Protocol for Patient Requesting Access to Online Services

 

Introduction

 

Online services allow the patient to access the following:

• GP Appointment booking
• Ordering medication
• Viewing Summary Information (allergies, adverse reactions and medications)
• Viewing the full medical record – prospectively only. Retrospective access on a case by case basis only.

Registration for online services

Patients can register for access themselves, or grant another person access who is acting on their behalf

 

The easiest way for patients to register is by downloading the NHS app on their smartphone. This requires no input from from the practice and the entire process (including ID verification) can by done by the patient without coming into the surgery.

 

For patients who wish to register in person, the process is outlined below:

 

ID Verification

ID verification is required to ensure access is granted to right person. There are a number of options for identification verification including:

 

Documentation

Two forms of documentation must be provided as evidence of identity, one of which must contain a photograph and proof of address. Acceptable documents include passports, photo driving licences and bank statements. If none of the above are available, utility bills may be accepted at the discretion of the reception manager

 

Self-Vouching

Vouching for a patient’s identity requires an authorised member of the practice staff  who knows the patient well enough to verify that they are who they say they are, and that no deception is taking place. Self-vouching will not be considered as usual practice and should only be used in exceptional circumstances.

 

At the point of request for Patient Online Access, patients are to be provided with the Online Services Application Form.

 

Patients requesting access to viewing the full medical record

 

Patients are able to request access to their full medical record. Requests can be made verbally via a reception team, or via the online services portal. All requests will be forwarded to a designated member of the team to review the record and determine if access can be granted. Patients will be notified that it may take the practice up to 28 days to review their application and grant access if appropriate. This is a guide only and in some circumstances may take longer.

 

Considerations/Approval of Access

 

The practice will not approve on-line access to the record if it is deemed that it may cause harm to the patient.

Staff will be responsible for checking if patients are on certain registers for example, learning difficulties register, child protection register, mental health or have been identified as a possible victim/perpetrator of domestic abuse.  Staff will consult with the patients usual GP if required before access is granted /denied.

The following will be considered:

 

 

Access for children, parents and guardians

 

• Parents have a right to access their child’s medical record until at the age of 12. After this age, children may have the right to refuse access to their record by anyone else
• Parental access to the child’s record will automatically be terminated at the age of 12
• Between the age of 12 and 16 there will be no online access available. This is to prevent accidental disclosure of sensitive information. This can be reviewed on a case by case basis at the request of the parent or child. After the age of 16, a young adult can request access to online services in the normal manner.

 

Considerations behind restricting access for children aged 12-16

 

The reasoning behind this decision is that children over the age of 12 are generally considered to have the capacity to give or withhold consent as to who can see their medical information. However all children are different and whilst some after the age of 12 would be competent to make this decision, others may not be.

Due to the sensitive nature of information that can be accessed via SystmOnline, it is felt that by allowing access to SystmOnline to those with parental responsibility for children aged between 12 and 16, it could mean the disclosure of information without the express consent of the patient.

 

This is a difficult scenario for the GP’s. On one hand, we want to give patients the freedom to access their own information, but we also have a very serious responsibility to patients to safeguard that data against unintended disclosure.

 

In practice, before deciding whether to grant access, each child would need to have their competency assessed by a GP. In reality, this would just not be possible and so we have taken the decision to not allow online access for children between the age of 12-16. After the age of 16, children are assumed to be competent and they can therefore request access in the normal manner.

 

The practice acknowledges that there will be occasional cases were online access for 12-16 year olds is overwhelmingly in the child’s best interests and these will be discussed on a case by case basis.

 

Proxy Access

 

All requests where the patient wishes to grant access to their record to a friend/relative or carer should be granted via the proxy access function.

We will not give the patient’s own login details to another person, and although the patient themselves may do this, we will not encourage it as the proxy access function is a more appropriate way to facilitate this.

A competent patient can choose and consent to allow access to relatives and/or carers. The proxy access registration form must be completed.

When access to the record is via proxy, access level will be kept to making appointments and requesting medication only. Record access will not be granted, unless on a case by case basis following clinical input.

Circumstances when the practice will consider authorising proxy access WITHOUT the patient’s consent will be:

 

• When a patient has been assessed and is deemed as not being competent to make a decision on granting proxy access. Access will be granted in their best interests and the practice will ensure the level of access granted to the Proxy is appropriate and not excessive.

 

Coercion

 

‘Coercion’ is the act of governing the actions of another person by force or by threat, in order to overwhelm and compel that individual to act against their will.

 

The practice will consider the implications of coercion during the patient application process for online services, and if necessary will decline access.

The practice manger will discuss with the applicant the reasons for refusal of access.

If coercion is identified as a risk with regard to a patient previously registered for online services, then access will be immediately removed.

 

 

Levels of Access for Patients

There are different levels of Access available to patients.  All requests for Online Access will be dealt with on a patient by patient basis and the suggested access will be granted within the agreed timescales.  All patients must be deemed competent to be granted access to Detailed Coded Data, however, some elements may be marked as sensitive/confidential and will not be shared via Online services.  Access levels can be as follows:

Appointments, Repeat Prescriptions, summary information and full record access

The practice will not automatically grant full record access to those patients currently with access to appointments, repeat prescription and Summary Information. Patients wanting access to their full record can request this separately. This will be considered within the practice and granted if deemed appropriate within 28 days. This is a guide only and in some circumstances may take longer.

At any point the practice can revoke Online Access to patients if the functionality is abused, or if it is deemed in the best interests of the patient.

 

 

 

Appointments

 

This practice will allow a patient to book GP and Advanced Nurse Practitioner appointments in advance on line. A maximum of two appointments may be booked up to four weeks in advance.

 

Abuse of the online booking facility may result in access being revoked.

 

Repeat Prescriptions

Patients with repeat medications that have been reviewed by the GP can order these via on line services.  Repeat medication requests can be made up to 10 in advance of the prescription becoming due.   Patients should be made aware that they must leave 48 hours before trying to collect their prescription from surgery or nominated chemist.

Hiding sensitive consultations

 

Any consultations of a sensitive nature may be highlighted as confidential. These will not appear in the online record.  Access to online records will be on a patient by patient basis.

 

Third Party Information

 

This practice will not share any information held within a clinical record that is deemed as 3^rd Party Information.

last reviewed 12/11/24