Implications of the changes to patient online records access in English primary care

BACKGROUND

This year, NHS England (NHSE) announced that from November, most patients in England registered for online services such as the NHS App will be able to see all new entries in their primary care record by default.¹ This includes free text, hospital letters, test results, and new data added to the detailed coded record (DCR). Historic information in the record has not become visible as a result of the November change, but there are plans to enable requests to access the historic DCR via the NHS App in 2023.¹

Since April 2019, the GP contract committed GPs in England to offer patients prospective online records access (ORA).² Prior to November, GP surgeries could grant access to patients on a case-by-case basis, determine the level of access (such as Summary Care Record only, DCR only, or full record), and set the date from which data was visible. This resulted in inconsistent levels of access, something that patients reported as frustrating.³ NHS Digital’s data highlight these inconsistencies; in August 2022, although 48.1% of adult patients in England could order repeat prescriptions online, only 13.9% were able to view their DCR.⁴ Despite documented benefits of ORA,^3,5,6 primary care staff have raised concerns^7–9 that can be grouped into issues around workload, safeguarding, patient confusion or distress, and health inequities.

WORKLOAD

One recent small qualitative study found that ORA could or did increase workload by requiring preparation of records prior to granting access, managing …