Online access to GP records: realising opportunities and overcoming challenges

More than 600 practices have now switched-on access to new GP record entries, which is great news for 2.3 million extra patients who have this improved access through online accounts such as the NHS App.

These patients can now read new entries, including free text, in their health record and are benefitting from an increased ability to manage their own health. It will also benefit practices by enabling patients to better prepare for appointments and reducing the need for patients to contact surgeries to get test results and referral notifications.

As a GP and clinical safety officer for the Accelerating Citizen Access to GP Records Programme, I am very supportive of enabling people greater access to their health record information.

At my practice in Chingford, we have been offering access to coded information on request – both for historical and new records – for quite some time and I see the benefits this brings. For example, patients with long term conditions, such as diabetes, can see their results in advance of a consultation and potentially have a more meaningful and focused consultation. Enabling patients to view free text and hospital letters has the potential to extend these benefits further.

Record access is well established in a number of countries around the world. Sweden was one of the first countries to launch record access in one of its 21 regions back in 2012 and it has since spread throughout the country. Its national patient portal provides Swedish patients with online services including appointment booking, prescription renewals, and full online access to electronic health records from both primary and secondary care, including free text notes and lab results. It is so successful that every month around 1.85 million people use the online health record, with over six million logins.

I understand why some colleagues may have concerns that these changes closer to home pose a risk for a small number of patients. Safeguarding considerations are always at the forefront of GPs’ minds – it is something we think about every time we see a patient, so GP colleagues may want to adopt a cautious approach when it comes to routinely giving most patients access to help protect these patients at serious risk of harm.

One argument for switching on access for all patients at once is that these at-risk patients may have other significant safeguarding challenges, which means they would already be known to general practice, or be identified as new information is added to their record.

Whilst record access is safe for the vast majority of patients, we must ensure processes and training are in place so that people who may be at risk of harm are identified, and their online access reviewed.

Workload is another issue I have heard raised. Whilst some practice staff are concerned that record access will result in an increase in workload from additional queries, this was not seen in our early adopter sites.

Teams that have embraced and integrated the change into the way they work say the impact on staff has been minimal: Some have advised that they perceive it to have actually reduced their workload (including one practice that estimates potentially one third of calls have been prevented) and that it has encouraged those patients without any online access to register. Others have described their experience as ‘very smooth’ and with ‘minimal’ risk.

You can read more about these and other key benefits for practice staff, together with feedback from patients about their experience of accessing their medical records, on the NHS Digital website.

Whilst some may promote a more gradual approach to implementing these changes to mitigate the safeguarding risks or workload concerns, we can take comfort from experiences of our early adopter sites and from across the globe.

Sixteen early adopter sites have been offering prospective record access since early 2022 and in general they have found the process to be smooth, without impacting workload or raising safeguarding issues.

They all took slightly different approaches with regards to preparations and specifically for excluding people who should not have access to their records due to a risk of serious harm to themselves or others.

More than 70 per cent of general practices have already accessed our support as part of their preparations, including webinars, an updated toolkit developed with the Royal College of General Practitioners , a practice readiness checklist and information governance guidance. There are insights and assets from early adopter sites with searches to include identification and review of patients potentially at greater risk from automatic record access.

We will continue to make available further webinar sessions and guidance in the coming weeks. Practices will continue to be supported in providing record access, safely and effectively, as it is rolled out throughout the country for the benefit of patients and clinicians alike.

Dr Phil Koczan

Dr Koczan has been a GP in Chingford North East London for nearly 30 years. He is a fellow of the Royal College of General Practitioners and a member of their Health Informatics Group. He is also a founding fellow of the Faculty of Clinical Informatics.

He has a long interest in medical informatics and has roles supporting shared records, digital primary care and clinical safety at both London and national levels.

His particular interest is around both the application of technology to support care and bringing data together from different care settings to support direct patient care and quality improvement.