The General Medical Services (GMS) GP Contract requires practices to use the GP2GP facility for the transfer of patient records between practices.
“The Contractor must use the facility known as ‘GP2GP’ for the safe and effective transfer of any patient records: (a) in a case where a new patient registers with the Contractor’s practice, to the Contractor’s practice from the practice of another provider of primary medical services (if any) with which the patient was previously registered”.
16.3.1. General Medical Services Contract – November 2022
GP2GP allows patients’ structured and coded electronic health records (EHRs) to be transferred directly, securely, and quickly between their old and new practices when they change GPs. This improves patient care by making full and detailed medical records available to practices for new patients’ consultations.
GP2GP was introduced via the GP contract as a requirement in 2007 and currently transfers over 100,000 electronic patient records per month between GP practices in England. If a patient’s registration moves between 2 GPs at the same practice (unusual but can happen) then there is no GP2GP transfer, but any move between GP practices triggers a GP2GP transfer.
TPP provides a way of transferring a patient record between two SystmOne practices using the patient’s single record. When a patient registers with the new practice, after locating them on the PDS, their record is viewable by the new site.
Benefits of GP2GP
GP2GP delivers patient safety and administrative benefits.
Patient safety benefits include:
- having the complete electronic health record available for a patient’s first and subsequent consultations
- having fewer transcribing errors and omissions – with the reduction of manual input from paper records, the need to key in information from paper records is greatly reduced
- safer prescribing through access to the patient’s current and past medication and to any recorded allergies or adverse drug reactions
- having repeat medication details available for the patient’s first medication review with the new GP
- improved continuity of patient care between sending and receiving GP practices
GP2GP provides for greater efficiencies, leading to reduction in administration time and costs. It also allows the NHS to preserve the usability of data accumulated in patient records. It provides for
- reductions in staff time summarising EHRs for the receiving practice
- reductions in printing costs and the requirement to print for the outgoing practice – less printing saves practice administration time and printing costs
Note: practices should integrate the received electronic health record promptly within the 8-day permitted window. If not integrated, the previous practice will automatically be notified at the end of day 8 that the file has not been integrated and that a paper copy of the electronic record should be printed to send with the paper record (Lloyd George envelope) to the new practice.
- reductions in administrative time and costs for the receiving practices with the removal of the need to scan and store the incoming patient records
- improvements from the messaging itself – for example, understanding the management information and how that improves the patient transfer and error messages helping practices ensure ease of processing
How does it work?
GP2GP has undergone a number of technical developments since its first introduction in 2007. Initial versions of GP2GP had limitations, caused in part by the use of different clinical systems, when it came to patient record size, number of attachments and permitted file types.
As the GP2GP record transfer programme has developed, these problems have been addressed and the current version, version 2.2, introduced in 2015, increases the number of digital patient record transfers from an old GP practice to a new one, and brings common sense improvements like reducing paper printing for patients that leave.
The three-stage process
GP2GP starts when a practice accepts a patient onto its list and ends when the electronic health record (EHR) is transferred from the previous practice into the new GP’s clinical system. The patient’s new and old GP practices currently both need to be in England and each to be live with GP2GP.
Stage 1 | The first stage is to register the new patient on the clinical system and perform a Personal Demographics Service (PDS) search, to see if the patient has an entry on the NHS SPINE. A successful search and match will trigger the request for their electronic health record to be sent.
Stage 2 | The second stage, sending, is automated and usually takes no more than a couple of minutes.
Stage 3 | Once the record is received, the third stage is to integrate or file the record into the clinical system. This makes it available for use within the practice. If the record isn’t integrated the sending practice is informed that they need to print copies of the record and attachments before they send the Lloyd George envelope to the new practice.
Integration should be performed promptly, whilst degrades (see section below) and medication authorisation can be completed later by summarisers or clinicians. It is important the receiving practice integrates the record within three calendar days, because at the end of day eight, GP2GP assumes the record won’t be integrated.
Hints and tips
The following guidelines help to ensure that a smooth and error free transfer of the record is achieved:
- Ensure that the staff member registering the patient accesses the clinical system via a Smartcard with the relevant role-based access control (RBAC) permissions. This will enable them to perform cross-organisation searches using PDS to match patients across organisations at registration.
- GP2GP relies upon a successful PDS trace at the point of registration, so practice staff need to ensure the correct patient is selected with the recommendation that the patient is present during the registration process.
- Having the patient present for the search can make for more effective use of the registration form and help to cross-check any source data using the PDS trace service.
- Follow up any patient deduction requests (i.e. requests for a patient to be removed from the list for some reason, e.g. abusive behaviour) with letters. The letter sent to a patient should explain the reason for the patient having been removed from the list and that they will need to register with a new GP as soon as possible.
- Ensure the incoming GP2GP record tasks are filed within the required 8-day service level agreement (SLA) period.
The GP registrations data platform can be used to view integration times for practices receiving GP2GP transfers. The platform provides monthly data about the number of transfers your practice has received, how many were integrated within 3 days, 8 days, and those that were not integrated within 8 days.
This information can be used to keep track of integrations and identify areas to investigate further. Transfers that are not integrated within 8 days trigger the paper process, so avoiding this will help reduce the administrative burden both on your practice and the previous practice.
Key roles and responsibilities
Each stage of the record transfer process needs to be managed effectively by the GP practice, including ensuring that cover is in place for leave, sickness and staff changes. The following are typical roles and responsibilities:
- obtain and check that new patient information is complete and correct
- register new patients on to the clinical system using a smartcard and to make sure that a PDS match is completed
- regularly monitor and manage tasks, to check and log any errors in the GP2GP inbox/folders/workflow
- ensure the prompt integration of the patient’s electronic health record when it arrives by GP2GP
- process degrades (see below) and check the electronic health record received via GP2GP
- summarise the patient’s Lloyd George paper record, when received
- check allergies/adverse reactions
- deal with inbound medications
When registering a patient that has transferred to one practice from another, it is not always possible to accurately translate all the information across. Any information that cannot be understood will become ‘degraded data’ and must be dealt with to ensure an accurate record.
There are a number of reasons for data becoming degraded, including different coding systems having been used in the past. Going forwards, the differences in coding should be addressed by the use of SNOMED-CT.
For each newly registered patient with degraded data the practice will receive a task, which needs to be actioned. Medication cannot be prescribed for patients who have outstanding degraded drug sensitivities or allergies on their record.
Other points of note
GP2GP fully integrates the EHR for returning patients such as students and seasonal workers.
Summary care record
Patient preferences, such as the decision to have a summary care record (SCR) and which data elements are to be included or excluded, are transferred through GP2GP.
Patient facing services
Access settings will be preserved for patient facing services during the record transfer, however patients will still need to verify their account prior to the issuing of new login details.
Further information about patient facing services (patient online services) can be found using the link provided.
Errors rarely happen but on occasion when they do, a clear message is sent within the clinical system detailing the action required.
These do not carry over from previous practices, however external screening schedules do.
At the current time redaction information does not get sent through GP2GP so any parts of the medical record that have been redacted to prevent their appearance in the online view will lose this setting. If continuing to provide online access after registration it is important to be aware that entries that had been redacted in the past may become visible if access to historic data is given.
Related GPG content
- GP connect
- Digitisation of Lloyd George records
- Personal demographic service (PDS)
- Smartcards and access control (RBAC)
- NHS Care Identity Service 2 (CIS2)
- Clinical coding – SNOMED CT
- Summary care records (SCR)
- Migrating records