GP Records on line!

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Records on line

NHS patients are to be offered access ‘on line’ to their GP medical record. Only a small number of GP practices so far have set up their computer system for their patients and clearly there is a long way to go before such a service is widely available. Whilst patients do have a legal right to access their records it is still quite unusual for patients to ask to see their record. For practices it is usually quite a palaver which involves a written request and arrangements made to view the hand held record and the computer record under supervision. Doctors, however, often turn the computer screen towards a patient so that they can see what is on the screen.

In the last two years the sharing of records within the NHS has actively been encouraged. Patients have been asked to agree to sharing in and sharing out of their GP records. Consent has been required. However, the anonymous sharing of records has not required patient consent.  The exercise to ‘get’ consent is enormous and time consuming.

Access requests

The requests for access are rare and are usually associated with a complaint or litigation. Attitudes amongst doctors vary on allowing access and understanding the law about access. Patients are entitled to see the whole of their record unless a GP has a sound reason tested in a court of law not to do so. Copies of NHS records are often sought to support insurance or accident claims and again the approach taken by practices varies. Some GPs like to review a record before it is copied. Care should be taken to ensure that the content of the record is such that a GP would be happy with the information contained being shared with the patient and a third party. This whole process can be quite time consuming and the practice has 40 days to respond (and often takes it) Copying records can be a nuisance so to allow computer access to records would save time and expense.

Quality of Records

It could be said that since the introduction of READ codes and computer records greater care has been taken on keeping records, organizing their content and standardizing the content. The use of ‘free text’ in records is always to be discouraged. The use of abbreviations and of standard phrases that could be open to different interpretations is also discouraged. However the complexities of coding systems can make record keeping even more difficult. Beware of the ‘delete’ button. Adding information to computer records after the event can also be traced – so making late claims or changing a record to fit is not advisable.

Keep it Simple

Records should simply record the health history of the patient in clear and simple terms that are understandable by the reader whether the reader is a patient or a health professional. To use modern medical language it needs to record the clinical encounters and interventions. This means that it should record consultations (with whom) and treatment and care prescribed. It should also include any allergies and routine repeat prescriptions associated with the patient. The record should include copies of all test results and clinical letters received from any hospital associated with the patients care.

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Robert Campbell is retired practice manager and has used both EMIS and Systm One GP Clinical systems


Editorial Comment

GP Ghost Patients ‘Strike Again’!

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Dead Letters Cause A Stir 

A recent article by Daily Telegraph Health Reporter, Laura Donnelly, tells of 30,000 patients stuck off GP’s Practice List who have not responded to ‘recall’ letters sent out by NHS Agencies. This is a practice that has gone on for years probably ever since the inception of the NHS in 1948. In fact there is around a 7% discrepancy between the number of people registered and the actual population.

Anecdotal ‘ghosts’

I recall incidences in the 1960’s where an Executive Council Registrar was in the habit of studying the obituaries column in the local newspaper every Friday so that he could remove patients from doctors lists who had died. GP Practices are required to notify NHS Agencies that patients have died but in my experience rarely do. Instead they wait until the patient’s death has been registered and the NHS Central Register effectively recalls the record and removes the deceased from the doctors list. To counter that, however, there were cases of patients who had died abroad but remained registered with a GP for many years after their death. These patients have become known as ‘ghost’ patients. And it has always been a well-known fact that GPs receive payments for more patients than actually resident in their practice area although pay settlement have tried to take account of this ‘overpayment’.

Modern practices result in less checks

To add to the complication NHS Agencies no longer automatically issue medical cards to patients when they register with a doctor and also when a doctor leaves or retires the Agencies no longer write to tell patients that their doctor has left and their names have been moved to a new doctor. This system of sending medical cards or notices to patients allowed patient lists to be managed. So called ‘dead’ letters would be received for patients who had moved away. The GP Surgery would be given 6 months to find a new address, failing that the patient would quite legitimately be removed. Nowadays the NHS Agencies send recall letters to patients for Cervical Cytology and other many reasons. Where the letters are returned to the sender action it is quite legitimate to remove the patient from the doctors list after the GP practice have been given the chance to find a new address or simply confirm that the patient still lives at the given address. Where there is no ‘dead’ letter it is arguably inappropriate to remove the patient  as the patient simply has the right to ignore the letter and not to reply. Letters are sent out for breast screening and bladder screening services. Invites are sent out for retinal screening. There are a whole host of reasons. However, in the days where a ‘real’ person managed the list rather than a computer system it was perhaps not so easy just to remove patients for the sake of it unless you were in the habit of reading the obituaries column.

Robert Campbell can be contacted with comments on


Dead wood costs money – more waste!

GP List sizes are often inflated by ‘dead wood’ and it does seem quite reasonable to find ways of managing the list as the GP Practice is unlikely to do this.  If the average list size was 1,800 patients then the ‘saving’ by removing non-existent patients would be over £10,000 per annum per full time GP.

Robert Campbell is a former GP practice manager and NHS EC Deputy Registrar