What do the DH's online patient access plans mean for GPs?

The DH is pressing ahead with plans for practices to provide online access to patient records by 2015 despite an RCGP review that found 'little evidence to support its benefits'.

By 2015 health secretary Jeremy Hunt wants all practices in England to let patients book and cancel appointments, order repeat prescriptions and communicate with their practice online, as well as offering online access to records and test results.

BMA leaders have called for the deadline to be scrapped, warning the plans create more work for practices that are already stretched to breaking point.

But the DH has insisted that 'thoughtful and phased introduction of electronic services provides benefits not only for patients but for GP practices themselves'. Health secretary Jeremy Hunt has said the plans are 'about reducing the workload of GPs', not increasing it.

An RCGP report commissioned by the DH, Patient Online: The Road Map, found 'no immediate major benefit to be gained from online access to records'.

But it adds that there is also no evidence of 'significant harm' and highlights the potential for online access to improve the patient/doctor relationship.

'Transactional services', such as booking appointments and ordering repeat prescriptions, have the 'greatest potential for providing benefits for patients and efficiency gains for healthcare providers', the report says.

The RCGP report draws lines in the sand on a series of issues previously highlighted by the GPC as concerns. It rules out universally allowing patients retrospective access to their records.

The Medical Defence Union warns in the report that from a medico-legal viewpoint, 'we do not think it would be possible for GPs to undertake the necessary level of scrutiny on all past records'.

The RCGP report also rules out allowing patients to edit their own records, but suggests that they could require practices to make changes to record entries on their behalf.

The report also makes clear GPs will have to write future notes in a lay-friendly form so patients can understand them, without reducing their quality.

GPC negotiator Dr Chaand Nagpaul called for more work to assess the impact of the changes. 'The roadmap highlights many complex issues around patient access. We don't have evidence that there is huge public demand for this.'

He added: 'Altering the way the record is written could have an impact on quality and create additional workload. This initiative should be put into context with other priorities.'

GP advocates of online access, such as south-east London GP Dr Brian Fisher, believe it could increase capacity in primary care.

Dr Fisher, patient and public involvement lead for the NHS Alliance, said: 'We have done research in two practices that shows 30% of patients who had online access to their records, at least twice a year, saved 11% of appointments and hundreds of telephone calls.'

About 75% of English practices have the technology to provide electronic access to medical records. But less than 1% of practices do so, the RCGP said. About 98% can let patients book and cancel appointments online but only 37% do so.

The DH has confirmed that there will be no penalties for practices that fail to meet the 2015 target.

Bedfordshire GP Dr Mary Hawking, a member of the British Computer Society's primary healthcare specialist group, said many practices will not even try to hit the deadline.

'The technology is not the problem,' she said. 'How are you going to persuade practices to put this as a number one priority when income and resources are being cut?'

Expert view - How can practices benefit from patient online access?

Dr Imran Rafi, RCGP lead on Patient Online programme

'Transactional services such as online booking and cancelling of appointments, the provision of online access to test results - initially seen by the practice - should help reduce the administrative burden on practices.

'In the broader sense, online access may provide practices with an opportunity to support or educate targeted groups of patients and to work with patients around care planning. There is the potential to empower the patient, particularly when offering access to the record.

'Online booking offers an alternative for some patients in the way they interact with their practice. Some patient groups with specific communication needs may benefit from information being presented in an electronic format.

'Between now and 2015, there is a real need for training and education for practices and patients in terms of considering the implications of online access, but we hope that the practical steps outlined in the road map will help.'

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