Practices fear protecting the risk of staff names in patient records

Practices are concerned about the safeguard risk posed by including staff names in patient records, as automatic access is due to be activated this month.

However, the practices have been told by a general practice expert that information – including names of staff – can be redacted if there is a risk of harm to team members.

Automatic access to records must now take place by November 30, according to a new target date set by NHS England after supplier delays when bringing capacity into service because of the concerns expressed by the practices.

But questions remain about the implications of these changes for safeguarding, including for staff members.

Dr Ralph Sullivan, a retired general practitioner and former chair of the health informatics group at RCGP, speaking on a personal basis, said he knew some colleagues who were concerned.

“I know GPs who are very concerned about this. It is mainly the risk of safeguarding when it comes to the names of health care workers or social care professionals,” he added.

He explained that it would be possible to redact records that included staff names in the case of a patient with a history of aggression and if there was a significant risk of harm to practice staff.

“If you knew, or had good reason to suspect, that someone who wrote something in the chart would be at risk because the patient might read it, then you could redact it,” Dr. Sullivan said.

“I don’t think anyone has ever tested this in law. But that would be my advice.

But, in principle, the practice should remove the entire consultation or action from the record, not just the name, according to Dr. Sullivan.

“In principle, I think you should redact the whole document, the whole consultation, or a standalone reading/SNOMED code with the name of the staff attached,” he said.

In practice, it will depend on the computer system used by the practice to know how to proceed.

Save justification

Firms that redact records on the basis of personnel protection should justify their decision in order to enforce it from a medico-legal perspective, advises Dr. Sullivan. They should also include the reasons for deleting the recording in the notes, and then redact that recording as well.

The reason for the change would be on the basis of preventing harm to someone, and not because the information is confidential, Dr. Sullivan said.

“Patients have a right to know who cared for them and what they said and did, so the information should generally be in the public domain,” he added.

However, patients may still be able to guess that their record has been redacted.

“The idea of ​​redaction is that it’s supposed to be invisible, so there would be no positive indication of redaction for the patient,” Dr. Sullivan said.

“But they might assume something was redacted if you went to see your nurse practitioner and you wait a week and there’s no consultation record.”

The The RCGP attacked access to files says the practices could go further and completely deny access to online records.

It says: “Access should only be denied where there is a clear risk of serious harm to the safety of the patient or members of the practice team, or to the privacy of a third party.

“It may be possible to give them access to a reduced part of the file, such as the summary care file, or to restrict access to appointments and repeat prescriptions.”

It adds: “Access to records should only be denied or restricted after discussion with those responsible for the practice of online services and safeguarding GPs, or after seeking further professional advice from an appropriate local agency. or a national medical compensation organization.”

“Difficult process”

In situations where safeguarding concerns have not previously been reported, there is always concern that patients may react poorly to information presented in their chart.

“People in practices are used to talking to patients, but they can still be upset by what they say,” Dr. Sullivan said. “I know of instances where something was put in a folder that was not meant to offend or upset, but did.”

He added: “We had a major complaint about something that was written in the notes – it was true, but the patient didn’t take it very well. And sometimes it’s not the patient, but the patient’s relatives or a partner who gets upset the most.

Managing partner of Alnwick Medical Group in Northumberland, Tony Brown, said gaining access to records was ‘a difficult process’ as it leads to many questions from patients.

“Two weeks ago a patient accused me of illegal behavior because he had a medication review on his file and denied any knowledge of what was going on. The patient accused me of making things up to fraudulently claim goals and funding,” he said.

“Turns out they didn’t remember the flu session I had held at a remote community center where I also had a team of social prescribers engaging with patients and two members of my team performing the very light distribution review of the use of Medicines to complement our annual program of quality of dispensing services.’

The BMA has previously expressed concerns on the security of implementing automatic access to patient records and has multiple times asked for a break on deployment.

GPC England vice-chairman at the BMA, Dr David Wrigley, said Management in practice there were “growing concerns” that the practices of drafting software are supposed to use to review records “are not fit for purpose”.

He added: “This is another example of how poorly thought out this scheme is, and we urge NHS England and NHS Digital to address this urgently, not just for the good of practice, but also to their patients.”

Earlier this week it was revealed that practices that deny automatic access to all of their patients will not be in breach of their contractas long as they manually offer access to each individual patient.