Let’s be prospective about retrospective access

Dr Tony Copperfield says that giving patients access to their retrospective records would be like asking GPs to rewrite history

I’d assumed that by the time you read this, the ‘records access chaos fallout’ would be settling into an acceptable post-Chernobyl cosy warmth. Which would, at least, save on our heating bills. But the situation as I write is that, on the one hand, it’s ‘halted until further notice’ and, on the other, NHSE is ‘working at pace’ to make the changes happen. So that’s clear.

Whatever: I have implemented my mitigation plan. Specifically, I’m no longer speaking during consultations, because a) I haven’t the time, if I have to write up punter-friendly notes without abbreviations, medicospeak or words of more than one syllable, and b) The patient can bloody well read it all online later.

If we’re learning one thing from this records access debacle, it’s that we should beware what is slipped into our contracts – especially when new ‘requirements’ are forward-dated to seduce us into mentally kicking the can of implications down the road.

These contractual timebombs can be trivial or apocalyptic. In the former category: the ‘Shared decision-making mandatory training’, which had me squawking in disbelief, while others were apparently unperturbed – presumably because they assumed it was a joke, right up to the point when the email reminders pinged in. And in the latter category I’d cite the preposterous work-generation machine that is the IIF, which no one batted an eyelid over until they realised they actually had to get on with it.

Yes, these were both PCN contract requirements, but the principle’s the same. And also yes, one was scrapped and the other modified once the penny dropped and everyone threw up their hands in horror, but that’s my point. Bonkers ideas are Trojan horsed into contracts because the Government realises that future dating them means we’ll put them on the backest of back burners and start protesting way too late. At which point NHSE can justifiably question all the fuss on the basis that we’ve had ages to prepare.

Which is probably a good moment to remind everyone about the next patient-record-access master stroke – the plan to give all patients full-on, publicised, one-click retrospective notes access from next year.

You thought we’d just faced Armageddon. Er, no. That was nothing. After all, moving forward, we can at least adapt our workflows, consultations and record keeping to mould prospective access into less of an existential threat.

But retrospective access? That literally means rewriting – or, at least, redacting – history. And that cannot be done. You and I and every other GP in the land could work from now to retirement on the task of reviewing old records for retrospective consumption, and we’d still not complete the job. It’s not feasible and it’s not fair. Medical records were never meant for this, and while we can adapt for the future, we simply cannot retrofit the past.

So to get seasonal, top of my Christmas list would be for the Governmental Santa to bury the retrospective plan in Lapland permafrost. And for our leaders to make a New Year’s resolution to stop sleeping at the wheel and in future warn us of bumps in the road ahead. Or, better still, do a U-turn.

Dr Copperfield is a GP in Essex. Read more of his blogs here