GP practices can block abusive patients from gaining automatic access to their records online if they pose a ‘risk of harm’ to staff, the RCGP has said.
Automatic access to patients’ prospective patient records is due to be switched on by the end of this month, following delays related to concerns about patient safety.
But the RCGP’s toolkit on access to records said practices can refuse access to online records for patients that pose a risk of harm to others too.
The guidance said access should ‘be refused where there is a clear risk of serious harm to the safety of the patient or members of the practice team, or to the privacy of a third party’.
It added: ‘If potentially harmful information cannot be successfully redacted and the practice remains concerned about the safety of record access for an individual patient – or in extreme cases, remains concerned that the patient may react violently to information in the record – then the practice may refuse to give the patient record access or restrict the level of access.
‘It may be possible to give them access to a reduced part of the record such as the Summary Care Record or restrict access to appointments and repeat prescriptions.’
The guidance said that records access should only be refused or restricted ‘after discussion with the practice leads for GP Online Services and Safeguarding or after seeking further professional advice from a local relevant agency or national medical indemnity organisation’.
Ex-chair of the RCGP’s informatics group Dr Ralph Sullivan, who took part in an expert panel on records access at the Best Practice conference in Birmingham last month, said that practices could also redact the names of staff members from patient records if they fear there is a risk of harm from identification.
However, he said practices that redact records to safeguard staff would need to justify their decision in order to uphold it from a medico-legal point of view.
Speaking in a personal capacity, Dr Sullivan said he is aware of ‘GPs who are very concerned’ about the safety risks automatically visible records will bring for staff members, especially ‘healthcare workers or social care professionals’.
He explained it would be possible to redact records that included staff names in the case of a patient with a history of being aggressive and if there was a significant risk of harm to practice staff.
‘If you knew, or had a good reason to suspect, that somebody who’d written something in the record would be at risk because the patient could read it, then you could redact it’, he said.
But the practice would need to remove the whole consultation or action from the record, and not just the name, according to Dr Sullivan.
And practices that redact individual staff names will need to give reasons for redacting the record in the notes, and then also redact that record, suggested Dr Sullivan.
He also cautioned that patients may be able to guess their record has been redacted if no record entry appears following a consultation.
And Dr Sullivan highlighted that there are still fears patients may react badly to notes, even if they have not been abusive in the past.
He said: ‘People in practices are used to talking to patients, but they can still cause upset in what they say. I’m aware of examples where something has been put in a record that’s not been intended to cause offence or upset but has done so.’
Managing partner at Alnwick Medical Group in Northumberland, Tony Brown, said access to records was ‘a difficult process’ because it leads to many queries from patients.
‘I had a patient two weeks ago accusing me of unlawful behaviour because they had a medication review on their record and denied any knowledge of it happening. The patient accused me of making things up to fraudulently claim targets and funding,’ he said.
‘It turns out they didn’t recall the flu session I organised in a remote community centre where I also had a team of social prescribers engaging with patients and two members of my dispensing team carrying out the very light touch Dispensing Review of the Use of Medication in order to complete our annual Dispensing Services Quality Scheme.’
Last week, Pulse revealed that practices who opt all of their patients out of automatic access will not be in breach of their contract, as long as they manually offer access to each individual patient.
A version of this article was first published by Pulse’s sister title Management in Practice