Practice Policies

 Patient Data

• We note that there is public concern as a result of the recent media reporting about the proposals for NHS Digital to collect data about individuals who are registered with GP Practices in England for the purposes of research and planning. It must be emphasised that these arrangements only apply in England and not in the rest of the UK.
• NHS Digital have published their reasons for collecting the data relating to people in England and the use to which they would put the data.
• As the NHS is devolved throughout the United Kingdom, Scotland has its own processes and arrangements for processing healthcare activity data for health and care reasons which may include research, planning, statistics, healthcare audits, and healthcare surveillance, and healthcare delivery.
• In Scotland, we do not share confidential patient information unless there is a legal reason to do so, or if the patient has given permission. The Scottish public should not be alarmed as NHS Scotland already has robust processes in place to safeguard personal data.
• Confidentiality is taken seriously in Scotland and NHS Inform has much information on how NHS Scotland handles patients’ personal health information.

Background Information

Since the late 1990s, each nation within the United Kingdom – England, Scotland, Wales and Northern Ireland – has had control over each of their healthcare systems through the process of devolution. This means that the 4 different nations have made independent choices on how they fund and manage their own health care systems. This in turn means that they have made different choices on how they each use data for healthcare planning and healthcare research.

In England, for example, provision is made for patients to opt-out of their data in GP Practices being used in research and planning for health and care purposes. This is known as the national opt-out of the General Practice Data for Planning and Research programme. This only applies in England.

In Scotland, we do not share confidential patient information unless there is a legal reason to do so, or if the patient has given permission. When national extracts of your healthcare activity information are used for research and planning purposes unrelated to your clinical care, clinical professionals and safe researchers apply to go through a national scrutiny process called the National Public Benefit and Privacy Panel (PBPP) for health and social care which is run by the NHS Scotland who also impose the strict conditions under which the data are accessed and analysed.  The Panel makes sure that there is a clear health benefit for any research and patient privacy is appropriately protected. The Panel includes NHS Caldicott Guardians, NHS clinicians, subject matter expertise, and NHS information governance professionals, as well as lay/patient representatives. Each application undergoes a proportionate governance scrutiny process. The Panel will not authorise the use of your confidential data, if that’s required, unless the law says that they can, or you have consented to this.

These authorisation processes provide robust, transparent, and proportionate scrutiny of the research need for data sharing, and ensure that data sharing is carried out within a secure and controlled NHS environment which meets security standards. For small localised types of research that require the use of personal information, the relevant NHS Caldicott Guardian will authorise the use of such data for research, along with scrutiny from the relevant NHS data protection officer. Every use of patient information has a lawful basis.

NHS Inform is Scotland’s national health information service and it provides a wealth of accurate and relevant information to help people make informed decisions about their own health and the health of the people they care for. For example, on its web pages that provide information on how NHS Scotland handles your personal health information, it sets out the types of information that NHS Scotland uses for various purposes such as healthcare delivery, health improvement, health protection, the safety of medicines and equipment, research and statistical purposes, maintaining NHS financial accounts and ensuring high standards of quality of care. Population health information helps health and care services understand how many people are affected by particular conditions, whether numbers are rising or falling and what the risk factors might be for getting a particular condition. You can read more about NHS Scotland’s use of data here: https://www.nhsinform.scot/care-support-and-rights/health-rights/confidentiality-and-data-protection/how-the-nhs-handles-your-personal-health-information

Public Health Scotland’s processing of personal data

Public Health Scotland (PHS) is one small part of NHS Scotland. The organisations that comprise NHS Scotland are listed here: https://www.scot.nhs.uk/organisations/.  PHS does not hold patients’ full medical records. PHS receives only extracts of patient information (i.e. specific data items) which enable it to carry out the activities which are outlined in its functions. The functions of Public Health Scotland (PHS) are set out in legislation – the Public Health Scotland Order 2019. This legislation empowers PHS to undertake, amongst other things, research and development services in the field of public health which include, for example:

• understanding the burden of premature death and disability for major disease and disease groups,
• impact of specialist drug treatment and care,
• monitoring of drug related harm,
• clinical trials management, and
• health and care experience survey

It also empowers PHS to engage in, and support, research into any matter relating to the causation, prevention, diagnosis or treatment of illness. By means of the Scottish cancer registry and related cancer information, for example, it allows PHS to assess the safety and effectiveness of cancer treatment, monitor particular cancers, carry out public health research for improving cancer care, report on national cancer treatment targets, all of which have huge benefits for patients with cancer today and the future.

PHS has supported, as at April 2021, the contact tracing of over 201,378 cases resulting in 487,548 people being contacted to self-isolate. Research that Public Health Scotland has led, partnered or enabled has made headlines around the globe. Data has helped PHS to support the monitoring of changes of the SARS-CoV-2 virus to assess whether any new variants could transmit more easily, make people more ill or evade the immune response generated by our vaccines. PHS has supported research into the consequences of school closures on access to education as well as the impact of asthma on mental health and wellbeing during the COVID-19 lockdown. You can read more about the range of research studies that PHS has led, collaborated or supported here: https://www.publichealthscotland.scot/our-areas-of-work/covid-19/covid-19-research-repository/. You may also wish to read about what we do on our privacy notice here: https://www.publichealthscotland.scot/our-privacy-notice/organisational-background/.

Public Health Scotland’s predecessor organisation engaged in extensive public engagement in 2017 with the public as well as privacy groups to agree on a controlled way to extract specific data items from GP Practice systems for specific purposes. The arrangements exclude all confidential discussions between patient and GP but nevertheless included provisions for individuals to contact their GPs to opt out of the GPs including data items related to them within the extracts. GPs themselves have the option to not participate.

Public Health Scotland is recognised in law as an Official and National Statistics producer in Scotland. This means that it is an authoritative source of statistics which are trustworthy, of high quality and of public value. Statistics support the decisions we make at home and at work, as individuals and collectively, and are part of the lifeblood of democratic debate. Official and National Statistics are an essential public asset. They provide a window on society, the economy and on the work and performance of government. They are fundamental to the judgements and decisions made by the public, by government and by an enormous range of other organisations. You can see examples of statistics we produce on a range of health topics here: https://www.publichealthscotland.scot/downloads/

Confidentiality & Medical Records

The practice complies with data protection and access to medical records legislation. Identifiable information about you will be shared with others in the following circumstances:

• To provide further medical treatment for you e.g. from district nurses and hospital services.
• To help you get other services e.g. from the social work department. This requires your consent.
• When we have a duty to others e.g. in child protection cases anonymised patient information will also be used at local and national level to help the Health Board and Government plan services e.g. for diabetic care.

If you do not wish anonymous information about you to be used in such a way, please let us know.

Reception and administration staff require access to your medical records in order to do their jobs. These members of staff are bound by the same rules of confidentiality as the medical staff.

Freedom of Information

Information about the General Practioners and the practice required for disclosure under this act can be made available to the public. All requests for such information should be made to the practice manager.

Access to Records

In accordance with the Data Protection Act 1998 and Access to Health Records Act, patients may request to see their medical records. Such requests should be made through the practice manager and may be subject to an administration charge. No information will be released without the patient consent unless we are legally obliged to do so.

Complaints

The Practice operates a complaints procedure that conforms to NHS guidelines. In the event that you feel the need to complain, please contact the Practice Manager. We would aim to deal with any problem both quickly and effectively. You will receive an acknowledgment within two working days and an explanation within 10 working days.

It would be helpful if you could inform us of any problems as soon as possible after the incident has taken place and, at latest, within 12 months.

In investigating your complaint we aim to:
• find out what happened
• enable you, if you like, to discuss the problem with those concerned
• ensure that, if appropriate, you receive an apology
• try to prevent the same thing happening in the future.

If you are complaining on behalf of someone else then, in order to maintain patient confidentiality, we will need to know that you have their permission to do so.

If you would prefer to complain to someone who is not involved, you can telephone, email or write/fax to the Complaints Office at the address below. You will be given a reply within four weeks of them receiving your complaint. Where there are good reasons why this cannot be achieved you will be kept informed of progress.

The Complaints Team
NHS Highland
P.O. Box 5713
INVERNESS
IV1 9AQ

Tel. 01463 705997
Fax. 01463 713844
E. complaints@mailbox.haht.scot.nhs.uk

Violence Policy

The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.