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 is the legal position for patient data (paper and electronic) if a practice transfers a patient's record to another practice via GP2GP?

The legal position has not changed. The EHR should be retained indefinitely and the paper record should be forwarded on in the same way as it is now.

Will the full audit trail be transferred from one practice to another?

No. The full audit trail is maintained for medico-legal reasons in the old practice. It is not technically possible to transfer the audit trail in its entirety. A limited audit trail will be held on the receiving practice system including details on who recorded the data.

If 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 that are 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 transfer attachments with a GP2GP transfer?

At present you can send and receive attachments that are directly held within the patient's record. With regards to attachments held within third-party document management systems, please check out the question and answer below.

Is it possible to transfer every record?

The current release of GP2GP is capable of transferring 99% of patient records. The remaining 1% are unable to be transferred because of technical limitations on the national Spine infrastructure. These limitations prevent the transfer of certain records as follows:

• Patient records that exceed 5Mb in volume.
• Patient records that have in excess of 100 attachments (e.g. scanned letters).

These limitations will be removed with a future Spine release.

In addition, it is not always possible to transfer attached documents. Some 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 they are attached to. For further information about specific document management systems we recommend that practices contact their clinical system supplier in the first instance.

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 information 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.

What happens with the records of temporary residents?

The records of temporary residents will not be electronically transferred in the current version of GP2GP.

Do I need a smartcard to use GP2GP?

A GP2GP transfer can only be activated if a smartcard is used when registering a patient.

Do GPs need a smartcard?

Yes. GPs must have smartcards registered in their names to ensure that patients can be registered against their GNC codes on the Spine Directory Service (SDS). However, GPs do not need to be logged onto GP2GP with ther smartcards to view or work with the transferred record.

What if a GP moves to another practice?

The GP needs to be correctly registered on SDS by the PCT Registration Authority (RA) Manager. The GP should be registered against the new practice and the association with the old practice should be removed from SDS. Failure to register the GP correctly will result in a failure of GP2GP transfers relating to that GP.

Will the quality of data be affected by GP2GP transfers?

No, the quality of the data will not be affected, GP2GP will accurately transfer the content of an electronic health record but it cannot improve it. Practices' PCTs should have issued guidelines about the importance of recording good quality data in GP systems in accordance with the new IM&T DES and the Good Practice Guidelines.

The quality of the data in the EHR will 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 being run by their PCT.
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. Although this will take some time GP2GP will still be quicker than the current process.

Why are medications transferred as inactive?

This is a safety feature. It prompts GPs to to review the medications of new patients.

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 guidance relates specifically to drug allergies. Non-drug allergies are handled like any other record entry: degraded if not understood, but imported as normal otherwise.

Do controlled drugs such as chemo/opiates transfer over in a different way from other drugs?

All drugs that are held on a previous practice's system will be transferred, including controlled drugs. As with all medications, they will apear at the new practice as inactive and will therefore need to be re-authorised by a clinician.

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 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 re-set.

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 practice as inactive medications. They will need to be re-authorised.

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. The patient should be registered following the normal registration process using a smartcard to ensure that GP2GP is activated.

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 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. Assuming that the trace is successful, the NHS number will be returned from the Spine.

What is a 'flagged record' (previously known as 'stop noted record') and are flagged records transferred using GP2GP?

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 that 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.

Flagged records will not be transferred using GP2GP.

Who in the practice should import the EHR?

Our experience from GP2GP implementions so far is 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, however, that authorised clinicians must take responsibility for authorising repeat medications, allergies etc. These are actions that involve the exercise of clinical judgement and it is important that they are undertaken by appropriately qualified staff.

Are there any times when I shouldn't process GP2GP transactions?

No, you can process them at any time. You do, however, need to remember to leave your practice server turned on at all times in order to receive transactions from other practices.

Does GP2GP need to be installed on its own dedicated PC?

No. You can use GP2GP on any PC that has your clinical software installed so long as it meets the minimum specifications communicated by NHS Connecting for Health.

What if I request a record from a practice that is not GP2GP-enabled?

You will not receive a transfer of the EHR clinical record. Your practice will receive the paper record via the normal process.

What happens if we have overdue EHRs?

Please contact your supplier's helpdesk in the first instance.