The state controls the contracts relating to the NHS by passing legislation (statutory instruments) that then has to be written into the contracts for NHS for the contracts to remain lawful.
The contract to deliver your primary care services is between the practice and NHS England ("Commissioning Board" and "Area Team" are some of the other names by which the organisation goes).
The state has ordered that we should include certain statements on our website. This information is not impartial and it may further the agenda of NHS England.
"16.5.1. The Contractor must promote and offer to its registered patients the facility for a patient:
(a) to book, view, amend, cancel and print appointments online;
(b) to order repeat prescriptions for drugs, medicines or appliances online; and
(c) to view and print a list of any drugs, medicines or appliances in respect of which the patient has a repeat prescription in a manner which is capable of being electronically integrated with the computerised clinical systems of the practice using appropriate systems authorised by the Board.
16.5.2. The Contractor must promote and offer to its registered patients, in circumstances where the medical records of its patients are held on the Contractor's computerised clinical systems, the facility for a patient to:
(a) access online any summary information derived from the patient's medical records and any other data which the Contractor has agreed that the patient may access; and
(b) view online, electronically export or print any summary information derived from the patient's medical records and any other data which the Contractor has agreed that the patient may access.
16.5.3. Where the Contractor has a practice website, the Contractor must also promote and offer to its registered patients the facility referred to in clauses 16.5.1(a) and 16.5.1(b) on that practice website."
We were one of the first practices in Kent to offer online access, so this is 'a day late and a dollar short'.
Named, accountable GP
Prior to 2004 everyone was registered with a particular GP. You could be seen by another GP in the practice, but if the practice would split up you would go with 'your' GP.
In 2004 the government thought it was best if you were registered with a practice. In our practice you are actually registered with a fictional doctor: "At Canterbury Road Surgery".
In 2014 (yes, before the 2015 general election) you were promised to be registered with a particular GP.
Can you chose 'your' GP? No, the practice decides on this.
Does it give you the right to be seen by that GP? No
Can the practice force you to see a particular GP even if you do not want this? Yes
Is 'your' GP required to be available for you? No
Can 'your' GP be held to account if anyone employed by the practice makes a mistake? No
So, what has changed? Nothing, except that thousands of hours of GP time are lost around the country, informing you of this non-event.
As this practice has only one 'flesh and blood' GP, it will not surprise you that Dr Beerstecher is indeed 'your' named, accountable GP.
"(3) The contractor must--
(a) inform the patient, as soon as is reasonably practicable and in such manner as is considered appropriate by the practice, of the assignment to the patient of an accountable GP and must state the name and contact details of the accountable GP and the role and responsibilities of the accountable GP in respect of the patient"
Other statements about control over our website can be found in the GMS contract (PDF file on the right).
Some other obligations:
Summary care record
The 2014 contract also specifies that some of your records have to be uploaded to a central computer, accessible to virtually anyone in the NHS and outside of our control (Summary Care Records). This started in 2011, and was done by a lot of practices without there being an obligation.
Dr Beerstecher thinks the biggest flaw of the Summary Care Record is that there is no system to warn you when your records have been accessed.
Unbeknown to us the computer software (controlled by the NHS) has not been uploading the records for our practice to the central store ('spine'). We have been incorrectly blamed for this problem and threatened with contract breach in 2015.
If you do not want your information to be available on the central computer, you have to actively opt-out by asking us to add certain codes to your records. Once the record is created, it can never be removed and you do not have control of what will be added to the central record in future.
The NHS information suggests that the access is controlled by a smartcard, comparing it to a pin and chip card, however there is an important difference: you don't have the card or the pin number. How safe would you feel if millions of NHS employees had your bank card and pin number?
The NHS information suggests that access will be checked, but this only happens if the person accessing your details ticks the box that you did not or could not agree to it, for instance you are unconscious. However if the person accessing your records ticks that you agree, then no checks are carried out and you would not know your records had been accessed.