GP2GP Business Process FAQs
These are the key steps involved in managing GP2GP Electronic Health Record transfers and the associated FAQs under each section:
Requesting the Record
Is GP2GP safe?
Yes. A team led by clinicians appointed by the Joint GP IT Committee (representing the Royal College of GPs and the General Practitioner Committee of the British Medical Association) have been responsible for detailed scrutiny of the safety of GP2GP at all stages of its development and deployment.
Clinicians have been engaged in validation of GP2GP and results have been used to demonstrate safety to the Health & Social Care Information Centre (HSCIC) Clinical Safety Group prior to authorising live GP2GP record transfers. All versions of the GP2GP software have been rigorously tested and piloted in a live environment before being implemented at other sites.
Is it possible to transfer every record?
The current implementation of the GP2GP message is capable of transferring the vast majority of patient records (90%). The remaining records are unable to be transferred because of technical limitations on the national Spine infrastructure.
These limitations prevent transfer of certain records as follows:
- Patient records that exceed 5Mb in volume.
- Patient records that have in excess of 99 attachments (e.g. scanned letters).
In addition, it is not always possible to transfer attached documents. Some GP practices use third party document management systems to handle attachments and not all of these applications make it possible to transfer documents together with the record that they are attached to. For further information about specific document management systems we recommend that practices contact their system supplier in the first instance.
These limitations will be removed within GP2GP version 2.2. The pilot for the GP2GP large messaging solution is expected to take place in 2013.
Can I transfer attachments during a GP2GP transfer?
At present you can send and receive attachments that are directly held within the patient's record.
If an attachment is held in a third-party document management system it may not be available for transfer depending on the detail of the document management system. For further information look at the response given to the question "Is it possible to transfer every record?"
Will the paper record still need to be transferred?
Yes, the transfer of paper records alongside Electronic Health Records (EHRs) will continue for the foreseeable future. This is for a number of reasons:
- EHRs for direct patient care are not used across 100% of patients.
- It will take some time for all GP practices to receive GP2GP.
- The need to validate EHRs against paper records.
- The NHAIS 'deduction' process will still run separately from GP2GP transfers.
It remains the responsibility of the sending practice to ensure that the paper record is complete before releasing it from the practice following the normal deductions process.
What if the patient does not know their NHS number?
At registration, demographic details such as surname, date of birth, postcode and sex should be entered to allow the patient to be traced on the Spine (please see training material). Assuming that the trace is successful, the NHS number will be returned from the Spine.
What impact could GP2GP have on my practice's N3 network speeds?
We have had no instances of GP2GP affecting network speeds within practices. PCTs however, need to have ensured that practices meet the general practice infrastructure requirements detailed on the GPSoC section of the HSCIC website.
What is the project's position on local initiatives to introduce CD transfer of patient records between GP practices?
We are aware that some CCGs and GP practices have been exploring CD transfer as an interim solution. These activities have not been scrutinised by and are outside the jurisdiction of NHS Connecting for Health. We cannot, therefore, comment on their suitability or their safety. NHS organisations who are involved in this should ensure that they have taken steps to assure themselves that the processes involved are safe and reliable.
Why are records sent automatically when a patient registers at a new practice?
When the patient signs the GMS1, they are instructing their new GP to retrieve their medical record. GPs are bound by their professional responsibility to transfer the patient records to the new practice as soon as the patient has registered with a new GP.
Immediate sending is valid because one of the greatest benefits of the GP2GP process is the ability to have the new patient's records available to the new GP within (in some documented cases) minutes and certainly hours. Having this information sooner rather than information that may have been tidied away or added later is generally thought to be of greater benefit to patient and clinician.
What happens with the records of temporary residents?
The records of temporary residents will not be electronically transferred in the current version of GP2GP.
Can patients be registered as non-regular and, when they have attended for the first consultation at their new practice, change their patient type to regular?
Yes, patients can initially be registered with a non-regular status and then be changed to a regular patient status at which point the patient should be registered following the normal registration process using a Smartcard to ensure that GP2GP is activated.
Who in the practice should import the EHR?
Our experience from implementing the GP2GP software shows that it is practice staff who have knowledge of the clinical software system and who have received GP2GP training who are best able to use GP2GP to import the EHR.
It is important to stress that authorised clinicians must take responsibility for authorising repeat medications, allergies etc. These are actions that involve the exercise of clinical judgment and it is important that they are undertaken by appropriately qualified staff.
If, as a result of being enabled with GP2GP, I receive an EHR from a practice with a different clinical system what will that record look like?
There are certain differences in how clinical information is represented in different clinical systems. However these differences are largely cosmetic and the clinical data that will be transferred across will still be useable by the receiving practice.
Will pathology results be preserved during a transfer?
The aim of the GP2GP project is to ensure that as far as possible all of the pathology results information that has been filed into the EHR will be extracted into the GP2GP message and transmitted
Equally, as far as possible, this information will then be imported into the new (receiving) practice system, preserving as much of the structure and associations as is possible.
Pathology results more than one year old, that remain unfiled or unactioned, are not transmitted in the GP2GP record transfer. The clinical responsibility still remains with the previous practice.
Can I refuse to accept any or all elements of a patient's health record on receipt from the previous practice?
The new practice has to accept all of the previous record or none at all. However, it is recognised that there may be circumstances where it is necessary to amend some of the content (e.g. to correct content that is known to be factually inaccurate). For this reason practices will be able to amend the received record at their discretion. Such amendments will be recorded in the system audit trail for medico-legal purposes, as with any other amendment to the record.
Will the quality of data be affected by GP2GP transfers?
GP2GP will transfer data exactly as it appears in the sender's system. The quality of the data in the EHR can only be as good as that entered by the sending practice. It is the responsibility of practices to ensure that they enter good quality data onto their clinical systems and practices should be fully engaged with any ongoing data quality improvement programmes that are run by their CCG.
In certain cases, practices may see a degradation of some data when the new patient record is imported into the clinical system. This will usually be because of difficulties in matching Read Codes or other codes. Any data affected in this way will be clearly highlighted in the received EHR, enabling the receiving practice to amend the record as required.
Why doesn't GP2GP work to transfer an EHR for a patient that has been registered with the practice, then leaves the practice and then returns to the original practice?
This is known as A2B2A. This fails at present due to replication of unique identifiers which are added to each clinical episode or update to the medical record. When a patient has been at practice A, all their episodes have an unique identifier (for example 1,2,3,4,5 etc). When the patient moves to practice B these unique identifiers are exported with the transferred data and added to when the record is updated at the newly registered practice (for example 6,7,8,9 etc).
When the patient transfers back to practice A, the clinical system at practice A still holds the historical clinical information for this patient and attempts to 'un-archive' the original record to import the new record coming back to the practice. At this point the transfer fails as the original episodes (1,2,3,4 etc) are still present and cannot be overwritten. The GP2GP project and clinical leads are working on a solution to overcome this issue.
Choose and Book defaults unknown date entries to 1841. Will GP2GP do this when it transfers data?
Unknown data entries will appear at the new practice as they did at the old practice, e.g. 'Not Known'.
What is a 'flagged record' (previously known as 'stop noted' record)?
A flag is applied to a patient's demographic record in specific circumstances, such as adoption, mental health or if the record contains sensitive information. The flag means that access to a patient's demographic record is limited. Healthcare professionals will only be able to see the NHS Number, name, date of birth and gender for the patient. No other demographic details will be displayed, including the patient's registered or preferred pharmacy. The flag is applied to that patient only and will remain with them if they move address.
Will flagged records be transferred using GP2GP?
No, flagged records will not be transferred using GP2GP.
Why are medications transferred as inactive?
This is a safety feature and prompts GPs to review new patients' medications.
Will un-issued medication (i.e. that which has not been printed off) from the old practice transfer across?
Yes, un-issued medication will transfer and will appear as un-issued medication.
How does GP2GP deal with allergies?
Drug allergies which are not 'understood' by the receiving system (i.e. the system would not be able to trigger prescribing decision support based on the received information) are degraded and the system prevents prescribing until the received allergies have been re-coded by hand into the native equivalent on that system.
This will only occur for transfers between different clinical systems as allergies are fully interoperable in same system transfers.
The above relates specifically to drug allergies. Non drug allergies are handled like any other record entry: degraded if not understood, but imported as normal otherwise.
How does GP2GP deal with call and recall?
Different GP clinical systems represent call and recall and other business functions differently. These differences are enhanced where users of the systems use their own methods for handling call and recall. This means that the receiving practice system will not be able to reliably recreate these functions; therefore call and recall will need to be reset.
What does the new practice need to do if a newly-registered patient has outstanding repeat prescriptions at the old practice?
The prescriptions will appear at the new practices as inactive medications. They will need to be re-authorised.