be misinterpreted and form the basis for complaints. It could lead to a vicious response. You want to avoid a bad atmosphere, a breakdown of the doctor-patient relationship.’

Dr John Hughes, chair of Manchester LMC, said the plans for access to online records would lead to worried patients.

He added: ‘GPs are going to have to be completely defensive when writing in them. Everything they write will be completely open to misinterpretation. I think it’ll lead to increased psychological pathology in patients, because they’ll be worrying about things in their record.’

A Government-funded report, published by the RCGP last month, raised similar concerns and ruled out retrospective online access to records as this would create too much work for GPs and risk disputes with patients.

A spokesperson for NHS England said it was taking the concerns raised in the RCGP report seriously.

He said: ‘We are pleased to see that the majority of GPs are developing their professional practice in order to prepare for the roll out of full patient access by 2015.

‘In line with the road map developed by the RCGP, they are taking seriously safeguarding, third party information and most importantly making patient records patient-friendly.’

‘All of these efforts will contribute to enabling patients to be in control of the information they need to improve their health and wellbeing.’

Pulse Live: 30 April – 1 May, Birmingham

Pulse Live

Dr Kartik Modha, a GP in London and founder of Tiko’s GP Group, will look at how technology and social media is changing GPs’ practice at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.