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Access to patient records through the NHS App

Enabling patients to view their medical record through the NHS App and other online services.

Latest updates

Discover more about the benefits of citizen access to records through the eyes of GPs, patients and overseas clinicians.

Our new case study and blog section provides an insight into how citizen access to records is being implemented and used

Read the latest update from NHS England on Accelerating Citizen Access to GP Data, 29 November 2022 and find resources to promote the NHS App access to GP health records in your surgery. 

More than 600 practices have now switched-on access to new GP record entries as part of the phased rollout, benefiting around 2 million extra patients. Practices that have recently switched-on access are encouraged to share feedback and learning to support others that are preparing to go live. 

Please take a couple of minutes to complete the survey that is being sent out and discuss your learning and experiences in a new forum on FutureNHS.

Background

Patients with online accounts such as through the NHS App will be able to read new entries, including free text, in their health record. This applies to patients whose practices use the TPP and EMIS systems. Arrangements with practices which use Vision as the clinical system are under discussion. The GPIT system configuration is being changed so that existing online users have access to their future, or prospective, health information entered after this change is made. 

This change only applies to future (prospective) record entries and not historic data.

This is an NHS England programme supported by NHS Digital. The change supports NHS Long Term Plan commitments to provide patients with digital access to their health records. It means GPs will need to consider the potential impact of each entry, including documents and test results, as they add them to a patient’s record. Patients will not see personal information – such as test results – until they have been checked and filed, giving clinicians the chance to contact and speak to patients first.

We also aim to enable patients to request their historic coded records in 2023 through the NHS App.

Research shows that increasing numbers of patients want easy access to health information about them, including 80% of the 28 million NHS App users. Better access supports patients as partners in managing their health, and can help reduce queries to general practice such as on negative test results and referral letters.

The change also supports existing GMS contract requirements to promote and offer online patient access to all future information, unless exceptional circumstances apply.

This change will apply to the NHS App and all other approved patient facing services apps that provide record access, for example Evergreen, Airmid, SystmOnline and Patient Access.

Read the letter to general practice from Dr Ursula Montgomery, Interim Director of Primary Care, and Dr Nikita Kanani MBE, Medical Director for Primary Care, outlining the planned changes. 


Why these changes are being made

Better access to health information enables patients to become partners in managing their health.

Evidence demonstrates that access to records:

  • increases patients’ feelings of autonomy, understanding of their health and ability to self-care
  • supports patients to prepare for appointments by acting as a written reminder or record of previous interactions
  • reduces the need for patients to contact general practice to get test results and referral notifications
  • increase data quality within patient record by enabling patients to flag if they think there are inaccuracies in their record
  • positively impacts on clinical indicators such as glycated haemoglobin (HbA1c) in diabetic patients

Automatic sharing of this information will reduce the burden on GPs long term, where they are currently required to manually share this information upon individual patient requests: the number of people who would like visibility of their records vastly outweighs the number of people who require limited/restricted access to their records.

Supporting a patient-centric approach to health and care, better access to records helps people to better understand and manage their health, leading to better health outcomes and improved patient and staff satisfaction.

The change supports existing GP contract obligation to provide individuals with access to their future, or prospective, health information entered after this change is made, unless exceptional circumstances apply (such as safeguarding concerns).

Resources are available for general practice to promote and support their patients with record access.

Find out about what the changes mean for health and care professionals working in secondary, community and mental health services.

What general practice staff should know

  • Patients whose GP practices use the TPP or EMIS system will see new entries in their GP record.
  • We are giving patients with an online account access to their future, or prospective, full GP health record including free text, letters and documents.
  • Be aware and mindful that patients will be able to see new records after the change.
  • Know how to manage this as a change to your workflow. Ensure sensitive information is redacted (make invisible from patient view) as it is entered onto the clinical system, or in rare circumstances know when it may be inappropriate to give a patient access to their record.
  • Patients will see new information once it is entered, or filed, onto their record in the clinical system.
  • This change will not give new access to historic, or past, health record information unless this is individually authorised by their GP practice. 
  • Patients will not have access to view administrative tasks or communications between practice staff.

GP readiness checklist

A GP readiness checklist is available to general practice staff, which includes a list of essential actions to undertake prior to launching prospective record access. There are also a number of resources available to support preparing for the change.

These include:


Global configuration settings

Immediate action is required by general practices to ensure that they are ready for the planned change, and their clinical system is updated to allow prospective (future) record access to patients


Safeguarding concerns and patient record access

While enabling patients to view their medical records through the NHS App will be beneficial to the majority of patients, there may be challenges for a minority. This is especially true in relation to safeguarding vulnerable adults, as the record may contain information that is confidential and sensitive, which the patient must not see, or could be harmful if the patient is unable to keep their record secure, such as in cases of coercion. The importance of safeguarding patients from harm is paramount. It may be appropriate to redact specific information entered into the GP medical record or prevent the patient from having access. 

In response to these concerns, the Royal College of General Practitioners is updating its GP Online Services toolkit, in collaboration with safeguarding experts. This will cover situations where safeguarding concerns may arise, and the steps clinicians could take to mitigate these risks.

Information and feedback have also been collected from general practice who became early adopters, granting prospective access to their patients ahead of the planned national switch-on. Early adopter sites have worked with the programme team to share key learning, lessons and the benefits of full record access.

Find more information on safeguarding on our Learning from early adopter sites page.

Template for shared learning - safeguarding issues and risks for online record access

The importance of safeguarding patients from harm is paramount. The NHS Safeguarding Reference group for Online Record Access would like to understand more about any safeguarding issues and risks that may have occurred involving online access to health information so that we can identify opportunities to improve our guidance and training resources.

 


Enhanced Review (SNOMED) codes

Ahead of the change, where there may be safeguarding concerns, healthcare workers can prevent patients from having automatic access to new information by adding a SNOMED CT code to their record.

Records with the code 1364731000000104 Enhanced review indicated before granting access to your own health record will be excluded from the changes if applied before switch-on. They should then be reviewed on a case-by-case basis to identify if access can be provided without a risk of serious harm.

A code will only work automatically before the switch-on. Applying a code after the change or switch-on will not automatically exclude access; this must be done manually on the record access settings.

Applying the SNOMED exclusion code to all patients

We are aware that some practices have suggested applying the SNOMED CT exclusion code to all their patients. This is not advisable, as access to records is appropriate for the vast majority of patients and should the patient transfer general practice, this code will transfer with them and may give a false indication of need for enhanced review before record access is provided to mitigate a risk of harm. This also introduces an additional workload on practices to manually review suitability and update online account settings for every patient after access is switched on to meet their obligation to provide prospective access for all patients. 

Undertaking the tasks described in the general practice readiness checklist alongside the resources to support staff should allow practices to prepare for switching on access. 

Early adopter sites have also shared good practice and tools to identify potentially at-risk patients

Should practices see challenges with providing the necessary safeguards, they are advised to contact their commissioner so they can be supported in achieving this first step towards greater citizen access to health records.

Further information on SNOMED CT codes to be used by general practice.


Benefits of citizens access to records

Discover more about the benefits of citizen access to records through the eyes of GPs, patients and overseas clinicians. 


Case studies and blogs


Information for secondary, community and mental health service staff


Advice for charities, patient groups and voluntary organisations

NHS England have spoken to people who might be at risk from this change to how patient access their GP record. They have worked closely with charities, patient groups and professionals to help product the following briefing and resources.
 


Contact us

If you have any questions or would like to discuss this further, email england.NHSEimplementation@nhs.net.


Further information and resources

Last edited: 27 January 2023 3:00 pm