Proxy Access

As your GP practice, we have been asked to provide you with, no later than 31 October 2023, access to your full medical record going forward via the NHS app (and NHS website) if you have a suitable NHS login

Your GP medical record contains consultation notes based on conversations between you, your GP and their team: medicines prescribed to you; all test results including hospital investigations; allergies; vaccines; and your medical conditions along with documents that may have been sent from local hospitals, clinics or other agencies, e.g. the police. There is likely to be sensitive and personal information within your medical record.

We are supportive of providing you with access to your record, but we wish to do this safely and make you aware that this is happening so that you can opt out, if you so wish. You may wish to speak with us first to understand what it is that you will see, and the risks which may be involved in having such confidential data either on your smartphone with the NHS app installed or online if other people might have access to that information through your devices. If you are in a difficult or pressured relationship for example, you may prefer your records to remain accessible only to those treating you, with them not appearing on your smartphone or online. Government has been clear that if a patient does not wish to have access, then we do not have to provide it. This is one reason why we have asked if you wish to opt out, or have it switched off for the time being.

For those who would like access, we are happy to explain the different levels you might like. Everyone can have access to their medication history and allergies, for example, and will be able to order their repeat prescriptions. It’s also possible to request access to what we call your ‘coded record’ where you can see a list of medical problems and results. You can also request access to the ‘full’ record where you will be able to see everything, including the notes which have been written by doctors, nurses and others involved in your care, at the GP surgery, and elsewhere.

It’s important to remember that these documents may, at times, contain information that could be upsetting, especially if they contain news of a serious condition. It can also be a cause for worry seeing results online when it isn’t clear what the results might mean, and no one is available to ask, as can be the case during the evening or at weekends, for example. 

Sometimes people with a mental health condition might prefer not to see documents that remind them of difficult times in their life. Letters from mental health teams sometimes go into detail about past events, and great care would be needed in deciding whether you would want to see these letters. It is possible for individual items to be hidden at your request and your GP would be happy to talk about any concerns you may have.

Great care is also needed in case private details might cause harm at home, should people in a difficult or pressured relationship be forced to show their medical record to an abusive partner. Anyone in such a position should make this clear to us at the practice, so we can take steps to keep you safe. This might mean removing access through the NHS app for the time being, or through a careful process where we hide sensitive things. We would talk this through with you.

The easiest way to get access is to create an NHS login through the NHS app. Although you can also access your GP records via the internet on a computer, the first bit is easiest if done through a smartphone. If you don’t have one, you may have a family member or friend you trust who can help you. You can also ask your practice receptionist, but you’ll need some proof of who you are, e.g. a passport, driving licence or household bill.

If you use the NHS app, you’ll have to set up an account using a unique e-mail address and then ‘authenticate’ yourself to the NHS system to prove you are who you say you are. This will involve confirming your name, date of birth and contact details. The NHS login has several levels of authentication and to gain access to your records you’ll need the highest level of authentication. This generally involves you recording a short video of yourself to prove you are a real person as well as uploading a copy of a suitable identification document. Your GP practice can bypass this step if you are struggling, but we’d ask you to try to sign up to the NHS app yourself.

Once you have suitably authenticated yourself to the NHS app and created your NHS login you can approach your practice and ask for access, being mindful of the risks associated with access and the importance of not sharing passwords or having them stored in your smartphone if you think other people might want to see them without your permission. If you have any concerns, you should explain these to your GP practice team who can guide you.

Your GP practice will have a form they will ask you to complete, with your NHS login (this will be the email address you used to sign up) and then you will have a chat about access and your agreement and understanding will be requested. Once you are happy to get online access, your request will be passed to the clinical team to review. It may be that the practice wishes to contact you to discuss your request if there are any concerns raised so that access can be given safely. We’re not sure how many people will ask for access all at once so there may be a wait, but we will do our best to get you online access as soon as we can. 

AGE GROUPS:  

Proxy access in children under the age of 11

All children under the age of 11 are assumed to lack the capacity to consent to proxy access. Those with parental responsibility for the child can apply for proxy access to their children’s online services to book appointments and order medication. 

When the child reaches the age of 11, access to the parent/guardian will automatically cease. Subsequent proxy access will need to be reauthorised by the practice. 
 

Proxy access in children above the age of 11 and under 13 years of age

Some children aged 11 to 13 have the capacity and understanding required for decision-making with regards to access to their medical records and should therefore be consulted and have their confidence respected. The practice will allow Parents or Guardians to book appointments and order medication as a proxy user for children aged between 11 and 13. 

Proxy access in adults (including those over 13 years) with capacity
Patients over the age 13 (under UK DPA 2018) are assumed to have mental capacity to consent to proxy access. Where a patient with capacity gives their consent, the application should be dealt with on the same basis as the patient. The practice will allow Parents or Guardians to book appointments and order medication as a proxy user for children aged between 13 and 16 with patient consent.

When the child reaches the age of 16, access for the parent/guardian will automatically cease. Subsequent proxy access will need to be reauthorised by the patient via a new application with explicit consent or proof of lack of capacity. 

Proxy access in adults (anyone over 16 years)
Upon reaching the age of 16, patients are deemed as adults in the eyes of the NHS. Explicit consent is required to provide any third party (including parents/guardians) access to a medical record.

Proxy access in adults (including those over 13 Years) without capacity

Proxy access without the consent of the patient may be granted in the following circumstances:

The patient has been assessed as lacking capacity to decide 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.
The patient has been assessed as lacking capacity to decide on granting proxy access and the applicant is acting as a Court Appointed Deputy on behalf of the patient.
The patient has been assessed as lacking capacity to make a decision on granting proxy access and, in accordance with the Mental Capacity Act 2005 code of practice, the responsible clinician considers it in the patient’s best interests to grant access to the applicant.

When an adult patient has been assessed as lacking capacity and access is to be granted to a proxy acting in their best interests, it is the responsibility of the responsible clinician to ensure that the level of access enabled, or information provided is necessary for the performance of the applicant’s duties.

• Is there any information in your records you would not like anyone to see or know about?
• Can you trust the person to keep your information safe and not share it with others or use it without your permission?
• Is anyone forcing you into sharing your online services with them or do you think someone could force you to share it with them? If so, we would advise that you do not give them access. If you have any concerns that someone has access to your online records without your permission, speak to your surgery and they can change your password or stop your online services
• How long would you like your chosen person to have access for? This can be for a short time, for example when you are suffering from a certain illness and you need support with managing your health during that time. It can also be ongoing so they can help you for a long period of time. You can discuss this with the Practice.

When a person is unable to make decisions for themselves, another person, usually a partner or close family member can be given legal responsibility over decisions concerning their life by the courts. This is called Health and Welfare Lasting Power of Attorney. A person with lasting power of attorney can ask the patient’s surgery for access to their online services. The GP will make a decision whether this should be allowed.

If you know that you would never want a particular person to have access to your online services if you become unable to make your own decisions, you should tell your GP and they will never share them with that person.

On rare occasions, your GP could refuse to allow your chosen person to use GP online services on your behalf. If this happens, your GP will discuss their reasons with you. Some of the reasons your GP could have are:

• Your GP does not think it is in your best interest for your chosen person to use these services on your behalf
• You or your chosen people have misused online services in the past
• The Practice is concerned that your chosen person will not keep your information safe
• The Practice suspects someone is forcing you to give them permission to use your online services
• You are not able to make decisions for yourself.

• We believe your chosen person is forcing you to share your GP records with them or with another person.
• Your chosen person has misused your GP information
• You are no longer able to understand or remember that you gave your chosen person permission to use online services on your behalf
• You have told the Practice in the past that if you become unable to make decisions for yourself, you do not wish for your chosen person or anyone to have permission to your online services
• You have died.

You can choose to take away access to your GP online services from your chosen person at any time. To end the service, you need to let your surgery know you would like them to switch off online access for your chosen person and give them the reason. We will then stop the service and your chosen person will not be able to use their login details to look at your information.

Some of the reasons you can choose to end the service are:

• You only needed your chosen person to support you for a short time, for example when you were suffering from a certain illness and you needed help with managing your health during that time
• You want to give this responsibility to another person, for example, if you have a new carer or personal assistant
• Your relationship with your chosen person has broken down
• Your chosen person has misused information in your GP records, for example, they have collected medication in your name or they have shared your private information with someone without your permission.