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The practice will also need to ensure that the patient is correctly identified before they hand over their registration details, so if the staff don’t know them they will need to ask for photo ID. From now on, it is also important for GPs to make a note during consultations if their patient has requested online access to their records or they have recommended it. It is a good idea to add a Read or SnoMed code to the record to remind you or alert colleagues to relevant patients.


Will I need to rewrite records or change the way I write them in the future?

Access to coded data will be retrospective online, but it is highly unlikely to contain

anything that the patient doesn’t know already or third-party data that the patient should not see, considering how brief it is. However, if you start offering online access to free text and letters, now or in the future, you should be aware that it could contain third-party information.

a problem. There will be eight different portals to choose from. Patients will be given outline information about each one when they register for online access and will be able to pick their favourite. But to make things more complicated, patients can use different systems for booking appointments, ordering repeat prescriptions or accessing their records. Sometimes a patient may even use more than one system at the same time. The big suppliers, EMIS, InPS, TPP, Microtest are already offering their own version of an online access program and from the end of March, four smaller companies, who are probably less familiar to practices, will also be offering the same services: PAERS, iPlato, Wiggly-Amps and These subsidiary suppliers will have online access to the big suppliers’ systems and will all be able to access the patient record directly, once the patient registers. The main differences will be in the add-ons or extra functionality in the basic, free package, for example links from test results explaining what they mean. How it will work with so many different suppliers and how the practices will cope is still unclear, but practices will not be able to recommend a program to their patient. In the long run companies that offer the most attractive service will gain market share.

What do I do if a patient challenges a diagnosis?

own personal record said that I had had a vasectomy when I knew quite clearly that I hadn’t. It turned out a discussion with my GP had been coded as the procedure. In many cases, the GP may have been correct in their diagnosis, but the patient may not have been informed or did not understand the explanation. You may find that this has implications for your practice’s processes so it could be worth discussing it with your colleagues.


Patients will only be able to see free text and letters that are filed after April. And program suppliers should have safeguards, eventually offering the ability for clinicians to exclude sentences or words from patient view. But in any case, clinicians should be writing records assuming their patient will read it. From now on I would recommend GPs scan hospital letters for any information they don’t want the patient to read before they file them. If a serious diagnosis is described or a third party is mentioned and it is not clear if this has been discussed with the patient, it would be best to contact the patient.


Do all the computer programs offer the same services to patients?

The number of computer programs available for patients wanting online access could prove

84 February 2016 Pulse

Preventing patient complaints escalating How to defuse a difficult situation pulse-learning.

However the law is complex and children become ‘Gillick competent’ or meet the ‘Fraser guidelines’6 at different ages, so the age at which an individual child can be allowed access will vary. It is therefore likely that every computer system will have a cut-off at 11 years old. Once a child reaches this age, parents will be able to have proxy access to manage certain elements of their record – such as demographic data, making appointments and ordering repeat prescriptions – until their child turns 16. The family will need to decide with the GP about the details of this so it may be a good idea for the practice to develop its own policy. Practices can then refuse parental access by saying it is not


A patient’s parents want access to their child's record. Should I give it?

Generally the practice will find it useful for parents to have access to their young children’s records.

The new access could lead to patients challenging information in the record. For example, my

practice policy. There are likely to be further complications if separated parents argue over access or if abuse is suspected. We have little experience of these situations in the UK.

An elderly patient’s son wants access to her record. Do we give it to him?


Proxy access to a family member or carer can be allowed only with the patient’s consent. The practice can only authorise access without this consent if the patient lacks capacity to make the decision themselves and has appointed the applicant with a lasting power of attorney.7

Ideally the patient and their son should discuss this decision with their GP first and this should be recorded in the patient’s notes. The practice should view a request like this positively, as it opens up better communication and involvement.

In practice, it is easy for patients to share their pins and passwords with anyone, so this will probably happen without their GP knowing. In the future, this process will be more formal, with separate logins and permissions for the proxy.

should be prepared for. If your patient tells you they are being


coerced, you can switch off the patient’s access immediately and suggest they contact the police or give the practice permission to contact the police. If any member of staff suspects coercion, particularly if the patient is or has been a victim of domestic abuse, the GP may consider delaying or suspending the patient’s registration for online access and offering them an appointment to discuss the issue.

Is there anything I can do to prevent a patient being coerced?


Many systems will have warnings that appear the first time a patient registers for

record access that reminds them of this risk and that they should tell the practice if it happens. Of course, that is easier said than done. And ultimately once the patient can access their coded information, that information belongs to the patient and they can decide what they do with it and who they show it to.

Dr Brian Fisher is a semi-retired GP in Lewisham, south-east London Declared interests: Dr Fisher is co-director of PAERS Ltd, one of the companies on the GPSoC Framework offering record access across England from April 16. He has carried out some of the peer-reviewed research quoted in this paper. He was involved in the early development of Patient Online

A patient is being coerced by their partner to share their online record. What should I do?

The issue of coercion is more of a theoretical risk of record access, but it is something that GPs


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