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Allowing access to clinical records in Primary Care Networks
How to manage patients concerns
Allowing access to clinical records in Primary Care Networks
The emergence of PCNs and their inclusion within the GP contract has paved the way for them to become the organisations through which future primary care health services will be provided. Increasingly PCN staff need to be able to access to clinical records to support the delivery of patient care.
The organisational unit of data controller-ship remains with General Practice. PCNs despite their pivotal nature have no legal status and are not data controllers.
The new ISS for direct care outlines the governance requirements for healthcare organisations using TPP and EMIS clinical systems when sharing data for direct care and now states that
“Primary Care Networks (PCNs) are now a vehicle through which health care services are delivered. Trained staff from PCNs and their GP practices will now form part of each GP practice team and will have supervised and audited access to patient records when this is required to deliver patient care.”
and also, in relation to TPP (with equivalent arrangements in EMIS)
- Only health care organisations who have a legitimate relationship to provide care obtained through a registration process can access the full patient record by ‘sharing in’ the full SystmOne patient record from the virtual pool.
- At all new registrations, consent is required to ‘share in’ the full SystmOne patient record from the virtual pool. For existing registrations in Primary Care consent is not required.
This significant change will allow PCN staff to see the GP record without requiring consent and in effect this policy change provides them with a Legitimate Relationship where there is clinical need. Existing GP staff will also have a legitimate relationship to access the records of all patients within their PCN in the same way that they currently have access to patients in their own practice.
In order to access clinical records PCN staff must:
- Have a Legitimate Relationship (LR) to provide care for the patient (or be working with or accountable to an organisation who has that LR)
- Have completed training and be able to demonstrate that they understand their legal and professional responsibilities to protect patient confidence (IG training)
- Have completed training and be able to demonstrate competence in the use of the clinical system
- Have access to clinical records controlled with Role Based Access Control mediated through a smart card or similar method of authentication
- Have a contractual link to a Caldicott Guardian whose role would be to oversee 1) 2) 3), sign an RA02 for 4) and provide accountability in the event of a breach in relation to data access or malpractice.x
Informing patients
The new ISS allowing sharing of records across PCNs is a significant change and practices can and should ensure that they have communicated these changes to their patients through a variety of media. There has already been public engagement via some PPG groups at practice, PCN and CCG level, also at the NW London IG board, and through other workshops. You should discuss the changes at your local Patient Participation Groups (PPGs) and direct them to a new section in your FPNs. You may wish to use the wording below as a basis for SMS, Email, website pages or practice noticeboards:
“We are working closely with neighbouring practices within our Primary Care Network (PCN) to support your care. PCNs and their constituent GP practices are now the organisations through which primary care health services will be delivered and when providing you with care their trained staff form part of our team and will have access to your NHS GP record. Please see our Privacy Notice [include url link to your FPN] for more details or discuss at your patient participation group”
Fair Process Notices should contain clauses explaining how their information is shared and below is the suggested wording to insert into the existing section under Local Information Sharing:
“Local Information Sharing
Your GP electronic patient record is held securely and confidentially on an electronic system managed by your registered GP practice. In order to provide you with health and social care services Your GP practice works in close collaboration with [insert your CCG / PCN name] a group of [Insert the number of local practices in your PCN] geographically local practices.
Trained staff from PCNs and their GP practices will now form part of each GP practice team and will have supervised and audited access to patient records when this is required to deliver patient care. Staff are trained to understand their legal and professional responsibilities of confidence to their patients and will only access your records when they are required to do so to support you care. They will identify themselves and their role using a smart card and access to your PCN record is recorded, monitored, and audited.
As your local PCN functionality extends they are likely to provide GP HUB and Out of Hours services directly in which case your records would be available without consent. If you require attention from a local health or care professional outside of your usual PCN services, through an Emergency Department, Minor Injury Unit or other Out Of Hours service, the professionals treating you are better able to give you safe and effective care if some of the information from your GP record is available to them. If those services use a TPP clinical system your full SystmOne medical record will only be shared with your express consent.
Where available, this information can be shared electronically with other local healthcare providers via a secure system designed for this purpose. Depending on the service you are using and your health needs, this may involve the healthcare professional accessing a secure system that enables them to view either parts of your GP electronic patient record (e.g. your Summary Care Record) or a secure system that enables them to view your full GP electronic patient record (e.g. TPP SystmOne medical records or EMIS remote consulting system).
In all cases, your information is only accessed and used by authorised staff who are involved in providing or supporting your direct care. Aside from your registered provider your permission will be asked before the information is accessed, other than in exceptional circumstances (e.g. emergencies) if the healthcare professional is unable to ask you and this is deemed to be in your best interests (which will then be logged).“
How to manage patient concerns
Patient who register an objection can be responded to with measures to limit access to their record in certain situations e.g: “My next door neighbour (with whom I have an ongoing boundary dispute) is a receptionist at a practice in your PCN and I would not want her to access my records”
Solution:
It is possible to configure both S1 and EMIS clinical systems to limit access to a ring fenced group of staff which would exclude the receptionist neighbour and practices can contact their IT teams to implement these changes
Patients who decline to share their records shared with the PCN, e.g: “I understand the potential benefit of sharing my record within the PCN staff and even though this might make it more difficult to provide me with care or cause potential delay, I do not want to share my record with the PCN unless I give specific permission“
… we anticipate very small numbers of these patients
Solution:
Medium term ability to honour opt- out requests. EMIS and S1 clinical systems have organisational codes and identification of these codes allows clinicians and patients to make choices about which local organisations can access patient data. PCNs are new organisations without legal status and currently they do not have their own ring fenced clinical systems with PCN codes. We are planning to implement these as soon as funds are available to do so and from that point in time (which may predate the end of COPI legislation) patients would be able to request that PCNs do not access their records, which would remain unseen in the absence of consent.
Opt-Out Of Sharing
Patients have a right to object to the use of their personal data outside their practice via GDPR. We recommend that patients who request this are counselled about this so they fully understand the implications of their decision. This includes missing out on joined up care with other primary care services eg extended access hubs, where access and writing into the GP record is needed.
For those who object, inadvertent access of their data will be avoided if they have opted out using the Snomed code ‘416409005 Refused consent for upload to the shared care electronic record', but their data will flow if opted out of Summary Care Record only.
This helpful video will explain how to correctly record a patient request to opt out of data sharing for direct care on EMIS systems: RECORDING A PATIENT OPT OUT OF SHARING FOR DIRECT CARE IN EMIS