BRAVE NEW WORLD!
Hello brave readers, and welcome to my
first ever ‘blog’! This is an attempt to inform, engage, delight and
frustrate (bore) anyone else who has an interest in seeking, or granting,
patients a real time electronic view of their own GP medical record. I will be
doing this by recording each step of the way, sharing the joy, pain and
experience + a number of irrelevant pictures.
But to avoid being rude some introductions
are needed.
My name is Peter Short and I am a General
Practitioner in Buxton, Derbyshire. This has been my base for nearly 23 years
as a family practitioner performing the usual mix of doctoring functions to the
best of my ability. My practice is one of three in our town, and serves 9,000
patients in addition to supporting local Community Hospitals. (I have no need
to advertise – they are all ‘good’ practices!)
In addition for more than three years I
have been giving clinical advice to NHS Connecting for Health, as a working GP
with experience of the joys and challenges of transferring to a world of
electronic records. To be very clear, this ‘blog’ is not an attempt to spread
policy from any particular organisation, but rather a personal open exploration
of what ‘access’ entails and might achieve.
So why am I embarking on the challenge of
giving ‘Records Access’ to my patients now, and reporting on the process as I
go along? Well there are a number of reasons I can clearly identify, but also
some doubts I need to resolve for myself by going through the process. The
current political aspiration is to ‘put the patient in control of the Health
Service’, and to anticipate that they will ‘hold the NHS to account’. As a
clinician with plenty of face-to-face contact each week with live and very interactive
patients, I feel they already hold me closely to account! They can get a copy
of the full electronic GP record already under the Data Protection Act, but it
takes time and there is a cost. I cannot remember the last time one was
requested, but I have provided paper and electronic records to people moving
abroad or working away for long periods.
For me, and my practice, the key reason for
giving access is not patient demand, policy pressure, financial inducements or
commissioning necessity. It is instead an exploration of how sharing the
patients own record with them can further enhance mutual trust, improve the knowledge
and care experience for all parties, and perhaps more fully involve the
willing, enthusiastic patients in their own care planning and delivery. Nothing
if not ambitious! To work this new development must benefit the patient and the
practice – and hopefully the NHS.
I am well aware that some highly enthusiastic
practices have had active patients sharing records for years, but have doubts
about what we can do without the same level of commitment. Some of our doubts
have been reduced by publications such as the Royal College of GPs ‘Electronic Records Access’ guidance – but
there is nothing like doing it yourself to check that theory CAN be translated
into real life.
We are starting from a position of
confidence that ‘on-line’ access to GP records in a secure way is possible, and
building on cautious implementation of appointment booking and repeat
medication ordering.
Looking back on these changes we can
reflect how nervous we felt in 2007 that appointments would be ‘consumed’
on-line leaving no day-to-day flexibility, and that medication requesting would
be haphazard and hard to control. In fact nothing of the sort happened, and
usage of these functions grows year on year – seemingly very popular with our
patients without the anticipated feeling of ‘loosing control’. Reviewing our
activity is seems to nearly double each year – so we must be doing something
right! We are also able to see that the bulk of use is during the day, when the
surgery is open – so we are confident we are saving receptionist time. There is
also significant activity in the evening when we are closed, and during the
first 4 years over 1,400 appointments were cancelled on-line, equating to a
minimum of 234 hours of doctor/nurse time saved.
So where am I starting?
Re-reading the ‘Electronic Records Access’
guidance, involving my practice and patient participation group, then
activating the software on ‘dummy’ patients. I also want to target my patients
to see what they think about the idea before they start, and later the reality
of access to records. Is it easy or worthwhile, do they have confidence in the
security and in the aims of the practice, and does it make a positive
difference to their lives and healthcare? I will have to think of the most
useful questions. Do you have any suggestions?
Next time I will have to put down my plans
and expectations, and perhaps later point you to other sites where GP surgeries
have done this well for years!
See you soon, and feel free to post
comments,questions and suggestions.
Peter Short
