17 April 2014 04:49


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Just 61 practices offer records access

17 April 2013   Rebecca Todd

GP records - off shelf, but not online

Just 61 GP practices in England are offering patients full online access to their patient records.

The government has said on a number of occasions that all patients who want online access to their GP-held records should have it by 2015.

This pledge was one of the few commitments in the ‘Power of Information’ strategy published last year, and will be mandated for suppliers in the GP Systems of Choice framework replacement due by the end of the year.

However, data collected by the Health and Social Care Information Centre and revealed on its Indicator Portal, shows that one fifth of practices do not have the functionality to do this.

As of December last year, those practices listed as using INPS, Microtest, iSoft and Informatica did not have the ability to offer records access. The rest have the functionality, but of more than 6,200 practices, just 61 have actually switched it on.

The figures mirror a survey by EHI Primary Care and doctors.net.uk earlier this year, which also found that the overwhelming majority of GP practices are not ready to implement the government’s flagship NHS IT pledge.

It found that almost half of the 1,000 GPs surveyed said they had yet to address the issue, while just 4% knew that their systems supported access and had switched this on.

Another, more recent survey by the Medical Protection Society provides some explanation for the slow progress.

It found that doctors wanted to be able to continue to write notes in medical language to support their own practice, but 84% felt this would mean they would have to spend more time explaining the contents to patients.

Dr Nick Clements, MPS head of medical services, said that suggested that doctors strongly believed medical records were principally for health professionals and should be administered by themselves.

“This could be problematic as it is at odds with what it appears patients expect – that medical records are about them and should be written with them in mind,” he said.

“Doctors may have to be prepared to simplify and adjust how they write their notes, or spend more time explaining the record to the patient, which was a major concern for 84% of doctors surveyed.”

However, the EHI / doctors.net.uk story found that half of respondents felt that it would be useful to some extent for patients to have access to their records, with a fifth undecided and a third disagreeing.

Similarly, Dr Clements said that access could be beneficial, but the government would need to invest in it.

"Without comprehensive educational support for both doctors and patients, frustration, confusion and complaints will arise from what should be a positive step forward in healthcare,” he argued.

Although practices are making slow progress on records access, the HSCIC figures suggest they are moving faster on giving patients access to other types of information.

When it comes to viewing letters electronically, nearly half of all practices are listed as not having the necessary functionality. Only Emis practices can let patients see clinical letters online and just 58 are doing it.

But online access to test results is more widespread. Only the 51 practices listed as using iSoft systems did not have the functionality to do this and 40% of GPs - all on Emis and TPP systems – were using it. The numbers were the same for allowing patients to order repeat prescriptions online.

The Indicator Portal also shows that giving patients the option to book or cancel appointments online is reasonably widespread, with more than a third of practices offering the functionality. About two thirds - 61% - could offer this functionality but are choosing not to.

EHI Primary Care columnist Dr Neil Paul discusses some of the drawbacks of giving patients access to records in his latest column, and outlines some other ideas that he has for digital patient services.

 


Related Articles:

9 Insight: Another view: Neil Paul | 16 April 2013
16 News: GPs not there on records access - survey | 21 February 2013
17 News: You don't have mail consultations | 21 February 2013
Last updated: 16 April 2013 16:04

© 2013 EHealth Media.


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Chasing headlines-surely not?

williamlumb 51 weeks ago

There is far more good news in the HSCIC returns than the headline statistic would suggest. Looking at my own CCG area approximately 30% of practices offer access to results and repeat medication requests on line. Remember that some can't for software reasons and some practices use their web-site for medication requests-figures that won't be captured here.

As a practice offering full access to the patient record, I see this as liberating. It may create extra questions, but it empowers and hopefully engages patients along with proving in contentious circumstances how hard we have worked on behalf of the them and why we did what we did. The record has to be clinical-but all clinicians know that there has been a right to record access dating from the early 1990's and e-access seems to be a logical extension.

At the moment we don't offer on line booking of appointments, because which ever way you look at it, however we apportion our appointment slots there is no way to bridge the digital divide. As a practice we work hard at offering excellent phone and walk-in access to appointments to offer a fair share to all sections of the population we serve. If we believe in the Inverse Care Law (where the most needy are the least likely to seek healthcare) then on-line booking of appointments may not be ethical (at this moment). That said the working population must be offered ease of access. We have shared this problem with our patient group who are currently understanding of our decision not to allow e-booking of appointments. Hopefully someone will solve this paradox soon.


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Inverse care law

Colin Cohen 51 weeks ago

I think what Julian Tudor Hart proposed in his paper in the Lancet was that: "The availability of good medical care tends to vary inversely with the need for it in the population served. This ... operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced."

So it wasn't about those in need seeking care as much as the healthcare system failing to provide services to those in greatest need. And with coalition government policies shifting resources away from local authorities with the highest levels of deprivation there is a risk that health inequalities will get worse. For example one way of bridging the digital divide could be to enable people on very low incomes to access the internet from local libraries, but government policies are leading to the closure of libraries. So although the records access policy may be laudable it could have unintended consequences.


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I see trouble ahead

brian@paers.net 51 weeks ago

We did a study that I hope will be published soon. In 2 practices with very different populations, we found that, overall, appointments and tel calls are saved by record access. On the basis of these results, we estimate that, if 30% of pts used record access at least twice a year, about 10% of appointments would be saved.

Some people do consult more, but the vast majority do not, it appears.


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I see trouble ahead

Big Al 51 weeks ago

The reason why patient access is feared comes from the experiences we receive from patients. Take one recent female patient who only ever consumes a bottle of wine in one sitting once a week. Now put the details into your algorithms and this comes up with "this patient MAY have a problem with alcohol".

Now you can try to explain until you are blue in the face that 10 units in one go, when the recommended levels are 14 in a whole week, is very easy to consider as a potential problem and is perfectly legitimate to be placed on their medical record, but I'll never be able to convince that person of this, and next time she will lie about her alcohol consumption.

Now multiple that by the 1% query level over a year (that might be expected) and that is a lot of time I don't want or need to be dealing with.


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GP access...

KamalTPP 51 weeks ago

No. In this case, access to SystmOnline is controlled by the GP practice that you are currently registered at. As you are no longer under the care of your old practice(s), they are no longer able to give you access. It may be worth encouraging the practice to switch on the service. For more information, please contact us.


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we are on the way

brian@paers.net 51 weeks ago

It looks like progress to me. Half of respondents feeling that some form of access is beneficial is good news. No-one wants the medico-legal nature of the record to be compromised. If the content has to be technical, it should be so. If it can say the same thing in a less technical way without losing meaning ("stroke" rather than "CVA"), then we should write that.

There is a long way to go, but the govt seems committed to investing in training and support. It's frustratingly slow from my POV, but it is heading in the right direction.

Record access is good for patients and practices. Risks can be minimised. We are on the way.


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Oh dear

Steve Fuller 52 weeks ago

Must try harder ... lets have another look in 3 months shall we?


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To clarify...

KamalTPP 52 weeks ago

SystmOnline, TPP%u219s free online service for patients, also allows patients to view their clinical letters. Currently, over 1,300 SystmOne GP practices use SystmOnline functionality.


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GP Access?

CertaCitrus 52 weeks ago

Interesting. Will have to give it a try.

If my current GP (System1) doesn't allow access, can I contact any of my previous GP's (all System1) and request access from them?


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SystmOnline

KamalTPP 51 weeks ago

No. In this case, access to SystmOnline is controlled by the GP practice that you are currently registered at. As you are no longer under the care of your old practice(s), they are no longer able to give you access. It may be worth encouraging the practice to switch on the service. For more information, please contact us.


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