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🥼 Life On The Ground

A series of articles and editorials about real world challenges and thinking - we welcome submissions! Read more here 🔗.

This week, we introduce the first of a two part series on Private General Practice and NHS Electronic Medical Records.

[Part 1] Whose record is it, anyway?

One of the fundamental shifts that ubiquitous access to information technology has caused in the last few decades, is the idea that personal data is in some way owned by the subject of that data. I think it fair to say that most of us almost instinctively believe that to be the case, and are often outraged when some event or practice seems to contravene what feels to us now as a deeply held right.

But it was not ever thus! The NHS patient record is an excellent case study and while I shall attempt to tip toe through the minefield of concepts and opinion that surround it, I aim to tease one or two points that may prove useful for us as Private GPs over two articles this month. In this first part we look at a little history and then current context bring into focus where both opportunity and perhaps even obligation may lie for the Private GP.

Any of us who have worked in an NHS practice, one that hadn’t yet digitized their paper records, will be familiar with the old Lloyd George records with the Ministry of Health stamp on them. And that’s absolutely who owned the records and the data: the Ministry of Health. The practice held them, and was fully responsible for them as per the GP contract until a patient moved elsewhere or died. Sent off in a batch once every few weeks, these records entered a byzantine (in my imagination certainly) sorting centre, and from there were magically transported to their next or final destination. There were strict rules about protecting and maintaining them while a practice had them – and of course strict rules about sharing anything in them, even with the patient themselves.

All of that has changed dramatically. Many of these old records have now been digitized and the physical originals destroyed in the same certified processes that are used for the destruction of Ministry of Defense paperwork. Depending on the quality of that digitization, the full extent of those voluminous mountains of paper is now easily available, attached or incorporated into the digital patient record held by practices within instances of EMIS Web or SystmOne.

So the ‘thing’ that the Ministry of Health once owned and gave to the practice to look after during the time a citizen was registered at that practice, is now a set of data. The only ‘folder’ around it now is created by the software and data sharing policies – meaning, one might presume, that whenever a patient and a clinician should meet on the basis of providing care for that patient, at a practice, a walk-in centre, social care or mental health - well surely that patient’s record will be available to ensure the best possible care, an understanding of clinical history, a list of medications!?

And you all probably know the answer to that question of course: No it isn’t!

We will touch upon the reasons for and impact of the general difficulty in managing access to NHS patient records and some examples of ways it can work differently (Sweden is particularly interesting…) next time.

But perhaps, after all that, you are now shifting uncomfortably in your seat, and asking yourself “Well, as a Private GP I keep my own records, and always have, and I obviously cannot see or get involved with the NHS record, can I?”, and “My patients are not really NHS patients, and there are no systems available to me as a private GP to do this anyway, are there!?”

Next time in Part 2 – Why the answer to those questions is ‘Yes, you can’ and ‘Yes, there really are’... and also ‘Yes, you really should!’