Patient confidentiality and privacy

This Privacy Notice explains what information we collect about you, how we store this information, how long we retain it and with whom and for which legal purpose we may share it. Guardian Medical Centre also publishes a number of specific notices which are available at the bottom of this page.

This privacy notice explains in detail why we use your personal data which we, the GP practice (Data Controller), collects and processes about you.  A Data Controller determines how the data will be processed and used and who this data will be shared with. We are legally responsible for ensuring that all personal data that we hold and use is done so in a way that meets the data protection principles under the UK General Data Protection Regulation (UK GDPR) and Data Protection Act 2018.  This notice also explains how we handle that data and keep it safe.

Caldicott Guardian

The GP Practice has a Caldicott Guardian. A Caldicott Guardian is a senior person within a health or social care organisation, preferably a health professional, who makes sure that the personal information about those who use its services is used legally, ethically and appropriately, and that confidentiality is maintained.  The Caldicott Guardian for the GP practice is:

Dr Julian Poulton

Data Protection Officer (DPO)

Under the UK GDPR all public bodies must nominate a Data Protection Officer.  The DPO is responsible for advising on compliance, training and awareness and is the main point of contact with the Information Commissioner’s Office (ICO).  The DPO for the practice is:

Camilla Bhondoo  IG@midmerseyda.nhs.uk

We will continually review and update this privacy notice to reflect changes in our services and to comply with changes in the law.  When such changes occur, we will revise the last updated date as documented in the version status in the header of this document.

We are here to provide care and treatment to you as our patients.  In order to do this, the GP practice keeps personal demographic data about you such as your name, address, date of birth, telephone numbers, email address, NHS Number etc and your health and care information.  Information is needed so we can provide you with the best possible health and care.  We also use your data to:

• Confirm your identity to provide these services and those of your family / carers
• Understand your needs to provide the services that you request
• Obtain your opinion on our services (with consent)
• Prevent and detect fraud and corruption in the use of public funds
• Make sure we meet our statutory obligations, including those related to diversity and equalities
• Adhere to a legal requirement that will allow us to use or provide information (e.g. a formal Court Order or legislation, investigations)

We use the following types of information / data:

Personal Data
This contains details that identify individuals even from one data item or a combination of data items. The following are demographic data items that are considered identifiable such as name, address, NHS Number, full postcode, date of birth. Under UK GDPR, this now includes location data and online identifiers.

Special categories of data (previously known as sensitive data)
This is personal data consisting of information as to: race, ethnic origin, political opinions, health, religious beliefs, trade union membership, sexual life and previous criminal convictions. Under UK GDPR, this now includes biometric data and genetic data.

Personal Confidential Data (PCD)
This term came from the Caldicott review undertaken in 2013 and describes personal information about identified or identifiable individuals, which should be kept private or secret. It includes personal data and special categories of data but it is adapted to include dead as well as living people and ‘confidential’ includes both information ‘given in confidence’ and ‘that which is owed a duty of confidence’.

Pseudonymised Data or Coded Data
Individual-level information where individuals can be distinguished by using a coded reference, which does not reveal their ‘real world’ identity. When data has been pseudonymised it still retains a level of detail in the replaced data by use of a key / code or pseudonym that should allow tracking back of the data to its original state.

Anonymised Data
This is data about individuals but with all identifying details removed. Data can be considered anonymised when it does not allow identification of the individuals to whom it relates, and it is not possible that any individual could be identified from the data by any further processing of that data or by processing it together with other information which is available or likely to be available.

Aggregated Data
This is statistical information about multiple individuals that has been combined to show general trends or values without identifying individuals within the data.

The law on data protection under the UK GDPR sets out a number of different reasons for which personal data can be processed for.  The law states that we have to inform you what the legal basis is for processing personal data and also if we process special category of data such as health data what the condition is for processing. 

The types of processing we carry out in the GP practice and the legal bases and conditions we use to do this are outlined below:

Provision of Direct Care and administrative purposes within the GP practice

Direct care means a clinical, social or public health activity concerned with the prevention, investigation and treatment of illness and the alleviation of suffering of individuals. This is carried out by one or more registered and regulated health or social care professionals and their team with whom the individual has a legitimate relationship with. In addition, this also covers administrative purposes which are in the patient’s reasonable expectations.

To explain this, a patient has a legitimate relationship with a GP in order for them to be treated and the GP practice staff process the data in order to keep up to date records and to send referral letters etc. 

Other local administrative purposes include waiting list management, performance against national targets, activity monitoring, local clinical audit and production of datasets to submit for national collections.

This processing covers the majority of our tasks to deliver health and care services to you.  When we use the above legal basis and condition to process your data for direct care, consent under UK GDPR is not needed.  However, we must still satisfy the common law duty of confidentiality and we rely on implied consent. For example, where a patient agrees to a referral from one healthcare professional to another and where the patient agrees this implies their consent.

This is information which is used for non-healthcare purposes. Generally this could be for research purposes, audits, service management, safeguarding, commissioning, complaints and patient and public involvement.

When your personal information is used for secondary use this should, where appropriate, be limited and de-identified so that the secondary uses process is confidential.

Safeguarding

Information is provided to care providers to ensure that adult and children's safeguarding matters are managed appropriately. Access to personal data and health information will be shared in some limited circumstances where it's legally required for the safety of the individuals concerned. For the purposes of safeguarding children and vulnerable adults, personal and healthcare data is disclosed under  the provisions of the Children Acts 1989 and 2006 and Care Act 2014.

Risk Stratification

Risk stratification entails applying computer based algorithms, or calculations to identify those patients who are most at risk from certain medical conditions and who will benefit from clinical care to help prevent or better treat their condition. To identify those patients individually from the patient community would be a lengthy and time-consuming process which would by its nature potentially not identify individuals quickly and increase the time to improve care.  A GP / health professional reviews this information before a decision is made.

The use of personal and health data for risk stratification has been approved by the Secretary of State, through the Confidentiality Advisory Group of the Health Research Authority (known as Section 251 approval). This approval allows your GP or staff within your GP Practice who are responsible for providing your care, to see information that identifies you, but CCG staff will only be able to see information in a format that does not reveal your identity.

NHS England encourages GPs to use risk stratification tools as part of their local strategies for supporting patients with long-term conditions and to help and prevent avoidable admissions.

Knowledge of the risk profile of our population helps to commission appropriate preventative services and to promote quality improvement.

Risk stratification tools use various combinations of historic information about patients, for example, age, gender, diagnoses and patterns of hospital attendance and admission and primary care data collected in GP practice systems.

If you do not wish information about you to be included in our risk stratification programme, please contact the GP Practice. We can add a code to your records that will stop your information from being used for this purpose. Please see the section below regarding objections for using data for secondary uses.

National Clinical Audits

The GP practice contributes to national clinical audits and will send the data which are required by NHS Digital when the law allows. This may include demographic data such as data of birth and information about your health which is recorded in coded form, for example, the clinical code for diabetes or high blood pressure.

Research

All NHS organisations (including Health & Social Care in Northern Ireland) are expected to participate and support health and care research. The Health Research Authority and government departments in Northern Ireland, Scotland and Wales set standards for NHS organisations to make sure they protect your privacy and comply with the law when they are involved in research. Our research ethics committees review research studies to make sure that the research uses of data about you are in the public interest, and meet ethical standards.

Health and care research may be exploring prevention, diagnosis or treatment of disease, which includes health and social factors in any disease area. Research may be sponsored by companies developing new medicines or medical devices, NHS organisations, universities or medical research charities. The research sponsor decides what information will be collected for the study and how it will be used.

Health and care research should serve the public interest, which means that research sponsors have to demonstrate that their research serves the interests of society as a whole. They do this by following the UK Policy Framework for Health and Social Care Research. They also have to have a legal basis for any use of personally-identifiable information.

How patient information may be used for research

When you agree to take part in a research study, the sponsor will collect the minimum personally-identifiable information needed for the purposes of the research project. Information about you will be used in the ways needed to conduct and analyse the research study. NHS organisations may keep a copy of the information collected about you. Depending on the needs of the study, the information that is passed to the research sponsor may include personal data that could identify you. You can find out more about the use of patient information for the study you are taking part in from the research team or the study sponsor. You can find out who the study sponsor is from the information you were given when you agreed to take part in the study.

For some research studies, you may be asked to provide information about your health to the research team, for example in a questionnaire. Sometimes information about you will be collected for research at the same time as for your clinical care, for example when a blood test is taken. In other cases, information may be copied from your health records. Information from your health records may be linked to information from other places such as central NHS records, or information about you collected by other organisations. You will be told about this when you agree to take part in the study.

Even though consent is not the legal basis for processing personal data for research, the common law duty of confidentiality is not changing, so consent is still needed for people outside the care team to access and use confidential patient information for research, unless you have support under the Health Service (Control of Patient Information Regulations) 2002 (‘section 251 support’) applying via the Confidentiality Advisory Group in England and Wales or similar arrangements elsewhere in the UK

Your choices about health and care research

If you are asked about taking part in research, usually someone in the care team looking after you will contact you. People in your care team may look at your health records to check whether you are suitable to take part in a research study, before asking you whether you are interested or sending you a letter on behalf of the researcher.

In some hospitals and GP practices, you may have the opportunity to sign up to a register to hear about suitable research studies that you could take part in. If you agree to this, then research nurses, researchers or administrative staff authorised by the organisation may look at your health records to see if you are suitable for any research studies.

It’s important for you to be aware that if you are taking part in research, or information about you is used for research, your rights to access, change or move information about you are limited. This is because researchers need to manage your information in specific ways in order for the research to be reliable and accurate. If you withdraw from a study, the sponsor will keep the information about you that it has already obtained. They may also keep information from research indefinitely.

If you would like to find out more about why and how patient data is used in research, please visit the Understanding Patient Data website:

https://understandingpatientdata.org.uk/what-you-need-know

In England you can register your choice to opt out via the “Your Data Matters” webpage on the link below:

https://www.nhs.uk/your-nhs-data-matters/

If you do choose to opt out you can still agree to take part in any research study you want to, without affecting your ability to opt out of other research. You can also change your choice about opting out at any time.

To find out more about UK GDPR and using personal data for research, please visit the Health Research Authority website on the link below:

https://www.hra.nhs.uk/hra-guidance-general-data-protection-regulation/

Complaints

If you contact the GP Practice about a complaint, we require your explicit consent to process this complaint for you.  You will be informed of how and with whom your data will be shared by us, including if you have or you are a representative you wish the GP practice to deal with on your behalf.

There are also other areas of processing undertaken where consent is required from you. Under UK GDPR, consent must be freely given, specific, you must be informed and a record must be made that you have given your consent, to confirm you have understood. 

Patient and Public Involvement

If you have asked us to keep you regularly informed and up to date about the work of the GP Practice or if you are actively involved in our engagement and consultation activities or patient participation groups, we will collect and process personal confidential data which you share with us.

We obtain your consent for this purpose. Where you submit your details to us for involvement purposes, we will only use your information for this purpose. You can opt out at any time by contacting us using our contact details at the end of this document.

Using anonymous or coded information

This type of data may be used to help assess the needs of the general population and make informed decisions about the provision of future services. Information can also be used to conduct health research and development and monitor NHS performance where the law allows this. Where information is used for statistical purposes, stringent measures are taken to ensure individual patients cannot be identified. Anonymous statistical information may also be passed to organisations with a legitimate interest, including universities, community safety units and research institutions.

This applies to identifiable patient data about your health (personal identifiable data in the diagram below), which is called confidential patient information. If you don’t want your confidential patient information to be shared by NHS Digital for purposes except your own care - either GP data, or other data we hold, such as hospital data - you can register a National Data Opt-out. 

If you have registered a National Data Opt-out, NHS Digital won’t share any confidential patient information about you with other organisations unless there is an exemption to this, such as where there is a legal requirement or where it is in the public interest to do so, such as helping to manage contagious diseases like coronavirus. You can find out more about exemptions on the NHS website.

From July 2022, it is a legal requirement for all health and social care CQC registered organisations to be compliant with the national data opt out.

The National Data Opt-out will also apply to any confidential patient information shared by your GP practice with other organisations for purposes except your individual care. It won't apply to this data being shared by GP practices with NHS Digital, as it is a legal requirement for GP practices to share this data with NHS Digital and the National Data Opt-out does not apply where there is a legal requirement to share data.

You can find out more about and register a National Data Opt-out or change your choice on nhs.uk/your-nhs-data-matters or by calling 0300 3035678.

Whenever you use a health or care service, such as attending the practice, important information about you is collected in a patient record for that service. Collecting this information helps to ensure you get the best possible care and treatment.

The information collected about you when you use these services can also be used and provided to other organisations for purposes beyond your individual care, for instance to help with:

•           improving the quality and standards of care provided

•           research into the development of new treatments

•           preventing illness and diseases

•           monitoring safety

•           planning services

This may only take place when there is a clear legal basis to use this information. All these uses help to provide better health and care for you, your family and future generations. Confidential patient information about your health and care is only used like this where allowed by law.

Most of the time, anonymised data is used for research and planning so that you cannot be identified in which case your confidential patient information isn’t needed.

You have a choice about whether you want your confidential patient information to be used in this way. If you are happy with this use of information you do not need to do anything. If you do choose to opt-out your confidential patient information will still be used to support your individual care.

To find out more or to register your choice to opt out, please visit:

www.nhs.uk/your-nhs-data-matters

On this web page you will:

• See what is meant by confidential patient information
• Find examples of when confidential patient information is used for individual care and examples of when it is used for purposes beyond individual care
• Find out more about the benefits of sharing data
• Understand more about who uses the data
• Find out how your data is protected
• Be able to access the system to view, set or change your opt-out setting
• Find the contact telephone number if you want to know any more or to set/change your opt-out by phone
• See the situations where the opt-out will not apply

You can also find out more about how patient information is used at:

https://www.hra.nhs.uk/information-about-patients/ (which covers health and care research);

and,

https://understandingpatientdata.org.uk/what-you-need-know (which covers how and why patient information is used, the safeguards and how decisions are made)

As stated above, where your data is being processed for direct care this will be shared with other care providers who are providing direct care to you such as:

• NHS Trusts / Foundation Trusts
• GP’s
• Independent Contractors such as dentists, opticians, pharmacists
• Private Sector Providers
• Voluntary Sector Providers
• Ambulance Trusts
• Social Care Services
• Out of hours providers
• Walk in centres
• Clinics

We work with third parties and suppliers (data processors) to be able for us to provide a service to you.  These include:

• System 1 – to provide our electronic clinical system
• MLCSU – to provide our IT services
• ACCURX - SMS
• ANIMA -Online consultations
• APEX - Anonymised data to manage appointment demand
• SRCL- Shredding company

There may be occasions whereby these organisations have potential access to your personal data, for example, if they are fixing an IT fault on the system.  To protect your data, we have contracts and / or Information Sharing Agreements in place stipulating the data protection compliance they must have and re-enforce their responsibilities as a data processor to ensure you data is securely protected at all times.

We will not disclose your information to any 3^rd party without your consent unless:

• there are exceptional circumstances (life or death situations)
• where the law requires information to be passed on as stated above
• required for fraud management – we may share information about fraudulent activity in our premises or systems.  This may include sharing data about individuals with law enforcement bodies.
• It is required to be disclosed to the police or other enforcement, regulatory or government body for prevention and / or detection of crime

Your data is processed with the GP surgery and by other third parties as stated above who are UK based.  Your personal data is not sent outside of the UK for processing.

Where information sharing is required with a country outside of the EU you will be informed of this and we will have a relevant Information Sharing Agreement in place. We will not disclose any health information without an appropriate lawful principle, unless there are exceptional circumstances such as when the health or safety of others is at risk, where the law requires it, or to carry out a statutory functions i.e. reporting to external bodies to meet legal obligations

All records held by the medical centre will be kept for the duration specified by national guidance from the Department of Health. The Records Management Code of Practice for Health and Social Care 2016.

Records Management Code of Practice for Health and Social Care 2016

We will keep a copy of your information in our medical centre for as long as you are registered with us, and If you leave the medical centre we will ensure that a copy of anything we hold is passed on to your new GP.  Your record status will be marked as ‘inactive’ in our clinical system but it will not be deleted”.

Confidential information is securely destroyed in accordance with this code of practice.

You have the following rights over your data we hold:

• Subject Access Rights – you can request access to and or copies of personal data we hold about you, free of charge (subject to exemptions) and provided to you within 1 calendar month. We request that you provide us with adequate information in writing to process your request such as full name, address, date of birth, NHS number and details of your request and documents to verify your identity so we can process the request efficiently. On processing a request, there may be occasions when information may be withheld if the organisation believes that releasing the information to you could cause serious harm to your physical or mental health. Information may also be withheld if another person (i.e. third party) is identified in the record, and they do not want their information disclosed to you. However, if the other person was acting in their professional capacity in caring for you, in normal circumstances they could not prevent you from having access to that information.

To request a copy or request access to information we hold about you and / or to request information to be corrected if it is inaccurate, please contact the AdministrationTeam.

 

• Right to rectification

The correction of personal data when incorrect, out of date or incomplete which must be acted upon within 1 calendar month of receipt of such request.  Please ensure the GP practice has the correct contact details for you. 

• Right to withdraw consent

Where your explicit consent is required for any processing we do, you have the right to withdraw that consent at any time.

• Right to Erasure (‘be forgotten’)
  This is not applicable to health records but is normally relied upon where consent is obtained for any processing. You have the right to have that data deleted / erased. 

• Right to Data Portability
  If we obtain consent for any processing we do, you have the right to have data provided to you in a commonly used and machine readable format such as excel spreadsheet, csv file.

• Right to object to processing

You have the right to object to processing however please note if we can demonstrate compelling legitimate grounds which outweighs the interest of you then processing can continue.  If we didn’t process any information about you and your health care if would be very difficult for us to care and treat you.

• Right to restriction of processing
  This right enables individuals to suspend the processing of personal information, for example, if you want to establish its accuracy or the reason for processing it.

Objections to processing for secondary purposes (other than direct care)

The NHS Constitution states "You have the right to request that your confidential information is not used beyond your own care and treatment and to have your objections considered".    The possible consequences (i.e. lack of joined up care, delay in treatment if information has to be sourced from elsewhere, medication complications which all lead to the possibility of difficulties in providing the best level of care and treatment) will be fully explained to you to allow you to make an informed decision.

If you wish to opt out of your data being processed and / or shared onwards with other organisations for purposes not related to your direct care, please visit our website and click on the link

Phone Call Recording – Call recording occurs either in relation to patient care or may be stored to provide an accurate and objective record for the protection of staff and patients alike as it may be used in cases of legal defence or prosecution.

Video Communications – Changes in the provision of healthcare outside of the usual methods this is delivered has been instituted in many NHS organisations. For this purpose video consultations may sometimes be recorded to provide an accurate record of the healthcare provided.

While the recording of these consultations proceeds under the Legal Basis’ noted elsewhere in this privacy notice, service users may be asked for their consent to continue with a recorded consultation. Please be aware that this consent does not form the Legal Basis for which this data is processed but is requested to allow service users to opt-out of care provided in this manner. 

Please contact the Practice Information Governance Lead:

Dr Julian Poulton

Guardian Medical Centre

Guardian Street

Warrington

Cheshire

WA5 1UD

Camilla Bhondoo

Mid-Mersey Digital Alliance (Information Governance Team)

St Alexandra Business Park

Court Building

Prescot Road

St Helens

WA10 3TP

IG@midmerseyda.nhs.uk 

The Information Commissioner’s Office (ICO) is the body that regulates the medical centre under Data Protection and Freedom of Information legislation. https://ico.org.uk/.

If you are not satisfied with our response or believe we are processing your personal data not in accordance with the law you can complain to the ICO at:

Information Commissioner's Office

Wycliffe House

Water Lane

Wilmslow

Cheshire

SK9 5AF

Tel: 0303 123 1113 (local rate) or 01625 545 745 if you prefer to use a national rate number

Fax: 01625 524 510

Email: casework@ico.org.uk