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Confidentiality, Medical Records & How we share your data

Confidentiality & Medical Records

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Your Information, Your Rights

Being transparent and providing accessible information to patients about how we will use your personal information is a key element of the Data Protection Act 2018 and the EU General Data Protection Regulations (GDPR).

The following notice reminds you of your rights in respect of the above legislation and how your GP Practice will use your information for lawful purposes in order to deliver your care and the effective management of the local NHS system.

This notice reflects how we use information for:

  • The management of patient records;
  • Communication concerning your clinical, social and supported care;
  • Ensuring the quality of your care and the best clinical outcomes are achieved through clinical audit and retrospective review;
  • Participation in health and social care research; and
  • The management and clinical planning of services to ensure that appropriate care is in place for our patients today and in the future

Data Controller

As your registered GP practice, we are the data controller for any personal data that we hold about you.

What information do we collect and use?

All personal data must be processed fairly and lawfully, whether is it received directly from you or from a third party in relation to the your care.

 

We will collect the following types of information from you or about you from a third party (provider organisation) engaged in the delivery of your care:

 

  • ‘Personal data’ meaning any information relating to an identifiable person who can be directly or indirectly identified from the data. This includes, but is not limited to name, date of birth, full postcode, address, next of kin and NHS Number.

 and
 

  • ‘Special category / sensitive data’ such as medical history including details of appointments and contact with you, medication, emergency appointments and admissions, clinical notes, treatments, results of investigations, supportive care arrangements, social care status, race, ethnic origin, genetics and sexual orientation.

 Your healthcare records contain information about your health and any treatment or care you have received previously (e.g. from an acute hospital, GP surgery, community care provider, mental health care provider, walk-in centre, social services). These records may be electronic, a paper record or a mixture of both. We use a combination of technologies and working practices to ensure that we keep your information secure and confidential.

Why do we collect this information?

 

The NHS Act 2006 and the Health and Social Care Act 2012 invests statutory functions on GP Practices to promote and provide the health service in England, improve quality of services, reduce inequalities, conduct research, review performance of services and deliver education and training. To do this we will need to process your information in accordance with current data protection legislation to:

  • Protect your vital interests;
  • Pursue our legitimate interests as a provider of medical care, particularly where the individual is a child or a vulnerable adult;
  • Perform tasks in the public’s interest;
  • Deliver preventative medicine, medical diagnosis, medical research; and
  • Manage the health and social care system and services.

How is the information collected? 

Your information will be collected either electronically using secure NHS Mail or a secure electronic transferred over an NHS encrypted network connection. In addition physical information will be sent to your practice. This information will be retained within your GP’s electronic patient record or within your physical medical records.

Who will we share your information with?

 

In order to deliver and coordinate your health and social care, we may share information with the following organisations:

  • Local GP Practices in order to deliver extended primary care services
  • Local GP Practice in order to deliver the Extended Access service delivered by Alliance for Better Care Ltd (ABC) via 5 satellite hubs which are existing GP practices.
  • NHS services, BSUH, SASH, ESHT and other Hospital Trusts
  • 111 and Out of Hours Service
  • Local Social Services and Community Care services
  • Voluntary Support Organisations commissioned to provide services by the local CCG and Public Health.

 

Your information will only be shared if it is appropriate for the provision of your care or required to satisfy our statutory function and legal obligations.

Your information will not be transferred outside of the European Union.

Whilst we might share your information with the above organisations, we may also receive information from them to ensure that your medical records are kept up to date and so that your GP can provide the appropriate care.

In addition we received data from NHS Digital (as directed by the Department of Health) such as the uptake of flu vaccinations and disease prevalence in order to assist us to improve “out of hospital care”.

How do we maintain the confidentiality of your records?

We are committed to protecting your privacy and will only use information that has been collected lawfully. Every member of staff who works for an NHS organisation has a legal obligation to keep information about you confidential.  We maintain our duty of confidentiality by conducting annual training and awareness, ensuring access to personal data is limited to the appropriate staff and information is only shared with organisations and individuals that have a legitimate and legal basis for access.

Information is not held for longer than is necessary.   We will hold your information in accordance with the Records Management Code of Practice for Health and Social Care 2016.

 Consent and Objections

Do I need to give my consent?

The GDPR sets a high standard for consent. Consent means offering people genuine choice and control over how their data is used. When consent is used properly, it helps you build trust and enhance your reputation.  However consent is only one potential lawful basis for processing information.  Therefore your GP practice may not need to seek your explicit consent for every instance of processing and sharing your information, on the condition that the processing is carried out in accordance with this notice.  Your GP Practice will contact you if they are required to share your information for any other purpose which is not mentioned within this notice.  Your consent will be documented within your electronic patient record.

What will happen if I withhold my consent or raise an objection?

You have the right to write to withdraw your consent to any time for any particular instance of processing, provided consent is the legal basis for the processing. Please contact your GP Practice for further information and to raise your objection.

 Health Risk Screening / Risk Stratification

Health Risk Screening or Risk Stratification is a process that helps your GP to determine whether you are at risk of an unplanned admission or deterioration in health. By using selected information such as age, gender, NHS number diagnosis, existing long term condition(s), medication history, patterns of hospital attendances, admissions and periods of access to community care your GP will be able to judge if you are likely to need more support and care from time to time, or if the right services are in place to support the local population’s needs.

To summarise Risk Stratification is used in the NHS to:

  • Help decide if a patient is at a greater risk of suffering from a particular condition;
  • Prevent an emergency admission;
  • Identify if a patient needs medical help to prevent a health condition from getting worse; and/or
  • Review and amend provision of current health and social care services.

 Your GP will use computer based algorithms or calculations to identify their registered patients who are at most risk, with support from the local Commissioning Support Unit and/or a third party accredited Risk Stratification provider. The risk stratification contracts are arranged by Horsham & Mid Sussex CCG in accordance with the current Section 251 Agreement. Neither the CSU nor your local CCG will at any time have access to your personal or confidential data.  They will only act on behalf of your GP to organise the risk stratification service with appropriate contractual technical and security measures in place.

Your GP will routinely conduct the risk stratification process outside of your GP appointment. This process is conducted electronically and without human intervention.  The resulting report is then reviewed by a multidisciplinary team of staff within the Practice.  This may result in contact being made with you if alterations to the provision of your care are identified.

A Section 251 Agreement is where the Secretary of State for Health and Social Care has granted permission for personal data to be used for the purposes of risk stratification, in acknowledgement that it would overburden the NHS to conduct manual reviews of all patient registers held by individual providers.

As mentioned above, you have the right to object to your information being used in this way. However you should be aware that your objection may have a negative impact on the timely and proactive provision of your direct care.  Please contact the Practice Manager to discuss how disclosure of your personal data can be limited.

 

Sharing of Electronic Patient Records within the NHS

Electronic patient records are kept in most places where you receive healthcare. Our local electronic system, SystmOne enables your record to be shared with organisations involved in your direct care, such as:

  • GP practices and extended access HUBs.
  • Community services such as district nurses, rehabilitation services, telehealth and out of hospital services.
  • Child health services that undertake routine treatment or health screening
  • Urgent care organisations, minor injury units or out of hours services
  • Community hospitals
  • Palliative care hospitals
  • Care Homes
  • Mental Health Trusts
  • Hospitals
  • Social Care organisations
  • Pharmacies

 In addition, NHS England have implemented the Summary Care Record which contains information including medication you are taking and any bad reactions to medication that you have had in the past.

In most cases, particularly for patients with complex conditions and care arrangements, the shared electronic health record plays a vital role in delivering the best care and a coordinated response, taking into account all aspects of a person’s physical and mental health. Many patients are understandably not able to provide a full account of their care, or may not be in a position to do so.  The shared record means patients do not have to repeat their medical history at every care setting.

Your record will be automatically setup to be shared with the organisations listed above, however you have the right to ask your GP to disable this function or restrict access to specific elements of your record. This will mean that the information recorded by your GP will not be visible at any other care setting. 

You can also reinstate your consent at any time by giving your permission to override your previous dissent.

 Invoice Validation

If you have received treatment within the NHS, the local Commissioning Support Unit (CSU) may require access to your personal information to determine which Clinical Commissioning Group is responsible for payment for the treatment or procedures you have received. Information such as your name, address, date of treatment and associated treatment code may be passed onto the CSU to enable them to process the bill.  These details are held in a secure environment and kept confidential.  This information is only used to validate invoices in accordance with the current Section 251 Agreement, and will not be shared for any further commissioning purposes.

 Your Right of Access to Your Records

The Data Protection Act 2018 and General Data Protection Regulations allows you to find out what information is held about you including information held within your medical records, either in electronic or physical format. This is known as the “right of subject access”.  If you would like to have access to all or part of your records, you can make a request in writing to the organisation that you believe holds your information.  This can be your GP, or a provider that is or has delivered your treatment and care.  You should however be aware that some details within your health records may be exempt from disclosure, however this will in the interests of your wellbeing or to protect the identity of a third party.  If you would like access to your GP record please submit your request in writing to:

Dr Hugo Wilson

Data Processing Officer & Caldicott Guardian

Mid Sussex Health Care

The Health Centre

Trinity Road

Hurstpierpoint

West Sussex

BN6 9UQ

 

Or via e-mail to:

 

hsccg.mshc.dpo@nhs.net

 

Complaints

In the event that your feel your GP Practice has not complied with the current data protection legislation, either in responding to your request or in our general processing of your personal information, you should raise your concerns in the first instance in writing to the Practice Business Manager at:

Mid Sussex Health Care

The Health Centre

Trinity Road

Hurstpierpoint

West Sussex

BN6 9UQ

 

If you remain dissatisfied with our response you can contact the Information Commissioner’s Office at Wycliffe House, Water Lane, Wimslow, Cheshire SK9 5AF – Enquiry Line: 01625 545700 or online at www.ico.gov.uk

 

Why is sharing my health information important?

Your electronic health record contains lots of information about you, including your medical history, the types of medication you take, any allergies you have and demographic information like your home address, and your next of kin.

In many cases, particularly for patients with complex conditions, the shared record plays a vital role in delivering the best care. Health and social care professionals can ensure coordinated response, taking into account all aspects of a person’s physical and mental health. Whilst some patients have extensive knowledge of their conditions and care requirements, this is not true for everyone. Many patients are understandably not able to provide a full account of their care. The shared record means patients do not have to repeat their medical histories at every care setting, or make guesses about their previous care.

 A shared record ensures health or social care professionals always have the most accurate, up to date information. They can rely on their colleagues, sharing accurate and relevant data in a timely way, to provide you with safe and efficient care.

You have choices about whether or not your information is available to other providers who care for you.

To provide the best care, your electronic health record will be made available to other services involved in your care. Until you are registered at one of the care services, no information about you will be shared to them.

Although your record is automatically setup to share your information, you can ask your doctor for this option to be switched off. This will mean none of the information recorded by your doctor will be visible at any other care service.

When you visit other care services that use SystmOne you can give your permission to override your previous dissent, allowing them to view your record including any items marked as private.

If you would prefer that the override option above is never made available, you have the ability to request your doctor prevents it. However, this means your data will never be available at other care services.

Providing consent to view

When you start receiving care from a care service (that uses SystmOne), you have the right to either agree or disagree that they may view your SystmOne record. The health or social care professional seeing you should ask your permission for them to view your electronic record.

If you answer YES: That care service will be able to view information recorded on your electronic record by other care services (excluding any data you have requested to keep private (see below)).

If you answer NO: That care service will not be able to see any information recorded anywhere else (even if your record has been set to share from any other care services).

As a patient, you have control over who can see your health information. Even if you give permission on one occasion, you can still change this at any time.

Can I choose what is made available?

To give you the most personalised care, it is recommended that you share your whole health record with every service that cares for you. However, you have control over your record and have the choice to specify specific elements of the record you don’t want to be shared.  For example, if you have had a consultation about a particularly sensitive matter, you can ask for this section of the record to be marked as private. That way, even if you consent for another service to see your record, that consultation will not be shown. If a consent override is used, then consultations marked as private will be accessible.

What choices do I have?

When thinking about how your information is shared, you as the patient can specify three main controls:

  1. Do you enable your record to be shared at all? If you have said ‘yes’ to sharing out from this organisation, for every care setting you visit you still get to decide if they can view your record. You do not have to make the same choice for every organisation.
  1. You can specify entries in your record that you want to remain confidential. These can only be viewed by the care service they were originally recorded at (unless the consent override is used for the reasons stated above). You can then decide if the rest of your record is shared at each care setting you visit.
  1. Saying no at this stage means no other care service can see any of your record. If you don’t want your record to ever be viewed by anyone you have a further choice to request that consent override is prevented

As a Practice we would strongly advise patients to register for online services. This will allow you to order prescription and book appointments over the web. It will also allow you to view your medical records and more importantly in terms of the Data Sharing will allow you to see who has looked at your medical records.

Locally the people who are most likely to view your medical record and provide additional valuable information are the community nurses and therapists, doctors and nurses who may see you at the Practice at Ditchling, Hassocks and Hurstpierpoint and St Peter & St James’ Hospice.

 What do I need to do now?

  1. If you are happy for people providing care to yourself seeing your records, do nothing.
  1. If you are not happy for other organization who are providing care to you to see your medical records, then please let the practice know and we will turn off the consent on your records, preventing anyone seeing your records.

 If you would like more information on how your data is shared please talk to us.

Freedom of Information

All requests for information should be made to the Practice Manager by email or by post.  We may ask for the reason for the request and are entitled to challenge the reasonableness of some requests, but we will work positively with anyone requesting information to help clarify what is required and whether the Practice can meet the request.  In cases where hard copies of info is required, charges will be made to cover the costs of copying, printing and postage.  A lot of information is available for free on this website or in hard copy form on our reception desks so we encourage you to check those resources first. 

Access to Records

In accordance with the Data Protection Act 2018 and Access to Health Records Act, patients may request to see their medical records. Such requests should be made through the Practice Manager. No information will be released without the patient's consent unless we are legally obliged to do so.

Access to Medical Records leaflet May 2018

Access to Medical Records request form May 2018

Privacy Notices

Fair Processing Privacy Notice
Care Quality Commission                      National Screening Programme
Emergencies                                          Payments
Direct Care                                            Summary Care Record
NHS Digital                                            Public Health
Research                                                Risk Stratification
Safeguarding

Complaints

Customer service formWe make every effort to give the best service possible to everyone who attends our practice.

However, we are aware that things can go wrong resulting in a patient feeling that they have a genuine cause for complaint. If this is so, we would wish for the matter to be settled as quickly, and as amicably, as possible.

To pursue a complaint please contact the Practice Manager who will deal with your concerns appropriately. Further written information is available regarding the complaints procedure from reception.

Complaints Leaflet

Complaint Form

Violence Policy

The Practice operates a zero tolerance policy with regard to violence and abuse and has the right to remove violent patients from our list with immediate effect in order to safeguard practice staff, patients and other visitors. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. 

Equal Opportunities service provision policy

NHS Constitution

Our committment to our patients and staff as stated by the NHS constitution - please click below for the link to the full document

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132958.pdf



 
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