As the NHS releases a new app for accessing online GP records, what can we learn from early adopters? This long read finds out
CREDIT: This is an edited version of an article that originally appeared on NHS
General practices were given the opportunity to become early adopters of the new app for accessing GP records, and to grant prospective online access to their patients ahead of the planned national switch-on.
Sixteen early adopter sites have worked with the programme team to share key learning, lessons and the benefits of GP-held record access. Information and feedback has been collected through various routes, such as primary care system supplier data submissions, practice surveys, interviews and a survey collecting feedback directly from patients.
These sites encompass a variety of patient demographics in order to collate data and learning from as wide a representation of the population as possible. They include representation from six of the seven regions across England, including areas with populations of high deprivation, longstanding health conditions, elderly and mixed ethnicity.
The following sections summarise the key findings from the early adopter sites.
Implementation
All early adopter sites had similar approaches to implementing patient access at their practices. Their feedback included:
encouraging advocacy by identifying practice staff who could be champions to drive and support this change;
raising awareness and involvement through regular communications and engagement sessions with all staff;
developing new processes and policies at the practice;
providing training to all relevant staff groups on redaction and patient data management;
restricting access for patients who were identified as having a potential ongoing risk of serious harm from having access to their health information, or where they were unable to keep online access to their records secure.
Concerns and mitigations
Early adopter sites had varying levels of concerns prior to the switch-on of prospective access at their practice. These included:
understanding what is involved in this change – a common misconception is that switch-on involves historic access;
how patients will react to this change – a common fear is that an increase in patient activity will cause disruption. Patient queries have been far lower than anticipated across early adopter sites;
how records need to be managed differently – there is some unease and uncertainty around identifiable information relating to staff being made available, and handling third party information and data from other practices.
Their concerns were mitigated by:
establishing a positive approach internally, and extending this to patients;
promoting the benefits of patient access to GP records to both practice staff and patients;
forming a multi-disciplinary workgroup that involves all staff groups;
appointing staff ambassadors to kickstart momentum and provide reassurance;
establishing a clear process for handling patient queries;
ensuring clear policies are in place, and communicated to staff, on what should go into a record and what information should be made invisible to the viewer.
Changes to ways of working
Early adopter sites were asked to describe how this change had impacted their practice and ways of working. Here are some of the findings.
Consultation notes
Several of the early adopters noted that their clinicians were already recording information in a way that was suitable for a patient to view. The ways in which the recording of information has improved include more concise, factual notes, favouring plain language rather than the use of acronyms. The early adopters consistently advised that the quality of note-taking should be stressed with high importance during induction with all new starters.
Amending patient’s records
Early adopter sites have not reported a notable increase in requests from patients for their records to be amended. Sites advised that it was a clinician who reviewed requests of this nature and made a decision on whether it was appropriate to change the patient’s record, or whether the entry in question was factually correct and, therefore, should not be changed. One practice stated that their patient liaison officer was responsible for this process.
It is important that GP practices have processes in place to manage requests to amend or change a patient’s record. There is national guidance on amending patient and service user records.
Workload impact
Most early adopter sites reported that, when switching on prospective access for their patients, they did not see a noticeable increase in workload. Some practices advised that they had perceived it to have reduced their workload, due to fewer subject access requests (SARs) from patients, fewer calls from patients requesting test results, and a reduced administrative burden on GP and reception staff resulting from the removal of requests for access.
One practice attributed a slight increase in workload to clinicians spending more time reviewing records for accuracy and any required redactions; however, this was recognised as a positive as it was anticipated to lead to improved data quality. Allowing patients to identify, and correct, inaccuracies in their records can improve clinical safety, as well as empowering patients to play an active role in their care.
Clinical safety incidents and near misses
Early adopter sites were asked to report immediately any clinical safety incidents or near misses, lessons learned, risks, issues and concerns; practices were given the opportunity to raise any issues during regular catch-up sessions with the early adopter team. Clinical incidents have not been widely reported, which is in line with the wider theme of numbers of patients querying information in their record being much lower than expected.
There are instances of patients highlighting errors which have led to clinical incidents being perceived as positives for the practice – a chance for learning to be shared with all staff as part of their continuous awareness-training on managing record access.
Involving patients in discussions and decision-making
Some early adopter sites highlighted how they have welcomed patients in playing an active role in their care. One practice highlighted that a noticeable area of queries related to patients wanting to understand the reasoning behind the frailty scores they had been given; the use of the word ‘frailty’ may, initially, come as a surprise to an individual who deems themselves to be healthy. Once the practice explained the reasoning behind the information, the patients understood the definition and terminology behind the codes used in their health records.
Benefits to practices
The key benefits observed to date by early adopter sites include the following:
A reduction in requests for test results from patients
One of the most significant benefits for early adopters has been that patients do not need to contact reception in order to get their test results. Whilst early adopters have not been able to provide a precise figure as to the fall in calls under certain categories, one practice has estimated that, potentially, one third of calls have been prevented.
A reduction in time on the ‘phone with patients
Early adopters noted that the duration of calls has now reduced because queries can be more easily resolved by directing patients to look at their online record.
A reduction of requests to set up patient online accounts
Another time-saving measure reported by several early adopters has been the removal of the need to process the setup of patient’s online accounts to be linked to their practice record, as this will now be done automatically following the switch-on.
Reduction in subject access requests
It has been noted that requests for SARs have largely reduced as the information previously being requested is now mostly available.
Cutting out tasks that the patient can now complete
Some early adopters have highlighted that patients can now access information for insurance forms, or to share with a third party, meaning that the practice no longer has to print off documents or spend time processing these tasks.
Maximising benefits to practices
It has been observed that the practices which have reported the most positive impact are the ones which have actively taken steps to maximise the benefits and promote and increase awareness of online access to their patients.
Be the first to comment