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Citizen Access v1.0.1

Citizen Access v1.0.1

24-11-2022

ID

S21

Version

1.0.1

Type

Context Specific Standard

Status

Retired 

Effective Date

Framework(s)

 

Description

Supports Citizens to access their services safely and securely. Also supports Citizens in viewing and updating Patient information online.

 

The diagram below illustrates the relationship between this standard and the Capabilities mentioned above which make up the Citizen Services (i.e. the requirements within this standard have to be met in order to deliver one or more of the Capabilities listed above). 

 

 

For Citizens to be able to access Citizen Services enabled by the Practice, they will need to undergo Account Linkage to link their Online Service Account (OSA) to their Verified User Account (VUA). This will provide access to their Patient Record, or the Patient Record of the Patient/s they will be accessing the Services for. Once Account Linkage is complete the Online Service Account (OSA) becomes a Linked Online Service Account (LOSA).

Patients can also access limited services by creating their own account (aside from receiving or requesting Citizen Service access via the Practice), at this point have an Online service Account (OSA). Once an account is created the Patient can request to get access to further Services defined by the Practice. 

The terms Online Service Account (OSA), Verified User Account (VUA) and Linked Online Service Account (LOSA) are intended to assist Suppliers in the implementation of Capabilities which make up the Citizen Services and it is recommended that they are not displayed on the interface of Solutions.

 

Structure and Lifecycle of Patient Online Accounts

 

Previous GPSoC requirements for Patients' online accounts were extremely confusing and difficult to understand. This document is essential reading for Solution providers as it seeks to more clearly articulate the different types of account a Patient can have, how they differ and the processes involved in their creation. There have been some minor changes in terminology intended to address the issue that certain terms (ROSU, OSU) were inappropriately attached to the Citizen, when they in fact described the state of an account.

Patient Account Model

Account Types

 

A Citizen (who need not be a registered Patient) can have three types of accounts:

Type

Description

Type

Description

Verified User Account (VUA)

Previously known as a Registered Online Service User (ROSU). A verified user account is the Practice based account for a Citizen who can be a registered Patient or a person acting as a proxy for a Patient. It is created by the Patient Information Maintenance - GP Solution which holds the record, this holds details such as the identity verification record and preferences.

Online Service Account (OSA)

Previously known as an Online Service User (OSU). An Online Service Account is an online account created on any other service which must integrate with the Patient Information Maintenance - GP Solution to enable online access to information and services, e.g. a third-party Appointment booking application. A Citizen with an OSA account can access limited Services (e.g. limited amount of Appointment Bookings).

Linked Online Service Account (LOSA)

A linked Online Service Account is an OSA which has been linked to a specific VUA to enable access to Citizen Services (e.g. View Record). The credentials to link the OSA to a specific VUA will be provided by the Practice.

 

From these definitions we can see that a Patient can hold multiple types of accounts simultaneously, e.g. a VUA at their registered Practice, an OSA with an Appointment Booking application and a LOSA linked to a VUA different from their registered Practice allowing access to another Patient's Record. This is why the old terminology of OSU/ROSU has been removed - a Citizen is not necessarily either a ROSU or an OSU exclusively. It is more accurate, and requirements are more understandable, to relate what service access is being required to the type of account being used to access it. 

Account Structure and Relationships

 

 

A Verified User Account consists of a user name (which is associated with the Suppliers' internal ID for the Patient at a specific Practice), password and Account Linkage Key.

An Online Service Account consists of only a user name and password, which may be different to the credentials of both the VUA and any other OSA/LOSA accounts held by the Citizen.

A Linked Online Service Account differs from an Online Service Account only in that it also consists of the Account Linkage Key, Practice ODS code and Supplier's Patient ID to enable the correct VUA account to be identified and linked.

Account Lifecycle

 

 

Any Citizen can create an OSA with a service which allows this, if you create an OSA as registered Patient this gives you an easy start point to access limited Citizen Services. Creating an OSA will also create an inactive VUA which will become live once identity verification has taken place and Account Linkage has been completed. This will allow access to Citizen Services available as configured by the Practice.

For further information on Identity Verification please see DCB3051 for Identity Verification and Authentication Standard for Digital Health and Care Services

Note that the authority does not limit how many VUAs may be associated with an LOSA, i.e. a Supplier could allow a service user to associate their OSA with both their own VUA and one for whom they're acting as a proxy so that they can manage both themselves and another Patient through a single login (see proxy service access below). 

Online Accounts and Proxy Service Access

In some circumstances Citizens can be granted access to Citizen services on behalf of another Patient i.e. as their proxy. For example, as a parent booking Appointments for a Child. The way that service account structures are created to support this can vary depending on the location of the records involved and also the Suppliers' Solution architecture:

Scenario

Outcome

Scenario

Outcome

Either:

  1. The Citizen is registered at a different Practice than the Patient for whom they are a proxy, and the Supplier is not able to offer a single VUA covering the Citizen who is a proxy at Practice A but a Patient at Practice B accessing Citizen Services

Proxy must go through identity verification with the Practice that holds the target Patient record (they will need to do this even if they have completed identity verification at their registered Practice). Account Linkage will need to be completed by the Proxy.

This will allow linkage of their VUA at the Patient's Practice with the Patient Record the Proxy needs to view. 

Either:

  1. The Citizen is registered at the same Practice as the Patient for whom they are a proxy

  2. The Citizen is registered at a different Practice than the Patient for whom they are a proxy, and the Supplier is able to offer a single VUA covering both individuals

Supplier associates the proxy's VUA with both their own and the target Patient's Patient Record, creating a unique Linkage Key for each association.

In scenario 2 the target Patient's Practice may require the proxy to verify their identity before allowing the association to be created. For further information on Identity Verification please see DCB3051 for Identity Verification and Authentication Standard for Digital Health and Care Services

Citizens will be able to access all enabled Citizen Services functionality as well as manage account details for any Patients with whom they have a VUA-Patient Association of type 'Proxy'. For further information on proxy access see proxy access guidance for General Practice.

A Citizen will be able to access Citizen Services for more than one Patient where required and receive notifications (e.g. around updates to Service Access and verification of Contact Details). Citizens will also be able to request to make changes to demographic information (either for themselves or for Patients that they are acting on behalf of).

 

 

Requirements 

Requirement ID

Requirement Text

Level

Requirement ID

Requirement Text

Level

GP-SPFS-5.2-01

Citizen Services Definition - Service - Patient

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

  • Communicate with Practice

  • Appointments Management - Citizen

  • Order Prescriptions

  • View Record

Allow a Patient with an OSA (Online Service Account) to only access the Limited Services – Appointments for OSA, as configured by the Practice i.e. the Practice holding the VUA.

See the Patient Information Maintenance - GP Capability for more information on access levels.

MUST

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:

  • Communicate with Practice

  • Appointments Management - Citizen

  • Order Prescriptions

  • View Record

See the Patient Information Maintenance - GP Capability for more information on access levels.

MAY

GP-SPFS-3.1-04

Configuration – VUA Transparency - Patient

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

The Patient is able to view all relevant information regarding:

  1. Their VUA (see E00166 in the Patient Information Maintenance - GP Capability for VUA creation)

  2. Service Access configured/enabled for the VUA-Patient Association

Relevant information to be shown:

  • Practice details including:

    • Practice name

    • Practice address

    • Telephone number

  • VUA demographics 

  • VUA preferences

  • The Patient Record with which they are associated:

    • Patient demographics including:

      • Title

      • Forename

      • Family name

      • Date of birth

      • NHS Number

      • Preference details

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 

  • 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

MAY

GP-SPFS-3.1-05

Citizen Services Usage Transparency - Patient

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

  • 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 Patients once the VUA-Patient Association has been established

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.

MAY

GP-SPFS-3.1-06

Contact Details Verification - Patient

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

Contact Details that require validation/verification include:

  • Email Address

  • Phone Number

See E00201 in the Patient Information Maintenance - GP Capability for further information

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 E00201 in the Patient Information Maintenance - GP Capability for further information

MAY

GP-SPFS-3.1-06A

Contact Details Validation - Patient

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

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 @.

MAY

GP-SPFS-3.1-09

System Configuration – Transparency of Audit Trail Information - Patient

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

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

MAY

GP-SPFS-4.1-01A

Citizen Services Account Creation - Patient

Allow a Patient 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

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.

MAY

GP-SPFS-4.1-02A

Citizen Services Account Linkage - Patient

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

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

Where Account Linkage is successful, the Patient 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 Patient 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.

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

For password management see GP-IG-2.2-3  

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 - GP (PIM) Solution.

Allow the Proxy to enter VUA Credentials and Demographics. Confirm, in conjunction with the Patient Information Maintenance - GP (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 password management see GP-IG-2.2-3  

MAY

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.

MAY

GP-SPFS-5.1-02A

Switch Patient

Proxies to have the ability to switch Patients within the session without the need to re-authenticate (log out and back in) to Citizen Services.

MAY

GP-SPFS-5.1-04

Welcome Message/Practice Information Display

Display a page with a welcome message/information when logging into Citizen Services.

See E00202 in the Patient Information Maintenance - GP Capability for defining the welcome message 

MUST

GP-SPFS-5.1-08

Citizen Notifications - Patient

Indicate to the Patient 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 Patient, with the ability to choose to either directly reattempt the action or abandon the activity.

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.

MAY

GP-SPFS-5.2-02

Citizen Notification – Service Access Update - Patient

Indicate to a Patient via Citizen Services where:

  • A Service is available

  • A Service is no longer available

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

MAY

GP-SPFS-5.2.1-01

Record Management Requests - Patient

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

  • The Patient can update Patient Demographic and/or Preference details where they have a VUA-Patient Association of type 'Self'

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 - GP 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 Citizen requires Practice confirmation prior to the data being updated.

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 - GP 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.

MAY

GP-SPFS-5.3-01

Request for a new VUA-Patient Association - Patient

Allow a Patient to create a VUA request 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