Giving patients online access to their medical records
There are benefits to giving patients access to their health record, including improvements in a range of healthcare quality and safety outcomes, and enabling patients to take greater control of the management of their health conditions. We also know patients want to see their records. Over 80% of new NHS App users try to view their GP record but are unable to. A lack of record access is the most complained about feature in the NHS App. We want to make it easier for GPs to provide record access and for patients to get access to their records.
What records access will be given to patients
From April 2022 we are giving patients with an online account access to their future, or prospective, full GP health record including free text, letters and documents. Patients will see new information once it is entered, or filed, onto their record in the clinical system. Patients will not see their historic, or past, health record information unless they have already been given access to it by their GP practice. Patients whose GP practices use the TPP or EMIS system will see new GP records entered from April 2022.
Will patients automatically see all new information about them
Patients will only see their information once it has been checked and entered, or filed, onto the GP practice clinical system. This means general practice staff will continue to be able to prevent patients from seeing any sensitive information before patients can see it. General practice will also be able to remove access for the very small number of exceptional circumstances where access is inappropriate, considered harmful or where there may be safeguarding concerns. These changes only apply to a patient’s general practice record. Other health services records will not be visible to patients. Even if other services use the same clinical system, information will not be viewable by the patient, unless it has been filed into the general practice record.
Patient access to past or historic records
We are not changing patient access to their historic information until later in 2022. This will be phased in carefully, using the NHS App, to ensure that general practice is not overloaded with requests. Patients who already have access to their historic, or past, health records will maintain this access - nothing will change for them.
When historic access changes are made, these will apply to detailed coded records only. This is so staff will not need to spend hours looking through previous freetext record entries and attached documents to identify issues that may require redacting.
General practice as the sole data controller
These changes will not change the status of general practice as a data controller. General practice decides on what information is made available to patients, either as it is being entered onto the clinical system, or by reviewing and responding to digital requests for historic coded data. No data is made automatically available without being entered by general practice.
Updates to the general practice Data Protection Impact Assessment
For the provision of access to future information, patients will access the same personal information as they do under current arrangements, via the NHS App and other existing record access apps. There is no change to the category of personal information being processed, the organisations involved or how that information is being processed and secured. These changes alone are not sufficient to necessitate an update to general practices’ DPIAs, however, as data controllers, each general practice should make an individual assessment of whether their Data Protection Impact Assessment (DPIA) needs to be reviewed and updated
Patients understanding their medical records
There is an existing professional responsibility to ensure that records are legible and patients understand and are informed about the care that is being provided - clinicians need to write notes bearing in mind that patients may see them. While this is a common concern, our engagement with practices where record access is routinely available, and as wide international experience suggests, this is not a significant issue for patients. Within the NHS App there is currently a ‘help with abbreviations section’ that supports users with abbreviations commonly found in medical records. We are continuing to improve our national resources to support patients to become more actively involved in their care, and as more people have access to their information this will help justify further investment into improving services and systems to improve the record access experience.