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health professionals, gender history need not be revealed unless it is directly relevant to the condition or its likely treatment. In the case of ear pain, it would not be appropriate to disclose details of gender surgery. Practices must always be wary of electronic referral templates that automatically include high-priority clinical information and be prepared to manually remove anything that is not relevant (or which the patient has asked not to be disclosed). More information is available in the Advice for doctors treating transgender patients section of the GMC website – and see also the article on page 12 of this issue.
SAR CHARGE Q A
A patient has submitted a subject access request (SAR) for information that was added to her record three weeks ago. As the information is currently only in electronic form, are we obliged to supply it to her for free or are we entitled to charge a fee?
According to the Information Commissioner’s guidance Subject access code of practice (
tinyurl.com/oksakle) you may charge a fee of between £10 and £50 for complying with a SAR relating to health records. The exact amount depends on how the health records are held. In this case, the guidance states you may charge up to £10 for complying with a SAR relating to health records if they are held only electronically. This would cover, for example, the costs of printing out the requested information. The higher charge can be made for records that are held either wholly or partly in non- electronic form. Be sure to also comply with standard Data Protection Act rules relating to issues such as non-disclosure of third party information or information that could cause serious harm.
WRONGFUL ACCESS Q A
We recently hired an admin assistant who lives in the local area. During routine checks we discovered she has accessed the health records of her uncle and we suspect also a number of her friends. She has been dismissed and we have informed her uncle about the incident. Should we also inform the other data subjects that there has been a possible breach?
It would be advisable for senior practice staff to hold a significant event analysis (SEA) meeting as soon as possible to review what happened. You should carefully review relevant guidance – for example, the Information Commissioner’s Office (ICO) website has a section on health which provides useful information on responding to data breaches across all four UK countries. This includes information and links on how to report incidents. In England, healthcare organisations must now use the IG Toolkit Incident Reporting Tool which will report all information governance serious incidents requiring investigation (IG SIRIs) to NHS Digital, the Department of Health, the ICO and other regulators. In Scotland, Wales and Northern Ireland reports are submitted to the ICO using its security breach notification form. You can contact the ICO helpline to discuss the incident and for guidance on whether you should inform the patients whose records have potentially been breached. As always, you should carefully document all discussions, including rationales for decisions that are made.
COMPLAINT FILES Q
How long is our general practice required to keep paper records of old resolved patient complaints and should these be stored separately from the medical notes?
A
NHS guidance states that a formal patient complaint file in England should be stored 10 years from the date of resolution and then reviewed to determine if no longer relevant before being destroyed. In Scotland a complaint file should be stored for seven years and, in children, until the patient is age 16. Complaint files are normally stored separately and only information that is relevant to ongoing care should be copied into the clinical file – but there should be a reference (flag) that a complaint folder exists.
DELEGATING INR MONITORING Q A
We are a DPS (discount practice scheme) practice with MDDUS. A number of our patients are on warfarin and we would like to know if it would be appropriate for our healthcare assistants (HCAs) to use a portable INR monitor and advise patients on doses based on the results.
Practice staff in discount schemes are normally vicariously indemnified but MDDUS expects that for any appropriately delegated tasks, HCAs will be adequately trained and supervised and adhere to best practice and guidance. Monitoring of INR and warfarin dosage can be complicated and getting it wrong can have serious consequences for patients and for the practice with the risk of a claim or GMC referral. Monitoring by HCAs might best be restricted to confirming stable INR status and a continued warfarin dose. Any change in INR should normally be referred to the prescriber – be that a practice nurse or doctor – for assessment of possible dose change and to instruct on scheduled review. The GMC makes clear in its guidance on Delegation and referral that: “When you delegate care you are still responsible for the overall management of the patient.”
WWW.MDDUS.COM
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