In November, NHS England’s plans on Accelerating Citizen Access to GP Data will be rolled out across England, in line with 2019/20 GP contract requirements. Patients aged 16 and over, whose GP practices use TPP and EMIS systems, and who have online accounts, will be able to view new entries to their own medical records using approved app services.
According to NHS Digital, 80% of NHS App users want easy access to their health information and research suggests potential benefits, such as empowering patients to manage their own health and reducing practices’ administrative burden. Indeed, the positive experiences of ‘early adopter sites’ are encouraging in terms of workload and safety.
Yet concerns over the implications for patient safety, GP workload and information governance led to considerable delays in implementation. NHS England has now provided further clarification and guidance for practices as the roll out goes ahead.
What records will patients see?
Patients will be able to access health records including free text, letters, and documents, but not administrative tasks or communications between practice staff.
Importantly, practices will be able to customise or remove individual patient access if online access is not appropriate. Furthermore, test results will be accessible only when checked and filed, so clinicians will be able to contact patients and discuss the results first.
Delays and concerns
NHS England originally planned to allow patients automatic access to prospective data entries from December 2021. However, concerns over safety and GP workloads meant that the plans were pushed back until April, then 1 November, 2022.
In October, the British Medical Association (BMA) and Royal College of General Practitioners (RCGP) raised concerns that not all practices would be able to uphold their obligations to patients in terms of information governance (as data controllers) as well as clinical safety if automatic access was enabled.
The BMA advised that practices could write to their system supplier and request a delay. In response, EMIS and TPP, the largest suppliers of patient online services, announced a pause to the scheme.
Roll out in November
NHS England subsequently released an update, confirming that prospective data entered into patient records from 1 November 2022 would automatically become visible to patients in a phased way.
However, EMIS and TPP were instructed to pause the scheme for practices that asked them, by 5pm on 4 November 2022, to not enable the change. NHS England asked those practices to engage with local commissioners for additional support and to agree plans to prepare for their systems to be automatically enabled to offer prospective records access from 30 November 2022.
The status of general practices as data controllers
The update makes it clear that patients will be offered digital access to their prospective health records through a ‘purely technical’ change in functionality to GP IT systems, and that:
“General practice retains full local rights, with a range of options to disable the new functionality and/or withhold patient access to some or all of their health information, to meet their obligations as data controllers and to ensure safe access.” The legal basis is now clarified on the NHS Digital website.
Are you ready? Action lists for practices and GPs
NHS England has provided resources to support general practice in preparing for the switch-on of prospective record access, including: RCGP patient online toolkit, ‘how to’ videos, and information governance guidance. In particular, GP staff should work through the GP readiness checklist.
Key actions include:
- Ensure staff receive relevant training about data entry and safeguarding processes.
- Identify patients who may be at risk of harm from automatic records access, such as those at risk of domestic violence or coercion; ensure that safeguarding processes are in place. It may be necessary to redact certain information or to prevent patient access.
- Establish procedures to redact information that is unsuitable for patient view (such as confidential third-party data), in compliance with data protection legislation.
- Correctly update the clinical system organisation (global) settings for online services to enable prospective patient records access.
- Promote and offer prospective access to patients.
The RCGP patient online toolkit advises practices to establish a record-keeping policy.
What to do if your practice is not ready
For those practices not ready to proceed in November, NHS England provided guidance about how to locally disable the functionality or to deny individual patient access if necessary:
- Before the technical change, practices can exclude individual patients by adding the appropriate SNOMED code to their records, or apply the code to groups of at-risk patients by using reports.
- After the technical change, practices can amend the individual patient configuration or redact individual elements.
- To disable the record access functionality, view the guidance on updating the organisational settings.
- Practices may have the option to disable access to specific components of the record, depending on the clinical system.
Please contact us at Medical Defense Society if you have any medico-legal queries or concerns about the implementation of automatic patient records access.