Use of personal health information

The practice manages the confidentiality of your medical records in accordance with the Data Protection Act 1998. Our Primary Care Trust may require some of this data for auditing and research purposes. You may request that your data is excluded from these audits and research at any time. Please speak with reception for more information.

Please click HERE for important information on how we use your medical records General Data Protection Regulation (GDPR):

GPDPR – 1st September 2021

The data held in the GP medical records is used to support health and care planning and research in England, helping to find better treatments and improve patients outcomes for everyone.

You may have seen concerns expressed in the media this June 2021 about the new ways the NHS plans to collect / extract patient data; for planning purposes. The pre-1st September GP data Extraction System (GPES) ,is due to be replaced on 1st September 2021 with a new system called the General Practice Data for Planning and Research (GPDPR) under legal legislation (General Practice Data for Planning and Research (GPDPR) – NHS Digital).

The British Medical Association’s statement is a good summary of what is going on and that it is a legal obligation for general practices like WLMC to comply:

“NHS Digital issued a DPN (data provision notice) on 12 May 2021 as part of the development of GPDPR (GP data for planning and research). This is a planned replacement for the GPES (GP extraction service) to collect data for planning and research from general practices in England.

It is a legal obligation to comply with the DPN as a result of a new direction from the secretary of state for health and social care as part of the Health and Care Act 2012. Once fully established, this new collection will replace multiple other data collections from general practices. Read our full statement >

However, GPC England chair Richard Vautrey and RCGP chair Martin Marshall wrote to NHS Digital at the end of last week to express their concerns about the lack of communication with the public regarding the GPDPR programme. Read their information to the public and practices >

GPC England and the RCGP informed NHS Digital that while they are aware of the crucial role that GP data plays in research and planning to improve public health, it is important that any sharing of data is transparent and maintains public trust in how general practice and the NHS uses their information.

We have strongly lobbied NHS Digital to reconsider their timetable for implementation and called on them to run a comprehensive and significant public awareness campaign to increase communication with patients and practices.”

What Data is shared?

The extraction will take almost all the coded data from our patients record and pseudonymise (not anonymise) it for the purpose of research and planning.  

The data that may be shared will be data from patients medical records about:

·         Any living patient registered at a GP practice in England when the collection started- this includes adults and children

·         Any patient who dies after 1^st July 2021, and was previously registered at a GP practice in England when the data collection started.

The NHS does not collect patients names or addresses. Records will be “pseudonymised” – which means that the identifiers such as date of birth, NHS number and exact postcode will be replaced by a code. This process is called pseudonymisation, and means the patient will not be identified directly in the data.

What are Some Concerned About? 

Some GPs and privacy campaigners are concerned about issues of data security. There is a long list of organisations outside the NHS, detailed on the NHS Digital website, including other government departments, research bodies, charities and pharmaceutical companies, with whom they might share the data.

Pseudoanonymisation can be reversed, according to NHS Digital, if there is “a valid legal reason” to do so. Concerns are that it is not clear what such a reason might be, but the fact that it is possible to re-identify the records may be a cause for concern.

Some are not confident that the tight rules and contracts proposed to prevent recipients of the data doing their own work to re-identify patients – for example, by combining bits of data with information gleaned from social media – will be 100% effective.

Most doctors and most patients are only just learning about this project, and at a time when General Practice is exceptionally busy and when time is short to give this matter consideration.  (Ref Apple News – Helen Salisbury – June 1, 2021 10:40 am (Updated June 1, 2021 2:14 pm)

How Can You Opt Out?

There are two types of opting out

1- Opt out by submitting this form to your GP

2- For any data that has left the GP practice, you would also need to register your objection here: Overview – Choose if data from your health records is shared for research and planning – NHS (www.nhs.uk)

As instructed by the North East London Chief Medical Officer, rather than automatically, access to your records can be applied for through our team and we will review and enable access. Our priority is your safety and providing optimal medical care so please bear with us regards timescale.

The NHS wants to give people better ways to see their personal health information online. We know that people want to be able to access their health records. It can help you see test results faster. It also lets you read and review notes from your appointments in your own time.

If you are over 16 and have an online account, such as through the NHS App, NHS website, or another online primary care service, you may then be able to see all future notes and health records from your doctor (GP). Some people can already access this feature, this won’t change for you.

This means that you will be able to see notes from your appointments, as well as test results and any letters that are saved on your records. This only applies to records from your doctor (GP), not from hospitals or other specialists. You will only be able to see information from 31/10/22.

These changes only apply to people with online accounts. If you do not want an online account, you can still access your health records by requesting this information through reception. The changes also only apply to personal information about you.

The NHS App, website and other online services are all very secure, so no one is able to access your information except you.

Please note your responsibilities.  If you are concerned about these please be very strongly consider if setting up online access to your records is right for you:

1. You’ll need to make sure you protect your login details. Don’t share your password with anyone as they will then have access to your personal information. We cannot be responsible for someone else accessing your records with your log in details.
2. If you find information in your record which is regarding someone else, eg a letter or test result which has been accidentally saved in your record, you must not share this information and you must report it to the practice immediately so we can correct this.
3. By looking at your records online be aware that you may see test results or information which you find alarming. You may see these before a clinician has had the opportunity to discuss the results or information with you. It may be that the clinician you need to discuss the information or results with is a hospital specialist rather than a clinician from the practice.

Changes to prescribing and other services

In order to protect funding our most essential Health services- things like cancer care, emergency care, life threatening conditions and mental health services-GP’s across Barking and Dagenham, Havering and Redbridge have made changes to prescribing and other NHS services.

The CCG has Stopped Doctors from Prescribing the Following on the NHS:

• Over the Counter pain killers for short term problems such as Paracetamol, Ibuprofen, Co-codamol
• Many other medicines which are available over the counter from your pharmacy
• Gluten-free products
• Medicines for dental conditions
• Head lice and scabies medicines
• Rubefacient creams and gels such as Deep Heat and Tiger Balm
• Omega-3 and other fish oil supplements
• Multivitamin supplements
• Eye vitamin supplements
• Colic remedies for babies
• Cough and Cold Remedies
• Soya-based formula milk
• Antimalarials
• Threadworm medicine
• Over the counter Sleeping Tablets
• Hay Fever medicine (for mild and moderate)
• Travel Sickness medicine
• Vitamin D maintenance
• Probiotics
• Bath oils, shower gels, shampoos
• Creams for mild/moderate skin conditions
• Sunscreens except cancer/specialist

Procedures the local NHS will no longer fund:

• Face lift and  brow lift surgery
• Breast enlargement
• Revising breast enlargement
• Hyperhidrosis surgery to reduce excessive sweating.
• Trigger finger surgery
• Scrotum swellings  surgery
• Labiaplasty
• Ear wax removal microsuction
• Spinal
  • disc injections
  • Facet joint injections
  • Epidural injections for spinal claudication
• Osteopathy

Why are the CCG is doing this?

They say: “Like many areas across the country, we are faced with some difficult choices to protect essential health services. The care and treatment that we provide every day for patients is funded by tax payers money. That’s why we have a duty to spend it wisely, to make sure we get the best value we possibly can for every penny- especially when NHS funding is being severely squeezed and we are seeing more patients with more complex health issues than ever before.
To protect essential services in our area we have to make savings of £55 million and we must look at further reducing spending now.
Local clinical commissioning groups(CCGS) recently held an eight week public consultation talking about some of the things we thought we could save money on.”
Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups

Updated 01/09/2022

WLMC has reviewed it’s benzodiazepine prescribing at a practice meeting 30/08/2022 and established this new policy not to prescribe benzodiazepines or sedatives (such as diazepam) to patients for fear of flying. Many other GP practices have a similar policy. 

People often come to us requesting that we prescribe diazepam for fear of flying or to assist with sleep during flights.

Initially in the 1960s benzodiazepines including Diazepam (also known as ‘Valium’) were hailed as a wonder drug. However, it became increasingly clear that, as well as having short term deleterious effects on memory, co-ordination, concentration and reaction times, they were also addictive, with withdrawal leading to fits, hallucinations, agitation and confusion.  Furthermore, they were found to have long-term effects on cognition and balance. Unfortunately, benzodiazepines have also become a widely used drug of abuse since they first came on the market. Because of these reasons the use of benzodiazepines has been a lot more controlled around the world since the 1980-90s; especially in the UK. Diazepam in the UK is a Class C/Schedule IV controlled drug. The following short guide outlines the issues surrounding its use with regards to flying and why the surgery no longer prescribes such medications for this purpose.

There are a number of very good reasons why prescribing this drug is not recommended.

• The use of any sort of benzodiazepines causes longer reaction times & slowed thinking, which during a flight will put the passenger at significant risk of not being able to act in a manner which could save their life, or that of a loved one or co-passenger, in the event of a safety critical incident. Incapacitation from benzodiazepines is a risk to the lives of all on board the aircraft in the event of an emergency requiring evacuation.
• The use of such sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at an increased risk of developing a blood clot (Deep Vein Thrombosis – DVT) in the leg or even the lungs. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than 4 hours
• Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and in aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.
• Benzodiazepine use added to alcohol consumption causes an increase in the risk posed by the points above
• According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) in treating phobic states. It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate. Your doctor would be taking a significant legal risk by prescribing against these guidelines. (They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight; benzodiazepine doses used for flying previously are not likely control an acute crisis in generalised anxiety disorder.)
• NICE guidelines suggest that medication should not be used for mild and self-limiting mental health disorders. In more significant anxiety related states, benzodiazepines, sedating antihistamines or antipsychotics should not be prescribed
• In some countries it is illegal to import these drugs, e.g. in the Middle East, and so the passenger will need to use a different strategy for the homeward bound journey and / or any subsequent legs of the journey; they may be confiscated or you may find yourself in trouble with the police. The passenger may also need to use a different strategy for the homeward bound journey and/or other legs of the journey.
• Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testingyou may fail this having taken diazepam.
• Benzodiazepines have been linked to the onset of dementia
• A study published in 1997 from the Stanford University School of Medicine (iv) showed that there is evidence use of benzodiazepines stops the normal adjustment response that would gradually lessen anxiety over time and therefore perpetuates and may increase anxiety in the long term, especially if used repeatedly. In an article in Clinical Psychiatry News, Shanna Treworgy, Psy.D., of the Dartmouth Geisel Medical School, said that though there may be reduced anxiety in the moment, benzodiazepines cause increased long-term anxiety reactions.

Given the above we will no longer be providing Diazepam for flight anxiety and instead suggest the below aviation industry recommended flight anxiety courses which are easily accessible for those who wish to fly & conquer their fear of flying, eg:

1. Easy Jet www.fearlessflyer.easyjet.com Tel 0203 8131644
2. British Airways www.flyingwithconfidence.com  Tel 01252 793250
3. Virgin www.flyingwithoutfear.co.uk  Tel 01423 714900
4. https://thefearofflying.com/programs/fly-and-be-calm/

• Flight anxiety does not come under the remit of General Medical Services as defined in the GP contract and so we are not obliged to prescribe for this.
• Patients who still wish to take benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.
• It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.

For further information/References:

[i] British National Formulary; Diazepam – https://bnf.nice.org.uk/drug/diazepam.html

[ii] British National Formulary; Hypnotics and anxiolytics – https://bnf.nice.org.uk/treatment-summary/hypnotics-and-anxiolytics.html

[iii] Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical guideline [CG113] Published date: January 2011 Last updated: July 2019 https://www.nice.org.uk/guidance/cg113

[iv] Acute and delayed effects of Alprazolam on flight phobics during exposure. Behav Res Ther. 1997 Sep;35(9):831-41

[v] Travel Health Pro; Medicines and Travel; Carrying medication abroad and advice regarding falsified medication – https://travelhealthpro.org.uk/factsheet/43/medicines-abroad