Sealed envelope safety risk raised by BMA

Doctors have raised concerns that Connecting for Health proposals to allow patients to hide some information in sealed envelopes puts patient safety at risk.

Representatives at the British Medical Association’s annual meeting backed a motion which claimed that allowing patients to keep some medical information confidential from other doctors “may lead to significant patient safety concerns and potential harm to patients.” Dr Stephen Austin, a consultant anaesthetist at Mater Hospital in Belfast, told representatives that, as an anaesthetist, he might feel duty bound to open every sealed envelope because it could contain information about medication the patient was taking which would affect his management of the patient.

He told EHI Primary Care: “If a patient decided to put information in a sealed envelope how would I know if it had information I needed to know about unless I opened it? I sit on the GMC’s [General Medical Council] fitness to practice panels and I would worry that I could be brought before it for not opening a sealed envelope.”

Dr Austin said he understood patient concerns about confidentiality but thought that doctors’ duties of confidentiality under the GMC were a more appropriate protection for patients and that sealed envelopes could cause problems for colleagues in all branches of the profession.

He added: “If I see a medical record or discuss a patient with a colleague I am bound to keep that information confidential which I think is a more practical solution rather than worrying about an IT solution.”

As well as backing the motion expressing concern about current plans representatives also called for Connecting for Health to give greater consideration to patient safety. However representatives held back from demanding that any medical information given to doctors by patients and held in any national patient record should be shared with any other doctor.

In a rider to the main motion, representatives also backed calls for the NHS Care Records Service technology to embody a system of identifying unusual patterns of access and reporting them to Caldicott Guardians or equivalents.

Dr Stephen Watkins, director of public health in Stockport, who proposed the rider, said such a system was needed to identify potential abuses of the system quickly.

He told EHI Primary Care: “At the moment if someone was looking at records inappropriately the medical records department might pick it up after a while but once it becomes electronic that sort of protection disappears.”

He said the alternative would be to make the access requirements to view a record very severe but that would make the system unworkable. An early warning system would also work alongside the proposed audit trail, he said, which would come into effect once a potential abuse had been spotted.

Doctors at the conference decided not to debate a motion proposing that all doctors and their families consider withdrawing themselves form the spine because of confidentiality concerns. A similar motion was passed by GPs at their local medical committees’ conference last month.