Date of Policy: 19 May 2023

Author: Lucie Lehane

Review Date: May 2024

  1. Patients are entitled to view their medical records under the Access to Medical Records Act and the Data Protection Act 1998, though some checks need to be made. In particular, the practice needs to make a judgement that there is nothing in the record that could be harmful to the patient, and that there is no third party information (e.g. names and information about others)

 

  1. We strongly encourage patient to register for on-line access which provides patient with greater flexibility and instant access to their records. Patients can access their medical records online by registering to NHS App or Patient Access or similar application.

 

  1. The patient should be encouraged to download NHS App and verify their identity via the app.

 

  1. Patient needs to fill out the application form online via our website attaching selfie photo holding their ID. Alternatively, patient can also complete the paper application form at the practice.

 

  1. If patient does not have a photo ID, staff member can verify their identity by asking questions from the medical records.

 

  1. If patient requires access to their full medical records, they can request it via email or by filling out “Enhanced Access to medical records” form at reception. Patient identity needs to be verified.

 

  1. Access to records can only be granted to third parties with full written consent from the patient, which must be signed and dated. A record of this should be kept.

 

  1. Patients may select to request on-line access to their records (preferred method) or for a printed copy.

 

  1. We do not charge patients for print outs of notes, unless the requests are excessive, any charge in such situation needs to be agreed with Practice Manager.

 

  1. If a request is deemed manifestly unfounded or excessive, the practice can refuse to respond to such requests. This will be done on a case by case basis and is in accordance with Data Protection Act 2018.

 

  1. Patients should provide photo ID (such as a photo driving licence or passport / national identity card) in order to view their notes. If patients request the access to all notes including free text and all documents, or asks for all copies, the notes should be checked by senior administrator. If there is sensitive information in there, third party information or when in doubt, the notes need to be reviewed by a named GP, and if sensitive information found, then an appointment would be offered with a GP to go through the notes before releasing them to a patient.

 

  1. Receptionists should follow Access to Medical Records Flowchart for step by step instructions

 

  1. Requests for access must be fulfilled within 1 calendar month from receiving the request.

 

  1. Patients may request amendments or corrections to be noted. Entries should never be deleted or removed, instead a note should be made that the patient requests an amendment. This can only be approved by named GP. For more guidance see https://transform.england.nhs.uk/information-governance/guidance/amending-patient-and-service-user-records/

 

  1. From 3rd May 2023 all patients registered (with few exceptions assessed by named GPs in view of patient safeguarding) have future (prospective) records access enabled. This means access to information and data added to the patient record from 3rd May 2023 onwards or from the date that a patient joined the practice or from a date when access has previously been granted.

Patients who have had future (prospective) access set up before the change will continue to be able to view this information.

  1. Medical records of deceased patients stay at the practice. If requested, please follow the guidance: https://transform.england.nhs.uk/information-governance/guidance/access-to-the-health-and-care-records-of-deceased-people/

 

MP 19/05/2023