Citizen access to records - advice for GP practices

Patients with online accounts will be able to see new entries in their records. We answer your questions on the impact on your practice.

From November 2022, patients in England whose practices use the TPP and EMIS systems, and who have online accounts, will be automatically able to see new entries made in their clinical records. This will also apply to practices using the Cegedim system (previously Vision) in future.

Here, we answer common questions about the changes.

When will patients get access to new entries in their record?

For practices that have asked TPP and EMIS to delay turning on automatic access, the changeover will happen on 30 November, rather than 1 November as initially planned. For other practices, NHS England is working with EMIS and TPP to implement the change as planned, meaning prospective data entered into patient records from 1 November 2022 will automatically become visible in a phased way.

Updated guidance from NHS England explains the steps that practices can take to locally disable the functionality or deny individual patient access, if they feel this is necessary.

Will patients have to ask for access to new entries in their records?

For existing patients already using online access, the change will be made automatically in a phased way. New users set up with online access from the implementation date will have the same level of access by default. Clinicians and other practice staff will, therefore, need to bear in mind that patients will be able to see what is written in new entries. There is more information on the new access arrangement from NHS digital.

What information will patients have access to?

They will have access to new entries in their GP health records including free text, letters and documents, but not administrative tasks or communications between practice staff.

The GP readiness checklist published by NHS England suggests setting up a test patient so that practices can confirm what information patients will see.

Should we amend the amount of information we record in the notes?

Patients have long been able to access their records under data protection legislation, so this amendment should not alter the amount of information you record in the notes. You can read our advice on online access to records.

For those involved in creating the record, think carefully about the purpose and content of the records and the impact they may have on patients reading them. The clinical record needs to contain relevant information to allow safe ongoing care of the patient.

Will patients also have access to historic records?

The aim is that patients will be able to request access to historic records through the NHS app at some point during 2023. However, they will not see past health record information unless they have been given access to it by their GP practice. This will give practices the chance to review records to ensure access is appropriate.

Can online access be withheld?

Yes - where a practice believes that online access would not be appropriate, access can be customised or removed. The updated guidance from NHS England explains the steps practices can take to do this, including the following.

  • Exclude individual patients before the change is made by adding the appropriate SNOMED code to their records. The code can also be applied to groups of at-risk patients by using reports.
  • Hide certain elements from patient view.
  • Disable the record access functionality, by updating organisational settings.
  • Disable access to components of the record that may be of concern - for example, if practices have not yet implemented processes to ensure screening of documents, access to documents can be disabled.

Will patients be able to see test results?

Yes, but these can only be accessed by the patient once they have been checked and filed. This is to allow clinicians an opportunity to contact patients and discuss their results with them first.

Will there be any benefits to the practice?

Yes. It's hoped that it will support patients in managing their own health, and will reduce queries to practices where test results are negative as well as queries about referral letters.

Will access only be available for patients using the NHS app?

No, it will apply to other approved patient-facing services apps - for example, Evergreen, Airmid, SystmOnline and Patient Access.

What about proxy access?

The change does not apply to proxy access. It only applies to competent people accessing their own record through their own online account.

Can information in the notes be redacted (eg, third-party information) in the same way as for a subject access request?

NHS England has published a GP readiness checklist with further information about redacting information in the records.

The RCGP patient online toolkit explains that all GP systems have a method of preventing information in the record being visible via GP online services. Documents containing reference to a third party should therefore be hidden from view, unless you have the consent of the third party.

The RCGP says that as a principle it is helpful to consider 'Ask before release', which means if you're uncertain whether information you are entering in the patient’s record may be something the patient or a third party would prefer not to be visible online, ask them if it should be redacted before a disclosure is made.

What if there's sensitive information in the records, such as child or adult safeguarding concerns?

Safeguarding the patient from harm is paramount. It may be necessary to hide documents from view, like those containing sensitive information or third-party information such as reference to family members or to remove online access. The GP readiness checklist from NHS England has further information about this.

Alongside the RCGP patient online toolkit, we advise practices to establish a record-keeping policy about recording and redacting new entries of potentially harmful and confidential third-party data. Consider doing this even for patients who do not currently have online record access, as they may gain access in the future.

Before online access to historic records is switched on, the RCGP recommends checking all the information the patient will see for potentially harmful information and redact accordingly.

What if patients request their records are amended?

One benefit of patient’s accessing new entries in their records may be that they are able to report any factual inaccuracies and have these corrected. Any corrections will usually need your agreement and it is your responsibility to make sure records are complete and accurate.

If factual corrections are agreed, it should be obvious who made the amendment and when (computerised records usually create an audit trail).

Patients should not be able to alter the content of records, if accurate. If a patient disagrees with the content of their record but the GP considers it to be accurate, a note can be added to highlight the patient's disagreement.

NHS England has advice on this topic. If you're not sure, members can contact us for advice.

This page was correct at publication on 18/11/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Kathryn Leask MDU medico-legal adviser

by Dr Kathryn Leask Medico-legal adviser

BSc (Hons) MBChB (Hons) LLB MA MRCPCH FFFLM MRCPathME DMedEth

Kathryn has been a medico-legal adviser with the MDU since 2007 and is a team leader, trainer and mentor in the medical advisory department. Before joining the MDU, she worked in paediatrics gaining her MRCPCH in 2002 and did her specialty training in clinical genetics. She has an MA in Health Care Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and deputy chief examiner for the faculty. Kathryn is currently a member of the faculty’s training and education subcommittee and a member of the Royal College of Pathologists (medical examiner).