Patient Online Services (Patient information leaflet)

The following leaflet tells you:

• What online services the practice currently offers patients
• Who can access these services
• Important considerations before requesting these services

What are Patient Online Services?

Patient Online services have been developed to help patients take greater control of their health and wellbeing and can be more convenient for some patients to use instead of contacting the Practice.  Online services include:

• Submitting Online Consultations/Questionnaires
• Ordering repeat prescriptions for medications taken regularly
• Viewing detailed information from medical records

Making sure everybody is included:

We recognise that not everyone is as comfortable using computers as others, but may still wish to have the benefits of using the Patient Online Services. 

There are lots of places where you can learn how to use the internet. A good place to start is your local library, but there are many others where you can learn for free, such as:

• UK online centres help people learn how to use the internet and manage their health online. Visit www.learnmyway.com or phone 0800 77 1234
• Age UK helps older people get online. For more information please go to www.ageuk.org.uk or phone 0800 169 6565

Is it secure?

You will be given secure login details at the point of registration. This will ensure that only you are able to access your record – unless you choose to share your details with a family member or carer.

Your Responsibilities

• Keep your login details and password safe and secure.
• It will be your responsibility to keep your login details and password safe and secure.  If you know or suspect that your record has been accessed by someone that you have not agreed should see it, you should change your password immediately or contact the practice.
• Keep any information you print out from your record secure.  If you are at all worried about keeping printed copies safe, we recommend that they do not make copies at all

For more information about keeping your healthcare records safe and secure, you will find a helpful leaflet produced by NHS England:

www.england.nhs.uk/wp-content/uploads/2015/11/po-protecting-your-gp-records.pdf

Considerations before accessing online services:

Before you register to access online services, there are things that should be considered first, particularly in relation to accessing medical records:

Viewing detailed information from medical records:

• Access: A GP will review your record before allowing access online. There may be circumstances where a GP may not think it is in your best interest for you to look at your records online or to share all of the information in your record.  In particular, there may be circumstances where it is likely to cause serious harm to your physical or mental health, or condition, or any other person, in which case the GP would withhold that information.

If this happens, the GP will discuss their reasons for their decision with you.

• Coercion: If you feel you may be pressured into revealing your login details or revealing details from your medical record to someone against your will, it is best that you do not register for access at this time.  If someone is pressurising you to show your record to them, you can talk to your GP about this. If you become worried about this in the future, you can have your access removed at any time. 

If staff at the practice are worried that you may be coerced to reveal your data, they can withdraw access as a temporary safety measure.  If this happens, please talk to a member of the practice team about reinstating that access if the safety issues have been resolved.

• Sharing your information: It is for you to decide whether or not you share your information with others – perhaps with family members or carers.  It is your choice, but also your responsibility to keep the information safe and secure.
  
• Forgotten history: There may be something you have forgotten about in your record that you may find upsetting.
  
• Abnormal tests: If you are given access to test results, you may see something that you find upsetting, or do not understand. This may occur before you have spoken to a doctor or while the surgery is closed and you cannot contact them.
  
• Information about someone else: There may be circumstances where information relates to, or is provided by, a third person who can be identified from the information and has not consented to its disclosure. The GP will consider whether it is reasonable to disclose the information without their consent.
  Sometimes, however careful we are, information can occasionally be filed in the wrong person’s notes by mistake.  If you spot something in the record that is not about you and you were not already aware of it, or you notice any other errors, please log out of the system immediately and contact the practice as soon as possible so we can review it.
  
• Misunderstood information: Your medical record is designed to be used by clinical professionals and therefore some information may be highly technical, written by specialists and not easily understood.  If you require further clarification, please contact the practice for a clearer explanation.

Can I access online services on someone’s behalf? (Proxy Access)

Patients may choose to share their login details informally with family, friends and carers, however, this is not recommended by the Practice.  Formal proxy access is a better option.  Patients who choose to share their login details informally should be aware that there will be no audit trail of access to their record by their proxy. It will not be clear who has been accessing the record online. The proxy will have the same access to the record as the patient.

Formal proxy access can be given either with the patient’s express consent or, in cases where the patient lacks capacity to make this decision the GP may authorise proxy access for the best interests of the patient.  This will be decided on a case-by-case basis at the discretion of the GP.

People aged 16 or above are assumed to be competent unless there is an indication that they are not. For patients under 16, please read the Children’s Access to Online Services section.

Legitimate reasons for the practice to authorise proxy access without a patient’s consent include:

The patient has been assessed as lacking capacity to make a decision on granting proxy access and…

• has registered the applicant as a lasting power of attorney for health and welfare with the Office of the Public Guardian; or
• the applicant is acting as a Court Appointed Deputy on behalf of the patient; or
• in accordance with the Mental Capacity Act 2005 code of practice, the GP considers it in the patient’s best interests to grant the requested access

The GP will review requests for Proxy access on an individual basis.  Proxy access will not be granted / will be withdrawn if:

• The patient has previously expressed a wish that if they lose capacity, proxy access should not be granted to the individual
• It is not in the best interest of the patient
• A GP or other health professional suspects that the patient is vulnerable to or already subject to coercion
• The practice staff believe that there is a risk to the security of the patient’s record by the person being considered for proxy access and record their concern
• The patient withdraws their consent to allowing proxy access to the Patient Online Services

Children’s Access to Online Services:

• Under 11 years: Until a child’s 11th birthday, the usual position would be for the parents of the child to control access to the child’s record and online services
  
• 11-16 years: Due to potential confidentiality issues for patients, full access will automatically be switched off when the child reaches the age of 11. We will contact the child and seek their consent for parents/guardian to be able to continue to use certain features of online services:
  • Submitting online consultations/questionnaires
  • Requesting medication and viewing any repeat medications
  • Online appointment booking (if it becomes available in future)
    
• Over 16 years: Once a child reaches the age of 16 they are assumed to be competent. Therefore on the child’s 16^th birthday our system will automatically switch off all the remaining proxy access. The child may request access to the online services for their own use or, if they are not competent, proxy access may be given in accordance to the terms previously mentioned in the Proxy Access section of this leaflet

How can I cancel my online services?

If you no longer wish to use the Online Services, or no longer wish to allow proxy access to these services on your behalf, please contact the practice who will be able to withdraw your, or your nominated representatives, access to these services.

Need further information about Online Services?

For further information about Patient Online Services you may find the following websites useful:

• NHS Choices (www.nhs.uk) and search for Patient Online
• NHS England (www.england.nhs.uk) and search Patient Online