Hospitals breaking DPA every day

Tags: BMA CfH Choice Confidentiality Contract DPA GP GPs Information Commissioner Safety Social care

31 Mar 2009

The BMA says hospitals are breaking the Data Protection Act on a daily basis by sending referral correspondence to the senior partner in a practice rather than the referring GP because of changes to hospital software.

The Personal Demographics Service was changed in 2008 to record patients as registered with a practice rather than with an individual doctor, reflecting changes agreed in the 2004 GMS contract. Some hospital patient administration systems are also set up in the same way, although newer versions include a field for ‘usual GP.’

The BMA’s General Practitioners Committee says hospitals are either not using the facility to select ‘usual GP’, or do not have it and are not taking the time to find out who the referring GP is when sending letters to practices.

However NHS Connecting for Health told EHI Primary Care that correspondence is only sent to the senior partner when the referring GP is not known and it would not change its systems further unless GMS regulations changed.

Dr Grant Ingrams, co-chair of the joint IT committee of the GPC and Royal College of GPs, says it has had endless complaints from GPs and local medical committees and it was “eminently false” that the problem only occurred where the referring GP was not known.

“My partner and the other GP who works here are referring people all the time and yet I am getting all the correspondence addressed to me”.

Legal advice obtained by the GPC states that trusts would be guilty of unfair processing under the Data Protection Act if they deliberately write only to a senior partner who may not be involved in a patient’s care. The GPC is advising practices to make a compliant to the Information Commissioner if hospitals do not respond to requests to address letters to the referring GP.

Dr Ingrams told EHI Primary Care: “It drives a coach and horses through patient confidentiality. Patients may not want one of the other doctors in the practice to know some of the information and in rural areas doctors themselves often have no choice but to register their families with the same practice where they work.”

Dr Ingrams said he also believed hospitals could be in breach of article 8 of the Human Rights Act and cited a case last summer where a hospital in Finland was found to be in breach of the Human Rights Act. The European Court of Human Rights ruled that the hospital had failed to keep the records of a nurse being treated in one part of the hospital secure from workers in another part of the hospital where she worked. The court said the hospital had a duty to exclude any possibility of unauthorised access occurring.

Dr Ingrams said one medical director in his area had written to his consultants asking them to remind their secretaries to ensure correspondence was sent to the referring GP but he himself had yet to see much change.

“I am still receiving 90% of correspondence direct to myself. Apart from the confidentiality issue there is a patient safety issue if I don’t have time to get through all the mail and it’s also a professional discourtesy.”

A spokesperson for CfH told EHI Primary Care: “In 2004 the GMS contract was agreed with the GP community. This changed how a patient is registered to receive primary care. Rather than being registered with an individual GP patients are registered with the practice. Patients are able to see a specified GP if they wish or any GP within the practice.

“One implication of the change in 2004 is that where the referring GP is not known correspondence must be sent to the practice. Some systems developers and trusts have opted to send the correspondence to the senior partner. It should be made clear that this only occurs where the referring GP is not known.

The CfH spokesperson added: “In mid 2008, NHS Connecting for Health updated its IT systems as part of this change. Rather than recording a specific GP against each patient, the Spine Personal Demographics Service was updated to reflect the registered practice. This change was agreed in consultation with stakeholders and approved by the Information Standards Board for Health and Social Care on which the GPC is a representative.

“NHS CFH does not intend to change its systems further unless a corresponding change is made to the GMS regulations which govern the relationship between a patient and their primary care provider.”

Fiona Barr

Reader's Comments

a Breach of the DPA

stressfreedave@hotmail.com

31 Mar 09 15:03

I am just asking for trouble saying this, but I can not understand why the BMA say the hospital is breaking the DPA. I have tried withholding information from some doctors/nurses but was not allowed because any doctor/nurse treating you is allowed full access to records including referal letters (I could not even stop a doctor I would never see from accessing the information). It seems a bit of a contridiction that the hospital sending the letter to the senior partner is seen as a breach of the DPA yet the same doctor would be allowed to access it when they see the patient anyway. In most practices I have been in there has been no choice of GP to see (if you would rather see a doctor of same gender, then you only get it by chance), so it is not as if you can stop the doctor accessing the information.

When you consider who else gets sent the information, I cant understand why the BMA are so against the senior partner in the practice getting it.

Referrring GP

31 Mar 09 16:03

I wonder what happens where the referring GP is from another practice. It's more important that they get the correspondence, I would have thought.

it's a workflow problem

01 Apr 09 10:04

that's causing a safety issue, if all return mail is essentially being dumped unsorted on the one addressee.

Since a regulatory change has apparently allowed essential routing data to be lost, there's now delay in getting the letter to the right clinician for action, despite practices having custom workflow systems (e.g. that allow for leave or other absences) to maintain continuity of care.

But would that bother the Health Secretary, who doesn't care which GP he deals with? It should, for safety.

BMA pronouncement

grant.forrest@nhs.net

01 Apr 09 10:04

This is nuts. In Scotland a patient is registered with a Practice rather than with an individual GP. Whilst it is beneficial if hospital correspondence is directed to the GP made a referral or requested a test, it should not be mandatory. It should be up to the GPs to manage the workflow of incoming clinical information so that important stuff is not missed. On the face of it, this would seem like another BMA pronouncement that has little relevance to life in the real world of eHealth.

Who sees this information in the hospital?

01 Apr 09 13:04

When I started in clinical medicine (1980's) a referral letter sent to a hospital was opened by a named consultant's medical secretary and passed directly to him/her for prioritization if there was a question about urgency of the appointment.

The present hospital (acute trust) workflow takes referral information past more pairs of eyes than this. Is this also "unfair processing"?

Whatever (relatively speaking) I cannot see what the fuss is about at the GP practice side.

It IS important

01 Apr 09 14:04

It is important that the letters or results go to the correct doctor. The GMC guidance is that the doctor initiating the referral or test is responsible for follow-up. The registration of patients with practices rather than individual doctors does not remove this requirement.

The justification that as hospital paper flows are so inefficient, GP communication should be downgraded to match, simply does not wash. The safest , quickest and cheapest approach is person-to-person communication. GPs would prefer to send correspondence to a named individual and would do so if choose and book or hospital systems would allow. Likewise most consultants would prefer to reply to the initial Dr.

I am sure that the managers who have decided to do this would not be happy to receive e.mails for their entire department and be expected to find out the correct recipient.

agenda

roseneath@ntlworld.com

01 Apr 09 18:04

The real agenda here is that letters should be addressed to the clinician they are intended for. It is discourteous and dangerous to do otherwise. In my practice we still get odd letters addressed to a Dr who retired 14 years ago.

The problem is that hospitals are impervious to the complaints so the BMA is pointing out that there may be legal consequences to their lack of courtesy and professionalism.

Be careful what you ask for?

02 Apr 09 09:04

Nobody has commented on the fact that this was not initiated by CfH, but, as pointed out in the article, by the GMS Contract, negotiated by the BMA.

The consequences of changing from GP Registration to Practice Registration were discussed at length, and this very issue was raised, but the BMA appeared to be happy to sign it off.

Now that CfH and its suppliers have implemented what they were asked to, the same GP negotiators are up in arms.

I'm not normally an apologist for CfH, but on this occasion they're being beaten up for following the customers' instructions.

Hang on

02 Apr 09 15:04

Even in the days when there was registration with individual GPs it was the referring GP, not the registered GP that received the correspondence. We even had a mailmerge field on our letters that said 'Please reply to '.

Named clinician referrals

grant.forrest@nhs.net

06 Apr 09 10:04

Perhaps one of my GP colleagues can explain what happens when the hospital want to contact the referring GP about a patient and the referring GP is on annual/sick/study leave ? What if the nature of the problem requires an immediate (same day) answer ? In situations like this, we all delegate for one another, GPs and hospital-based clinicians alike. Named consultant referrals were great in the days when GP x played golf with Surgeon y. I think we all accept that those days are gone.

Named referrals

06 Apr 09 11:04

Yes we have a system of cover for when a doctor is away. This is not a reason to justify downgrading communication the rest of the time.

As for named consultant referrals, this is not a back-scratching exercise. It is now increasingly rare for GPs to meet consultants either professionally or socially.

Named referrals are to ensure that the patient sees the best specialist for their care. It could also be that they have previously seen the consultant or they have been recommended by a friend or other professional.

I refer to hospitals that use named consultants and 'department' referrals. It is not uncommon to receive letters from the latter asking for re-referral to a more appropriate specialist. I suspect this is because the appointments clerks try to fill empty slots rather than picking the most appropriate consultant.

However, I am sure the fact that this means 2 first appointments and more income to the trust has nothing to do with it.

re: 11 - maybe accounts for the dramatic increase in cost of referrals

06 Apr 09 15:04

In October 08, Pulse carried an interesting story PCTs face £100m-plus overspend on referrals see - http://tiny.cc/referral

it all seems to fit together when we hear comments from the ground like the previous one.

Re. 11 & 12

06 Apr 09 22:04

. . . and you know that CaB has a built in 'redirect referral' feature so the Dermatologist who receives a Leg Ulcer referral can transfer it to his Vascular Consultant colleague within the Trust?

And the referral is only counted once, and the GP's worklist advises the referrer of the transfer? You knew that, right?

Yes, yes. I know it's not always used because the Trust couldn't be arsed training its consultants properly, or the consultant doesn't read simple guidance, or the Trust is keen to duplicate referrals/tariffs.

Another example of shoddy training, or providers 'gaming the system' being laid at the door of CaB.

Let's keep on blaming the lorry for shoddy cargo chaps, that's the spirit!

Our clinicians deserve quality training, protected time to implement it, and the freedoms & foresight to adapt their routine processes to capitalise on new technological functionality.

Without those, we'll carry on smashing perfectly good screwdrivers by trying to use them to knock nails in.

No-one blaming lorries here!

08 Apr 09 01:04

.. just trying to piece together issues that need to be aired - hopefully this thread may have been useful to someone in PCT land to go and find out more about referral redirects or at least provide a reminder to RTFM.

Meanwhile, 'Unprecedented' financial situation as the report in Pulse eludes to (see comment 12) suggests there has been a step change somewhere along the way and the processes and smokescreen around C+B may be partly to blame.

I agree that protected training is an absolute requirement to introduce any large system with so many dependencies, but having a whole system view is also a must and it would be good to hear from one area of the country at least where following a thorough implementation of C+B and sufficient training: 1) DNA rates have reduced as a result of increased patient choice / convenience 2) Referral rates have stayed in line with expected norms 3) Patient satisfaction and outcomes have both improved

I believe the acid test should also be that GPs as a profession can unite around the benefits that they see for their patients.

If these aren't fulfilled what has been the point of this whole exercise? - I'm not a GP BTW.