Details of the contract published last week by NHS England say that £20m in funding to support practices with subject access requests (SARs) for patient records will stop in 2022 because 'the digitalisation of Lloyd George paper records [will be] completed' by that time.
SARs will become unnecessary, the document suggests, because patients will then 'have access to these full digital records'.
A BMA spokesperson told GPonline that negotiators were still 'discussing the details' of how the digitisation process would work.
But Hampshire GP Dr Neil Bhatia - whose practice has already digitised its Lloyd George notes as part of a vanguard programme - said the process will be a ‘huge job’ for primary care staff.
Dr Bhatia’s practice - the Oakley Health Group in Yateley - used an external company to scan notes into a PDF file for each patient. Practices are then expected to upload the PDF documents to their electronic patient records system ‘one by one’ - a process that takes ‘maybe a few minutes’ per file.
This process alone could generate hundreds of hours of work for an average-sized practice with 8,500 patients - five minutes per patient would mean 708 hours of work - more than 90 full working days. Across around 7,000 practices in England, this would add up to around 5m hours' work.
Dr Bhatia, who is the records access lead and data protection officer at his practice, told GPonline that his practice IT system - one of the most widely used in England - was unable to link records to PDF documents 'en-masse'.
'It has to be done individually,' he said. 'We’re stuck in a limbo at the moment where we have the Lloyd George notes available (on PDF) but they’re difficult to access and can’t be accessed immediately.’
Under GDPR rules, a staff member must also check patient records to to ensure that all third party information is redacted before making it available online - resulting in additional workload for practices.
‘[The companies] don’t redact information when they scan [the Lloyd George file] - they just scan it,’ Dr Bhatia said. ‘If you’re going to make [the file] electronically available and smack in the middle of the file is a page that you need to redact - none of us have access to software that could do that easily. So every time we get a request for this we have to look through as quickly but as thoroughly as possible. There are going to be real issues later on when it comes to that.’
It’s not just practices that face an increase in workload as a result of going paperless, according to Dr Bhatia. He warned that IT systems suppliers' databases would 'almost quadruple in terms of size’.
'They’re going to have to make contingencies for this,' he said. 'You’re talking NASA-type storage for the entire country and I don’t know [if they] have got the capacity to do that.’
The BMA said it would demand funding to support GP practices with any workload involved in going paperless.
A BMA spokesperson said: ‘We have agreed the policy intention but are still discussing the details on how this will be implemented. There are a number of ways of digitising records that we have been made aware of already, through practices doing it themselves. Some have received funding from their CCG to employ someone on a fixed term contract to digitise records. Some have received funding to outsource the digitisation altogether.
‘We do not expect practices to have to pay for this themselves – as with other IT and software, it is CCGs’ responsibility to provide the resource to practices free of charge.’
Dr Bhatia added: ‘I think it’s great and it has to be done but practices can’t do it themselves. It has to be done commercially and I’ve no idea about costs. It will save some GPs time some day but there’s no easy way of reducing the burden on practices.'
All practices in England are expected to start offering 'digital-first' primary care - which includes online access to health records, prescription ordering and video consultations - from 2020.