Primary care staff need more training and support to implement automatic patient access to prospective records as the change could instigate a ‘significant cultural shift’, a study in the BJGP has found.
The small qualitative study, which interviewed 30 primary care staff in England between December 2021 and March 2022, suggested that giving patients access to their records could trigger a significant change in the way that primary care staff work, and relate to patients.
It added there could also be a change in the purpose and function of records as a result of access.
The research recommended that additional staff training and support be put in place to help practices adapt.
The study said: ‘Participants acknowledged that online records access (ORA) may transform the purpose and function of the record and that ORA has potential to instigate a significant cultural shift in primary care, changing how staff work and relate to patients.
‘This underlines the need for additional staff training and support to expand capability and capacity to adapt practice and enhance patient engagement with, and understanding of, their health records.’
Patients were initially set to be given automatic access to their records from 1 November 2022, however this was paused following concerns over patient safeguarding.
The programme is now in a phased rollout, with all practices needing to offer automatic access to prospective records by 31 October 2023.
Continued concerns
However, the BJGP study highlighted that there are concerns among primary care staff that still need to be addressed.
The authors said: ‘Although most staff agreed with the principles behind online records access, many are yet to be convinced about managing this alongside existing workloads or that the benefits will outweigh perceived risks.
‘These concerns need to be addressed, alongside ensuring that practices can access resources and training required to provide online access safely, effectively, and equitably.’
Concerns cited include around the changing purpose of patient records.
One GP trainee respondent said: ‘We’ll fundamentally change how and why we’re recording notes. I think it’ll make us less safe because I won’t be writing “query Ca [cancer]”. And then the next person might not think about that, or I won’t think about it again, or I’ll think that’s been ruled out. Or I can’t write a clear set of notes that explains my thinking and what I’m doing because it will upset the patient.’
There were also fears expressed about records being released into the public domain beyond the patient record, and the subsequent consequences for the quality of the record.
‘I think some people are quite aware or afraid of writing something that will be misunderstood or can be screen grabbed off a mobile device and put on Facebook. That’s then in the public domain then and they’ve [staff] got no control of where it goes,’ said a nurse associate.
‘I know some people, we’ve talked about it in the staff room, and some people are quite cautious about what they write to the point where they write less.’
Safeguarding concerns
The study also found that staff continue to be concerned over safeguarding and the risk to patients.
One GP trainee respondent said: ‘I’m not anti it as a fundamental concept, but it feels it’s been done too quickly and without the right people involved and without thinking, and for the minimal benefits that we are likely to get, the risks are huge.’
A GP partner added: ‘What if I forget to do that [redact information], what if something goes wrong with that? There could be absolutely disastrous consequences in that situation.’
Other respondents said that though there may be a reduction of administrative tasks due to patients having access to their records, there could also be an increase in patient enquiries and clinicians may spend more time writing their notes.
A reception manager added: ‘If anything, workload will just change.’
It comes after a recent Government review suggested that patients should have greater access to their NHS record, including checking their position on waiting lists and removing themselves.
The Hewitt review, released earlier this month, also recommended that patients should access their data through the Shared Care Record and add information about their health and wellbeing.
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