A London ICB has expressly advised GP practices not to switch on automatic patient access to prospective records ahead of the 31 October deadline.
Instead, practices should only switch it on for patients who specifically request access, North East London ICB told practices during a webinar yesterday.
New BMA guidance last week advised practices to ‘consider a slower process in the coming months’ while it is also taking advice and considering a legal challenge regarding the imposed requirement.
Dr Osman Bhatti, a GP and chief clinical information officer at North East London ICB, told GPs: ‘One of the points I’m not advising at the moment is for practices to sign up for the automatic access to happen before 31 October.
‘I think things can change in the next five months and we should see what happens, and we should try and err on side of caution and have processes in place so that we can manage our patients, and then see if our unions and others can negotiate a more sensible thinking into NHS England.’
Echoing the BMA’s position, Dr Bhatti stressed that he thinks ‘all patients should have access to all their records’ but added that this ‘needs to be done in a controlled way and the practices need to be in control’.
Dr Bhatti suggested practices should have ‘a clear pathway’ for patients to request their medical records via the NHS App that both patients and staff understand.
He said: ‘The first step of the proposed process that we are looking at in North East London is that the patient is going to request online access, so we are not doing this automatically.
‘We are not going to automatically sign off the EMIS request from NHS England to allow patients to have automatic access and we will wait to see what happens by 31 October.
‘The rules might change again so I think we might need to hold out rather than run the risk of implications that I personally think would be greater for practices if they enable this right now.
‘If patients want online access you deal with that on an individual basis, much easier to manage and practices would be in control.’
Dr Bhatti also pointed out that the imposed GP contract changes include wording changes to ‘force’ practices to provide online access.
He said: ‘Rather than “practices must promote and offer”, they changed the wording slightly to “they must do”.
‘So rather than giving practices some autonomy, it’s changed the contractual wording to really force practices to change.’
He added: ‘They have totally removed any mention of redaction software. There is lots of changes that have happened contractually that haven’t been communicated to practices effectively and I think that is going to cause problems down the line and we need to be aware of that as practices.’
EMIS wrote to all GP practices to sign up for the release of records for prospective access, and tomorrow (1 June) they are going to enable anyone who has signed up to release the records to be enabled, Dr Bhatti said.
On 31 October there will be ‘a contractual enforcement’.
He added: ‘What that contractual enforcement is going to be, I’m not sure – I think this is something that the BMA have also taken up and are going to be discussing.’
Dr Bhatti also said that NHS England’s message to ICBs was to support practices to update global configuration as well as supporting them to remove bulk codes.
But new BMA guidance made it clear that there is no contractual obligation to remove the codes urgently, and raised concerns about redaction tools which ‘are not fit for purpose.’
The guidance in full
Implement Practice and Patient Processes
Suggested Practice Processes
- Ensure that practices have set EMAS manager to a particular date from which retrospective medical record access is available to all patients (default is 1/1/1900 for all records) – ONE OFF PROCESS
- The AccuRx Florey is set up at the practice (see above) – ONE OFF PROCESS
- Have a clear pathway for patients to request access to their medical records through the NHS App that both patients and staff understand. Promotion of the NHS App is encouraged to be advertised via the practice website.
- The patient process as below is clear to all practice staff dealing with patient requests.
Suggested Patient Processes
- Patient requests online access
- Practice issues patient with access information via AccuRx Florey
- Patient completes and returns Florey that is saved in the patients notes
- Practice will further verify the identity of the patient if required
- A code “314191000000103” (Patient registration data verified) should be added to the medical record
- Patients are either:
– given full prospective access as per the request on their application form at the point of verification (the practice would need to then review and allow retrospective access within a set time period (eg 2 weeks)
– informed that their request will be processed within a set time period (eg 2 weeks) - The practice will then review the records within a set time period (aiming for 2 weeks) and it is recommended that this is also an opportunity for clinicians to tidy up the medical record to ensure:
– The problem list is accurate with significant, active and minor problems accurately coded
– Medications are appropriate and repeat medications are correctly listed and linked
– Any data deemed confidential is marked as such
Source: Dr Bhatti
