Lloyd George (LG) envelopes, and the paper records they contain, were first used in 1911 but are no longer issued.  Some envelopes are, however, still in use today.

Paper records can still form an important record of a patient’s broader, detailed, medical history.  It is essential these records are stored and are available if they are needed. Physical records, however, take up vital space in organisations and can take hours of practice time to sort through.

Paper records may follow patients around when they change GP practice, a process managed by Primary Care Support England.

Paper patient record digitisation involves scanning of all hard copy patient notes, according to local policy and to a national data scanning standard.  These can then be transferred into the National Document Repository (NDR). This process may be funded by the practice or the local integrated care board (ICB). 

Scanning suppliers work with practices to scan their Lloyd George records and upload them to the NDR via secure file transfer protocol (SFTP). 

You can find information about the scanning standard and approved scanning suppliers on the FutureNHS Digital Primary Care workspace (you will need a FutureNHS account to access these specifications):  

Challenges to digitisation

The challenges associated with digitising Lloyd George records include:

• lack of interoperability | most electronic record systems are not currently fully interoperable and do not fully support data sharing, although work is ongoing to resolve this
• technical glitches | technical issues can cripple a medical facility reliant on online records, and all clinicians are heavily reliant on a patient’s medical history to manage consultations, make accurate diagnoses and provide treatment, so power outages and internet or network crashes can mean limited, immediately necessary, treatment only 
• cyber security | cloud storage solutions can be at greater risk of hacking, and the greatest disadvantage to fully digitised health records is the vulnerability to ransomware, and other data security breaches – although the loss of digitised LG records is less significant than the loss of full records

Practices should ensure all staff complete the Data Security Awareness training, available through eLearning for healthcare, annually and have measures in place to report suspicious emails and monitor internet usage and access.  

• violation of privacy laws | practices need to be aware of the privacy policies and data protection laws surrounding all health records and ensure that staff have access appropriate to their roles, enabled

Related GPG content

• GP2GP – transferred in records – processing
• GP contract
• Interoperability
• Shared care records
• Cyber security
• Redaction
• Smartcards and access control (RBAC)
• NHS Care Identity Service 2 (CIS2)
• Information governance and data protection

Other helpful resources

• PCSE, Missing or incomplete records

• NHS England, GP2GP record transfer