From November 1st, 2022, patients in England and over the age of 16 will be able to access more detailed information from their medical records through online apps. Access to this will become automated so that all patients, unless restricted by the general practice, can access the service. Currently, patients request access which allows decisions to be made by practices about whether it is safe for a patient to have access or not.
Unless access to the record is restricted by GPs, all patients will be able to see consultation notes and codes which are added to the record after the launch date.
GP practices can decide to restrict access to the online records, either for individual patients, or groups of patients. For example, patients with learning disabilities, or patients who have a history of domestic violence. But we are aware that this will create additional work for practitioners.
There is already guidance which has been produced for practitioners by a number of organisations. This includes a document written by named Safeguarding leads who have outlined safeguarding considerations and concerns (click here to see it).
NHS England have also produced a GP readiness checklist for practices to identify actions which might need to be taken before November the 1st (click here to see it).
General practices who have already been IRIS trained will already be aware of how they should be recording DVA in their patient’s medical records. This includes the very clear guidance that when documenting DVA clinicians should: “Use the online visibility function to hide this consultation from patient online access”, this is covered in both Clinical 1 and Clinical 2 training. Clinicians should continue to adhere to this guidance. Clinicians might also want to hide other medical information from online visibility for those patients in abusive relationships. For example, information about sexual or reproductive health.
However, it is likely that IRIS Advocate Educators and Clinical Leads will be asked about the new automated access when discussing documenting DVA within IRIS training. We want clinicians to continue to document DVA but to do this safely by hiding online visibility.
General practices can decide to prevent automatic access to ALL patients who have DVA coded on their records. This can be achieved by adding the SNOMED code “Enhanced review indicated before granting access to own health record” (the “104 code”). This can be done by practices for individual patients or for groups of patients where there might be a risk associated with granting online access (see links above).
We have some concerns about the visibility of third-party communications received by general practices, for example, letters from other professionals which might refer to DVA or issues of concern. We recommend that AEs raise this with clinicians, as well as within reception and admin, in training.
IF IN DOUBT – DOCUMENT IT – THEN BLOCK IT OUT
IRISi’s key message is that they should continue to document abuse as this is very important, especially to document the impacts of abuse which might not be collected elsewhere, particularly in cases of coercion and control. But if clinicians have any concerns, they should document and then block it out by removing online visibility.
If you belong to the IRIS network, we will be providing an online training session/drop-in for AEs and CLs on Monday 31st October to outline this information in more detail. This is to make sure you are comfortable discussing the changes with clinicians if they ask in training.
We are happy for you to forward this outline to your local GPs if they ask about the changes, and if you do not feel comfortable responding to a specific query, you can always ask your Regional Manager.
Please note, this change is only relevant, presently, to practices in England.
Finally, we will be holding an information/drop-in session for AEs and CLs, details of how to book onto that will follow.