This is where someone is given access another person’s medical record.
For example:
- A parent or guardian who has legal responsibility for a patient under 11
- A parent or guardian where a patient aged 11 or over has given permission
- A parent or guardian who has legal responsibility for a patient between 11 and 16 where GP has assessed that the patient is not capable of making their own decisions re medical health
- A carer for a patient over the age of 16 – we would need a letter from the patient giving them permission
The proxy does not have to be a registered patient at the practice, but must be registered for online services on the GP system and always use their own login credentials.
To be given proxy access, a patient’s representative must have the informed consent of the patient or, in cases where the patient does not have capacity to consent, the GP has decided that it is in the best interests of the patient for them to have proxy access.
Patients aged 16 or above are assumed to have the capacity to consent unless there is an indication that they are not. Young patients between the ages of 11 and 16 who are judged as having capacity to consent by their GP may also consent to give proxy access to someone else.
Legitimate reasons for the practice to authorise proxy access without the patient’s consent include:
- The patient has been assessed as lacking capacity to make a decision on granting proxy access and/or the applicant has a lasting power of attorney for health and welfare registered with the Office of the Public Guardian,
- the applicant is acting as a Court Appointed Deputy on behalf of the patient, or
- the GP considers it to be in the patient’s interest in accordance with the Mental Capacity Act 2005 code of practice.
- The patient is a child who has been assessed as not competent to make a decision on granting proxy access
The practice may refuse or withdraw proxy access, if they judge that it is in the patient’s best interests to do so.
On a child’s 11th birthday, the scope of the current proxy access will be restricted, unless the GP has already assessed the child as able to make an informed decision and the child has given explicit consent for their record to be shared. This is a national standard created by imposed by NHS England to protect the confidentiality rights of young people.
From 11-16, a parent with proxy access will be able to manage certain elements of the young person’s record, such as demographic data, and make appointments and order repeat prescriptions, but they will not be able to see the young person’s past appointments or clinical record, although they would still be able to see the current repeat prescription record.
At the child’s 16th birthday the remaining proxy access will be switched off, except where the young person is competent and has given explicit consent to the parental access. If the child wants proxy access re-instated, they will need to come to the surgery in person, with proof of ID, to request it.
Parents may continue to be allowed proxy access to their child’s online services, after careful discussion with the GP, if it is felt to be in the child’s best interests.
Background information
In UK law, a person’s 18th birthday draws the line between childhood and adulthood (Children Act 1989 s105) – so in health care matters, an 18 year old enjoys as much autonomy as any other adult. To a more limited extent, 16 and 17 year-olds can also take medical decisions independently of their parents. The right of younger children to provide independent consent is proportionate to their competence – a child’s age alone is clearly an unreliable predictor of his or her competence to make decisions.