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Bulk applying SNOMED code 104

Practices are advised not to apply the SNOMED code ‘1364731000000104 Enhanced review indicated before granting access to your own health record’ to all or most patients (bulk-applying).  

There are several reasons why this is not advisable
  • By 31 October, general practices must provide patients online access to their prospective records unless they have been individually excluded as they are at-risk or decide to opt-out. Bulk-applying a code does not constitute an individual assessment
  • This creates additional workload to review and manually update online account settings
  • Should the patient transfer general practice, this code will be in the record and may give a false indication of risk of harm from records access
  • Patients with access to records may see this code. This could cause concern for some, leading to them contacting their general practice to question what relevance it has

NHS England has made functionality available that can bulk-enable prospective access whilst excluding a very small number of patients known to have risk. This is the most efficient way to provide access as it replaces the need to manually give access to individual patients, without significant issues or increases in workload. 

Bulk enablement functionality will not be applied unless it has been requested by the general practice. Should a practice wish to manually review and update access settings, they can choose not to use the bulk-enablement functionality instead of bulk applying the 104 code. 

What to do if you have already bulk applied the SNOMED code ‘1364731000000104 Enhanced review indicated before granting access to your own health record’

If you have incorrectly bulk applied the SNOMED code ‘1364731000000104 Enhanced review indicated before granting access to your own health record’ to large cohorts of patients, you should ensure that individuals who are not at risk have SNOMED code ‘1364751000000106 Enhanced review not indicated before granting access to your own health record’ applied. 

This is most efficiently undertaken by identifying the small number of at-risk individuals and ensuring the remaining patients have SNOMED code ‘1364751000000106 Enhanced review not indicated before granting access to your own health record’ applied. 

Last edited: 18 October 2023 10:00 am