GPs will need to spend time redacting prospective records once automatic patient access goes ahead, the RCGP has said.
NHS England will switch on automatic access to patient’s prospective GP record via the NHS App in November, following a delay due to ‘safeguarding’ concerns.
Newly-published RCGP guidance said that the GP practice ‘is responsible for ensuring that any potentially harmful or confidential third party information in the patient’s record is not visible to the patient online’.
‘Such information should be redacted,’ it added.
‘This prevents it being visible through GP online services but does not affect the visibility of the information in the practice and when shared for direct patient care or used for decision support software and clinical audit,’ the guidance explained.
It also stressed the importance of practices keeping ‘high-quality records’.
The guidelines added: ‘The risk that patients may view harmful information or confidential third-party information online or may be coerced to share their record with others places a responsibility on practices to maintain high-quality records, ready to be shared with the patient, and, when necessary, to consider -withholding record access from the patient.’
In order to prepare for patient access to the records, NHS England primary care directors Dr Nikki Kanani and Dr Ursula Montgomery asked GP teams to identify patients who may be ‘at risk of serious harm’ from having automatic access to their records and ‘ensure the right safeguarding processes are in place to support access to all future data’.
Their letter, sent on 21 July, added that ‘an individual review may be required to exclude patients from having access due to a risk of serious harm’.
Manchester GP Dr Haider Ali told Pulse the added workload for GPs from redactions was ‘troublesome’.
‘From a legal perspective, we can’t offhand it to an admin staff member to do it, as far as I know,’ he said.
He added: ‘There’s so much more of this stuff GPs have to do. We’re getting a lot of our workforce turning to the locum side, so they don’t have to do all the laborious paperwork.
‘Things like this take time, and if you make a mistake, let’s say you don’t redact something, then the patient might level a complaint against you or their next of kin might, and for good reason, because you’ve caused them upset. So it’s very difficult to navigate.’
Hertfordshire GP partner Dr Mike Smith also has workload concerns regarding automatic records access.
He told Pulse: ‘There’ll be some degree of trying to go and redact and some degree of workload in that. I think that is a risk.’
However he said his main concern was increased workload from patients misunderstanding their records.
Dr Smith said: ‘The problem is, when you write clinical records, you write them for other healthcare professionals, you don’t write them for the patient.
‘Even the little access that they do have, the amount of work that’s generated by someone not understanding something on their record, or them thinking something has been incorrectly coded on their record… the thought of that tsunami of workload that’s going to hit us makes me tremble a little bit.’
He added: ‘I don’t understand what the purpose is, I don’t know why the summary care record isn’t enough. Why does somebody need to know the details of every consultation that they’ve had? I don’t see how that’s going to improve patient care.’
Somerset GP partner Dr Peter Bagshaw said that in the past, ‘the problem has been editing for third party’.
‘Previously, when people have requested access to records, you can give them all the stuff that the GP has written, but if there’s third party information that may not be accessible,’ he said.
He added: ‘For the 95% of people who are reasonable, it’s going to be fine, but on the whole, my experience is that people access records if they’ve got a grievance or a concern, so it’s self-selecting the tricky population.
‘You have so many separated families where it’s unclear with who has parental rights, and who has the access to view records and things like that. So it can cause quite a lot of quite serious problems.’
Dr Michael Mulholland, GP in Buckinghamshire and RCGP Honorary Secretary, said: ‘I’ve been working on this at the RCGP and wanted to clarify that the automatic access will only be for new entries to the record from 1 November, so there’s no need review historic records.
‘The decision on automatic access rests with NHS England but we’ve worked hard to slow down the roll out and we’ve produced guidance to support practices as much as possible with the change.’
The road to automatic patient record access
NHS Digital had first intended for patients whose practices use TPP would 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’, but it remained unclear when the launch would finally take place.
Under the plans, patients will not be able to make changes to their GP records at this time, although a Government white paper published in February said that plans were ‘underway’ for patients to be able to access and contribute to their shared care record.
In 2019, NHS England said GPs did not have to allow patients to access their full records if they contain sensitive information that can’t be redacted, despite contractual requirements.
READERS' COMMENTS [18]
Please note, only GPs are permitted to add comments to articles
Absolute shambles. How is it that the RCGP are colluding in this? Oh yes – forgot they have form …
WE ARE BEYOND CAPACITY ALREADY And now we become responsible for potential harms to our patients through a process that we have no say in
Govt and NHSE’s approach to the complexity of this exercise is populist and unnuanced. It’s another hill which they wish us to die on.
Am I ?
If this is RCGP guidance, presumably RCGP have also agreed to fund the additional workload their guidance will cause? Because NHSE certainly aren’t going to.
RCGP: to whom do I address the invoice?
GP so this, GP do that, always cleaning up their mess. And they wonder why we have no time and people are leaving. If patients complain why they cannot see me then I’ll tell them it is because we are charged to read patient’s medical records life story.
Fantastic, something to do in my free time at last!
Yes but she wrote I have a TAAT GAD and my DNA is TOP.
That is simply not physically possible. Idiots. The GP soloution is potentially to just globally redact everything on everyone if they want to make us responsible for their decision. It is the only safe option GDPR wise. Or preferably they own their own decision and accept their may be harms. So many patients ecords may have 3rd party details in or reports on multiple siblings in safeguarding records.
I remember when NPFIT came in and BT were taking 27 hours to run a daily back up. This was because they were so clueless about the volume of data held in GP records. This shows that in 20 years they are not any less clueless.
Is there any way of knowing which records need redact, or do they expect a GP to read every patient record from start to finish?? When is there time to do this?? Won’t be doing any clinical work then.
Medical records cannot be reliably redacted for the volumes required. It’s just impossible and one wonders if this is not another exercise in setting us up to fail.
Has nobody thought of mass-resignations or contract hand-backs?
Well, then, looks like GPs will be spending all their time between now and november redacting notes.
They may get about 10% done by november, full-time, doing no clinical work alongside, so you better not get ill this summer/autumn, or will just have to go to A&E.
Or will there be a mass lying about the number of records completed, like there was with electronic summaries?
(yes, we know most practices were giving wrong figures, and many notes still not summarised yet!)
Yet another ridiculous idea that simply piles on more work with absolutely zero benefit to the health of the nation.
There are not enough GPs to do the necessary work let alone this unnecessary nonsense.
This level of stupidity is the reason I had to leave Partnership.
The NHS is in crisis and this is their contribution- I think that speaks for itself!!!
I will up sticks the minute they suggest doing this Wales. Will leave GP. Am not going to stick around for the barrage of complaints and requests to change what has been written in notes.
I agree with David. Surgeries should ban together. All say they are going to give the contracts back. Take salaried jobs and be blocked during working hours to be the admin monkeys for the NHS and patients wont be able to see their GP for 6 months.
Sounds great.
I suggest a public statement along the lines of anyone who has capacity can look at their records but please advise the surgery if there are bits of it you don’t want to see and we will redact them. I have deep misgivings about the ethics of holding information about anyone with with capacity and not respecting their autonomy and right to see it. I think we go too far.
please share where we are meant to store third party safeguarding concerns that will follow the patient if they change practices remain hidden but be visible to those who are allowed to see it, assuming they know it is there
I think some of the people commenting may have the wrong idea about this as It applies to prospective notes. The patient will not be able to see retrospective notes. There will be no need for anybody to trawl back through patient’s records. The expectation is that you will hide anything sensitive that is new.
Yes it is for information going forward, but it means that we have to redact every sensitive piece of information that comes into the practice from this day forward. Before we would just redact a small percentage that asked for access.
This is a massive amount of work.