Prospective access to full records is subject to the same safeguarding requirements and management of third-party information as applied when patients have access to their DCR. When recording third party information, that is unknown to the patient, GP practices will need to ensure that this information becomes hidden from patient view.
GP practices should ensure that information is recorded in a way which is accessible to patients. Guidance on safeguarding, sensitive data and data recording is available within the records access section of the Royal College of General Practitioners (RCGP) toolkit.
An individual’s right to access their information that is held by an organisation is a legal right enshrined in law, and general practice requirements for a patient's digital access comply with those rights under Article 15 of GDPR. The decision to withhold information should take into account the guidance issued by the Information Commissioner’s Office (ICO), the UK data regulator. The practice must consider whether disclosure would be likely to cause serious harm to the physical or mental health of the data subject or another individual (Paragraph 2(1) of Schedule 3, Part 2 of the DPA 2018). BMA guidance on the Serious Harm Test states circumstances in which information may be withheld on the grounds of serious harm are extremely rare. Not every patient who has safeguarding concerns is at risk of serious harm from access to their record information.
General practice is required to provide patient access “if its computerised clinical systems and redaction software allow”. Both EMIS and TPP have an established ability to make information invisible from patient view (redact) as it is being entered into the general practice clinical systems, before it becomes available for patient view. This applies to information entered directly into the clinical system, such as consultation information and test results or documents received by general practice. Vision (Cegedim Healthcare Solutions) are not yet fully compliant with the NHSD GPIT Futures requirements for provision of citizen access to records and are working with them to achieve this.
Within EMIS and TPP it is only possible to make invisible the entire consultation entry or document attachment from patient view. This is a limitation of the current redaction software, and we therefore do not expect general practice to provide patient access to part-entries should a component require redaction.
Making records available for all patients requires general practice to consider if redaction is required as information is entered onto the system, in real time. Some people already have ongoing access to their records and whilst clinical judgement would have been exercised when access was initially given, a patient can subsequently develop a safeguarding concern. All staff entering information into the record must have an awareness that the patient may be able to see it and know when and how to hide information from patient view.
We are therefore not requiring general practice to review every patient's entire record before future access is given, but to ensure that an awareness of the patient's ability to view their information is integrated within their existing processes. Those patients most at risk of serious harm will already have safeguarding plans in place and should already be known to general practice. As this is a specific concern, we will undertake some focused work with the profession to provide clearer direction in this area.