Dr Masood Nazir interview: Leading the digital revolution

Wider access to GP records online will benefit GPs and patients, NHS England informatics adviser Dr Masood Nazir tells David Millett.

Online access to records is about 'improving care, increasing choice, increasing convenience and responding to the needs of patients', says GP and IT expert Dr Masood Nazir.

General practice is entering a period of great change, he says, which will see it embracing modern technology to liberate patient records.

While some GPs fear the consequences of forfeiting their role as sole custodian of patient records, Dr Nazir firmly believes innovative technology will cut workloads and transform primary care.

A GP at his South Birmingham practice for the past 11 years, he has a leading role at the local CCG and has worked for nearly two years as clinical informatics adviser for NHS England.

As part of the latter role, he is clinical director for the Patient Online programme, a resource designed to support practices in making the contractually required shift towards a more digital and remotely accessible GP service.

Skills and resources

Dr Nazir accepts this change won't come naturally to all practices. 'Some have already been doing this and may not need support, because they already have the skills and resources to do these things,' he says.

'But some practices might think: I like the idea of this, but I'm not certain how to do it. Rather than having to look for lots of different resources, we've worked with the RCGP to provide simple guidance and support.'

People increasingly expect access to services and the ability to manage their lives online, he says, and the NHS must adapt.

'The NHS has worked in the same way for a long time. We know patients nowadays are regularly accessing other services online, be it their bank, booking holidays, ordering shopping - but they weren't able to access NHS services.'

By 1 April, all GP practices will be required to allow access to summary information to any patient requesting it.

This is the first step in a long process. 'The long-term aim is to offer more access to more information in the coming years,' says Dr Nazir.

Eventually, this will see patients being able to access full records, minus some potentially sensitive data. The 2015/16 GP contract deal says practices will offer access to detailed records by March 2016, but practices will have the 'choice and opportunity' to offer it to interested patients before that date.

Practices will be expected to comb through each individual record before allowing the patient full access, to ensure that no references to third parties or inappropriate information reach patients.

It is 'reasonable' for GPs to decline access if the records contain any sensitive data, says Dr Nazir.

But access to full records can greatly benefit patients, he argues, and some practices already offer this.

'Those practices are in the minority now, but we've seen from them that patients are able to take control of their health when they can access more of their information.'

Allowing full access to records could also free up practice time by removing the need for patients to visit or call to check for test results or whether they are up-to-date on immunisations.

Dr Nazir hopes that greater electronic access will further drive down practice workloads by streamlining consultations.

'The average consultation time has gone up. If patients have the ability to see some of the information in advance, we can have a more focused consultation, because patients know which areas are of concern.

'It will increase choice, increase convenience to patients, and you will find that some do not need appointments.'

But some GPs are sceptical about the benefits and wary of the difficulties that opening up GP records to patients - and by extension, third parties - can bring.

Many have expressed concerns about how the data will be used and exactly who will be able to view and control it once remote, unrestricted access is made available.

For example, such a situation might result in abusers being able to access their victims' records.

Controlling access

But Dr Nazir says practices will 'absolutely' have the power to block or retract record access from a patient, even without their explicit consent, if they think it is in their best interest and to ensure safety.

In this way, GPs can ensure their patients are protected from abusers and others who might attempt to access their records.

'This has raised awareness that we must have resilient, robust processes in place to protect patients,' he says. 'If we feel there is any suggestion a patient is being coerced or may be at risk, then as clinicians, we have to do everything in our power to protect that patient.

'One of those choices might be, in that scenario, for us to say to patients: "Actually, it is in your best interest not to have access to your record."

'Having that conversation with a patient is the best way to do it, but being able to identify those patients is just as important.

'Practices are worried that patients may complain if they say no to them. But if you're doing it with the right intentions and you can justify it, then actually, the practice has nothing to fear,' he says.

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