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Confidentiality and Shared Care in The New NHS. Squaring circles – if possible Mary Hawking GP Dunstable England. What degree of Confidentiality is possible or desirable?. What information do Fred’s support team need?. Services needed DNs for insulin administration Carers Dog walker
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Confidentiality and Shared Care in The New NHS Squaring circles – if possible Mary Hawking GP Dunstable England PHCSG HC2011 06/04/11
What degree of Confidentiality is possible or desirable? PHCSG HC2011 06/04/11
What information do Fred’s support team need? • Services needed • DNs for insulin administration • Carers • Dog walker • Respite care for dog • Transport for appointments • Housework/shopping • Financial assessment • Single point of contact • No medical information needed. PHCSG HC2011 06/04/11
What information do his medical support team need? • He is on four pathways • DM • COPD • Arthritis • Depression • He is housebound • All pathways require either home visits or transport • Medication interaction inevitable: what is priority? • Steroids vs DM & insulin • NSAIs vs ACE • Who decides? • How should the medical care and record be organised? PHCSG HC2011 06/04/11
DM and complications GP & practice team Community Diabetic specialist nurse Specialists Hospital care Retinopathy screening Diabetic foot services Vascular surgery Limb-fitting Wheel chair services COPD GP & practice team Specialist nurse Stop Smoking (giving up!) Respiratory consultant Pulmonary rehabilitation RhA GP Rheumatology OOH A&E and emergency admissions Who is in charge of total care? How will inadvertent harm be avoided? How is the care to be co-ordinated? What information do the various organisations involved need for:- Direct care Billing Audit Accountability/transparency Performance and contract management How is the information to be regulated and confidentiality protected? Who is providing care along the pathways? PHCSG HC2011 06/04/11
Clinical GP practice? All clinicians involved? Organisations involved? Other people’s data? Changing management e.g. prescriptions? Who can amend or evolve information? “Data controllers” Clinical responsibility. Organisational Individual data Population data Billing data Service management data Retention of identifiable data ? Secondary uses? Who controls what data? PHCSG HC2011 06/04/11
“What is the correct amount of confidentiality?” • Patient information is used for direct care & service management • These cannot be provided without some patient identifiable information • Aggregated information not contentious • Purposes for which information needed/desired/demanded • Consent issues • Trust or lack of it – and who trusts whom. PHCSG HC2011 06/04/11
Wicked questions still need to be addressed… Answers to my questions when the Chair says! PHCSG HC2011 06/04/11