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Sharing your Medical Record

Increasingly, patient medical data is shared e.g. between GP surgeries and District Nursing, in order to give clinicians access to the most up to date information when attending patients.

The systems we operate require that any sharing of medical information is consented to by patients beforehand. Patients must consent to sharing of the data held by a health provider out to other health providers and must also consent to which of the other providers can access their data.

e.g. it may be necessary to share data held in GP practices with district nurses but the local podiatry department would not need to see it to undertake their work. In this case, patients would allow the surgery to share their data, they would allow the district nurses to access it but they would not allow access by the podiatry department. In this way access to patient data is under patients’ control and can be shared on a ‘need to know’ basis.

View your Medical Record

Sharing your NHS Patient Data

Information sharing in the NHS is subject to rigorous regulation and governance to ensure your full identifiable and personal medical data is kept confidential and only ever seen by carefully vetted doctors, nurses and administrative staff responsible for overseeing your care.

With the development of information technology the NHS will increasingly be sharing key information from your GP medical notes with Out of Hours GP Services, Hospital A&E Units, Community Hospitals, Community Nurses all of whom may at various times in your life be looking after you. Sharing information can improve both the quality and safety of care you receive and in some cases can be vital in making life-saving decisions about your treatment.

There are currently two different elements of “sharing NHS patient information”

SCR = The NHS Summary Care Record
Local Shared Care Record

Summary Care Record

The NHS Summary Care Record was introduced many years ago to help deliver better and safer care; it contains basic information about:

Any allergies you may have
Unexpected reactions to medication
Any prescriptions you have recently received

The intention of the SCR is to help clinicians in Hospital A&E Departments, Paramedics and GP ‘Out of Hours’ health services to give you safe, timely and effective treatment. Clinicians are only allowed to access your SCR record if they are authorised to do so and, even then, only if you give your express permission. You will be asked if healthcare staff can look at your Summary Care Records every time they need to, unless it is an emergency, for instance if you are unconscious. You can refuse if you think access is unnecessary.

Over time, health professionals treating you may add details about any health problems and summaries of your care. Every time further information is added to your record, you will be asked if you agree (explicit consent).

Patients under 16 years have an NHS Summary Care Record created for them so if you are the patient or guardian of a child then please either make this information available to them or decide and act on their behalf.

More Information

For further information visit the NHS Care records website or the HSCIC Website

The Devon and Cornwall Care Record

Wallingbrook Health Group is part of a new system that brings together patient data from a number of health and care systems and presents it as a single record.

The Devon and Cornwall Care Record enables frontline staff to see details held by GP practices, hospitals, hospices and other organisations across Devon and Cornwall, giving them a more complete view of a patient’s history.

For instance, imagine that you’ve attended A&E with an injury in the morning and been told to see your GP in the afternoon. Under the new system, the GP will be able to see what happened to you in A&E by the time they see you in the afternoon.

Having access to patients’ overall health and medical history will help health professionals identify problems more effectively and make quicker diagnoses.

They’ll be able to see what medication patients are taking, what they’ve taken in the past and if they have any allergies. As well as making treatment safer, this will provide patients with greater continuity of care.

The improved administration will save healthcare staff time chasing down information and spare patients the frustration of having to repeat themselves to various professionals throughout the system. It will also cut down on duplicate appointments and tests and reduce clinical errors. And, by using their time more efficiently, clinicians will be able to spend longer with patients.

You can find out more about the Devon and Cornwall Care Record at https://www.devonandcornwallcarerecord.nhs.uk/

Local Shared Care Record

Many people think that their GP health record is available to all healthcare professionals involved in their care, but this is not always the case.

At the moment, each professional a patient sees keeps a separate record. This can mean some important information not being communicated between health services as well as it could be. Having a single electronic record with all health information in one place means that care providers can give patients the most safe and efficient care possible. Health information recorded at Wallingbrook Health Group can be shared digitally with other health and care organisations where patients are being treated. Wallingbrook Health Group asks patients if they wish to share their information on an individual patient basis with regard to record sharing.

Sharing IN determines whether or not our GP Practice can view information in your record that has been entered by other NHS services who are providing care for you or who may provide care for you in the future (that you have consented to share out).

Sharing OUT controls whether information recorded at our GP Practice can be shared with other NHS health Care providers.

NHS England » Shared care records

Your Data Matters to the NHS

The NHS wants to make sure you and your family have the best care now and in the future. Your health and adult social care information supports your individual care.

Unless you have chosen to opt out, your confidential patient information can be used for research and planning. You are able to make or change your decision at any time. Your confidential patient information provides numerous benefits. It is used in research to find cures and better treatments for diseases like diabetes and cancer.

Most of the time, we use anonymised data for research and planning. So your confidential patient information isn’t always needed. If you do opt out, data that does not identify you may still be used.

Confidential patient information can also be used to plan health and care services more effectively. The NHS and local authorities can plan where they need to provide further care services more efficiently.

With your data, we are better able to develop and improve health and care services for the future. This helps to improve health and social care for you and your family.

The NHS collects health and care data from all NHS organisations, trust and local authorities. Data is also collected from private organisations, such as private hospitals providing NHS funded care. Research bodies and organisations can request access to this data. Further information can be found here.

There are very strict rules in how your data can and cannot be used, and you have clear data rights. Access to confidential patient information will not be given for marketing purposes or insurance purposes – unless you specifically request this.

Protection of your confidential patient information is taken very seriously and is looked after in accordance with good practice and the law.

Every organisation that provides health and care services will take every step to:

ensure data remains secure
use anonymised data whenever possible
use confidential patient information for marketing or insurance purposes (unless you specifically request this)
make it clear why and how data is being used
respect your decision if you decide to opt out
only use information about you where allowed by law

All NHS organisations must provide information on the type of data they collect and how it is used. Data release registers are published by NHS Digital and Public Health England, showing records of the data they have shared with other organisations.

Manage your choice

Online – Use this service to request that your confidential patient information is not used beyond your own individual care.

Telephone: 0300 303 5678 Open: 9am to 5pm Monday to Friday (excluding bank holidays). – You may contact the NHS Digital Contact Centre to verify your identity and discuss your data sharing choices.

Parents or legal guardians may also set and manage a choice on behalf of their child under the age of 13 years.

You can set and manage a choice on behalf of another individual, who is unable to manage their choice independently. For example, if you have power of attorney.

If you decide to opt out, this will be respected and applied by NHS digital and Public Health England. These organisations collect, process and release health and adult social care data on a national basis. Your decision will also be respected and applied by all other organisations that are responsible for health and care information by March 2020.

An opt-out will only apply to the health and care system in England. This does not apply to your health data where you have accessed health or care services outside of England, such as in Scotland and Wales.

If you choose to opt out, your data may still be used during some specific situations. For example, during an epidemic where there might be a risk to other people’s health.

For more information on where opt outs do not apply click here.

How we Process and Share your Data

The GDPR sets out the key principles about processing personal data, for staff or patients;

Data must be processed lawfully, fairly and transparently
It must be collected for specific, explicit and legitimate purposes
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
Data must be held securely
It can only be retained for as long as is necessary for the reasons it was collected

There are also stronger rights for patients regarding the information that practices hold about them. These include;

Being informed about how their data is used
Patient to have access to their own data
Patients can ask to have incorrect information changed
Restrict how their data is used
Move their patient data from one health organisation to another
The right to object to their patient information being processed (in certain circumstances)

What is GDPR?

GDPR stands for General Data Protection Regulations and is a new piece of legislation that will supersede the Data Protection Act. It will not only apply to the UK and EU; it covers anywhere in the world in which data about EU citizens is processed.

The GDPR is similar to the Data Protection Act (DPA) 1998 (which the practice already complies with), but strengthens many of the DPA’s principles. The main changes are:

Practice 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
The Information Commissioner’s Office must be notified within 72 hours of a data breach
Higher fines for data breaches – up to 20 million euros

What is ‘patient data’?

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

What is consent?

Consent is permission from a patient – an individual’s consent is defined as “any freely given specific and informed indication of his wishes by which the data subject signifies his agreement to personal data relating to him being processed.”

The changes in GDPR mean that we must get explicit permission from patients when using their data. This is to protect your right to privacy, and we ask you to provide consent to do certain things, like contact you or record certain information about you for your clinical records.

Individuals also have the right to withdraw their consent at any time.