Citizen Services Proxy Access

IDRM28
Version2.0.3
TypeRoadmap Item


TitleCitizen Services Proxy Access
Description

Proxy access requirements for Citizen Services to become 'MUST'.

Date Added

 

Standards and CapabilitiesAppointments Management - CitizenCitizen Access, Communicate With Practice - Citizen, Communication ManagementPatient Information Maintenance - GP, Prescription Ordering - Citizen, Recording Consultations - GPView Record - Citizen
Change RouteManaged Capacity - SRO Priority
Change TypeUplift
StatusPublished
Publication Date 
Effective DateTBC
Incentives / FundingNo
Incentive DatesN/A


Summary

Capability Specific Standards

Proxy related requirements for Citizen Services to become 'MUST'. Detailed below are the relevant Capability Specific Standards and the affected requirements i.e. those requirements where the Level is changing from MAY to MUST.

Appointments Management - Citizen

Updated standards:

Epic MappingRequirement IDRequirement TextLevel
C1E2AMC01

Appointment Management - View and Book - Proxy

Allow Proxies to view, book (available slots as defined by the Practice) and cancel an Appointment.

  • Proxies are able to view all past and future Appointments.
  • Appointment Booking is prevented when the maximum number of future Appointments is reached. The maximum is set by the Practice.
  • Appointment Bookings will not require Practice Staff intervention unless there are constraints or technical issues.

See GP-PPFS-3.3-03 for future Appointment configuration

MUST
C1E2AMC02

Appointment Management - Free Text - Proxy

Allow Proxies to optionally add 'free text' to accompany the Appointment. Also display an appropriate clinical warning, including a disclaimer/message that 'free text' can be seen by non-clinical staff and not read until the time of the Appointment.

MUST

Communicate with Practice - Citizen

Updated standards:

Epic MappingRequirement IDRequirement TextLevel
C2E2GP-CWP-4

Communication Management - Proxy

Allow the Proxy to create, receive, view, and respond to communications with the Patient's Practice.

See GP-PPFS-3.2-07 for incorporation of communications into Patient Record.

MUST
C2E2GP-CWP-5

Communication Attachments - Proxy

Allow Proxies to attach documents to their communications.

MUST
C2E2

GP-CWP-7

Proxy Notification of Patient-Practice Communications

Notify a Proxy via their preferred Verified Contact Details (see COM1) that they or the Patient have received a message from the Practice. When the message is related to an existing communication (e.g. a reply to an existing message), only Patients and Proxies involved in the communication will need to be notified.

MUST
C2E2

GP-CWP-8

Display Configurable Disclaimer - Proxy

A practice configurable disclaimer to be displayed to Proxies when creating a communication so that important information about this service is always visible.

See GP-PPFS-3.3-14 for practice configuration of disclaimer.

MUST

Patient Information Maintenance

Updated standards:

Epic MappingRequirement IDRequirement TextLevel

C13E20

PIM18

Service Access - Proxy

This is dependent on the Proxy being eligible for access.

MUST
C13E18PIM19

Record Management Notification - Proxy

Notify Practice Users that a Proxy has requested to change their own VUA Demographics or Preferences and/or the Patient’s Demographics or Preferences.

Practice User to be able to process the update and have an option to send a notification to the Citizen and Patient.

See GP-PPFS-3.4-02 for notifications around demographic and preference changes

MUST

C13E21

PIM20

Service Configuration – Record Access Start Date(s) - Proxy

Provide the Practice with the ability to configure a Start Date for Full Record Access for Proxies.

The Start Date determines the date from which the data made available goes back to, not whether the Service is offered/available by the Practice e.g. where the Full Record Access Start Date is set to 15th March 2015 and the Full Record Access is enabled (‘switched on’) by the Practice on the 1st April 2015:

  • Any entries prior to 15th March 2015 relating to Full Record Access will default to 'Restricted from View Record' (see GP-PPFS-3.2-11)
    • Items prior to 15th March 2015 relating to Detailed Coded Record (see GP-PPFS-3.2-10) and Summary Information Record (see GP-PPFS-3.2-09) will need to be still available to view unless marked as 'Restricted from View Record' by a Practice User. (e.g. a previous asthma diagnosis prior to the Full Record Access Start Date is significant information that will still need to be visible)
  • Any entries post 15th March 2015 will default to display to a Proxy unless marked as 'Restricted from View Record' by a Practice User

For the Proxy to see any entries prior to 15th March 2015 the Record Access Start Date can be set earlier upon review of the Patient Record.

MUST
C13E21PIM21

Service Configuration - Welcome Message - Proxy

Functionality to define text to be displayed to Proxies at the point of logging into Citizen Services, such as a Welcome Message or Practice Information.

See GP-SPFS-5.1-04 

MUST
C13E21PIM22

Service Configuration - Configure Disclaimer - Proxy

Functionality to define text to be displayed to Proxies when creating a message using the Communicate with Practice - Citizen Solution

See GP-CWP-3 for displaying the disclaimer 

MUST
C13E21

PIM24

Identity Verification Recording and Configuration - Proxy

Enable the Practice to configure the Solution to support Practice Policy on recording Identity Verification for Proxies. Such configuration will include the ability to support DCB3051 for Identity Verification and Authentication Standard for Digital Health and Care Services

When the Identity verification is recorded it will include:

  • Date (pre-populated with current date – amendable by Practice User)
  • Practice User (populated by a list of Practice Staff, default to logged on Practice User)
  • Type of Verification (Vouching, Identity Documentation)
  • Attached evidence e.g. ID document (optional)
MUST
C13E21PIM23

Service Configuration - Communication Channels Configuration - Proxy

Ability to set default Communication Channels to be used to provide Proxies with Citizen Service specific information.

MUST
C13E21PIM25Identity Verification – Multiple Instances - Proxy
  • Enable Identity Verification to be recorded multiple times if required by the Practice User.
  • Where the Proxy requesting access to Citizen Services is a registered Patient at that Practice and Identity Verification has already been recorded:
    • An Identity Verification Record will not need to be created as part of the VUA Creation process unless locally configured to separate VUA Identity Verification during the Registration process. 

See DCB3051 for Identity Verification and Authentication Standard for Digital Health and Care Services

MUST
C13E21PIM26

VUA Creation - Proxy

Practice Users to create VUAs for Proxies, to record and the update the following information:

  • VUA ID*
  • VUA Demographics (See GP-PPFS-4.3-03 for demographics required)
  • VUA Linkage Key*
  • ODS Code (of the Practice creating the VUA)*
  • VUA Status
  • VUA-Patient Association (association with one or more Patient Records)
  • VUA Identity Verification Record (See PIM24 for requirements)
    • This can link to a Patient Identity Verification Record where the Proxy is also a Patient at the Practice, though Practice Users will be able to undertake Identity Verification again, as part of the Citizen Service registration process) 

All information above is mandatory to create a 'Live' VUA and will adhere to the data requirements defined within this Capability.

Data items marked with * will be Solution-generated and are non-editable, other data items can be pre-populated by the Solution or manual entry.

A VUA can be created without the VUA-Patient Association and/or VUA Identity Verification Record, however the Account would have a Status of Inactive until these are provided (See GP-PPFS-4.3-06 for VUA status)

The Solution will ensure that a Citizen has a maximum of one VUA per Practice.

A Supplier may choose to design a Solution where a single VUA is created for an individual for use and management by any Practice that uses their Solution to avoid duplication.

An example of a scenario this could support is if you are a Citizen at Practice A with a VUA-Patient Association of 'self', but at Practice B you are a 'proxy' for a relative.

Identity Verification would need to occur at each of the Practices in the above scenario.

See GP-PPFS-6.1-01 for VUA management and Structure and Lifecycle of Patient Online Accounts for further information on Patient Online Accounts

MUST
C13E21PIM27VUA Demographics - Proxy

Adhere to the following data requirements:

VUA Demographics to include the following data items:

  • Title
  • Forename(s)
  • Family Name
  • Date of Birth
  • Contact Details (this can include multiple instances/sets of Contact Details where the VUA has VUA-Patient Associations of both Type ‘Self’ and ‘Proxy’)
    • Postal Address
    • At least one Telephone Number (and associated category e.g. Mobile)
    • Email Address

The Solution will provide the ability to record all VUA Demographics as above, however some VUA Demographics are not mandatory fields:

A Citizen will provide at least Forename(s), Family Name, Date of Birth and at least one set of Contact Details.

GP-PPFS-3.4-02 for notifications around demographic and preference changes

MUST
C13E18PIM30

Contact Details Verification - Proxy

Verify a Proxy's Contact Details via a time-limited challenge-response mechanism, where the Solution will request confirmation details in the response. Upon successful verification i.e. receipt of confirmation details and the matching of those details against the data held within the Solution,

Contact Details to be given a Verification Status of ‘Verified’. Contact Details that require verification include:

  • Email Address
  • Mobile Phone Number
MUST
C13E21PIM31

Contact Details Verification – Proxy status update

Record and update the Verification status of the Proxy's Contact Details, including

  • Verified
  • Unverified (default for any new Contact Details recorded and for existing unverified data)
  • Requires Re-verification

Status can be recorded or updated

  • Manually by the Practice Staff 
  • Automatically by the Solution e.g. upon successful verification or upon receipt of a delivery failure
MUST
C13E21PIM32

VUA-Patient Association - Proxy

Adhere to the following data requirements:

VUA-Patient Association will exist between a VUA and at least one active Patient Record, each instance to include the:

  • Type of Association (See GP-PPFS-4.3-08)
  • Assurance of the Relationship (See GP-PPFS-4.3-09)
  • Services Registered
  • Start Date
  • End Date to be populated:
    • Where a timespan is known (e.g. Patient record looked after for 6 months)
    • The VUA-Patient Association will be end-dated/inactivated if the Patient is no longer registered at the Practice
    • If the Patient withdraws Consent for the VUA-Patient Association
    • Automatic updates which are age-related or Competence based e.g. VUA-Patient Association of Type ‘Proxy’ will have access automatically removed upon a Patient’s 16th birthday where a Competent Patient has not given Explicit Consent.

The Solution will support:

  • Many to many VUA-Patient Associations i.e. Proxies can be associated with multiple Patient Records and
  • A Patient Record will be capable of having multiple VUAs associated with it.

Where possible and appropriate, the Relationship information to link to / be populated by the Related Persons recorded within the Solution with a Related person type of 'Proxy'.

MUST
C13E21PIM33

VUA-Patient Association – 'Self' or 'Proxy' Association

Adhere to the following data requirements:

Each VUA-Patient Association will have a Type of Association of either:

  • Self (zero or one such Self Association is permitted). Where the Type of Association is ‘Self’, the Solution to pre-populate all necessary Assurance of Relationship detail, such that a Practice User is not required to record any further information except the Type of Consent given by the Patient
  • Proxy (zero, one or many such Proxy Associations are permitted)
    • Where Child competence has been recorded as 'not competent' or Adult Capacity has been recorded as 'lacks capacity' then they cannot have an Association of 'Proxy' with another Patient.

Practice User to be able to record Preferences for use with the Proxy Association and any subsequent Proxy Association. 

See GP-04.5-01A for Patient preference details

See RCGP documentation for information on proxy access

See GP-PPFS-3.4-06 for recording Child Competence and GP-PPFS-3.4-08 for recording Adult Capacity 

MUST
C13E21PIM41VUA-Patient Association – Assurance of the Relationship - Proxy

Adhere to the following data requirements:

Practice User to record the Legal Basis including:

  • Type of Relationship / Relationship to Patient (including Self, Mother, Father, Son, Daughter, Friend, Carer)
  • Explicit consent of the Citizen (where VUA-Patient Association is of type 'Self' this can be pre-populated by the Solution)
    • Method of Consent
      • Written
      • Verbal
  • Parental Responsibility (this can be pre-populated by the Solution only where the VUA-Patient Association is of Type ‘Proxy’, the Patient is a Child for which no Competence Decision of ‘Competent’ exists and there is a Patient Relationship of Mother or Father recorded in the Patient Record). Such a Basis will need a Type of Verification recording:
    • Vouching
        • Type of Vouching, including
            • Personal
            • Information confirmation (e.g. knowledge of details on their medical record)
        • Vouched for by (populated by a list of Practice Staff, default to logged on Practice User)
    • Identity Documentation (multiple instances and associated documents, as per local configuration)
        • Type of Document, including
            • Passport
            • Birth Certificate
            • Marriage Certificate
            • Other
        • The Practice User might not always have the opportunity to attach ID documents at the point of registration, this flexibility will need to be considered.
        • ID documents attached will need to be excluded form GP2GP transfer
        • Associated Document (copy of or link to an image of the identity document, likely scanned in the Practice – Practice User to have ability to scan and attach or link to already stored image of the identity documentation as part of this process)
    • Previously recorded e.g. where the Related persons details are already stored within the Solution and as such have been previously verified
  • Patient lacks Capacity
    • Lasting Power of Attorney for health and welfare
    • Court Appointed Deputy
    • Best Interests (with ability to record the Clinician, who with a clear appreciation and understanding of the facts, implications and future consequences in line with the Mental Capacity Act, has agreed the VUA-Patient Association)
      • Clinician (populated by a list of Practice Staff, default to logged on Practice User)

For each/any Legal Basis selected, Practice User to have the ability to record Details (free text) to support the Assurance of the Relationship

MUST
C13E21PIM34Citizen Service Registration - Proxy

Grant Proxies access to Citizen Services at the VUA-Patient Association level. The Proxy will be able to request access for a specific VUA-Patient Association

A Proxy will not be granted access to any Citizen Services that are not enabled for the Practice and for the Patient for whom they are associated with.

The minimum default access when creating a new VUA-Patient Association is practice configurable and detailed in GP-PPFS-3.2-01.

See GP-SPFS-5.3-01 for VUA-Patient Association requirement 

MUST
C13E21PIM38

VUA Credentials Generation – Prevention (due to incomplete activity for Proxy)

Credentials cannot be generated until:

  • VUA created and 'Live'
    • Where a VUA already exists and it is not Inactive
  • Identity Verification of the Proxy requesting Services has been recorded
  • VUA Association with one or more Patient Records including:
    • Citizen Registration for Services
    • Assurance of the Relationship between the Proxy and the Patient (where the Proxy is acting on behalf of a Patient who is not themselves)

See GP-SPFS-4.1-02A for Account Linkage  

MUST
C13E19PIM35

Notification of new VUA-Patient Association - Proxy

Notify a Proxy via their preferred verified Contact Details (see COM1) that:

  • The Patient is the subject of a new VUA-Patient Association due to VUA Activation and/or VUA Management (Patient Notification).
  • The Proxy's access to services has changed, where the Registration for Services relating to a VUA-Patient Association for which the Patient is the subject, has been amended (Proxy notification)

See GP-SPFS-5.3-01 for VUA-Patient Association requirement, and GP-PPFS-3.4-02 for notifications around demographic and preference changes

MUST
C13E19PIM36Notification of Account Linkage - Proxy

Notify a Patient and their Proxy via their preferred verified Contact Details (see COM1) upon successful Account Linkage:

  • That a new Proxy is now using Citizen Services with their Patient Record and/or that a Proxy is using a new Citizen Services Solution (Patient Notification).
  • That a new Citizen Services Solution is being used (Proxy Notification).

Once a notification for successful Account Linkage has been sent if a Proxy chooses another Citizen Services Solution then another notification is not needed

See GP-PPFS-3.4-02 for notifications around demographic and preference changes

MUST
C13E18PIM37Practice indication of missing or unverified Contact Details - Proxy

Indicate to Practice Users when accessing a VUA where the Proxy does not have any Verified Contact Details recorded.

Such that the Practice User can inform the Proxy of the implications of not providing verifiable Contact Details e.g. VUA Credentials Reminder only possible via Citizen Services and VUA Linkage Key reset functionality will require a visit to the Practice

MUST
C13E21PIM39

Child Competence Management – Proxy

Upon recording a Competence Decision of ‘Competent’ for a Child who is a Patient, Clinician to have the ability to update Proxy Service Access as required. In such instances, where VUA Associations are reviewed by the Patient and considered appropriate and/or updated, the Legal Basis for those VUA-Patient Association(s) to be automatically updated to ‘Explicit Consent’.

See GP-PPFS-6.3-03 for Competence Assessments with maturing children

See GP-PPFS-3.2-01 for Service Access

See Competence Assessment for further information

See GP-PPFS-3.4-06 for recording Child Competence and GP-PPFS-3.4-08 for recording Adult Capacity 

MUST
C13E21PIM40

Citizen Services Access – Age and Competence - Proxy

Allow access to Citizen Services based on age and Competence.

  • A Child can be deemed eligible to have an association of 'Self' and be a Proxy for another Patient if they are considered Competent (default is not eligible as a Child needs to be actively assessed and recorded as Competent before they can have a Live VUA)

See GP-PPFS-3.4-06 for recording Child Competence 

MUST
C13E21GP-PPFS-3.4-10A

Citizen Services Access Following 11th Birthday

On the Child’s 11th birthday, the Solution will automatically restrict the scope of existing proxy access.

Access to the following services will be switched off automatically when the Child reaches the age of 11:

  • View Record

Proxy access can be reinstated if, after discussion with the Citizen/s requesting access, the Child’s GP believes that proxy access would be in the Child’s best interest.

Such Patient age-related updates to result in information being passed to all/any Citizen Services used by each of the affected Citizens, such that the Citizen Service Solution can highlight to the Citizen the change in Service Access that has been applied and the need for them and/or the Patient to consult with the Practice if they wish to enhance or re-establish their Service Access.

See RCGP documentation on proxy access on behalf of children and young people

MUST
C13E21GP-PPFS-3.4-10B

Citizen Services Access Following 16th Birthday

A Citizen of VUA-Patient Association of Type ‘Proxy’ will have access automatically removed upon a Patient’s 16th birthday where a Competent Patient has not given Explicit Consent

Once the Child turns 16, their Competence becomes irrelevant as they are an Adult and the relevant allowances/restrictions apply i.e. they are assumed to have Capacity under the Mental Capacity Act 2005.

Such Patient age-related updates to result in information being passed to all/any Citizen Services used by each of the affected Citizens, such that the Citizen Service Solution can highlight to the Citizen the change in Service Access that has been applied and the need for them and/or the Patient to consult with the Practice if they wish to enhance or re-establish their Service Access.

MUST

Prescription Ordering - Citizen

Updated standards:

Epic MappingRequirement IDRequirement TextLevel
C3E6GP-ORPR-4

Prescription Management - Repeat Prescription Requests - Proxy

Allow Proxies to view, request, and cancel outstanding (unactioned) requests for repeat Prescription medications (including repeat dispensing) for the Patient. Proxies to have the ability to:

  • View all medications currently available for a repeat Prescription or repeat dispensing Prescription including:
    • Name, Strength (where applicable), Form (e.g. tablets), Most recent issue date, duration, suggested date of next issue (if applicable)
    • Date & status of last request including associated free text (free text to display only when the request originated from Citizen Services)
    • Which medications are due for a review, including the expected review date, if applicable
  • Select and request one or multiple Prescription medications
  • Cancel unactioned requests

See Prescribing - Standard for information on recording medication

MUST
C3E6GP-ORPR-5

Prescription Management - Repeat Prescription Requests - Free Text - Proxy

Allow Proxies to optionally add 'free text' to accompany

  • Each Prescription medication item being requested
  • The overall Repeat Prescription request
  • The cancellation of a Prescription medication item
  • The cancellation of the overall Prescription request
MUST
C3E6GP-ORPR-6

Prescription Management - Unable to request pre-authorised repeats - Proxy

Proxies will not be able to request repeat Prescription medications which have outstanding pre-authorised future issues (e.g. a repeatable Prescription - see GP-07.10-011)

MUST
C3E6, C3E9GP-ORPR-9

Prescription Management - Request Notification - Patient

Upon successful submission of the Prescription request, Proxies will be informed of the collection approach for their request. For example,

  • Where the Patient is participating in EPS, Proxies to be notified that the requested Prescription will be sent to the Patient's nominated pharmacy.
    • If the Prescription medication being requested is not available via EPS, Patients will be informed that the Prescription will need to be collected.
MUST
C3E7 GP-ORPR-10

Prescription Management - EPS Nominated Pharmacy - View - Proxy

Allow Proxies to view the Patient's EPS nominated pharmacy where the Patient is already participating in EPS.

MUST
C3E7GP-ORPR-11

Prescription Management - EPS Nominated Pharmacy - Amend/Cancel

Allow Proxies to:

  • Amend the Patient's EPS nominated pharmacy, by selecting from a list of all pharmacies participating in EPS
    • Immediately notify the Citizen that future Prescriptions will be sent to the Patient's new EPS nominated pharmacy. Citizens can select to:
      • Continue to amend. Update Patient's nominated Pharmacy on the NHS Spine and indicate to the Practice that the Patient's EPS nominated pharmacy has been amended
  • Cancel the request at this point. EPS nominated pharmacy to continue as before. Remove/delete the Patient's EPS nominated pharmacy,
    • Immediately notify the Citizen that Prescriptions will no longer be sent to the Patient's EPS nominated pharmacy.

A Proxy will be able to change EPS nominated pharmacy without requiring any action by the Practice.

Any such selection to result in the Proxy being automatically notified via their preferred Verified Contact Details.

MUST

Recording Consultations

Updated standards:

Epic MappingRequirement IDRequirement TextLevel
C15E1GP-RC-3-01

Child Competence Management - Child not registered at the Practice

The Solution will support assessments of a Child where they are not registered at the Practice but has requested to become a Proxy for a Patient at the Practice.

MUST

View Record - Citizen

Updated standards:

Epic MappingRequirement IDRequirement TextLevel
C4E2GP-VWRD-4

Record Access - Proxy

When any Record Access Level is enabled (at Practice or individual level), Proxies to have access to relevant elements of the Patient Record as per Service Configuration (GP-SPFS-5.2-01), as a minimum.

All/any elements of a Patient Record marked as 'Restricted from View Record' will not be displayed to the Proxy irrespective of Record Access Level Configuration.

e.g. Where Service Configuration determines Detailed Coded Record enabled with a Start Date of 1st February 2013 but a Clinician has reviewed a Patient’s Record back to 1st January 2010, any elements of the Patient Record not marked as ‘Restricted from View Record’ as part of the Record review/preparation (between January 2010 and February 2013) to display in addition to those displaying due to the Detailed Coded Record configuration.

Proxies to have the ability to:

  • Be informed upon every access that they might not be accessing the full information held using the following statement “This is a limited view of the Patient Record and may not include any free text. Information that is considered to be sensitive or that existed before the creation of this service may not be available for viewing online.”
  • View relevant elements of the Patient’s Record logically grouped as appropriate, including:
    • The clinical term description i.e. not the code
    • Associated Free text
    • Date and Time of the Event
    • Source/Provenance (Organisation/System, User/Role, Name)
    • Translated elements of a Patient Record 
  • Sort the Patient’s Record by relevant elements, including:
    • Event Date
    • Type
    • Problem (where available)
    • Source/Provenance (Organisation/System, User/Role, Name)

See GP-PPFS-3.2-01 for Practice configuration of Record Access Levels.

MUST
C4E2GP-VWRD-5

Extract Patient Record - Proxy

Ability to extract all or selected parts of the Patient’s Record in a suitable layout/format, including

  • Printing
  • Exporting/downloading

The output to detail the Source/Provenance of all such extracted data. 

Practice administrative data need not be provided e.g. document workflow actions.

MUST
C4E2GP-VWRD-6

Record Access Level – Summary Information Record - Proxy

The Summary Information Record Access Level will be the default. When set/enabled for a Patient, the Summary Information dataset (and *only* that data) will be made available irrespective of any agreement with the Patient regarding their actual Summary Care Record.

i.e. if certain information for the Patient is excluded from their Summary Care Record, this information will not automatically be excluded from the Summary Information record and vice versa. 

The Summary Information Record dataset includes medications, allergies and adverse reactions – specific requirements are as defined within the Summary Care Records requirements documentation.

See GP-PPFS-3.2-01 for Practice configuration of Record Access Levels.

MUST
C4E2GP-VWRD-7

Record Access Level – Detailed Coded Record - Proxy

Adhere to the following requirements regarding Detailed Coded Record Access:

  • Include all data held as coded data (See Data Standards for definition of coded data and associated requirements) within the Patient Record, excluding associated free text
    • Where free text associated with coded data has been marked as ‘Restricted from View Record', this will not be displayed to the Proxy.
  • Build upon the data provided to the Proxy via the Summary Information Record; as such the Detailed Coded Record cannot be enabled without the Summary Information Record also being enabled. This is the case for all levels of Service Access – Practice configuration, Patient Record level and VUA-Patient Association level.

See GP-PPFS-3.2-01 for Practice configuration of Record Access Levels.

MUST
C4E2

GP-VWRD-8

Record Access Level – Document Access (Clinical and Administrative) - Proxy

Adhere to the following requirements regarding Document Access:

  • Ability for Proxies to be able to view all clinical and administrative documents where configured by the Practice.
  • Proxies will not be able to view Pathology and Radiology test results if they have not been reviewed by the Practice.
  • Proxies will not be able to view Documents if they have not been reviewed by the Practice.

See PIM42 for Pathology and Radiology Results and Document review requirements.

See GP-PPFS-3.2-01 for Practice configuration of Record Access Levels

MUST
C4E2GP-VWRD-9

Record Access Level – Full Record - Proxy

Adhere to the following requirements regarding Full Record Access:

  • Clinical data held within the Patient Record (coded or otherwise i.e. includes free text data associated and not associated with clinical codes e.g. Consultations, Medications, Pathology Results)
  • Demographic and Patient administrative data
  • Documents associated with or embedded within the Patient Record, including annotations associated with any documents.

See GP-PPFS-3.2-01 for Practice configuration of Record Access Levels.

See GP-PPFS-3.3-08A for start date restrictions.

MUST

Context Specific Standards

Proxy related requirements for Citizen Services to become 'MUST'. Detailed below are the relevant Context Specific Standards and the affected requirements i.e. those requirements where the Level is changing from MAY to MUST.

Citizen Access

Updated standards:

Requirement IDRequirement TextLevel

CA01

Citizen Services Definition - Service - Proxy

Allow the Proxy to access the Practice enabled Citizen Services as configured by the Practice i.e. the Practice(s) holding the VUA (Verified User Account), including:

See GP-PPFS-3.2-01 for more information on access levels.

MUST

CA02

Configuration – VUA Transparency - Proxy

Citizen Services to support transparency of Citizen Service registration and management.

The Proxy is able to view all relevant information regarding:

  1. Associated Patients for whom they are a Proxy and
  2. Service Access configured/enabled for each VUA-Patient Association

Relevant information to be shown:

  • Practice details including:
    • Practice name
    • Practice address
    • Telephone number
  • VUA demographics (See GP-PPFS-4.3-03)
  • VUA preferences
  • Patient Record(s) with which they are associated:
    • Patient demographics including:
      • Title
      • Forename
      • Family name
      • Date of birth
      • NHS Number
      • Preference details
    • VUA-Patient Association(s) including:
      • VUA Demographics
        • Only title, forename and family name can be shared between Proxies with a VUA-Patient Association of type ‘Proxy’ to restrict sensitive data being shared
      • Type of association
      • Services registered for associated Patients
      • Status and/or start and end dates
MUST
CA03

Citizen Services Usage Transparency - Proxy

Citizen Services to support full transparency of Citizen Services Usage by displaying information including:

  • Which Proxies have accessed Citizen Services for the Patient
  • Usage of Citizen Services including detail of the Service and/or Record Access Level
  • Account Linkage
  • Previous usage of Citizen Services, including detail of the Service and/or Record Access Level

Previous usage to only display to Proxies once the VUA-Patient Association has been established

Where there are multiple Proxies, usage information for all Proxies to be transparent between each Proxy. Such transparency is in relation to Citizen Services Usage regarding mutually associated Patient Record(s) only.

MUST
CA04

Contact Details Verification - Proxy

Verification to be initiated by Citizen Services Solution when contact details are recorded via this Solution, notifying the Proxy of successful verification.

Contact Details that require validation/verification include:

  • Email Address
  • Phone Number

See GP-PPFS-3.4-03 for further information

MUST
CA05

Contact Details Validation - Proxy

Validate the format/structure of any Contact Details that a Proxy is amending e.g. mobile phone number will not include letters or special characters, email address will include an @.

MUST
CA06

System Configuration – Transparency of Audit Trail Information - Proxy

Aside from the requirements detailed in GP-SPFS-3.1-04 - The Proxy can view current/historic Audit Trail information e.g. Citizen Services registration and Management Information

MUST
CA07

Citizen Services Account Creation - Proxy

Allow a Proxy to:

  • Create a unique Citizen Services Account
  • Create/obtain Citizen Services Account Credentials e.g. by creating a Username & Password, by integrating a web Single Sign On (SSO) service or by associating a device identifier (such as Mobile Phone Identity IMEI - International Mobile Equipment Identity number)
  • Set up security questions for use when Citizen Services Account Credentials has been forgotten.

All Citizen Services Account Credentials to be created/assigned as per Authentication standards.

MUST
CA08

Citizen Services Account Linkage - Proxy

Establish a connection between an Online Service Account (OSA) and a Verified User Account (VUA) Account in the Patient Information Maintenance (PIM) Solution.

Allow the Proxy to enter VUA Credentials and Demographics. Confirm, in conjunction with the Patient Information Maintenance (PIM) Solution, that information provided is a successful match.

Where Account Linkage is successful, the Proxy to be informed of the successful linkage.

Once an Online Service Account has been linked to a VUA this then becomes a Linked Online Service Account (LOSA). 

Where Account Linkage is attempted but is unsuccessful:

  • If a VUA is not found in the PIM Solution, Citizen Services to provide sufficient information via the Interface Mechanism for an ‘Inactive’ VUA to be created.
  • If a VUA is found, but the specific VUA-Patient Association is not ‘Active’, Citizen Services to inform the Proxy of their need to visit the Practice to complete the VUA registration.

Any Account Linkage that exists between a Citizen Services Account and an ‘Inactive’ VUA, a ‘Live’ VUA with regards to an ‘Inactive’ VUA-Patient Association (e.g. the Legal Basis for the association is yet to be established/recorded) will result in that individual having limited access as per the Online Service Account (OSA) for that Patient

The implementation of some aspects of such a requirement will need to be addressed between Suppliers during Pairing Integration i.e. PIM Solution can request the additional information required to confirm a match and enable Account Linkage between VUA and Citizen Services.

Account Linkage can occur between a Citizen Services Account and multiple VUAs e.g. if an individual has a VUA-Patient Association of Type ‘Self’ at one Practice and also a VUA-Patient Association of Type ‘Proxy’ for a Patient registered at a different Practice.

For VUA credentials reminder see: GP-SPFS-5.3-06

For VUA credentials prevention see: GP-PPFS-4.5-03

For password management see GP-IG-2.2-3  

MUST
CA09

Patient Selection - Proxy

Allow the Proxy to select the Patient with whom they have a VUA-Patient Association with, this will allow the Proxy to undertake activities for the Patient via Citizen Services.

The Patient selected will be clearly displayed throughout the activities.

MUST

CA10

Citizen Notifications - Proxy

Indicate to the Proxy a successful action via Citizen Services for the following areas

  • Management of Appointments
  • Patient-Practice Communications
  • Requesting of Prescriptions
  • Citizen Services requests

Where unsuccessful (including system errors or Appointment conflict) alert the Proxy, with the ability to choose to either directly reattempt the action or abandon the activity.

MUST
CA11

Citizen Notification – Service Access Update - Proxy

Indicate to a Proxy via Citizen Services where:

  • A Service is available
  • A Service is no longer available
MUST
CA12

Record Management Requests - Proxy

Allow the Proxy to make updates to Demographics and Preferences for:

  • Patient Demographic and/or Preference details for a Patient with whom they have a VUA-Patient Association of type 'Proxy', providing the Patient (individual) does not have a live VUA Account.
  • The Proxy will be able to record multiple different contact details and Preferences for use with any subsequent Proxy Association where the VUA-Patient Association is of type ‘Proxy’.

Demographics and Preferences for which updates can be made to include at least:

  • Title
  • Forename(s)
  • Family Name
  • Contact Details
    • Communication Preference(s)
    • Postal Address 
    • At least one Telephone Number (and associated category e.g. Mobile)
    • Email Address 
  • Marital Status

Detail of such requests to be provided to the Patient Information Maintenance Solution to enable Practice Users to review the requested change and accept or reject all or part of the update i.e. any changes requested by a Proxy requires Practice confirmation prior to the data being updated.

See GP-PPFS-3.2-03A for Practice notifications around demographic and preference changes

MUST
CA13

Request for a new VUA-Patient Association - Proxy

Allow a Proxy to create a VUA request for a Patient by entering Patient Demographic Details (Title, Forename, Family Name, Address and date of birth) i.e. begin the VUA Creation/Registration process via Citizen Services by

  • creating an ‘Inactive’ VUA with a Citizen Services Request Status of Requested

or by

  • updating an existing VUA with a new VUA-Patient Association

A proposed VUA -Patient Association to be recorded in the Patient Information Maintenance (PIM) Solution, but no assurance of the relationship has occurred; therefore, access will be limited to the OSA Appointments functionality (even if VUA Identity Verification has been previously undertaken) until Assurance of the Relationship of the VUA-Patient Association occurs.

In all instances the request will not result in immediate change of Access as the Practice will need to action the request by updating the VUA within the PIM Solution (e.g. undertaking Identity Verification and establishing a Legal Basis for the Relationship).

For VUA service registration see: GP-PPFS-4.4-01

For notification of a new VUA -Patient Association see: GP-PPFS-6.2-01

See DCB3051 for Identity Verification and Authentication Standard for Digital Health and Care Services

MUST
CA14

Last Access - Proxy

When logging in and throughout the usage of Citizen Services, indicate to the Proxy of their most recent authentication (date & time) to Citizen Services.

MUST
CA15

Request for updated Service Access - Proxy

Allow a Proxy to request to amend their Service Access for an existing VUA-Patient Association

A Proxy will not be able to request update to Service Access details for any other Proxy.

The request will not result in immediate change of Access as the Practice will need to action the request by updating the VUA within the Patient Information Maintenance Solution (e.g. undertaking Identity Verification and establishing a Legal Basis for the Service Access), unless:

  • the Proxy is asking for Service Access or the entire VUA to be restricted / disabled

See GP-PPFS-4.4-01 for granting access to Citizen Services

MUST

CA16

Request Notification - Proxy

Notify the Proxy via Citizen Services of the outcome of their GP-SPFS-5.3-03(i.e. VUA Status updates)

See GP-PPFS-4.3-06 for status updates

MUST

CA17

VUA Credentials Reminder - Proxy

Enable the Proxy to be reminded of their VUA Credentials.

This is to allow other Citizen Services to be used by the Proxy when required (e.g. Supplier B gives functionality that is not available from Supplier A)

VUA Credentials include:

  • Practice ODS Code
  • VUA ID
  • VUA Linkage Key

VUA Credentials Reminder to only occur via Citizen Services where the VUA is ‘Live’.

See GP-PPFS-6.1-04 for generating VUA Credentials within a Practice

MUST
CA18

VUA Linkage Key Reset - Proxy

  • When a Proxy requests an Account Linkage Key reset via Citizen Services:
    • All access to Citizen Services via any Citizen Services with regards to each/every VUA-Patient Association will be terminated (i.e. the VUA becomes 'inactive)
    • Patient Information Maintenance Solution informed via the Interface Mechanism of a ‘Compromised Credentials’ Reason for Inactivity. 
    • The Proxy will need to undertake Identity Verification in order to be provided with new VUA Credentials.
    • The Proxy to be able to confirm a reset is required to give opportunity to cancel out of the process and carry on using Citizen Services 

See GP-PPFS-6.1-03 for resetting the Account Linkage Key within a Practice

See DCB3051 for Identity Verification and Authentication Standard for Digital Health and Care Services

MUST
CA19

Access Update Notification - Proxy

Indicate to the Proxy within Citizen Services of any update to their Access, including where:

  • A VUA-Patient Association has been removed e.g.
    • Where the Patient has moved Practices,
    • The Patient has withdrawn consent or
    • The Patient has reached an age of 16 resulting in automatic removal of a Proxy
  • Service Access for a VUA-Patient Association has been changed e.g.
    • Upon action of their request or
    • Where access for a Citizen is automatically updated in the Patient Information Maintenance Solution such as  Proxy access upon the 11th birthday of the Patient

See GP-SPFS-5.1-08 for notifications via Citizen Services

MUST
CA20

Citizen Communication/Notification - Proxy

Any communication directly between Citizen Services and the Proxy containing or based on information from the Patient Information Maintenance (PIM) Solution to use the Proxy's Preferred Verified Contact Details (as obtained from the PIM Solution)

  • Where Preferred Verified Contact Details have not been recorded, any verified Contact Details to be used.
  • Where no Contact Details have been verified, Proxy to be informed via any Contact Details provided, however, Patient Details (with the exception of Patient Name (Title, Forename(s) and Family Name) will not be included within the Communication
MUST



Assurance Approach

Suppliers will need to evidence they meet the uplifted Standards by updating the Traceability Matrix for each Standard and submitting to NHS Digital for review.