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Using Enhanced Review (SNOMED) codes when giving a patient access to their health record

From November 2022, patients will be able to use the NHS App and other GP online services to read new entries in their health record.

Ahead of the change, where there may be concerns that certain patients should not have access because of risk of harm, healthcare workers can prevent automatic access to new information by adding a Systematised Nomenclature of Medicine (SNOMED Clinical Terms (CT)) code to their record. 

Whilst applying the 1364731000000104 Enhanced review indicated before granting access to your own health record code to a record will prevent that patient from automatically receiving access to read new entries in their health record, it will not amend any access that has previously been given. If a patient is identified at risk of harm, you MUST also review any access the patient currently has.


SNOMED codes to be used by general practice

1364731000000104 Enhanced review indicated before granting access to your own health record 

Add this code to a patient's record to prevent them from automatically being able to see new entries. This will mean that you will have to undertake a review to determine if it is safe to offer online records access.

Applying this code before access at the practice is switched on will prevent a patient’s GP Online Services account from being updated to provide access to future information. After the script has run at the general practice, applying either the '...104'  or '...106' code alone has no automatic effect to any access the patient currently has, but can affect the level of access when a patient sets up a new online account in the future. (For the code to be effective it must be applied before the script is run).

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 at the practice is switched on in order 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 access to be switched on.

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.

1364751000000106 Enhanced review not indicated before granting access to your own health record

Should the patient be considered as being no longer at risk, adding this code into a patient’s record will override the SNOMED code 1364731000000104 Enhanced review indicated before granting access to your own health record. This means the patient will automatically receive access to information when access at the practice is switched on or when a new GP Online Services account is created, for example by registering for the NHS App.


Other considerations when using SNOMED codes

Even when access has previously been denied, it is necessary to apply the 1364731000000104 Enhanced review indicated before granting access to your own health record to prevent the patient from automatically receiving access to future information.

The 1364731000000104 Enhanced review indicated before granting access to your own health record will not change any access settings the patient already has. It is therefore important to also review and when necessary, update existing GP Online Services user settings for record access if a patient is identified as at risk of harm.

These codes do not affect proxy access but when applied to those under 16 years old it will prevent them from automatically having access to records entered after their 16th birthday when they turn 16.

A patient's circumstances will change, and these codes should be updated, and their GP Online Services user settings for record access settings reviewed when risk is identified to mitigate any potential for harm. 


Patients transferring to a different general practice

These codes will transfer with the patient record via GP2GP and the same logic will apply at the receiving practice once the record has been received and accepted. Their use will also help to alert the new practice of concern around online access to records.

When a patient transfers to a different general practice, any GP Online Services account at the old practice is deleted. When the patient next logs into the NHS App using their NHS login a new GP Online Services account is automatically created at the new practice.

By default, any new GP Online Services account is provided access to prospective information entered after access at the practice is switched on or the date a patient registered at the new practice, if this is later. If the SNOMED CT code 1364731000000104 Enhanced review indicated before granting access to your own health record is present in the record, then only access to summary information (medications, allergies, and adverse reactions) is provided.

Therefore, should GP2GP fail, or the GP Online Services account be created before the GP2GP transfer, the GP Online Services online user settings for record access must be manually reviewed/updated if the patient is identified at risk of serious harm. 


Safeguarding vulnerable people

Most patients who are at risk of serious harm will belong to known high risk groups, including those known to be at increased risk of coercion such as victims of domestic abuse or individual who may lack capacity. These patients should already have safeguarding plans in place, and therefore may already be known to general practice and have an adult safeguarding code in their record. 

At risk patients may also be unknown to general practice and individuals’ circumstances can change to place them at risk. When risk is identified, record access should be considered as part of wider safeguarding planning to maintain safety and reduce the risk of harm.

Healthcare workers should review and when necessary, turn off access for any individual considered to be vulnerable to coercion, whose recorded information may be harmful to them, or who is unable to keep it secure. This functionality already exists in general practice systems. 

When a patient is newly identified as at risk the 1364731000000104 Enhanced review indicated before granting access to your own health record code should be added to their record to prevent access to future health information being automatically given.

Patients who have had their records access restricted prior to this upcoming change, must have the 1364731000000104 Enhanced review indicated before granting access to your own health record added to their record before access at the practice is switched on to prevent access to future health information automatically being given.


Contact information

If you have any questions about the above guidance, or would like further clarification, email [email protected]


Patient Online Toolkit

Last edited: 21 February 2023 4:06 pm