Using information for reflective practice guidance for IG professionals

Regulated health care professionals have a regulatory responsibility to undertake reflective practice to improve the safety and quality of their care. Reflective practice can usually be undertaken without access to confidential patient information.

But there may be times when health care professionals need access to confidential patient information about an episode of care they provided to fully understand how their assessments, decisions and care affected an individual. They may access confidential patient information if they can justify that it is necessary for their reflection to support safe, high quality care. Any access must follow local processes and comply with the safeguards outlined in this guidance.

While caring for a person, health care professionals may access relevant parts of their confidential patient information for the purpose of reflective practice. This may be done on the basis of implied consent for individual care. See section on Common law duty of confidentiality.

Sometimes, a health care professional may no longer have access to the information needed to reflect on the care they provided because the patient or service user has moved on from their care. At these times the health care professional may require time-limited access to information related to that episode of care to assess its impact.

Regulated health care professionals can access this information on the basis of implied consent for individual care, when:

• they had a legitimate care relationship with the person to whom they provided the episode of care they wish to reflect upon
• they can justify that confidential patient information is essential to enable reflective practice and understanding that is integral to their provision of safe, high quality care.

See the section governing access and mitigating risk for more details.

If the health care professional has moved to a different organisation, they will need to demonstrate the continuing relevance of their need to reflect on the episode of care, to their role in the new organisation. Their reflection on the episode of care must remain necessary for the provision of safe and high quality direct care. If the health care professional has moved to a role or organisation that does not provide care, they should no longer be able to access confidential patient information for reflection.

Individual objections about use of their information for reflective practice should be recorded on the person’s health and care record.

Health and care records should be checked for objections before sharing for reflective practice and any individual objections to information sharing for their own care should be respected.

Before access to confidential patient information for reflective practice is allowed, any professional needs to be:

• subject to terms and contractual obligations of employment which include an explicit duty of confidentiality
• up to date with information governance (IG) training mandated by their organisation
• made aware of local procedures and expectations for using confidential patient information in reflective practice, understanding that these procedures may vary locally

Access to confidential patient information for reflective practice should be restricted to regulated health care professional who are required by their professional standards bodies to engage in reflective practice.

Additionally, they must have a legitimate care relationship, past or present, with the person to whom they provided the episode of care they wish to reflect upon.

In a team-based approach to reflective practice, some team members may include non-registered nursing staff not regulated by the Nursing and Midwifery Council, or emergency medical technicians not regulated by the Health and Care Professions Council. These non-regulated staff can still participate in team reflective practice, provided:

• the reflective practice, and the decision to access confidential patient information to support it, is led and supervised by a registered and regulated health care professional
• the non-regulated member of staff has a legitimate relationship, past or present, to the patient or service user for care and was involved in the provision of the episode of care reflected upon
• the non-regulated member of staff is subject to terms and contractual obligations of employment which include an explicit duty of confidentiality

At times health care professionals may need support from their supervisor or mentor to effectively reflect on their practice. That supervisor should also be a regulated professional. When the clinical supervisor is based in a different team in the organisation, confidential patient information to support reflective practice should only be shared within the context of this supervisory arrangement. This process should be formalised in line with the clinical supervision model relevant to the particular professional’s reflective practice.

For any agreed episode of reflective practice, access should be limited to the information necessary for each specific role. Health care professionals must justify why access to confidential patient information is necessary for their reflective practice and explain how it will enable understanding that is integral to their provision of safe, high quality care.

Clear local processes must be in place to govern access to confidential patient information for reflective practice, to ensure that access is appropriate, limited only to the necessary information and mitigates associated risks.

This will include ensuring that:

• there are clear local processes for granting access to relevant parts of the person’s record for the purpose of reflective practice
• access is limited to information relevant to the episode of care the health care professional provided to the person
• the health care professional can justify access to this information to enable reflective practice and understanding that is integral to their provision of safe, high quality care
• a brief entry is made in the individual’s record explaining why access was necessary for reflective practice
• access to confidential patient information for reflective practice is limited to recent episodes of care
• direct patient identifiers should be removed from any reports used for reflective practice

The appropriate timeframe for access to confidential patient information will be dictated by the reflective practice processes relevant to the particular health care professional and their clinical supervision cycles. In most cases, a time limit of up to six months on access to confidential patient information will be sufficient to allow for reflective practice. This also reflects the need to influence the safety of future care provision.

It is important to note that the reflective process itself does not need to be completed within this time frame. See relevant regulators’ guidance on reflective practice.

Organisations that support reflective practice should clearly state in plain English in their privacy notices that Health care professionals may access confidential patient information related to the episode of care they provided. The privacy notice must state that:

• the health care professional reflecting on their practice is a registered and regulated health or social care professional, who has a regulatory responsibility to undertake reflective practice
• the regulated health care professional engaging in reflective practice has a legitimate relationship, past or present, with the patient or service user for the provision of their care
• the health care professionalcan justify accessing confidential patient information to enable reflective practice and understanding that is integral to their provision of safe, high quality care

Organisations may wish to include the following sample text in their privacy notices:

To satisfy the common law duty of confidentiality, health care professionals may rely on implied consent for individual care as the legal basis for accessing confidential patient information for reflective practice.

This is justified where reflective practice is needed to improve understanding which in turn supports the delivery of safe, high quality individual care.

With many aspects of individual care, it will be clear to patients and service users that their information will be used to support their care. However, when certain aspects of individual care such as reflective practice are less well understood, additional transparency measures should be considered to inform patients and service users.

Reflective practice is about individual and team learning by those directly involved in an episode of care. As such, this guidance does not apply to broader organisational or system-wide learning.

The most likely lawful bases under UK GDPR to apply for use of personal data for reflective practice are:

• article 6 1 (e) public task; and
• article 9 2 (h) health and social care; or
• article 9 2 (i) public health