The Jersey Primary Care Record Guarantee
Our Guarantee for Health Care Records in Jersey
Document Status: draft
(Adapted from the NHS Care Record Guarantee with kind permission of Mr Harry Cayton)
Version Number: 0.3
Created: 06/10/13
Jersey Care Record Guarantee
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INTRODUCTION
In Jersey, your GP aims to provide you with the highest quality of healthcare. To do this, your GP
will keep records about you, your health and the care provided or plan to provide to you.
Your care records may be electronic, or paper or a mixture of both and Health and Social
Services use a combination of working practices and technology to keep to this guarantee.
This guarantee is a commitment that your records will be used in ways that respect your rights
and promote your health and wellbeing.
The people who care for you use your records to :
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provide a good basis for all health decisions made by you and healthcare professionals;
allow you to work with those providing care;
make sure your care is safe and effective; and
work effectively with others providing you with care.
You have the right :
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to confidentiality under the Data Protection (Jersey) Law 2005, the Human Rights (Jersey)
Law 2000 and the common law duty of confidence; and
to ask for a copy of all records about you held in paper or electronic form (you may have to pay
a fee); and
to choose someone to make decisions about your healthcare if you become unable to do so
There will be a duty to :
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maintain full and accurate records of the care provided to you;
keep records about you confidential, secure and accurate; and
provide information in a format that is accessible to you (for example, in large type if you
are partially sighted).
It is good practice for people who provide your care to :
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discuss and agree with you what they are going to record about you;
give you a copy of letters they are writing about you; and
show you what they have recorded about you, if you ask.
Jersey Care Record Guarantee
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THE JERSEY PRIMARY CARE RECORDS SERVICE
Some of your health records are already held on computer, but many are still kept on paper. While
the paper records kept are protected by strict confidentiality and security procedures, these records
are not always available to healthcare professionals looking after you. Handwritten entries in the
record may be difficult to read and important information may be missing. Modern computer systems
are being introduced over the next few years. These will hold electronic health records about you
securely, making them available to the right people where and when they are needed for your
healthcare, while maintaining your confidentiality.
This new system will:
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hold electronic records about your healthcare so that, wherever you need care,
healthcare professionals can have access to the most up-to-date information;
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allow you to control whether the information recorded about you by a care provider can be
seen by other healthcare workers that are also providing you with care;
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show only those parts of your record needed for your care;
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allow only authorised people to access your record;
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allow only those involved in your care to have access to records about you from which you can
be identified, unless you give your permission to the contrary or the law allows;
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allow use of information about your healthcare, in a way that doesn’t make your identity known,
to improve the services offered or to support research; (This is known as unlinked anonymous
data analysis)
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keep a note of everyone who accesses the records about you.
Jersey Care Record Guarantee
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10 COMMITMENTS TO YOU :
1
When a request is received from you in writing, you must normally be given access to
everything recorded about you. You will not be given confidential information about other
people, or information that a healthcare professional considers likely to cause serious
harm to the physical or mental health of you or someone else. This already applies to
paper and electronic records. However, if you give permission, other healthcare providers
allied to general practice will be able to see health records about you.
Wherever possible, your health records will be made available to you free of charge or at a
minimum charge. Other ways for you to apply to see your records will be provided if
you cannot do so in writing.
Information will be provided in a format that is accessible to you (for example, in large type if
you are partially sighted).
2
When healthcare is provided, your record(s) will be shared with the people providing care or
checking its quality (unless you have asked that we limit how your record(s) is disclosed).
Everyone looking at your record, whether on paper or computer, must keep the
information confidential.
Access to only as much information as people need to know to play their part in
your healthcare will be permitted.
3
Health information that identifies you for any reason other than providing your care will
not be disclosed unless:
 you give permission;
 specific permission is requested;
 compelled by law;
If information is shared without your permission, this will only occur if this complies with the
Data Protection (Jersey) Law 2005 and GMC guidelines on best practice.
When we might use or disclose information that names you without asking you :
1. Sometimes there is a legal duty to give information about people. Examples include:
 births of children;
 reporting some infectious diseases;
 reporting gunshot wounds to the police; or
 because a court orders us to do so,
2. In the case of registered drug addiction it may be necessary to share information relating
to patients only with other health professionals either because
 it is considered to be necessary for medical purposes or
 the disclosure is considered necessary for the prevention of crime
3. Special permission may also be given when the public good is thought to be of greater importance
than your confidentiality. This is very rare, but some situations where this might happen include:
 when a serious crime has been committed;
 when there are serious risks to the public or healthcare staff; or
 to protect children.
This permission is given by the Caldicott Guardian, who is normally the senior clinician in charge of
protecting your privacy in each health or care organisation.
Jersey Care Record Guarantee
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4
Sometimes your healthcare will be provided by members of a care team, which might
include people from other organisations, such as social services or education. We will tell
you if this is the case. When it could be best for your care for your health information to
be shared with organisations outside the States e.g. hospitals in the UK. We will agree
this with you beforehand. If you don't agree, we will discuss with you the possible effect
this may have on your care and alternatives available to you.
5
With the more widespread introduction of electronic healthcare records you can choose to
limit the information in them. This may affect the ability to provide you with care or
treatment, and any alternatives available to you. You can discuss this with your GP.
6
Questions, concerns and complaints about how information about you is used will be dealt
with fairly and efficiently. The Primary Care Body has a complaints procedure.
7
Appropriate steps will be taken to make sure information about you is kept up-to-date and
accurate. You will be given opportunities to check records about you and point out any
mistakes. Factual mistakes will normally be corrected. If you are not happy with an opinion
or comment that has been recorded, your comments will be added to the record. If you feel
you are suffering distress or harm as a result of information currently held in your record,
you can apply to your GP to have the information amended or deleted.
8
Contract terms and staff training will ensure, as now, that everyone who works in or on behalf
of your GP understands their duty of confidentiality, what it means in practice and how
it applies to all parts of their work.
9
Appropriate steps will be taken to make sure the records held about you – both paper and
electronic – are secure and only made available to people who you have agreed might
have access to them or are otherwise authorised. Unauthorised access will be identified
and the appropriate disciplinary or criminal action will be taken.
10
There will be a record of everyone who accesses the electronic information held about you.
You will be able to ask for a list of everyone who has accessed records that identify you,
and when and why they did so.
There may be times when someone will need to look at information about you without
having been given permission to do so beforehand. This may be justifiable, for example, if
you need emergency care. You will be informed if the action cannot be justified.
4 THINGS THAT YOU CAN DO IN RETURN
1. Make sure that you have been identified you correctly
2. Tell people responsible for your care if any information in your record is wrong.
3. Allow healthcare workers to disclose and use as much information about you as needed
to provide you with healthcare (Discuss any concerns with your GP).
4. If you have decided to limit how the information in your electronic care record is shared with
others, tell your doctor if you change your mind – so your GP can action your request.
Jersey Care Record Guarantee
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FOR PARENTS AND YOUNG PEOPLE
Introduction
Care records are important for the wellbeing of children and young people. Knowing about your child’s
health is important for parents. Parents include birth parents and anyone else who has been granted
parental responsibility for a child by a court.
Parents
If you are a parent, you will be able to see your child’s care record or be given a copy if you ask. If
your child is able to understand and make decisions, he/she may be asked for his or her agreement
first. Your child’s care record will probably include some information about you. You will be asked
permission before showing it to your child. You can choose to hide these parts of your child’s record
from your child.
Young person
If you are a young person capable of understanding and making decisions for yourself, we you will be
able to see your record or be given a copy if you ask.
You can ask someone giving you care not to share information with your parents. Your request will be
honoured unless it is deemed not to be in your best interest.
Parents and young people
You and your child will be encouraged to make decisions about the care record together. If you
disagree about who can see the care record, your GP practice will ask the advice of the Caldicott
Guardian, who is responsible for protecting the privacy of patients?
Sharing information
When it is best for your child’s care to share health information – which may include sharing it with
people who are not healthcare workers – you or your child will always be asked before we do so.
Sometimes information has to be disclosed without your or your child’s permission, as detailed above.
This is particularly when there is concern about the safety or welfare of the child and asking for
permission could put the child at risk.
How do we make sure your electronic care record stays secure and confidential?
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By controlling access
Secure Access – GP Care Records can only be accessed using a recognised secure
authentication process.
Good reasons – Healthcare professionals have to have a legitimate reason (for example,
being involved in providing your care) before they can access information in your record.
Access controls – All healthcare professionals are issued with access rights to care
records based on their job. The amount of clinical information they can access is
based on their role and consent you have given.
Audit trails – Every time someone accesses your record, a record will be made of who
they were and what entries they may have made.
GP Co-Op Practitioners out of hours service who access summary care records will
be audited and reported to the patients primary GP
By asking you to:
o tell healthcare workers if you don’t want an electronic care record to be
created for you;
o decide whether the information contained in your electronic care record can be
shared; and
o decide whether some of the entries in your record are so sensitive that you want
to further control who can see them
Jersey Care Record Guarantee
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HOW TO COMPLAIN
If you are unhappy with the way your clinical information is being used and feel that the
commitments of the Jersey Care Record Guarantee are not being upheld you are entitled to make a
complaint, have it considered, and receive a response from the primary care practitioner concerned.
If you are dissatisfied with the response you can write to the Chairman of the Primary Care Body or
the head of the Primary Care Governance Unit. (Details under CONTACT US > COMPLAINTS on
the PCB Website.)
Plans for the future
It is planned to introduce the following features over the next few years. They will give you even more
control over your record.
Your health care record will be made available to you at all times, free of charge, over a
secure internet connection.
If you are concerned about particular entries in your care record, you will be able to ask for those
parts of your record to be kept from general view.
If you request this, the entries will always be able to be seen by the doctor in the practice that created
them. For information that identifies you, you can decide whether you want to do the following.
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Allow other people outside the care team that created it to see that there is hidden information.
This is called ‘sealing’. They can ask for your permission to see sealed information, but you can
refuse. In an emergency, if you are not able to give your permission, they can unseal it if they feel
that your care justifies doing so.
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Allow no-one other than the team that created it to know that there is hidden information. This
is called ‘sealing and locking’. Sealed and locked information will not be available to other
people, even in an emergency.
Particular entries that identify you will not be shared without your specific permission, except:
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when there is a legal duty to give information about you; or
when there is a case for special permission because the vital interests of you or another person
is considered to outweigh your right to confidentiality
CONTACT DETAILS:
You can get more information about rights under the Data Protection (Jersey) Law 2005 from:
The Data Protection Commissioner’s Office
Morier House, Halkett Place
St Helier, Jersey, JE1 1DD
Phone: 01534 441064
Website: www.dataprotection.gov.je
Or
By writing to :
Primary Care Body Chairman
Dr Nigel Minihane
Laurels Medical Centre
28 Clarendon Road
St Helier
Jersey, JE2 3YW
Phone: 01534 733866
Email : [email protected]
Jersey Care Record Guarantee
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