Our healthcare system needs to relax its grip on patient records

An advanced nurse practitioner wonders why we can’t follow the lead of online banking and give patients more control 

An advanced nurse practitioner wonders why we can’t follow the lead of online banking and give patients more control

Picture: iStock

After 24 years working mainly in emergency care I decided to move to general practice to enhance my skills, knowledge and experience. My beliefs about primary care were challenged as I had assumed that most healthcare interventions occurred in secondary care.

My first year as an advanced nurse practitioner can only be described as like being a rabbit in the headlights.

The complexity of patient presentations and management was vastly different to secondary care, where I managed acute and isolated exacerbations, referring patients back to primary care. I recognised that I was now the health practitioner managing a person's ongoing care.

There are many challenges to healthcare with 11.8% (42,000) of NHS nursing posts unfilled and 9.3% (11,500) of medical posts vacant (NHS Improvement 2018). With increases in life expectancy – 79.6 years for men and 83.2 years for women – the health and social care sector is challenged in working with people who present with increased complexity and need ( 2018).

The decline in smoking has been replaced by higher rates of obesity and mental health needs (Cancer Research UK 2018). Long-term conditions are on the rise, with more individuals living with multiple co-morbidities. This trend is being mirrored in children, where nine-year olds are being diagnosed with type 2 diabetes and there is a predicted 30% increase of heart disease by 2035.

Conflicting information

People can be experts of their own illness, but the internet can be a hindrance due to the types of information people can access to self-diagnose and manage, sometimes in conflict with the care provided. Healthcare practitioners need to navigate this information and establish appropriateness, reliability, evidence-base and availability of treatment and/or knowledge. This process takes time, resulting in lengthly consultations, while appointment slots are generally around ten minutes.

Information technology has advantages where patients’ can be directed to specific reliable sources of guidance and support. We want our patients to take charge of their own health; once an individual understands and owns their health behaviours they can aim for sustainable changes (Foot et al 2014). Despite this evidence and technology, healthcare systems still maintain control of patient health and social care data.

'Data management needs to evolve so people can make genuine choices and decisions about their health'

Care records are kept in locked computer systems, which the patient can only access after much form filling. If we can manage our finances online why not our health? Data management needs to evolve so people can make genuine choices and decisions about their health.

The move from secondary care to primary care has changed my perception of healthcare management and care provision. The patient should be able to choose where and when they access the most appropriate service.

For this to happen patients need to know where each service is located and this can be achieved by giving them easily accessible partnership responsibility of their records.

The healthcare system needs to let go of the elements of power that it holds over individuals’ own healthcare.


About the author

Anna Neary is a senior lecturer and advanced practitioner in primary care at the University of the West of England, Bristol

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