Transferring your electronic health record

Here at Penwortham St. Mary’s we utilise an electronic system for transferring patient records to and from other GP surgeries called GP2GP.

GP2GP enables patients' electronic health records to be transferred directly and securely between GP practices. It improves patient care as GPs will usually have full and detailed medical records available to them for a new patient's first consultation.

Why it’s needed

• GP2GP is the project that enables patients' electronic health records (EHRs) to be transferred directly from one practice to another.

• GP2GP starts when a practice accepts a patient onto their list of patients for primary health care and ends when the EHR is transferred from the previous practice into the new GP clinical system.

• GP2GP electronic transfers will be more accurate and secure - and much faster than the current paper-based approach, which can take weeks to complete.

What are the benefits of using GP2GP?

Improved quality and continuity of care

• Full patient Electronic Health Record (EHR) available for the patient's first appointment, which results in a more focused and informed consultation.
• Past medical history available and information about medication, allergies, adverse reaction.
• Immunisations and vaccinations.

Improved safety

• Fewer transcribing errors and omissions, the need to key in information from paper records will be greatly reduced.
• Allergies and adverse drug reactions are flagged for review for new patients, resulting in safer prescribing.

Clinical time savings

• The EHR contains information such as lab results and letters from specialists, which helps in the clinical decision making process. This also means there are fewer request for unnecessary duplicate lab tests.

Administrative time savings

• The need to key information from paper records is greatly reduced. This results in quicker summarisation of new patient records.
• Attachments are received electronically, which results in time saved not having to re-scan items into patient's EHR.

Background to GP2GP

There are some 9,000 GP practices in England. They each currently deal with an average 500 patient record transfers each year. As a university practice we deal with far more, up to 4000 transfers per year!

The process involves:

• Printing out the details of the patient health record held on the GP clinical system and then putting that print-out into the patient's 'Lloyd George' envelope, together with any historical paper records, laboratory forms, hospital referral letters and the letters that result from that referral.
• These documents are then transferred to the new practice via the local medical records transfer process.
• Upon receipt of the Lloyd George, the new practice reviews the information received, summarises the record and enters any appropriate information into their GP clinical system.

The time it takes to receive a patient record from the time it is requested can be anything from a few weeks to a few months. As a result, the new practice often does not have the benefit of the old record when the patient attends for the first consultation. Once received, it can be very time-consuming for the new practice to key in the summary of the record into its own clinical system.

GP2GP, on the other hand, enables an almost instantaneous transfer of a patient's EHR. As a result, GPs and their teams will be able to provide patients with a safer and more efficient service. Read more about the benefits of GP2GP.

Your rights

• We are committed to giving you the best possible service and are pleased you are registered with this practice.
• We will make every effort to make sure you know about the services we offer which directly affect your health.
• We will treat you politely and with respect at all times. The practice will respect any privacy, dignity and religious and cultural beliefs of all our patients.
• You have the right to see your health records on request, in accordance with current legislation.
• We will never give information we hold about you to a third party without your consent.
• All our staff respect and understand your right to confidentiality within the law.
• We meet the standards of the NHS complaints procedure. If you are not happy with the service you receive from any of our staff, please contact the Complaints Manager, Fiona Greenbank. We will try to sort out your concern within the practice. If you are still not happy, you can contact the Patient Advice and Liaison Service (PALS), at NHS Central Lancashire on 0800 032 24 24.
• We welcome your suggestions to improve our service. You can give us your views and suggestions by writing to Lorna Laflin, Practice Manager, at the surgery or email her on [email protected]

Your responsibilities

• Please be polite to the staff at all times (remember they are working under the doctors’ orders). We will not tolerate abuse. If you behave badly, we may remove you from the practice list.
• Please attend appointments on time or tell us in plenty of time if you want to cancel.
• Please remember that an appointment is for one person only. If another member of the family needs to be seen, or if you need to discuss their care, please make another appointment.
• You should only ask for a home visit if the patient is housebound or too ill to visit the surgery. The doctor will decide if a visit is needed and may offer you advice over the phone.
• Please only ask for an out-of-hours call (evenings, nights and weekends) if it is really necessary and cannot wait until the surgery re-opens. The out-of-hours service is recharged to the practice.
• Please do not expect a prescription with every consultation. Doctors will only prescribe antibiotics or other medicines if they will help your medical condition.

Your Rights, your Information

Why we need your information:

Your doctor and other health professionals caring for you keep records about your health, treatment and care. In some circumstances other NHS services, such as 111 may access these records, to ensure that you receive safe and effective care. You should always be asked for your consent before your information is accessed.

 How we use your records to help you:

Your records are used to guide healthcare professionals in the care you need and administer the care you receive.

We routinely record calls to the service to support on going training, development of the service, and to ensure safety and quality.

 How we keep your records confidential:

Everyone working for the NHS has a legal duty to keep information about you confidential. We may need to share some of your information with our NHS colleagues so we can all work together for your benefit, but we will only pass on information about you if there is a genuine need to do so.

In some circumstances we may be required by law to report certain information to the appropriate authorities’. In this instance we would either be operating under a court order, ask Dr Buckley, our Caldicott Guardian, to ensure this is the correct action, or seek advice from our medico-legal advisors if necessary, before information is shared.

For further information please see the GDPR section

Giving Feedback or Making a Complaint about the Practice

Our complaints manager is Fiona Greenbank, who will deal with any issues. Our Complaints Team will listen to your complaint, and fully investigate the matter for you. 

If you wish to make a complaint, please speak to a member of our reception team who will help you to fill out a complaints form. It is important that this form is completed in as much detail as possible to enable us to investigate your complaint thoroughly and in a timely manner.

Once you have filled out a complaints form, a member of our complaints team will look in to the matter and take the appropriate action. You should also be contacted to inform you of the progress and outcome of your complaint, as well as to offer you any further advice or assistance if required.

You may also complain to us in writing, addressed to the branch at which you are registered, or by email at [email protected]

We aim to acknowledge your complaint within 48 hours and do our utmost to resolve the issue to your satisfaction. However, if you are not completely satisfied with the outcome of your complaint, you have the right to contact the Health Service Ombudsman. You can do this by visiting www.ombudsman.org.uk/make-a-complaint, or by calling the PHSO Customer helpline on 03450154033.

NHS Complaints Guidance

NHS Complaints Guidance Leaflet

What is GDPR?

The General Data Protection Regulation (GDPR) is a new law that determines how your personal data is processed and kept safe , and the legal rights that you have in relation to your own data.

The GDPR strengthens many of the Data Protection Act principles. The main changes are:

•         Practices must comply with subject access requests

•         Where we need your consent to process data, this consent must be freely given, specific, informed and unambiguous

•         There are new, special protections for patient data

•         We are obliged to reply to your request within one month of receipt of the request.

What is patient data?

Patient data is information that relates to a single person, such as your diagnosis, name, age, earlier medical history etc. 

What is consent?

Consent is permission from a patient and is defined as “any freely given specific and informed indication of your wishes by which the data subject signifies the agreement to personal data relating to him/her being processed.” However, consent is only one potential lawful basis for processing information. We may not need to seek your explicit consent for every instance of processing and sharing your information, please refer to our privacy notice on the website and in the surgery which provide further information on our legal basis.

We may share your information for direct care purposes - this is when information is used for healthcare and medical purposes. e.g. directly contributing to your treatment, diagnosis, referral and care and this will require appointment bookings and inputting test results etc.

Some of the organisations involved in your care may include:

• Out of hours services / Ambulance services / NHS hospital trusts/ Social Services / Community Support Services, e.g. health visitors, district nurses etc.

With your consent, we may also share your information with other organisations for example Local authorities (councils)

We may also use your personal information when required to by the law (for example following a court order to release documentation) and, in exceptional circumstances, where the use of your personal information is justified in the public interest. For example, when assisting the police with the investigation of a serious crime, or if there are concerns regarding child protection, it may be necessary for us to share your personal information with external agencies. For other uses of your personal information we will either directly ask for your consent or use data that does not identify you.

What does GDPR mean for you?

The GDPR highlights key points about processing personal data for staff or patients:

·      Data must be processed lawfully, fairly and transparently

·      It must be collected for a specific, explicit and legitimate purposes

·      Data must be held securely

·      It can only be retained for as long as is necessary for the reasons it was collected

·      It must be limited to what is necessary for the purposes for which it is processed

·      Information must be accurate and kept up to date

Your Rights

·      Being informed about how your data is used

·      Access your own data

·      Can ask to have incorrect information changed

·      Restrict how your data is used

·      Move your t data from one health organisation to another

·      The right to object to patient information being processed (in certain circumstances)

Why do we collect information about you?

 Health professionals caring for you keep records about your health together with any treatment and care you receive from the NHS in order to ensure that you receive quality care. By registering with the practice, your existing records will be transferred to us from your previous practice so that we can keep them up to date while you are our patient. We take great care to ensure that your information is kept securely, that it is that it is up to date, accurate and used appropriately. All our staff are trained to understand their legal and professional obligations to protect your information and only look at your information if they need to.

How are your records used?

Your care records are used to guide health professionals involved in the care you receive to:

• Assess your health and decide the most appropriate care and treatment for you to review and improve the quality of care you receive.

Ensure appropriate information is available if you need to see another doctor, or be referred to a specialist or another part of the NHS

• Investigate your concerns if you have a query, concern or a complaint.

We may also use your information to:

 • Provide evidence of treatment given, so that the correct payments are made to the practice

• To prevent further ill health or worsening of current conditions by using ‘risk stratification’ tools and will be done by our commissioners using pseudonymised records. For example to use the tool to identify which patients are at high risk of heart attack. We will contact those patients at risk to ensure correct treatment is given to help prevent them from having a heart attack.

Some other examples for the use of pseudonymised information can be used without you being identified. Some examples include:

• Health research and development / Teaching and personal development (particularly for doctors and nurses) /Commissioning/contract monitoring / Staff and patient surveys

Access to medical records

Personal Medical Records:

If you wish to access your medical records, please contact the Medical Centre to register to patient access online or contact the surgery to obtain a copy of the medical records.

Medical Records of Deceased Patients:

If you are a carer, guardian or a family member that is requesting to view medical records of a deceased patient , please contact Primary Care support England on 03330142884 to put a request for viewing medical records.

How to complain

In the event that you feel your GP Practice has not complied with the current data protection legislation, please raise your concerns in the first instance in writing to the Practice Manager at the address below.

If you remain dissatisfied with our response you can contact the Information Commissioner’s Office full details could be found at www.ico.gov.uk

General Privacy Notice

Privacy Notice - Provision of Direct Care