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