NHS Scotland mailed households explaining its emergency care summary (ECS) and telling patients how to opt out of having their data available for download outside their GP practice.

As a result, 646 patients out of a population of five million (0.01 per cent) have refused consent for data extraction.

But when Wigtown GPs Dr Gordon Baird and Dr Mary Donnelly sent a personal letter to their 1,710 patients explaining the data extraction process and asking the same question, 326 - 19 per cent - withheld consent.

The Wigtown refusal rate is more than 1,500 times higher than in the whole of Scotland.

'We have misgivings about the consent process being adequate,' Dr Baird said.

'This is personal information and it's precious to people. They have a right to refuse and we have a duty to protect that right.

'The high refusal rate may be a rural phenomenon,' he added. 'In a rural area the chance of someone you know treating you and finding out about your medical history is much higher.'

In August 2006, households in Scotland were sent an eight-page booklet on the ECS and told to let their GP surgery know if they did not want data uploaded.

They were told data in the ECS would be used by out-of-hours centres, NHS 24 - Scottish NHS Direct - and A&E staff. In future, ambulance staff might see it.

'The mailshot was very fair but a lot of people told us they did not get the letter,' Dr Baird said.

'Our results question whether government strategies of obtaining consent for the release of such information reflect proper process,' Dr Baird and Dr Donnelly wrote in the June issue of BJGP.

Joint GP clinical lead in England for Connecting for Health Dr Gillian Braunold said she understood the leaflet was sent as 'junk mail'.

GPC chairman Dr Hamish Meldrum said: 'In England we are still in discussions but the intimation is that patients will be given the chance to review what they want to be uploaded.'

He said public confidence in Scotland might have been dented by problems with the Medical Training Application Service.

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