“Prospective medical records” via the NHS App

After 1st November 2023: If you have found this page after coming across something distressing and googling various terms, we’re sorry the Government has made the NHS and your GP put you in this position.

If immediate attention is required by what you have read, your GP will get in touch with you as soon as they read what you have already read (as you may have seen it before them). If you are immediately concerned and your GP has an out of hours message box, you can leave them a message asking for a call back when they’re open, or you can call 111. When this feature was being tested, people would think to call 999 or go to A&E (this is when to do that), and neither the Government nor NHS England did anything to minimise the fear or confusion you feel; they should have done so.

If someone else has become aware of information from misusing your app, NHS England give you no recourse. If you have become aware of something that was being withheld from you for legal reasons, please don’t harm your children, yourself, or anyone else.

The Government has contractually required your GP (in England) to facilitate access to “prospective medical records” from your GP record to the NHS app. From 31 October 2023, any correspondence sent to your GP will be available to you through the NHS app (and, over time, the NHS website).

In simple terms, these are letters about your care, not “to” you as such, but to/from different doctors providing your care, who may also send a copy to your GP. The doctors outside your GP have not been effectively told this is happening, and so won’t know to take it into account when writing the letters.

These may be distressing, as they may contain medical language you’d need to look up, they may discuss your mental health, and may contain bad news and diagnoses that the author of the letter expects a doctor to break to you with compassion.  You may also see how much work is shifted onto your GP from other parts of the NHS, and how secondary care “manages” their waiting lists. 

With the usual lack of attention to detail, Government and NHS England have not told anyone other than GPs that this is happening.

Online access will be helpful for most patients, but the process of making this available has created unnecessary risks and The Government with NHS England has chosen to leave them unaddressed, as described by domestic violence charity Refuge.

What happens next?

To implement the requirement placed on them, some GPs will text you to ask what you choice you would like to make, and some will turn it off until you ask them to turn it on for you. There are no government provided communications on this – every GP will have to do this all themselves. The Health Secretary has demanded it be on for everyone from day one, saying as his Tory Conference speech that family GPs “are even threatening to take the Government to court over our plans to let patients see their own test results on their own phones, rather than taking up a GP appointment. This clearly shows that the BMA leadership is not on the side of change, and they are not on the side of patients”. You will see these test results potentially before your doctor, and you may have to interpret them alone.

If this is harmful to you, you can ask for it to be turned off

If your device is not your own or is shared in a way which makes this uncomfortable, or you have reason to be concerned, you can send your practice a message asking for “prospective access” to be turned off for your record. (Deleting the NHS app isn’t enough if someone else knows your NHS Login username and password and has the app on their device).

You can’t see if others have accessed your record this way

Despite requiring access be made available, there is no requirement to see whether your record has been accessed to give the reassurance that your record has not been abused by others who may gain temporary access to your device.   If this feature were to be abused, the app gives you no indication that it has happened, so NHS England doesn’t care to protect you.

You should be able to see what’s in your record if you wish, and equally, you should be able to know how that record is accessed, but this government is playing contractual games with the biggest bit of the NHS that hasn’t yet gone on strike.

Access to records is a useful tool for the majority of people (and those it harms should be better protected than they are), but we await, more in hope than expectation, any announcement that NHS England will also provide the details of when your record has been accessed and from where. Will NHS England hold themselves to the same standards they mandate from others?

This process is a mess, and patients and GPs pick up the pieces. Again.

(That this change is being imposed at the same time as the “Palantir procurement” continues is a source of confusion, the reasons for which are… speculation)