Appendix A

The Practice will share patient information with these organisations where there is a legal basis to do so.

Activity:

• Commissioning and contractual purposes
• Invoice Validation
• Planning
• Quality and Performance

Rationale:

Purpose – Anonymous data is used by the Integrated Care Board (ICB) for planning, performance and commissioning purposes, as directed in the practices contract, to provide services as a public authority.

Legal Basis – UK GDPR 6 1(b) Contractual obligation as set out in the Health and Social Care Act for Quality and Safety 2015

Patients may opt out of having their personal confidential data used for Planning or research. Please contact your surgery to apply a Type 1 Opt out or logon to Your NHS Data Matters to apply a National Data Opt Out

Processor – NHS Sussex ICB

Activity:

• Summary Care Record
• Including additional information

Rationale:

Purpose – The NHS in England uses a national electronic record called the Summary Care Record (SCR) to support patient care. It contains key information from your GP record. Your SCR provides authorised healthcare staff with faster, secure access to essential information about you in an emergency or when you need unplanned care, where such information would otherwise be unavailable.

Legal Basis – Direct Care under UK GDPR:

• Article 6(1)(e) ‘…necessary for the performance of a task carried out in the public interest or in the exercise of official authority…’; and
• Article 9(2)(h) ‘necessary for the purposes of preventative or occupational medicine

Patients have the right to opt out of having their information shared with the SCR by completion of the form which can be downloaded here and returned to the practice. Please note that by opting out of having your information shared with the Summary Care Record could result in a delay to care that may be required in an emergency.

Processor – NHS England and NHS Digital

Activity:

• Research

Rationale:

Purpose – We may share anonymous patient information with research companies for the purpose of exploring new ways of providing healthcare and treatment for patients with certain conditions. This data will not be used for any other purpose. 

Where personal confidential data is shared your consent will need to be required.

Where you have opted out of having your identifiable information shared for this Planning or Research your information will not be shared.

Legal Basis – Where sharing of personal identifiable data is required the legal basis of Article 6 1 (a) and 9 2 (h) Consent will be required.

Where identifiable data is required for research, patient consent will be needed, unless there is a legitimate reason under law to do so or there is support under the Health Service (Control of Patient Information Regulations) 2002 (‘section 251 support’) applying via the Confidentiality Advisory Group in England and Wales 

Sharing of aggregated non identifiable data is permitted.

Processor – name research organisation

Activity:

• Individual Funding Requests

Rationale:

Purpose – We may need to process your personal information where we are required to fund specific treatment for you for a particular condition that is not already covered in our standard NHS contract.

The clinical professional who first identifies that you may need the treatment will explain to you the information that is needed to be collected and processed in order to assess your needs and commission your care; they will gain your explicit consent to share this. You have the right to withdraw your consent at any time but this may affect the decision to provide individual funding. 

Legal Basis – Under UK GDPR Article 6 1(a) consent is required

6 1 (e) Public Task
Article 9 2 (h) health data

Data processor – NHS Sussex ICB

Activity:

• Safeguarding Adults

Rationale:

Purpose – We will share personal confidential information with the safeguarding team where there is a need to assess and evaluate any safeguarding concerns and to protect the safety of individuals.

Consent may not be required to share information for this purpose.

Legal Basis – in some case consent will be required otherwise

• Article 6(1)(e) ‘…necessary for the performance of a task carried out in the public interest or in the exercise of official authority…’; and
• Article 9(2)(h) ‘necessary for the purposes of preventative or occupational medicine

Data Processor – NHS Sussex ICB

Activity:

• Safeguarding Children

Rationale:

Purpose – We will share children’s personal information where there is a need to assess and evaluate any safeguarding concerns and to protect the safety of children.

Legal Basis -

• Article 6(1)(e) ‘…necessary for the performance of a task carried out in the public interest or in the exercise of official authority…’; and
• Article 9(2)(h) ‘necessary for the purposes of preventative or occupational medicine 

Consent may not be required to share this information.

Data Processor – NHS Sussex ICB

Activity:

• Risk Stratification – Preventative Care

Rationale:

Purpose - ‘Risk stratification for case finding’ is a process for identifying and managing patients who have or may be at-risk of health conditions (such as diabetes) or who are most likely to need healthcare services (such as people with frailty). Risk stratification tools used in the NHS help determine a person’s risk of suffering a particular condition and enable us to focus on preventing ill health before it develops.

Information about you is collected from a number of sources including NHS Trusts, GP Federations and your GP Practice. A risk score is then arrived at through an analysis of your de-identified information. This can help us identify and offer you additional services to improve your health.

If you do not wish information about you to be included in any risk stratification programmes, please let us know. We can add a code to your records that will stop your information from being used for this purpose. Please be aware that this may limit the ability of healthcare professionals to identify if you have or are at risk of developing certain serious health conditions.

Type of Data – Identifiable/Pseudonymised/Anonymised/Aggregate Data

Legal Basis

UK GDPR Art. 6(1) (e) Public task and Art.9 (2) (h) Health data.

The use of identifiable data by ICBs and GPs for risk stratification has been approved by the Secretary of State, through the Confidentiality Advisory Group of the Health Research Authority (approval reference (CAG 7-04)(a)/2013)) and this approval has been extended to the end of September 2022 NHS England Risk Stratification  which gives us a statutory legal basis under Section 251 of the NHS Act 2006 to process data for risk stratification purposes which sets aside the duty of confidentiality. We are committed to conducting risk stratification effectively, in ways that are consistent with the laws that protect your confidentiality.

Processors – Bridgeside Surgery

Activity:

• Public Health
• Screening programmes (identifiable)
• Notifiable disease information (identifiable)
• Smoking cessation (anonymous)
• Sexual health (anonymous)
• Vaccination Programmes

Rationale:

Purpose – Personal identifiable and anonymous data is shared.

The NHS provides national screening programmes so that certain diseases can be detected at an early stage. These currently apply to bowel cancer, breast cancer, aortic aneurysms and diabetic retinal screening service to name a few. The law allows us to share your contact information, and certain aspects of information relating to the screening with Public Health England so that you can be appropriately invited to the relevant screening programme.

More information can be found at: Population Screening Programmes or speak to the practice

Patients may not opt out of having their personal information shared for Public Health reasons.

Patients may opt out of being screened at the time of receiving an invitation.

Legal Basis:

Sharing personal data for this purpose is governed by the COPI Reg 2.

Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’

6 1 (f) Legitimate interests

And Article 9(2)(h) Health data as stated below

9 2 (i) Public health

Data Processors – Public Health England

Activity:

• Direct Care
• NHS Trusts
• Community Providers
• Pharmacies
• Enhanced care providers
• Nursing Homes
• Other Care Providers

Rationale:

Purpose – Personal information is shared with other secondary care trusts and providers in order to provide you with individual direct care services. This could be hospitals or community providers for a range of services, including treatment, operations, physio, and community nursing, ambulance service.

Legal Basis - The processing of personal data in the delivery of direct care and for providers’ administrative purposes in this surgery and in support of direct care elsewhere is supported under the following Article 6 1 (e) direct care and 9 2 (h) to provide health or social care:

In some cases patients may be required to consent to having their record opened by the third party provider before patients information is accessed. Where there is an overriding need to access the GP record in order to provide patients with life saving care, their consent will not be required.

Processors – Eastbourne, Conquest, Brighton, Tunbridge Wells and associated Hospitals

Activity:

• Care Quality Commission

Rationale:

Purpose – The CQC is the regulator for the English Health and Social Care services to ensure that safe care is provided. They will inspect and produce reports back to the GP practice on a regular basis. The Law allows the CQC to access identifiable data.

More detail on how they ensure compliance with data protection law (including UK GDPR) and their privacy statement is available on our website: https://www.cqc.org.uk/about-us/our-policies/privacy-statement

Legal Basis - Article 6(1)(c) “processing is necessary for compliance with a legal obligation to which the controller is subject.” And Article 9(2) (h) as stated below

Processors – Care Quality Commission

Activity:

• Population Health Management

Rationale:

Purpose – Health and care services work together as ‘Integrated Care Systems’ (ICS) and are sharing data in order to:

• Understand the health and care needs of the care system’s population, including health inequalities
• Provide support to where it will have the most impact
• Identify early actions to keep people well, not only focusing on people in direct contact with services, but looking to join up care across different partners.

(NB this links to the Risk Stratification activity identified above)

Type of Data – Identifiable/Pseudonymised/Anonymised/Aggregate Data.  NB only organisations that provide your care will see your identifiable data.

Legal Basis - Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) as stated below

Data Processors  -  Optum, Cerner

Activity:

• Payments, Invoice validation

Rationale:

Purpose - Contract holding GPs in the UK receive payments from their respective governments on a tiered basis. Most of the income is derived from baseline capitation payments made according to the number of patients registered with the practice on quarterly payment days. These amounts paid per patient per quarter varies according to the age, sex and other demographic details for each patient. There are also graduated payments made according to the practice’s achievement of certain agreed national quality targets known as the Quality and Outcomes Framework (QOF), for instance the proportion of diabetic patients who have had an annual review. Practices can also receive payments for participating in agreed national or local enhanced services, for instance opening early in the morning or late at night or at the weekends. Practices can also receive payments for certain national initiatives such as immunisation programs and practices may also receive incomes relating to a variety of non-patient related elements such as premises. Finally there are short term initiatives and projects that practices can take part in. Practices or GPs may also receive income for participating in the education of medical students, junior doctors and GPs themselves as well as research. In order to make patient based payments basic and relevant necessary data about you needs to be sent to the various payment services. The release of this data is required by English laws.

Legal Basis - Article 6(1)(c) “processing is necessary for compliance with a legal obligation to which the controller is subject.” And Article 9(2)(h) ‘as stated below

Data Processors – NHS England, ICB, Public Health

Activity:

• Patient Record data base

Rationale:

Purpose – Your medical record will be processed in order that a data base can be maintained, this is managed in a secure way and there are robust processes in place to ensure your medical record is kept accurate, and up to date.  Your record will follow you as you change surgeries throughout your life.

Closed records will be archived by NHS England 

Legal Basis - Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) as stated below

Processor – EMIS, PCSE

Activity:

• Medical reports
• Subject Access Requests

Rationale:

Purpose – Your medical record may be shared in order that:

Solicitors/persons acting on your behalf can conduct certain actions as instructed by you. 

Insurance companies seeking a medical reports where you have applied for services offered by then can have a copy to your medical history for a specific purpose. 

Legal Basis – under GDPR Article 6 1 (a) and 9 2 (a) explicit consent will be required before a GP can share your record for either for these purposes.

Processor – Solicitors, Insurance organisations

Activity:

• Medicines Management Team
• Medicines Optimisation

Rationale:

Purpose – your medical record is shared with the medicines management team pharmacists, in order that your medication can be kept up to date and any necessary changes to medication can be implemented.

Legal Basis - Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor – NHS Sussex ICB

Activity:

• GP Federation

Rationale:

Purpose – Your medical record will be shared with Sussex Downs Health & Care in order that they can provide direct care services to the patient population. This could be in the form of video consultations, Minor injuries clinics, GP extended access clinics. The Federation will be acting on behalf of the GP practice.

Legal Basis - Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor – Sussex Downs Health & Care

Activity:

• Primary Care Network (PCN)

Rationale:

Purpose – Your medical record will be shared with other GP practices in the Hailsham Primary Care Network in order that they can provide direct care services to the patient population. 

Legal Basis - Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor – Hailsham Medical Group, Bridgeside Surgery, Quintins Medical Centre

Activity:

• Smoking cessation

Rationale:

Purpose – personal information is shared in order for the smoking cessation service to be provided.

Only those patients who wish to be party to this service will have their data shared

Legal Basis – Article 6 1 (a) and 9 2 (h) consent

Processor – One You

Activity:

• Social Prescribers

Rationale:

Purpose – Access to medical records is provided to social prescribers to undertake a full service to patients dependent on their health social care needs.

Only those patients who wish to be party to this service will have their data shared

Legal Basis – Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below 

Processor - Southdown

Activity:

• Police

Rationale:

Purpose – Personal confidential information may be shared with the Police authority for certain purposes. The level of sharing and purpose for sharing may vary. Where there is a legal basis for this information to be shared consent will not always be required. 

The Police will require the correct documentation in order to make a request. This could be but not limited to, DS 2, Court order, s137, the prevention and detection of a crime. Or where the information is necessary to protect a person or community.

Legal Basis – UK GDPR –6 1 (c) Legal Obligation. Article 6 1 (f) legitimate interest
Article 9 2 (f) requests for legal reasons

Processor – Police Constabulary

Activity:

• Coroner
• Medical Examiner

Rationale:

Purpose – Personal health records or information relating to a deceased patient may be shared with the coroner or medical examiner upon request.

Legal Basis – UK GDPR Article 6 1 (c) Legal Obligation 9 2 (h) Health data

Processor – The Coroner, Medical Examiner

Activity:

• Private healthcare providers

Rationale:

Purpose – Personal information shared with private health care providers in order to deliver direct care to patients at the patient’s request. Consent from the patient will be required to share data with Private Providers.

Legal Basis – Article 6 1 (a) and 9 2 (h) Consented and under contract between the patient and the provider

Provider – BUPA, AXA, Spire

Activity:

• Messaging Service

Rationale:

Purpose – Personal identifiable information shared with the messaging service in order that messages including; appointment reminders; results; campaign messages related to specific patients health needs; and direct messages to patients, can be transferred to the patient in a safe way.

Legal Basis – UK GDPR Article 6 1 (b) Contract, Article 6 1 (e) Public task, Article 9 2 (h) Health data

Provider  - AccuRX, Mjog, engage consult

Activity:

• Remote consultation
• Including – Video Consultation
• Clinical photography

Rationale:

Purpose – Personal information including images may be processed, stored and with the patients consent shared, in order to provide the patient with urgent medical advice.

Legal Basis – Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Patients may be videod or asked to provide photographs with consent.  There are restrictions on what the practice can accept photographs of. No photographs of the full face, no intimate areas, no pictures of patients who cannot consent to the process. No pictures of children.

Processor – engage consult, AccuRX, LIVI

Activity:

• MDT meetings

Rationale:

Purpose – For some long term conditions, the practice participates in meetings with staff from other agencies involved in providing care, to help plan the best way to provide care to patients with these conditions. Personal data will be shared with other agencies in order that mutual care packages can be decided.

Legal Basis – Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor – MS Teams

Activity:

• COVID-19
• Research and Planning

Rationale:

Purpose – To understand the risks to public health, trends and prevent the spread of infections such as Covid-19 the government has enabled a number of initiatives which include research and planning during the Covid-19 pandemic which may include the collection of personal confidential data has been necessary. This is to assist with the diagnosis, testing, self-isolating, fitness to work, treatment medical, social interventions and recovery from Covid-19.

COPI Reg 3 has been extended and you can find further information here:

Coronavirus (COVID-19): notice under Regulation 3(4) of the Health Service (Control of Patient Information) Regulations 2002

NHS England » OpenSAFELY – the Coronavirus (COVID-19) Research Platform

Legal Basis – In order to share personal confidential data with other agencies for research or planning. 

Either the Article 6 1 (a) and 9 2 (a) Explicit consent will be required.
or 
The Processor would need to meet Section 251 CAG approval.
Or
It would need to be approved under direct care to patients Article 6 1 (e) Public Task and 9 2 (h) Health data

Provider – COVID vaccination Hubs, BIOBANK, Oxford University,

Activity:

• General Practice Extraction Service (GPES)
  1. At risk patients data collection Version 3
  2. Covid-19 Planning and Research data
  3. CVDPREVENT Audit
  4. Physical Health Checks for people with Severe Mental Illness

Rationale:

Purpose – GP practices are required to provide data extraction of their patients personal confidential information for various purposes to NHS Digital. The objective of this data collection is on an ongoing basis to identify patients registered at General Practices who fit within a certain criteria, in order to monitor and either provide direct care, or prevent serious harm to those patients. Below is a list of the purposes for the data extraction, by using the link you can find out the detail behind each data extraction and how your information will be used to inform this essential work:

1. At risk patients including severely clinically vulnerable

2. Covid-19 Planning and Research data, to control and prevent the risk of Covid-19

3. NHS England has directed NHS Digital to collect and analyse data in connection with Cardiovascular Disease Prevention Audit

4. GPES Physical Health Checks for people with Severe Mental Illness (PHSMI) data collection.

Legal Basis - All GP Practices in England are legally required to share data with NHS Digital for this purpose under section 259(1)(a) and (5) of the 2012 Act

Further detailed legal basis can be found in each link. 

Any objections to this data collection should be made directly to NHS Digital.

Processor – NHS Digital or NHS X

Activity:

• Medication/Prescribing

Rationale:

Purpose: Prescriptions containing personal identifiable and health data will be shared with organisations who provide medicines management including chemists/pharmacies, in order to provide patients with essential medication regime management, medicines and  or treatment as their health needs dictate. This process is achieved either by face to face contact with the patient or electronically. Pharmacists may be employed to review medication, Patients may be referred to pharmacists to assist with diagnosis and care for minor treatment, patients may have specified a nominated pharmacy they may wish their repeat or acute prescriptions to be ordered and sent directly to the pharmacy making a more efficient process. Arrangements can also be made with the pharmacy to deliver care and medication 

Legal Basis : Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor – Pharmacy of choice

Activity:

• Professional Training

Rationale:

Purpose – We are a training surgery. Our clinical team are required to be exposed to on the job, clinical experience, as well as continual professional development. On occasion you may be asked if you are happy to be seen by one of our GP registrars, pharmacists or other clinical team to assist with their training as a clinical professional. You may also be asked if you would be happy to have a consultation recorded for training purposes. These recordings will be shared and discussed with training GPs at the surgery, and also with moderators at the RCGP and HEE.

Legal Basis – 6 1 (a) consent, patients will be asked if they wish to take part in training sessions.
9 2 (a) - explicit consent will be required when making recordings of consultations

Recordings remain the control of the GP practice and they will delete all recordings from the secure site once they are no longer required.

Processor – RCGP, HEE, iConnect, Fourteen Fish

Activity:

• Learning Disability Mortality Programme
• LeDer

Rationale:

Purpose: The Learning Disability Mortality Review (LeDeR) programme was commissioned by NHS England to investigate the death of patients with learning difficulties and Autism to assist with processes to improve the standard and quality of care for people living with a learning disability and Autism. Records of deceased patients who meet with this criteria will be shared with NHS England.

Legal Basis:  It has approval from the Secretary of State under section 251 of the NHS Act 2006 to process patient identifiable information who fit within a certain criteria.

Processor: ICB, NHS England

Activity:

• Technical Solution
• Pseudonymisation

Rationale:

Purpose: Personal confidential and special category data in the form of medical record, is extracted under contract for the purpose of pseudonymisation. This will allow no patient to be identified within the data set that is created. SCWCSU has been commissioned to provide a data processing service for the GPs, no other processing will be undertaken under this contract.

Legal Basis: Under UK GDPR the legitimate purpose for this activity is under contract to provide assistance.
Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor: SCW CSU

Activity:

• Shared Care Record

Rationale:

Purpose: In order for the practice to have access to a shared record, the Integrated Care Service has commissioned a number of systems including GP connect, which is managed by NHS Digital, to enable a shared care record, which will assist in patient information to be used for a number of care related services. These may include Population Health Management, Direct Care, and analytics to assist with planning services for the use of the local health population.

Where data is used for secondary uses no personal identifiable data will be used.

Where personal confidential data is used for Research explicit consent will be required.

Legal Basis: Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor: NHS Digital

Activity:

• Local shared care record

Rationale:

Purpose: Health and Social care services are developing shared systems to share data efficiently and quickly.  It is important for anyone treating you to be able to access your shared record so that they have all the information they need to care for you. This will be during your routine appointments and in urgent situations such as going to A&E, calling 111 or going to an Out of hours appointment.  It is also quicker for staff to access a shared record than to try to contact other staff by phone or email.

Only authorised staff can access the systems and the information they see is carefully checked so that it relates to their job.  Systems do not share all your data, just data which services have agreed is necessary to include.

Legal Basis: Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor: ESHT, SDHC, ESOPS

Activity:

• Anticoagulation Monitoring

Rationale:

Purpose: Personal Confidential data is shared with LumiraDX in order to provide an anticoagulation clinic to patients who are on anticoagulation medication. This will only affect patients who are within this criteria. 

Legal Basis: The legal basis for this activity under UK GDPR is
Article 6(1)(e); “necessary… in the exercise of official authority vested in the controller’ And Article 9(2)(h) Health data as stated below

Processor: LumiraDX INRStar

We keep our Privacy Notice under regular review. This notice was last reviewed on 29th July 2022.

Lawful basis for processing:

The processing of personal data in the delivery of direct care and for providers’ administrative purposes in this surgery and in support of direct care elsewhere is supported under the following Article 6 and 9 conditions of the UK GDPR:

• Article 6(1)(e) ‘…necessary for the performance of a task carried out in the public interest or in the exercise of official authority…’; and
• Article 9(2)(h) ‘necessary for the purposes of preventative or occupational medicine for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services...”