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Philippa Doyle considers the implications of pharmacists having access to GP-held patient records.

Pharmacists do not routinely have access to GP-held patient records but, in late 2013, health secretary Jeremy Hunt announced that the DH would be pressing ahead with a national scheme to permit pharmacists access to GP records.

The provisions of Dame Fiona Caldicott's second review into information governance make clear that only where clinicians (or those working with clinicians) are delivering €direct care€, could they be deemed to have implied patient consent to access their health records.

Gold standard

Pharmacists would say that, in the vast majority of cases, dispensing medication as ordered by the GP is the last link in the chain of direct care. However, as this may not be accepted by patients, the gold standard of express patient permission is currently preferable to implied consent.

As the technology to share information becomes more widespread, the expectation that it will be shared will, hopefully, also grow.

The purpose of giving pharmacists direct access is to improve services and safety. They would no longer need to interrupt a GP and potentially avoid the need for the patient to return to their GP as often as previously, and the pharmacist can assist in the management of long-term conditions.

The Caldicott review was clear in that there is a general consensus of support among health professionals and the public that safe and appropriate sharing of information in the interests of an individual patient's direct care should be a rule, not an exception. Making this a reality will be dependent on technology and public awareness, neither of which should be an insurmountable problem.

Patient awareness

So are changes in legislation required to enable pharmacists to have access to GP records? In the short-term, the answer is no. All that is required is an increase in patient awareness. As indicated already, express patient consent to allow pharmacists to access their records would be the optimum way forward. This can be achieved by acquiring consent from the patient at their next GP appointment where a prescription is generated.

If the patient cannot give consent, then consideration will need to be given as to whether access is in the patient's best interests. If a patient does not want the pharmacist to have access to their records, this can be clearly documented.

General awareness of the benefits of pharmacists having access to records can be raised by way of poster and leaflet campaigns, for example, and patients may voluntarily come forward for their records to be marked as being accessible to a pharmacist.

Consideration will need to be given by the patient as to whether the access is for a particular pharmacist, or pharmacists working in a particular pharmacy, or any pharmacist who may reasonably require access for the purposes of furthering the individual's direct care.

Making entries

Stage two would be whether the pharmacist could also make entries in the GP record. Currently the record is held by the GP as the data controller. If pharmacists are to be permitted to make entries in the GP record, this too will require patient consent.

It will also require compatible computer systems and security measures to be put in place in the pharmacy, restricting access but also ensuring that inadvertent sight of a patient's records does not occur by another staff member looking over the pharmacist's shoulder. A pharmacy is generally more open than a room in a GP surgery and consideration will need to be given as to how patient confidentiality is preserved in this context.

Assuming these hurdles are not insurmountable, patient consent is the way forward. This could be either €read only€ for the pharmacist, €read€ and €write€ if the patient is happy for the pharmacist to make relevant entries, or nothing at all if the patient is uncomfortable.

Insurance & indemnity issues

Pharmacists will need to consider their insurance and indemnity cover and may wish to liaise with insurers regarding any extension they may need. This could not only need to cover reviewing GP records to check a condition/medication instead of speaking to the GP, but also making entries in the notes.

As soon as the pharmacist takes control of a clinical issue or situation, he/she becomes potentially liable for any inaccuracies or inappropriate treatment and there is always the potential for a pharmacist to be sued for failing to pick up on a GP error, if he/she can be shown to have checked the records.

Finally, if pharmacists have greater access to information about the patient, then express care will need to be taken regarding the information shared in the pharmacy itself. Currently anyone can present a prescription on behalf of another person. Under no circumstances should anything other than the medication being prescribed be discussed with the person collecting the prescription unless it is clear they are the patient, or the patient has given consent.

_{Philippa Doyle is an associate for specialist health and social care law firm Hempsons}