Learning from early adopter sites

General practices were given the opportunity to become early adopters, and to grant prospective online access to their patients ahead of the planned national switch-on.

The 16 early adopter sites have worked with the programme team to share key learning, lessons and the benefits of GP-held record access. Information and feedback has been collected through various routes such as primary care system supplier data submissions, practice surveys, interviews and a survey collecting feedback directly from patients.

These sites encompass a variety of patient demographics in order to collate data and learning from as wide a representation of the population as possible. They include representation from 6 of the 7 regions across England, including areas with populations of high deprivation, longstanding health conditions, elderly and mixed ethnicity.

You can access this learning by downloading the Accelerated patient access to GP records - Blueprint. This is available by signing into our dedicated FutureNHS pages. 

The following sections summarise the key findings from the early adopter sites.

All early adopter sites had similar approaches to implementing patient access at their practices.

Their feedback included:

• encouraging advocacy by identifying practice staff who could be champions to drive and support this change
• raising awareness and involvement through regular communications and engagement sessions with all staff 
• developing new processes and policies at the practice
• providing training to all relevant staff groups on redaction and patient data management
• restricting access for patients who were identified as having a potential ongoing risk of serious harm from having access to their health information, or where they were unable to keep online access to their records secure

See the GP practice readiness checklist for a range of resources to support you and your practice in taking similar steps to prepare for this change.

Early adopter sites had varying levels of concerns prior to the switch-on of prospective access at their practice.

These included:

• understanding what is involved in this change - a common misconception is that switch-on involves historic access
• how patients will react to this change - a common fear is that an increase in patient activity will cause disruption. Patient queries have been far lower than anticipated across early adopter sites
• how records need to be managed differently - here is some unease and uncertainty around identifiable information for staff being made available and handling third party information and data from other practices

Their concerns were mitigated by:

• establishing a positive approach internally and extending this to patients
• promoting the benefits of patient access to GP records to the practice staff and patients
• forming a multi-disciplinary workgroup that involves all staff groups
• appointing staff ambassadors to kickstart momentum and provide reassurance
• establishing a clear process for handling patient queries
• ensuring clear policies are in place and communicated to staff on what should go into a record and what information should be made invisible to the viewer

Early adopter sites were asked to describe how this change had impacted their practice and way of working. The following sets out some of the findings.

Consultation notes

Several of the early adopters noted that their clinicians were already recording information in a way that was suitable for a patient to view. Details of the ways in which the recording of information has improved include more concise, factual notes, favouring plain language rather than the use of acronyms. 

The early adopters consistently advised that the quality of note-taking should be stressed with high importance during inductions with all new starters. Watch the film on conducting and documenting consultations that empower patients when they access their records.

Amending patient's records

Early adopter sites have not reported a notable increase in requests from patients for their record to be amended. Sites advised that it was a clinician who reviewed requests of this nature and made a decision on whether it was appropriate to change the patients record, or whether the entry in question was factually correct and therefore should not be changed. One practice stated that their Patient Liaison Officer was responsible for this process.

It is important that GP practices have processes in place to manage requests to amend or change a patient’s record. National guidance on amending patient and service user records.

Workload impact

Most early adopter sites reported that, when switching on prospective access for their patients, they did not see a noticeable increase in workload. Some practices advised that they had perceived it to have reduced their workload, due to fewer subject access requests (SARs) from patients, fewer calls from patients requesting test results and a reduced administrative burden on GP and reception staff resulting from the removal of requests for access.

One practice attributed a slight increase in workload to clinicians spending more time reviewing records for accuracy and any required redactions. However, this was recognised as a positive as it was anticipated to lead to improved data quality. Allowing patients to identify and correct inaccuracies in their record can improve clinical safety, as well as empowering patients to play an active role in their care.

Most early adopter sites have reported very minimal queries following this change. Feedback from staff within our early adopter sites includes: 

"We have next to no subject access requests as our patients already have access to their records."

"Our receptionists can be doing other work instead of answering calls about test results."

"Potentially one third of calls have now been prevented. The time spent on the phone is also a lot less."

Early adopter sites were asked to report immediately any clinical safety incidents or near misses, lessons learned, risks, issues and concerns.

Additionally, practices were given the opportunity to raise any issues during regular catch-up sessions with the early adopter team.

Clinical incidents have not been widely reported, in line with the wider theme of patients querying information in their record being much lower than expected.

Instances of patients highlighting errors that have led to clinical incidents being perceived as positives for the practice and a chance for learning to be shared with all staff as part of their continuous awareness training on managing record access.

Visit Learn from patient safety events, which is a central service for the recording and analysis of patient safety events that occur in healthcare.

Some early adopter sites highlighted how they have welcomed patients in playing an active role in their care.

One practice highlighted that a noticeable area of queries was in relation to patients wanting to understand the reasoning behind the frailty scores they had been given due to the use of the word ‘frailty’, which may initially come as a surprise to an individual who deems themselves to be healthy. 

Once the practice explained the reasoning behind the information, the patients understood the definition and terminology behind the codes used in their health records. 

Feedback has included:

"The patient's record should ultimately belong to the individual, and if they wish to discuss something that they believe is incorrect they should be able to."

"Patients like to see what has been written about them. This increased level of transparency can help humanise clinicians and reassures patients that they have genuinely been listened to."

The key benefits observed to date by early adopter sites include the following:

A reduction in requests for test results from patients

One of the most significant benefits for early adopters has been patients do not need to contact reception in order to get their test results. Whilst early adopters have not been able to provide a precise figure as to the fall in calls under certain categories, one practice has estimated that, potentially, one third of calls have been prevented. 

A reduction in time on the phone with patients

Early adopters noted that the duration of calls has now reduced because queries can be more easily resolved by directing patients to look at their online record. 

A reduction of requests to set up patient online accounts

Another time-saving measure reported by several early adopters has been the removal of the need to process the setup of patient’s online accounts to be linked to their practice record, as this will now be done automatically following the switch-on. 

Reduction in subject access requests (SARs)

It has been noted that requests for SARs have largely reduced as the information previously being requested is now mostly available. As more information is added to patients’ records. 

Cutting out tasks that the patient can now complete 

Some early adopters have highlighted that patient can now access information for insurance forms or to share with a third party, meaning that the practice no longer has to print off documents or spend time processing this task. 

It has been observed that the practices who have reported the most positive impact are the ones who have actively taken steps to maximise the benefits and promote and increase awareness of online access to their patients. 

This includes:

• following a consultation, where applicable, the clinician will advise the patient to check their online account for an awaited test result, rather than calling reception and waiting to get through
• when patients call reception teams to request test results or other information available in their record, they are first directed to find this information via their online account if they would prefer
• introducing a ‘did you know’ campaign to promote online access and welcoming patients who have questions about their access or NHS app account to contact the practice

"Patients were ringing up regarding their blood results. Our receptionists’ first response is ‘you’ve got patient access, you can see this yourself now and if you want to discuss further our doctors are there if you need to.’ It was always positive from everyone as the practice got everyone involved. The amount that it’s changed and helped every part of our staff and team... I can’t imagine it ever not being there now."

"We plan to encourage clinicians to suggest checking online access for test results with patients, rather than calling the practice."

Five early adopter sites distributed a link to a questionnaire to their patients via text message to capture their experience of accessing their medical records, 712 responses were received in total.

The key findings from the patient survey is set out below.

How are patients accessing their record?

• 60% of patients confirmed they access their GP health record via a health services app
• 17% were not sure, suggesting that there is still an opportunity to increase awareness and for practices to promote the change to their patients in order to maximise benefits
• 73% of patients state that they view their record via an app on a mobile device

Use of the NHS App

• 70% of patients stated that they use the NHS App in some capacity 
• 66% said they used the NHS App to access their GP health record. This suggests that the NHS App will be strongly associated with automatic prospective access by patients

How are patients using their record?

• Patients are more likely to review events that have already taken place rather than proactively prepare for upcoming consultations
• The most common uses of record access include viewing prescribed medicines, reviewing test results, viewing vaccination status and reviewing information after a consultation
• Patients are most likely to review their record on a monthly basis

Positive themes and benefits to patients

When asked to highlight positive aspects of using their health record 53% of comments received related to accessibility, noting that their record was quick and easy to access.

44% of comments received related to insight. This was predominantly in the form of being able to monitor and review the information already recorded about them, such as: 

• reviewing consultation notes as a reminder of outcomes
• keeping track of ongoing investigations
• checking dates of future appointments and the scheduling of a care plan
• reviewing information to make sure it is recorded correctly

Patient concerns

Four main themes were identified after patients were asked to identify any negative aspects of accessing their GP health record, 88 patients responded to this question:

• 34% of these patients felt there was not enough information
• 25% noted data security concerns
• 18% advised it was difficult to access 

Patients may expect information such as historic data to be included in their record access, so it is important for practices to be clear what will be made available to minimise negativity and queries from patients

Identifying errors

• Patients were asked ‘do you consider the data shown in your GP health records to be up-to-date and accurate’, to which they were overwhelmingly either neutral or positive
• Only 8% of patients either disagreed or strongly disagreed with the statement
• 10% confirmed they identified an error and 2% had informed their practice about this

Early adopter sites used a variety of different approaches to excluding people who should not have access to their records due to a risk of serious harm to themselves or others.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group, Named Safeguarding GPs have developed some supporting guidance, these have been shared below as good practice.

It should be noted that the below code lists and processes are a mitigation and rely on patient records being coded to show they may lack capacity or have safeguarding concerns correctly within the record, before these tools are used by practices.

Practices were provided with a SNOMED code, to be added to an individual patient's record in order to prevent them from automatically being able to see new entries. The SNOMED code can be applied to patient’s identified with the code lists, or on an individual basis. Some practices chose not to proactively apply the code to at risk groups, and instead had robust processes to identify and review record settings as new information was being entered.

For more information on safeguarding see Safeguarding concerns and patient record access.