Using patient record codes
The codes below can be added to a patient’s record and are reviewed automatically when certain events occur if you have opted into the accelerated access functionality (EMIS) or have set the default level of access to be that of the full clinical record (TPP).
(Note: SCTID is the SNOMED-CT identification number.)
- The ‘103’ code – used when a patient has declined access.
Online access to own health record declined by patient (situation)
- The ‘104’ code – used to (temporarily) block access.
Enhanced review indicated before granting access to own health record (situation)
- The ‘106’ code – used to negate a ‘104’ code and allow access.
Enhanced review not indicated before granting access to own health record (situation)
With EMIS, codes are read 1) at ‘go live’, 2) at the creation of a suitably authenticated NHS login with subsequent connection to the practice via the NHS app/website, 3) on turning 16 years of age if an online services account is already in existence. Once an online account has been created or had its access levels adjusted by the accelerated access functionality the codes serve no further purpose.
With TPP, the codes are used in the searches that TPP supplies that each practice can run at a time of its choosing when provisioning access. The codes will also be read if the organisation preferences have set the default level of access to be that of the full clinical record. It is the BMA’s understanding that TTP does not do anything automatically to the level of access of a 15-year-old when that person turns 16.
Patients who have requested access
The easiest way to create an online account (which can then be provisioned by the practice for prospective access) is if a patient downloads the NHS app and completes the sign-up process through the app. If a patient already has an NHS login authenticated to the high level and has used the NHS app whilst a registered patient, it should be possible to provide the required access levels at that point too.
If NHS app sign-up proves difficult for the patient, practices can still issue the codes required to set up an online account in the usual way, after checking identification documents with the patient. Clinical systems continue to allow registration letters to be issued for this purpose. Use of the NHS app by patients should be encouraged due to the other functions it offers, particularly in regard to messaging.
Patients who have declined access
‘103’ codes should be applied and the clinical system checked to remove any existing access. This code is able to be sent via GP2GP and may be helpful in the future should the patient move practice. If you have gone live and access has already been given then you can change the settings within the patient’s own record to restrict access.
Patients identified as at risk
We would also suggest you consider if those patients you have identified as ‘at risk’ from being able to automatically view their records require the addition of the ‘104’ code. If you haven’t yet gone live, you could ask your patients if any wish to decline consent to the programme and wish to opt out, as not all will want access. You should also direct them to an information resource explaining how they may choose to opt in, should they change their mind. Those you consider ‘at risk’ and code as ‘104’ still need the opportunity to request access, and they need to be made aware of this via patient messaging. We have provided a template message you could send to such patients below.
Guidance for TPP practices
TPP already supports provision of records access, including the ability to redact information before it becomes available for patient view. It is possible to manually change existing user settings for groups of existing users to provide access to future information and change system defaults to provide this access for new users. No functional change is required to their software.
You could ask your patients if they consent to the programme and wish to seek an opt-out, as not all will want access. You should also direct them to an information resource explaining how they may choose to opt in, should they change their mind.
Accelerated access functionality
In April 2023 it became a contractual requirement through an imposed contract by government to provide prospective full records access to all patients unless they declined. The accelerated access functionality could be used to help achieve this goal, if implemented at a practice level, but manual means could still be used to provision access. The accelerated access functionality only applied to patients age 16 or over and who didn’t have a ‘104’ code applied to their records. In exceptional circumstances access could be declined and the functionality allowed for this. The regulations laid before parliament in April 2023, however, did not reference any age range for the provision of prospective access and did not reference any exceptions for exceptional circumstances for the provision of access, only that those who declined access didn’t need to be given it, and ‘excepted information’ didn’t need to be supplied, which would be third party information or information likely to pass the serious harm test. NHS England have recently indicated that access is for those 16 or over but the regulations do not state this.