GP online services toolkit
Site: | Royal College of General Practitioners - Online Learning Environment |
Course: | Clinical toolkits |
Book: | GP online services toolkit |
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Date: | Thursday, 5 December 2024, 11:11 AM |
Description
This toolkit helps practices provide GP online services effectively, efficiently, safely and securely.
Introduction
For many patients, online access to their GP’s services is a normal part of their everyday interaction with the NHS. The majority of patients in England use at least one GP Online Service to request prescriptions, book appointments or access their electronic health record. It is part of modern, responsive primary care services for patients, their families and carers. It is convenient and reliable for patients and useful for practices. It can foster a person-centred approach to care, especially for patients with long term conditions or complex multi-morbidity.
The Royal College of General Practitioners (RCGP), in collaboration with NHS England, have developed the guidance and resources in this Toolkit to help practices provide GP online services effectively, efficiently, safely and securely. The Toolkit
includes clinical exemplars which demonstrate how GP online services can empower patients to take greater control of the management of their health conditions. It does not cover online consultations.
The contents of the toolkit
Providing GP online services
The first section of the Toolkit presents guidance on how to organise and provide GP online services and supporting resources that you might find helpful.
Practices in England have been required by their contract to offer online services since 2015 and full prospective record access since 2019 and have well established policies and procedures in place. The majority of people in England have access to their practice’s online services with over 50 million transactions a month.
Nevertheless, this section may be useful to practices seeking to improve their management of online services or to practice team members who are new to GP Online.
Each supplier has interpreted the requirement to provide record access slightly differently. This Toolkit does not replace your IT system supplier’s training materials in explaining exactly how to use your systems for GP online services.
Section: Providing GP online services
Patient registration for GP online services
Patients may register for GP online services without applying to their practice. Several patient facing services (PFS) apps and web portals work with NHS Login, which people can use to prove who they are safely and securely so they can be connected to their NHS records. This enables access to book and cancel appointments, request prescriptions, and access their full prospective record without needing to come into general practice. In rare circumstances, patients may still need to apply to the practice to obtain login credentials so they can have their identify verified to use NHS Login, or to use an app or web portal that does not use NHS Login. They will also need to apply in order to access their historic record or consent to a trusted third-party having proxy access to their GP online services on their behalf.
This section describes how practices should manage applications for GP online services, including the steps to clinically assure the safety of historic records for online access, to verify the identity of applicants before they are given login credentials and ensure that applicants understand how to make best use of their services and how to maintain their privacy by keeping their record access secure before their access is switched on.
- Websites and apps you can use with NHS Login, NHS.uk, – lists apps that patients can use with their NHS Login to access online NHS services.
Section: Patient registration for GP online services
GP online services in clinical care
Improving the care of patients with multimorbidity remains one of the most important challenges facing general practice. It requires a consistent emphasis on collaborative care planning, solution-focused coaching, goal setting and action planning by health professionals taking into consideration the patient’s personal goals and priorities to enable patients to work in partnership with their health professionals. Patients need accessible and trusted information delivered through reliable sources and effective communication with their health professionals. Online access to their health record is an essential part of this.
Online services can also bring benefits for the practice. It can save time when patients use it to book appointments, order repeat prescription and check recent test results and hospital reports. “Did not attend” rates are lower with appointments booked online. Communication is less prone to error and patients can use record access to prepare for consultations, saving time in the consultation and improving patients’ ability to make decisions about their care. Patients can help to improve the accuracy of their record.
Section: GP online services in clinical care
Working with online record access - the challenges
This section of the Toolkit discusses the impact of online record access on the work of everyone in the practice team who enters or files new information in patients’ records or discusses GP online services with patients. This includes temporary staff, including locums and trainees. It should be remembered that any patient may obtain record access at any time and safeguarding risks may fluctuate. It covers data quality, potentially harmful information and clinical safety.
Section: Working with online record access - the challenges
A note on this iteration of the Toolkit
The GP Online Services Toolkit is intended to support and inform general practice teams who are offering online services for their patients, including transactional services and record access. It updates the previous guidance provided by the RCGP, in collaboration with NHS England. It does not cover online consultations.
Supporting information
- Patient online: The Road Map, RCGP, 2013 (1.9 MB PDF) – Report on workshops held to define the professional standards for the provision access by patients to online services (booking and cancelling of appointments, ordering of repeat prescriptions), online communication with the practice and online records.
Acknowledgements
We would like to thank the many people who have given their time to contribute to the material on this toolkit.
Our thanks go to Dr Imran Khan and Dr Joy Shacklock for their work this year on automatic record access; Dr Nutan Patel, Joyce Pickering, Dr Geoff Schrecker and Dr John Lockley for their work on the previous iterations of the Toolkit. Thanks to Dr Ralph Sullivan, RCGP Clinical Champion for Patient Online for leading the work from the beginning. And lastly, we would like to acknowledge the invaluable support and input from colleagues at NHS England and many more organisations who have shared their knowledge and insight with us over the years.
Providing GP online services
Most practices now offer some form of GP Online Services. In England practices are required by their contract to offer services to book and cancel appointments, order repeat prescriptions and record access. Since 2019 practices the requirement has been to offer full prospective record access. Prospective access means access to information recorded after a specified date, with no access to earlier information.
This section of the Toolkit offers guidance on how to provide GP online services and supporting resources that you might find helpful.
- Patient information themes for GP online services (88 KB, DOCX) – the themes that practice might find useful to use in the practice information for patients on GP online services.
NHS England and BMA, Patient access to records online: Prospective record access..
Transactional services
Transactional services are the online facilities patients use to book and cancel appointments, order repeat prescriptions and send messages to the practice about their medication. They are popular because they are efficient and convenient for patients and practices. In 2022 more than 45% of people in England had signed up for them.
Since 1st April 2015 it has been a contractual requirement for English GP practices to offer these services. Practices must routinely ensure that the number of appointments available to be booked online meets the reasonable needs of their registered patients.
Practices have found online booking quick and easy to set up. Registration for online booking of appointments is a relatively simple process. Patients appreciate the convenience of this service and it has several benefits for practices, which are detailed in the Online Appointment and Prescriptions guidance.
- Online Appointments and Prescriptions (68 KB DOCX) – a guide to getting started to offer online appointment and prescription services.
Record Access
GP Online Services is an efficient and effective method of providing patients with access to their current GP clinical record, which empowers patients to manage their health. It is particularly useful for patients with multiple long-term conditions, and their carers, because it enables them to take a more active role when, for example, preparing for consultations, reviewing care plans and hospital reports, and making informed decisions about what matters to them as part of a person-centred approach to care.
Practices in England have a contractual requirement to offer the prospective record. Patients who have a patient facing services account and app will have automatic access to their full prospective record (with the exception of administrative messages and emails about the patient). Practices may offer online access to the full record, including past information to patients and trusted proxies. Practices must ensure that the record is safe to share and that the patient is not subject to coercion to share their record unwillingly.
When patients move general practice, they will lose access to their record at their previous practice. They will usually gain automatic access to new record entries at the new practices but will not be able to see their previous practice’s record anymore. If they want to have access to that data again, they will have to apply to gain access any record transferred from the old practice.
In certain circumstances, if patients may not be able to protect the privacy of their online record, it may be safer to limit a patient’s online record access. Ideally this decision should be done in collaboration with the patient.
The risk that patients may view harmful information or confidential third-party information online or may be coerced to share their record with others places a responsibility on practices to maintain high quality records, ready to be shared with the patient, and, when necessary, to consider withholding record access from the patient. The practice is responsible for ensuring that any potentially harmful or confidential third party information in the patient’s record is not visible to the patient online. Such information should be redacted. This prevents it being visible through GP online services but does not affect the visibility of the information in the practice and when shared for direct patient care or used for decision support software and clinical audit.
- Infogram - Reception process for applications for practice online services (50 KB PDF) – seven steps to receive and complete an application for any GP online services
- RCGP Application form template (267 KB DOC) - a template for patients to use to apply for GP online services. It includes a series of statements that the patient should agree to before access is agreed.
- Proxy access consent form (37 KB DOC) – a template for practices to use to record consent from patients for a trusted third-party to have proxy access to any of their GP online services
- Information governance (93 KB DOC) - brings all the guidance on information governance for the practice’s GP online services, including the data protection policies you may consider developing into one place.
- Patient Information themes for GP Online Services (88 KB DOC) - a list of suggestions for topics that you may wish to include in practice publications about your online services.
- Flowchart - new patient registration and auto access (171 KB PDF) – a guide to manage automatic record access for a new patient registering with the practice.
Subject Access Requests
The Information Commissioner’s Office (ICO) has agreed that practices may be able to comply with a subject access request (SAR) from a patient under data protection legislation by offering to provide a patient with online access to their full health records. This applies to requests on behalf of the patient from legal representatives and insurers. However, if the record is not fully digitised, paper copies may need to be provided on any data, including letters and reports, not available online.
Supporting information
- DCB3051 Identity Verification and Authentication Standard for Digital Health and Care Services, NHS Digital, this information standard sets out the nationally agreed approach to identity management for health and care, used for NHS Login and conformant with identify assurance principles endorsed by the government.
- GMS contractual requirement, NHS England
- Patient Online Management Information (POMI), NHS Digital, – Data on the numbers of patients in England with access to GP Online Services by practice and by Clinical Commissioning Group (CCG)
- Websites and apps you can use with NHS Login, NHS.uk, – lists apps that patients can use with their NHS Login to access online NHS services,
- About NHS Login, NHS.uk – explains to patients how to set up an NHS Login,
- Confidentiality: good practice in handling patient information, GMC
- Guidance on Gillick competence and Fraser guidelines, NSPCC, – explains how these two often confused terms differ and apply to clinical care,
- Digital inclusion, Good Things Foundation, – contains resources and links that practices can use to help reduce digital exclusion.
Patient registration for GP online services
The guidance in this section is for practice clinicians, managers and staff manage GP online services and make decisions about patients’ online access. Anyone in the practice who interacts directly with patients should be aware of the patient registration process for online services, especially reception staff.
It describes in detail how to sign up new applicants for GP online services, including the procedures for verifying the identity of the person requesting an online account, clinically assuring the patient record for online access and discussing access with the patient before services are switched on. It also covers applications from people acting on behalf of the patients, such as parents, family members and carers (proxy access).
Patients may book an initial appointment online as soon as they have completed a simple online registration process. Full access to appointment, repeat prescription ordering or record access services require a secure identity verification process. This may be carried out by the practice or remotely by the NHS as part of an application for an NHS Login.
- Infogram - Reception process for applications for practice online services (50 KB PDF) – Seven steps to receive and complete an application for any GP online services.
- Checking patient records - FAQ (60 KB DOC) – Guidance on how to check patient’s record for evidence that the patient may be at risk from record access.
- Managing potentially harmful information (87 KB DOC) – Guidance on the purpose of redaction tools in the practice IT system and when to use them. This should be read with your system suppliers training materials on redaction.
- Patient information themes for GP online services (88 KB DOC) – the themes that practice might find useful to use in the practice information for patients on GP online services.
- Identity Verification (60 KB DOC) – Guidance on how to verify the identity of someone who is asking for login credentials for GP online services.
- SNOMED CT terms that control automatic record access (252 KB DOC) – Guidance on using the SNOMED CT terms created to block individual patient’s receiving automatic record access.
- Flowchart - SNOMED CT terms that control automatic record access (168 KB PDF) – a summary of how and when the SNOMED CT terms function.
- Flowchart - new patient registration and auto access (171 KB PDF) – a guide to manage automatic record access for a new patient registering with the practice.
- Coercion (154 KB DOC) – Guidance on the impact of coercion to share record access with a third person or failure to maintain the privacy of online record access.
- Safeguarding and automatic record access (733 KB DOC) – Guidance on managing safeguarding risks and online record access.
- Safeguarding and vulnerable groups (838 KB DOC) – Guidance on how specific groups of vulnerable groups of patients may not be able to manage online record access safely.
- Woodman J et al, Online access to medical records: finding ways to minimise harms, BJGP, 2015.
- Online Health and Prescription Services, NHS.uk, – an introduction for patients on GP Online Services, with links to help patients download the NHS App, get for an NHS Login, and a list of other patient facing services apps that let you register for access to GP Online Services with the NHS Login.
Automatic record access
When patients move practice, they will lose any access to their record at their previous practice. They will gain access to their new records at the new practices but will not be able to see their previous practice’s record anymore.
If they want to have access to that data again, they will have to apply to the new practice for access to the record after it has been transferred from the old practice.
- Flowchart - SNOMED CT terms to manage auto access (168 KB PDF) – a summary of how and when the SNOMED CT terms function.
- Flowchart - new patient registration and auto access (171 KB PDF) – A guide to manage automatic record access for a new patient registering with the practice.
- Clinical assurance before automatic record access (564KB PDF) – A guide to the pre-emptive preparations to identify and protect vulnerable patients before they obtain automatic record access
Useful resources and guidance when registering new applicants
- Websites and apps you can use with NHS Login, NHS.uk, – lists apps that patients can use with their NHS Login to access online NHS services.
- About NHS Login, NHS.uk – Explains to patients how to set up an NHS Login
- Information for Practices on GP online services, NHS England, – Produced before automatic record access
- Online Centres Network - Patients who may struggle to use the internet or smartphone apps for Patient Online may benefit from the Online Centres Network. They can phone a national support line at the Good Things Foundation (every weekday from 9:00am-5:30pm on 0114 349 1666)
- Woodman J et al, Online access to medical records: finding ways to minimise harms, BJGP, 2015
Applications for proxy access
Patients may find it helpful if someone else, usually a trusted family member, close friend, carer or care home, has access to their GP online account to book appointments, order repeat prescriptions, or view their GP record on their behalf. This is proxy access. In certain circumstances, particularly when patients lack capacity or have complex multimorbidity, it can be very helpful for a proxy to have access to their record to keep up-to-date and collaborate in their healthcare.
The proxy should have their own login credentials. This means that the proxy can be given different levels of access to the patient and their access can be switched off and the patient’s request or if the practice judges it to be in the patient’s best interest. Normally the patient must complete a form that gives consent to the proxy access.
NHS England has provided guidance for practices and care homes on how to establish proxy access for patients who are resident in care homes (see below).
- Proxy Access (68 KB DOC) – Guidance on when and how to provide proxy access for a trusted third party to a patient’s GP online services.
- Children and Young People Record Access (52 KB DOC) - Guidance on how to provide proxy access to a child or young person’s GP Online Services to people with parental responsibility and how a young person’s developing capacity and how decisions about proxy access are influenced by a young person’s developing capacity and right to confidential.
- Proxy consent form (37 KB DOC) – a template consent form to record a patient’s consent to proxy access for a trusted third person
- Proxy access to GP Online services by care home staff: Guidance for care homes and GP practices, NHS England
- GP Online Services, Dementia UK and RCGP, - information for the carer of a person with dementia.
Supporting information
- Safeguarding Related to Online Services: Proxy Access and Coercion, NHS England – Coercion guidance, presentation from NHS England
- Parental rights and responsibilities, GOV.UK – explains who has automatic parental responsibility and how to apply for it
- Protecting children and young people: The responsibilities of all doctors, GMC – It includes eight guiding principles. It explores how you can make sure children and young people receive the care and support they need, will help you know what to do if you identify children at risk of, or suffering, abuse and neglect.
- Children and young people ethics toolkit, BMA - Legal and ethical factors doctors need to consider when making decisions about children and young people such as consent, refusal of treatment and confidentiality.
- Safeguarding Children Toolkit for General Practice, RCGP - Contemporary risks to children and young people including increasing awareness of risks to children from outside the home such as child sexual exploitation, trafficking, domestic abuse within teenage relationships, radicalisation and online abuse.
- Confidentiality and children, Medical Defence Union – Guidance on doctors’ duty of confidence to children and young people.
- Gillick or Fraser? A plea for consistency over competence in children, BMJ - Explains how these two often confused terms differ and apply to clinical care.
Practice preparation for automatic record access
Automatic record access is new and will be switched on nationally in 2022. This section offers guidance on the steps that practices may take to prepare for automatic record access. It may not be relevant once automatic record access is active across England.
People aged 16 and over who are registered with a practice in England and have an account for any GP Online Services will have automatic prospective access to their GP record. This includes coded information, medication, consultations, and documents but not administrative messages and emails that refer to the patient. Nor does not include online consultations.
Patients who obtain a GP Online Services account for the first time once automatic record access begins will have access to their full GP record from the date when automatic record access was rolled out.
Patients who transfer to a new practice will lose their access to the record from their previous practice. If they have an NHS Login, their access will be automatically transferred to their new practice when they register. If they use a PFS app or web portal that does not use the NHS Login, they will have to register for login credentials at their new practice in the usual way (see the section on Patient registration for GP Online Services).
Once a patient has automatic record access, the clinical benefits of enhanced person-centred care and the risks from viewing potentially harmful information online will be the same as when record access is agreed for an individual patient by the practice.
- Checklist – Preparation for automatic record access (57 KB DOC) – A one page summary of the suggested preparations.
- Checking patient records - FAQ (60 KB DOC) – Guidance on how to check patient’s record for evidence that the patient may be at risk from record access.
- Patient information themes for GP Online Services (88 KB DOC) – A list of suggestions for topics that you may wish to include in practice publications about your online services.
- SNOMED CT terms that control automatic record access (252 KB DOC) – Guidance on using the SNOMED CT terms created to block individual patient’s receiving automatic record access.
- Flowchart - SNOMED CT terms to manage auto-access (168 KB PDF) – a summary of how and when the SNOMED CT terms function.
- Flowchart - new patient registration and auto-access (171 KB PDF) – A guide to manage automatic record access for a new patient registering with the practice.
- Managing potentially harmful information (87 KB DOC) – Guidance on the purpose of redaction tools in the practice IT system and when to use them. This should be read with your system suppliers training materials on redaction.
- Coercion (154 KB DOC) – Guidance on the impact of coercion to share record access with a third person or failure to maintain the privacy of online record access.
- Safeguarding and automatic record access (733 KB DOC) – Guidance on managing safeguarding risks and online record access.
- Safeguarding vulnerable groups (838 KB DOC) – Guidance on how specific groups of vulnerable groups of patients may not be able to manage online record access safely.
- Online GP Record Access For Other Sectors (159 KB DOC) – Guidance on GP online services for other organisations.
- Woodman J et al, Online access to medical records: finding ways to minimise harms, BJGP, 2015.
- Online Health and Prescription Services, NHS.uk, – an introduction for patients on GP online services, with links to help patients download the NHS App, get for an NHS Login, and a list of other patient facing services apps that let you register for access to GP online services with the NHs Login.
GP online services in clinical care
Anyone in England with a patient facing services account will automatically have access to their full prospective record and GPs in England are required by their contract with the NHS to offer and promote online access to the full prospective GP record.
Practices may also provide online access to the patient’s past electronic health record, referred to as the historical record. This may be helpful for patients who have complex health needs and want to keep up to date with care plans and hospital reports. It may also replace the need to provide paper-based subject access request reports (SAR) commonly requested by patients for legal purposes.
Clinical benefits of record access
Patients can use record access as part of routine clinical care to self-manage complex health conditions, meet their personal health goals and achieve better health outcomes. Examples include:
- using access to coded laboratory results to monitor long-term conditions and prepare for consultations
- using the coded data recorded by the practice to check on immunisations, adverse drug reactions, allergies, screening and preventive procedures and preferences and advance decisions recorded in care plans
- reading clinical correspondence from hospital admissions, outpatient appointments and investigations to gain a better understanding of their health and care
- using portable access to the record on tablet computers or smartphones to share data with other health professionals in all health settings.
The Toolkit includes five clinical exemplars where the role of GP online services in helping people manage long-term conditions is discussed in more detail. Each clinical exemplar includes a guidance document, a webinar and slide set, a podcast and relevant supporting information. The aim of each exemplar is to demonstrate the different ways in which online transactional services and record access support patients and carers to manage multiple long-term conditions.
Supporting information
- Patient information themes for GP online services (88 KB DOC) - the themes that practice might find useful to use in the practice information for patients on GP online services.
- Person-Centred Care Toolkit, RCGP
- House of Care, NHS England – a framework for the care of long term conditions
- Explaining laboratory test results to patients: what the clinician needs to know, BMJ Practice Pointer, 2015
- Labtestsonline, The Association of Clinical Biochemistry and Laboratory Medicine – Provided for patients to help them understand the many clinical laboratory tests that are used in diagnosis, monitoring and treatment of disease.
- Moll J et all, Patients’ Experiences of Accessing Their Electronic Health Records: National Patient Survey in Sweden, Journal of Medical Internet Research, 2017 - on the impact of online services for patients in Sweden. Reasons for access related to patient empowerment, involvement and security.
- Mohammed M A et al, The value of a Patient Access Portal in primary care: a cross-sectional survey of 62,486 registered users in the UK, Univ Access Inf Soc, 2020 – Feedback from patients of practices using EMIS on the value of GP online services.
Working with online record access - the challenges
Providing record access can be beneficial for patients allowing them to better manage their health and ultimately reduce burden on staff. However, it can also present ongoing challenges for practices.
The impact of online record access should be considered for every patient, not just those who currently have record access or who may currently have known safeguarding risks. Patients are entitiled to access their health information and may obtain record access at any time. Any risk of harm from a safeguarding risks may fluctuate. Everyone who enters or files new information in patients’ records or discusses GP online services with patients should have awareness of these concerns. This includes temporary staff, including locums and trainees.
This section of the guidance is about how managing record access affects the everyday work of the practice.
- Working with automatic record access (726 KB DOC) – details of the suggested actions to consider to help manage automatic record access.
- Checklist – Working with automatic record access (58 KB DOC) – A one page summary of the suggested actions to consider to help manage automatic record access.
- Checking patient records–FAQ (60 KB FAQS) - Guidance on how to check patient’s record for evidence that the patient may be at risk from record access.
- SNOMED CT terms that control automatic record access (252 KB DOC) – Guidance on using the SNOMED CT terms created to block individual patient’s receiving automatic record access.
- Flowchart - SNOMED CT terms to manage auto-access (168 KB PDF) – a summary of how and when the SNOMED CT terms function.
- Flowchart - New patient registration record access process (171 KB PDF) – A guide to manage automatic record access for a new patient registering with the practice.
- Introducing Online Test Results (179 KB PDF) – Guidance on how to prepare patients for online access to their test results.
Data quality
The quality of data in a patient’s record can be assessed by the extent to which it meets the various purposes that the record is used for. For online services this means that it must be clear and unambiguous for the patient to understand, without displaying information that might be harmful to the patient or others or confidential information relating to third-parties.
Poor data quality may confuse or mislead both patients and clinicians and have a negative impact on the patient’s health care and safety.
Health and care professionals have a legal duty and professional responsibility to keep health and care records accurate and up to date. However, mistakes in record keeping can occasionally happen. Patients and service users have the right to request for their records to be rectified if they feel inaccurate information is held about them. If you believe that the amendment request concerns health or care information that is factually accurate, you should not amend the record. However, it is good practice to give patients and service users the opportunity to have an entry put into the record to say they do not agree with a particular part and why. See NHS England website for more information.
- Data quality for record access (88 KB DOC) –
Guidance on how to create and curate patient records that are ready for patient
online access, including how to respond to patient’s comments or complaints on
the content of their record.
Potentially harmful data
GP records sometimes contain confidential information that relates third party which the patient must not see. There may also be information that may harm the patient: a diagnosis, abnormal result or opinion that the patient is not aware of or records of a past traumatic event that might re-traumatise the patient.There may be information that a patient who is coerced to share their online record access may want to have redacted.
As a principle it is helpful to consider “Ask before release”, which means if you are uncertain whether information you are entering in the patient’s record may be something the patient would prefer not to be visible online, ask the patient if it should be redacted.
All GP systems have a method of preventing information in the record being visible via GP online services. This is redaction. Before online access to historic records is switched on all the information that the patient will see should be checked for potentially harmful information that needs to be redacted.
It is important to establish a practice record keeping policy about recording and redacting new entries of potentially harmful and confidential third party data even if patients do not currently have online record access, as they may gain access in the future.
- Managing potentially harmful information (87 KB DOC) – Guidance on the purpose of redaction tools in the practice IT system and when to use them. This should be read with your system suppliers training materials on redaction.
Clinical safety
Patients who are subject to controlling coercion by an abuser are the most common group at risk from record access
Patients who register for the NHS App will automatically receive access to book and cancel appointments, order repeat prescriptions and record access.
If the patient is not able to keep these services secure, providing access could allow abusers to monitor:
- If the victim has revealed abuse
- If the victim has accessed healthcare, especially issues like injuries, mental health, contraception or sexual health
- Evidence in documents that other agencies have recognised abuse
- Infer any of these from the absence of expected consultations or documents in the online record.
The Toolkit has guidance on how to recognise coercion and the safeguarding risks. This is relevant to every patient, not just those who currently have record access or who may currently have known safeguarding risks. Any patient may obtain access, and safeguarding risks may fluctuate.
- Coercion (154 KB DOC) – Guidance on the impact of coercion to share record access with a third person or failure to maintain the privacy of online record access.
- Safeguarding and automatic record access (733 KB DOC) – Guidance on managing safeguarding risks and online record access.
- Safeguarding vulnerable groups (838 KB DOC) – Guidance on how specific groups of vulnerable groups of patients may not be able to manage online record access safely.
- Online GP records access for sectors (159 KB DOC) – Guidance on GP online services for other organisations.
- The RCGP has several resources in its adult safeguarding toolkit and child safeguarding toolkit on domestic violence that are relevant to the topic of coercion.
- NICE has succinct advice on recognising and responding to evidence of domestic violence or abuse and in their guidance on domestic violence and abuse: multi-agency working.
- Safelives provides many useful resources on coercion and domestic abuse, including resources for GPs and guidance on identifying domestic abuse.
Clinical exemplars
In these five clinical exemplars, the role of GP online services in helping people manage long-term conditions is discussed in more detail. Each clinical exemplar includes a guidance document, a webinar and slide set, a podcast and relevant supporting information. The aim of each exemplar is to demonstrate the different ways in which online transactional services and record access support patients and carers to manage multiple long-term conditions.
1: Diabetes mellitus
The resources in this section are for GPs and practice nurses who help patients make decisions about their diabetes, especially practice nurses working in diabetes clinics, but the principles can be applied to many long-term conditions. It covers the use of Patient Online record access to enable patients to:
- use laboratory results and other coded data that is relevant to their diabetes to monitor the impact of their self-care and adherence to treatment
- use the information to help decide what matters most to them and prepare for consultations
- review and contribute to their diabetes care plan.
The guidance and resources are meant for GPs and practice nurses caring for patients with all types of diabetes mellitus to help you offer your patients online access to their record safely and confidently. They describe how access to GP online services contributes to providing person-centred care to patients with diabetes. It presents the case for recommending online record access to patients with diabetes and gives advice about how the practice can help patients use it to prepare for consultations and improve their ability to self-manage their condition.
RCGP resources
- Patient Online: Person-centred care and diabetes mellitus (987 KB PDF)
- Patient Online and Diabetes Care: webinar slides (2.1 MB PDF)
2: End of life care
This guidance is for GPs and practice nurses caring for patients approaching the end of life irrespective of underlying condition or co-morbidities. The aim is to describe how access to GP online services contributes to person-centred care in this context and to present the case for recommending online record access to patients and their families and carers at the end of life.
It describes how you can help them make use of online access to information about their healthcare to improve their ability to self-manage their condition and help to co-ordinate their care. It describes how carers or relatives can use Patient Online on behalf of patients without capacity. It explains how patients can share access with supporting family members, carers and the multidisciplinary healthcare team to help them look after the patient safely and confidently.
The GP coded record is shared to support direct care in many parts of the country through electronic palliative care co-ordination systems (EPaCCS) or through direct views of the GP record. Patients do not have access to these systems but Patient Online enables them to see whether the data about them in these records is complete and up-to-date.
RCGP resources
- Using Patient Online in End of Life Care (634 KB PDF)
- Patient Online in End of Life Care: webinar slides (2.7 MB PDF)
- Palliative and End of Life Care toolkit
- EPaCCS: electronic systems that help improve patient care, RCGP & Marie
Supporting information
- Background to Gold Standards Framework, National Gold Standards Framework Centre
- End of life care for adults quality standard, NICE
- SCCI1580: Palliative Care Co-ordination: Core Content, NHS Digital
- The Role of Care Homes in End of Life Care, The National End of Life Care Intelligence Network
- New UK General Practice Core Standards for Advanced Serious Illness and End of Life Care, BJGP
- Crash course in EPaCCS (Electronic Palliative Care Coordination Systems), BMJ
- The impact of advance care planning on end of life care in elderly patients: randomised controlled trial, BMJ
3: Dementia
Dementia is typified by increasing memory loss and intellectual impairment that creates difficulties for patients, their families and carers, and health professionals alike. Forward planning with early referral to local memory services, involvement of family members and carers and a shared understanding of the patient’s priorities and preferences are at the core of good healthcare.
As patients lose the mental capacity to understand the decisions that are necessary for their health and social care, family and carers have to make decisions on their behalf. As capacity declines Patient Online becomes increasingly helpful.
Over 90% of patients with dementia have at least one co-morbidity with a median number of three co-morbidities for each patient. Primary care consultation rates, hospitalisation, prescribing rates and mortality increase with increasing co-morbidity. The complexity is difficult for patients and their families and carers to understand and manage. Access to Patient Online appointments, prescriptions and up-to-date information from the GP record can be invaluable to patients and carers.
This guidance describes how Patient Online can help patients with dementia understand and manage their healthcare in the face of complex multimorbidity and failing mental capacity. It also describes how Patient Online can be used to support family members and carers helping the patient as the patient loses mental capacity and how practices can provide access to their Patient Online services safely and effectively. The guidance is intended for GPs, practice nurses and other healthcare professionals involved in the care of patients living with dementia in the community.
RCGP resources
- Patient Online for dementia (545 KB PDF)
- Patient Online and dementia: webinar slides (2.1 MB PDF)
- Safeguarding Adults at Risk of Harm Toolkit
- GP online services - Information for the carer of a person with dementia, Dementia UK and RCGP (1.8 MB PDF)
Supporting information
- Dementia UK
- What is Dementia, Alzheimer’s Disease Society
- Dementia: assessment, management and support for people living with dementia and their carers, NICE
- Dementia Roadmap, Dementia Pathfinders CIC
- Dementia: Good Care Planning, NHS England
- My Future Wishes, NHS England
- The Dementia Guide, living well after diagnosis, The Alzheimer's Society
- Recoded Dementia Diagnoses - June 2018, NHS Digital
- Mental Capacity Act 2005; Deprivation of Liberty Safeguards, HM Government
- Office of the Public Guardian, HM Government
- Join Dementia Research, NIHR
- Association of comorbidity and health service usage among patients with dementia in the UK; a population-based study, BMJOpen
4: Inflammatory arthritis
This guidance is for GPs and practice nurses caring for patients with inflammatory arthritis. The aim is to describe how access to GP online services contributes to person-centered care in this context and to present the case for recommending online record access to patients with inflammatory arthritis.
It describes how you can help them make use of online access to access information about their healthcare to improve their ability to understand and self-manage their condition and help to co-ordinate their care. It also describes how patients can make use of online access to test results and other health information to prepare for consultations and empower them to be more engaged in their own care.
This guidance does not seek to cover aspects of shared care, but its aim is to help the patient become more engaged and informed by utilising Patient Online. Therefore, for clinical management, please refer to your local shared care agreement and NICE guidelines.
RCGP resources
- Using Patient Online in Inflammatory Arthritis (807 KB PDF)
- Patient Online and Rheumatoid Arthritis care: webinar slides (2.1 MB PDF)
Supporting information
- Collaborative Care and Support Planning toolkit
- RCGP Person-Centred Care toolkit
- Rheumatoid arthritis in adults, NICE
- Guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs
- The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century
5: Mental health
This guidance is for GPs and practice nurses. Its purpose is to describe how access to GP online services contributes to person-centred care for patients with mental health conditions, and to present the case for recommending online record access to these patients.
It describes how you can help patients use Patient Online to access information about their healthcare to improve their ability to understand and self-manage their condition; in particular, how patients can use access to test results and other health information to prepare for consultations, enabling them to be more engaged in their care. It also describes the specific risks that online record access may hold for patients with mental health conditions and the practice, and offers advice about how they can be addressed.
RCGP resources
- Patient Online and Mental Health Conditions (494 KB PDF)
- Patient Online and Mental Health webinar slides (5.4 MB PDF)