GP practices can prevent abusive patients from automatically accessing their records online if they pose a “risk of harm” to staff, the RCGP said.
Following delays related to patient safety concerns, automatic access to future patients’ medical records is scheduled to be enabled by the end of this month.
However, the RCGP’s toolkit for accessing records states that practices can deny access to online records to patients who also pose a risk of harming others.
The guidance states that access “should be denied where there is a clear risk of serious breach of the safety of the patient or members of the practice team, or the privacy of a third party”.
It added: “When potentially harmful information cannot be successfully redacted and the practice remains concerned about the safety of an individual patient’s access to records – or, in extreme cases, remains concerned that the patient may react violently to information in the record could – then the practice can deny access to the patient record or limit the level of access.
“It may be possible to grant them access to a restricted part of the records, e.g. B. the Summary Care Record, or access to appointments and repeat prescriptions are restricted.”
The guidance said that access to records should only be denied or restricted “after consultation with the practice directors for GP Online Services and Safeguarding or after obtaining further professional advice from an appropriate local authority or national medical liability organization”.
Former Chair of the RCGP Informatics Group, Dr. Ralph Sullivan, who attended an expert panel on access to records at the best practice conference in Birmingham last month, said practices could also redact staff names from patient records if they feared there was a risk of harm from identification.
But he said practices that involve redacting records to protect staff would need to justify their decision to uphold it from a medico-legal perspective.
As a private individual, Dr. Sullivan said he was aware that “GPs are very concerned” about the security risks that automatically visible records pose to employees, particularly “healthcare workers or social workers.”
He explained that it is possible to redact records with staff names when a patient has a history of aggressive behavior and there is a significant risk of injury to practice staff.
“If you knew or had good reason to believe that someone who had written something in the chart would be at risk because the patient could read it, then you could redact it,” he said.
according to dr Sullivan, however, would require the practice to remove the entire advice or action from the record, not just the name.
And practices that redact individual employee names must provide reasons for redacting the records in the notes, and then redact those records as well, suggested Dr. Sullivan before.
He also warned that if no record entry appears after a consultation, patients may suspect their record has been redacted.
and dr Sullivan emphasized that there are still concerns that patients may respond poorly to notes even if they have not been abusive in the past.
He said: “People in practices are used to speaking to patients but they can still cause a stir with what they say. I am aware of examples where something has been put on a file that was not intended to cause offense or anger but has done so.
Alnwick Medical Group’s managing partner in Northumberland, Tony Brown, said access to records is “a difficult process” as it leads to many inquiries from patients.
“I had a patient two weeks ago who accused me of unlawful conduct because he had a drug proving on his record and denied any knowledge of it. The patient accused me of making things up to fraudulently claim goals and funding,” he said.
“Turns out they didn’t remember the flu session I organized at a remote community center where I also had a team of social prescribers who dealt with patients and two members of my dispensing team who did the very light check the dispensing of the use of medication performed to complete our annual Dispensing Services Quality Scheme.’
Last week, Pulse announced that practices opting out of automatic access for all their patients are not violating their contract as long as they manually grant access to each and every patient.
A version of this article was first published by Pulse’s sister title, Management in Practice