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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.

Part 2 of our focus on the NHS Medical Record

Last week on ‘Whose record is it anyway?’

In the last edition (see here for Part 1), we tiptoed around some the history of the NHS Patient Record; once a stack of paper, property of the Ministry of Health and held by a registered NHS practice for the life of the patient. We heard that this record is now a set of digital data, which one might hope and imagine would be accessible to those with both the right permissions and the aim to ensure the best possible outcomes for patients.

Where are we now?

I think it fair to say that the relatively small market for Private GP work in the UK has traditionally rested on the assumption that there is a group of (typically affluent) people who do not engage, don’t want to engage and don’t need to engage with the NHS – that for most of these peoples’ lives, their healthcare will be managed entirely within the private sector. Generally speaking, this market has been focused on central London.

For the traditional London based private GP, there was certainly a good life’s work to be done in this way. And while it may continue for a while,, as the sector grows, I believe that reliance on such a discrete group of patients, detached from the wider healthcare economy of public and private sector, is unlikely to be viable and, indeed, may well be unsafe.

Our patients: Who will they be?

The future of Private GP work, absolutely a fast and growing future, cannot effectively be one of separation from the NHS. Do not be blinded by statements in the press that patients are ‘leaving the NHS in droves’, they are not. They are increasingly, repeatedly, ‘stepping outside the NHS’ to engage with private medicine, drawing on private clinicians alongside their existing NHS care provision.

There has always been a fairly large number of patients electing to have surgery in the private sector of course. Now there is a well-established trend for the wider public to feel that engaging with a private GP is very much an option for them.

I have no doubt at all that within a relatively short period of time, the bulk of the patients on our lists, will be registered at an NHS practice, and attend that practice a couple of times a year or more. I know in fact that this is true for many of you already.

‘Our’ patients are, in a real and meaningful sense, NHS patients.

So what?

What are the implications of this for us? Hopefully nothing much, right?

Wrong.

Private GPs need to take note of this new customer: the patient who switches between the NHS and private sector, drawing on each service as they need. We need to engage with this new customer type and the implications they bring.

So how do we manage this? What tool or platform, what silver bullet will allow us to navigate, support and even benefit from this new, more complex world? I think there will be no surprise I am proposing the answer to be the very subject of these articles…

The NHS Medical Record and you

If we accept that greater and greater proportion of Private GP work is and will be with patients who have a history and relationship within the NHS, access (with permission) to the NHS Medical Record solves pretty much every potential pitfall facing us.

The NHS Patient Record is a single consolidated view of a patient’s care history, a record of that individual’s interactions with Primary Care, Secondary Care, even Social Care. Surely we, as Private GPs, have a responsibility to leverage this record too when delivering care and indeed a responsibility to keep it updated with our interactions and interventions(always with the patient’s consent). In doing so, we ensure that there continues to be a single source of truth for that patient’s care.

Simply put, access to the NHS Medical Record allows a different standard of medicine to be practiced. No GP is, or indeed should be, an island. The best medicine is practiced within a context. It is safer for patients. It is far safer for us. That safety, that context of quality of practice and the outcomes for the patient are enabled by the NHS patient record.

But that’s all so…NHS…!?

But let’s be honest with ourselves, many of us may not want to do all this! Indeed we may have left the NHS to ‘get away from all that’. We may even believe that our patients don’t want us to tell their NHS GP about their private treatment (Why? Really, …why?).

I would suggest that most patients will simply expect that their record is available to whoever they go to for care. It is certainly true that when patients know that there is a continuity of information across both NHS and private, they feel more able to move comfortably between the two. And in those rare cases where a patient may be actually be keen that you don’t have access to their NHS record? In this day and age, how safe is that for you?

But what about costs?

But wouldn’t using one of the systems (such as EMIS or SystmOne) that can access the NHS medical cost so much more than my existing record keeping system.

Yes, an NHS backed and used system that works with the gold standard patient data and allows clinicians to be part of national care while maintaining independence as a Private GP will cost more than a locally sited, walled-off private sector record system.
I don’t think it unfair to say that, unless one is accessing the national patient medical record via a system that allows the exchange of information with private and NHS patients, you are not really using an EMR at all - you are using a CRM – a customer database with some added notes.

Indemnity reductions

Bringing your practice systems up to a level of quality that enable you to consult within a national context will cost you more money than you spend now on whatever local analog you may use. But the reduction of risk, the alignment with a growing national understanding of the patient as a mobile, verified individual, whose care must be recorded and considered within that national context, will also engender vastly reduced indemnity costs. And that reduction will certainly be at a level that would allow a single-handed private GP to cover the costs of the systems required to work in this way.

Last words

I value our Practice’s independence enormously. I also believe we deliver the highest possible quality of clinical care. But I don’t believe that we practice in a vacuum, or that many of my patients will never have cause to access the NHS. I simply wouldn’t want our practice to operate without the NHS medical record now. I want to welcome patients who access our care for a variety of reasons, and whom I can treat in the confidence that my work will be seen and understood by colleagues across the private and public sector, all of us working for the best outcomes for those patients.

None of this is possible without the appropriate adoption and use of the NHS Patient Record. I have absolutely no doubt that access to and interaction with the NHS record will soon become the cornerstone and a driver of growth for Private General Practice .