LMC email update
Date sent: Friday 24 March 2017
Email sent by Wessex LMCs, on Friday, 24 Mar 2017
This email provides some additional information about data sharing and also some information about indemnity payments and reimbursement for sick leave.
The GPC has now issued their guidance re: TPP and Data sharing and this can be found by clicking here.
My personal view, is that this guidance clearly identifies two issue about the TPP Data sharing model:
1. The extent to which records can be accessed, if an organisation has a version of TPP and is able to register a patient and
2. That patients are almost certainly not fully aware that there are over 6000 organisations (including 2700 practices) who potentially can access their notes.
My concern is that the GPC's guidance raises these important issues and identifies the potential risk to patient care and then leaves individual practices to decide what action to take. This is an impossible dilemma for practices.
This a guidance also omits the latest advice from the Information Commissioner which recognises the potential risk to patient care if the data sharing is switched off and advises against this at this time.
So what should practices do?
1. Read my email below that I sent out earlier this week - or click here .
2. Discuss data sharing in your practice - have you permitted the sharing in and out within your practice?
3. Review your data sharing information and compare it to the guide I am developing within my practice - if your final produce is better, please share it with me and I will share it more widely.
4. Ensure your data sharing information is widely available and it should be:
- Part of your new registration pack
- Displayed as a poster in your waiting room
- Add something to your waiting room
- Put a paragraph in you practice booklet
- Review and update your patient leaflet - then leave copies in your waiting room
- Email a copy to patients for whom you have an email address
- SMS the link to your website
5. Discuss the issue with your PPG.
6. If there are entries that you make that you do not wish to share outside your practice are you aware how to secure these entries - if not learn!
When you have completed a consultation or entry you may wish to secure this, you can click on the continue icon below the consultation, you can then select an entry you have made, click on the hand icon which is above the entries on the toolbar, this will then give you the option to secure an entry that you do not wish to share outside the practice. There is also an option next to this which allows you to secure the entry so that it cannot be seen by the patient online.
7. Save this email in your learning diary - reflect on it and this will be an hours worth of information governance for your appraisal! You see we are here to help you in so many ways!!!
Date sent: Wednesday 22 March 2017
You will probably have read that concerns have been raised about the NHS IT systems in general practice and the sharing of data - click here - to read the Daily Telegraph article last Saturday.
The issue relates to the enhanced Data Sharing Model (eDSM) that exists within TPP SystmOne. There have been concerns raised with the Information Commissioner (ICO) that this model is not sufficiently robust to meet the requirements that exist within the Data Protection Act, particularly Principle 1 and Principle 7. Click here to access DPA Principles.
There are over 6000 organisations that use TPP SystmOne and this includes 2700 practices but also includes:
Community Service Providers
Accident and Emergency Services
Mental Health Trusts
The Prison Medical Services
There are large parts of Wessex where the sharing of information held within the GP patient record is occurring now. The Community providers in Dorset, Wiltshire, Southampton, Portsmouth and the Isle of Wight all use Community TPP, some of our hospices now use Palliative care version of TPP, Poole Hospital is shortly going to go live with a core module to enable the hospital clinicians to see the GP records with the patients consent. The Primary Care Access Centres, such as the one in Lymington, when they see patients, the clinicians are able to access the complete GP record.
These example are benefiting patients now and where sharing this data occurs patients need to be made aware and so there is a model of informed consent and generally their is a Data Sharing agreement in place.
One of the issues is that there are potentially over 6000 organisations who can access your patient records if the practice sets TPP SystmOne to the sharing in and sharing out option.
My understanding, and I am happy to be corrected, is that for someone to see my medical records (and I am registered with a TPP practice) a person would need to work for an organisation that uses TPP SystmOne, they would need to have a unique identifier and password to access their system. They would then need to register me on their system, which would include various demographic information about me, they would then need to search for my records, once they found them and to access they they would have to indicate that they have consent to view the record. This consent can be overridden and therefore allow unauthorised access from sites or individuals not related to providing direct care to the patient. There would then be an audit trail in my records to show who had accessed them and when and which organisation the worked for. Practices are alerted when consent is overridden. Records of consented accessing have to be searched for o reports can be run. A message is sent to the practice to indicate someone has accessed these records. In addition I am registered for online services with TPP SystmOne so I can, if I wish to look to see who has viewed my records.
There are concerns that the consent to view model is not secure enough.
Patients can decide they do not want to share their records and can therefore ask for this facility to be turned off for their records. In addition there is the facility to make an entry in any patients notes that is only visible by the person making the entry, or you can restrict the access to the practice so that anyone outside the practice cannot view this entry.
Fair processing of data
Your patients have the right to know what you are doing with their data and any action that fails to achieve this could potentially end up in a prosecuting under the Data Protection Act. This is balanced with the duty of a GP under the GPC to share information for the provision of direct care for a patient.
The Information Commissioner is not requiring practices to write to every patient to inform them of any changes to the Data Sharing but there does need to be a proportionate response from an orgaisation to inform patients.
Last year, I was involved in a pilot with the TPP practices, a Community Provider and a local Hospice to create a shared record to benefit patient care and to try to become more efficient. To get the pilot started we engaged with the Information Commissioners's office to try to ensure that we were compliant with the DPA.
We suggested that we would inform patients by:
- Producing a leaflets explaining the Data Sharing and put this in our surgery waiting room
- Put information of our practice website
- Add the detail to our patient information leaflet
- Display a poster in our surgery waiting room
- Create a slide to use on the TV display in the practice
- Use all available patient email addresses and mobile numbers to send information
- Add this information to the practice Facebook page and twitter account
- Discuss the Data Sharing with the practice patient participation group
- Write to the local paper who published an article on the matter
- We produce a pack for newly registered patients that included a consent form for Data Sharing
We did all the above and then about 6 weeks later we switched the data sharing on. This was acceptable to the ICO's office.
Attached is a leaflet that I have drafted for my practice, I am waiting further discussions before I finalise this but I am sharing the unfinished leaflet to give you an insight into the issues that I believe need to be shared with the patients.
The GPC, RCGP, NHS Digital and TPP are working with the ICO to try to resolve this matter. The GPC is about to produce guidance for GPs which I will share when this is available.
Today the ICO's office has issued the following statement:
ICO statement in relation to the potential risk to patient medical records held by GPs on TPP SystmOne
An ICO spokesperson said: “The ICO has data protection compliance concerns about SystmOne’s enhanced data sharing function and the potential risk to patients’ medical records held by GPs.
“However, given the possible impact to patient care, the ICO is not advocating that users switch off data sharing at this stage.
“The ICO’s concerns are centred on the fair and lawful processing of patient data on the system and ensuring adequate security of the patient data on the system. We continue to work closely with TPP, NHS Digital and NHS England and have seen an initial plan that they have put forward. This includes initial steps they are taking to remedy these issues and further work is planned.”
Click here - to access the ICO's statement.
Indemnity payment – briefing note
As part of the 2017/18 GP contract agreement, it was agreed that £30m would be paid to practices to cover 2016/17 rises in indemnity insurance costs for all doctors delivering GMS work. This amount has been based on average rises in costs using figures received from surveyed GPs and medical indemnity organisations. This will be paid to practices on a per patient basis, set out under the Statement of Financial Entitlements (SFE), and will not be weighted as a result of the Carr-Hill formula. This funding is intended to cover the average rise in indemnity cover costs.
Practices will receive a payment of 51.6p per patient based on their registered list as at December 2016. This funding will be paid to practices in March 2017. Some payments have now already been made.
These payments will be made to practices on the condition that, where principal and salaried GPs are paying for part or all of their indemnity costs, the practice will reimburse to them, from the payment received, an appropriate proportion of the amount which the GP has paid for their cover. The reimbursement amount should be based on the proportion of GMS services which the GP is providing for the practice.
It is recognised that every practice will have its own arrangements in place. In some practices, GPs are responsible for paying the entirety of their own indemnity costs. In some, part or all of the indemnity costs for GPs at the practice are paid for by the practice/reimbursed by the practice. Therefore, each practice will need to allocate payment to its GPs which is equitable and proportional based on their circumstances.
The conditions above will be set out in the revised SFE which will be in place from 1 April 2017. A similar funding arrangement has been confirmed for 2018.
Locum GPs will need to ensure that, as with all other business expenses, their charges reflect their costs, which should include indemnity insurance costs.
LMC advice: Wait for the SFE - this will hopefully provide full details of how this should work and this should be available shortly.
Sick leave reimbursement
The LMC is getting lots of questions about sick leave reimbursement.
The GPC have also negotiated important beneficial changes to sickness cover reimbursement. Practices are currently at considerable financial risk of paying for sickness absence of GPs, due to discretionary reimbursement, outdated list-size criteria and the need for cover to be provided by an external locum.
The GPC have secured that sickness cover reimbursement will no longer be a discretionary payment, but a practice entitlement. The qualifying criteria based on list size, which often prevents a practice from being able to claim a payment to cover locum costs, has been removed. Payments will be made after 2 weeks of a GP being absent from the practice due to sick leave.
As part of the agreement, existing GPs within the practice can now be used to cover sickness, mirroring existing maternity cover arrangements. The amount payable for sickness cover has also been uplifted to £1734.18 per week in line with current maternity cover arrangements. There will be no medical exclusion criteria for this sickness reimbursement, which we believe will be a very significant benefit to GPs with long-term conditions who currently find sickness cover difficult or expensive to source. It should also reduce practice locum insurance cover expenses, and enable practices to offer better sickness absence terms for salaried GPs.
LMC Advice: Again wait for the SFE and further advice which will be published shortly.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)
Attached file: Please read this leaflet carefully v3.docx