Patients in England whose practices use the TPP and EMIS systems, and who have online accounts, can now see new entries made in their clinical records. We know this might raise some questions for practices - so here are some answers you might find helpful.

Do patients have to ask for access to new entries in their records?

For existing patients already using online access, the change is made automatically. New users set up with online access from April 2022 onwards have the same level of access by default. Clinicians and other practice staff therefore need to bear in mind that patients can see what is written in new entries. NHS Digital has more information on the new access arrangement.

In our own guidance on online access to records, we advise that those involved in creating the record think carefully about the purpose and content of the records, as well as the impact they may have on patients reading them.

Do patients now have access to historic records as well?

The aim is that patients will be able to access historic records through the NHS app at some point during 2022. However, they will not see past health record information unless they have been given access to it by their GP practice. This will give practices the chance to review records to ensure access is appropriate.

Can online access be withheld?

Yes - where a practice believes that online access would not be appropriate, they can make a decision to withhold information, for example, where access may cause serious harm or in some circumstances where safeguarding concerns exist, access can be customised or removed.

Can patients see test results?

Yes, but these can only be accessed by the patient once they have been checked and filed. This is to allow clinicians an opportunity to contact patients and discuss their results with them first.

What are the benefits to the practice?

It is hoped this will support patients in managing their own health, and will reduce queries to practices where test results are negative as well as queries about referral letters.

Is access only available for patients using the NHS app?

No, it will apply to other approved patient facing services apps - such as Evergreen, Airmid, SystmOnline and Patient Access.

What information do patients have access to?

Patients have access to their full GP health records, including free text, letters, and documents, but not administrative tasks or communications between practice staff.

What about proxy access?

The change does not apply to proxy access. It only applies to those over 16 with capacity accessing their own record through their own online account.

Can information in the notes (such as third-party information) be redacted in the same way as for a subject access request?

There may be no way of redacting records successfully. Documents containing reference to a third-party should therefore be hidden from view, unless you have the consent of the third-party.

What if there's sensitive information in the records, such as child or adult safeguarding concerns?

Safeguarding the patient from harm is paramount. It may be necessary to hide documents from view, like those containing sensitive information or third-party information such as reference to family members, or to remove online access.

These concerns have been acknowledged, and to help clinicians mitigate the risk, the RCGP is updating its patient online toolkit, in conjunction with safeguarding experts. This will help clinicians redact information in the record or prevent specific information, which has been entered into the record, from being shared within the patient's access to the system, preventing them from viewing it.