Using information for reflective practice

Reflective practice involves HCPs taking time to think about an episode of care they provided and the effect this had on the patient or service user. This helps them to learn from their experiences so that they can continue to do a good job, or do a better one if needed to provide better care.

Using your information for reflective practice

Those caring for you can usually reflect on the care they provided without looking at your confidential information. But there may be times when they do need to look at it, as in the following example:

A case of hidden stroke

Ambulance clinicians were called to help a patient with dizziness and a headache. Because the patient was in good health the ambulance team thought they may have vertigo, which is not urgent and doesn’t normally need emergency care. The team tested for stroke and other conditions, but found nothing unusual. But the patient had high blood pressure and trouble balancing so the team took them to the local general hospital emergency department.

Afterwards, the team started to wonder if they had done the right thing. Had they missed something? Did the patient have something more serious than vertigo?

They decided to look into this as part of their reflective practice. After checking, they discovered that the patient never had vertigo. It turned out that they had suffered a posterior stroke, which doesn’t always show up in regular stroke tests. The patient needed to be transferred to a specialist acute stroke unit.

By reflecting on the case, the crew learned that some strokes don’t show up in the usual way. Now, they are better at recognising the signs of a posterior stroke which might not be identified in a normal stroke test. This means they can respond in the right way by taking the patient urgently to a specialist acute stroke unit for urgent treatment to give the patient the best chance of recovery.

While they are still caring for you

While a HCP is still caring for you, they are allowed to look at the relevant parts of your record to reflect on the care they are providing. This helps them check that they are providing you with safe, high-quality care.

After you have left their care

After you have left their care, if the HCP needs to see your information to reflect on the care they provided to you, they:

• must add a written note to your record explaining why they need to see your information to reflect on their care
• must show that they need to see your information to deliver safer, high-quality care
• may only look at the relevant parts of your record
• need to look at the information within six months of the care they provided to you. They can only look at it after six months if there is a very good reason

If you do not want your information to be used for reflective practice

All health and care services need to explain in their privacy notices what reflective practice is and how your information may be used for it. If you do not want your information to be used for reflective practice, you have the right to ask those caring for you not to use it. They will note this on your health and care record so it is not used for reflective practice.

Accessing confidential patient information for reflective practice

If you are a regulated HCP, you are required to engage in reflective practice as part of your professional regulation. This guidance supports you and your supervisors to understand whether access to confidential patient information is justified in each case.

This guidance does not:

• dictate how reflective practice should be carried out
• insist on the use of confidential patient information for reflection
• propose a specific approach to reflection

For detailed information on the reflective practice process, refer to guidance issued by your regulator using the links at the bottom of this page.

Reflective practice while still caring for the individual

While you are still caring for an individual, you may access relevant information about them for your reflective practice. This may be done on the basis of implied consent for individual care.

Reflective practice while no longer caring for the individual

There may be times when, to maintain safe, high-quality care, you need to reflect on the treatment you gave someone who has since left your care.

Whilst reflection can often be done without accessing confidential patient information, it may at times be essential. At these times, you may access confidential patient information to engage in reflective practice if you:

• only access the minimum information required for reflection on that episode of care
• only access information where understanding the impact of your actions could directly influence the safety of future care you provide
• limit access to confidential patient information to recent episodes of care which are less than six months old, unless there is a good reason to extend the period
• follow your organisation’s local approval processes for all access to confidential patient information
• make a brief entry in the individual’s record explaining why access was necessary for your reflective practice
• respect any objection the patient or service user has made with regard to access to confidential patient information for reflective practice

The timeframe for accessing confidential patient information should allow you to work with your existing work commitments, such as clinical supervision cycles or planned team reflections. Note that while access to confidential patient information for the purposes of reflection should be time limited, the reflective process itself does not need to be time limited.

If you need to document information for the purposes of your own reflective practice you should ensure that any direct patient identifiers are removed. If you are using your organisation’s systems to document, you should follow all relevant organisational policies. If you use a personal electronic device to document your reflective process that includes information about a patient, you will need to follow the NHS England Bring your own device (BYOD) guidance.

A whole team approach to reflective practice

Regulated HCPs

Only regulated HCPs who have a legitimate care relationship, past or present, with the person whose care they wish to reflect upon, should be allowed to access confidential patient information for reflective practice once a care episode has ended.

Non-regulated health care workers

Some teams may include non-regulated staff - see Non-regulated health care workers in the IG professionals section of this guidance. These staff can participate in team reflective practice which requires access to confidential patient information, if:

• the team reflective practice is led by a regulated HCP
• the decisions to access confidential patient information are made by a registered and regulated HCP
• the non-regulated member of staff has a legitimate relationship, past or present, with the patient or service user for care, and was involved in the provision of the episode of care reflected on
• the non-regulated member of staff is up to date with their mandatory IG training
• their terms of employment include an explicit duty of confidentiality

Supervisors

At times you may need support from your clinical supervisor to effectively reflect on your practice. Where your supervisor has access to confidential patient information through your reflective practice, they should be a regulated professional and will usually be part of the care team involved in the episode you are reflecting on. If your supervisor is based in a different clinical team, you must follow your organisation’s formal process when sharing information with them for reflective practice. If you are not sure about this process, you should check with your IG team.

Individual objections to their information being used for reflective practice

You should respect any objection an individual has made to the use of their information for reflective practice. Also consider other reasons that could make the individual likely to object to you having access to confidential patient information to reflect on the care you provided. These could include the sensitivity of the records or the presence of unrelated information in the relevant section.

Broader organisational learning

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.

Regulated HCPs 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 HCPs 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.

Reflective practice while still caring for the individual

While caring for a person, HCPs 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.

Reflective practice while no longer caring for the individual

Sometimes, an HCP 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 HCP may require time-limited access to information related to that episode of care to assess its impact.

Regulated HCPs 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 HCP 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 HCP 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 to sharing information for reflective practice

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.

Professional requirements

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 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

Regulated HCPs

Access to confidential patient information for reflective practice should be restricted to regulated HCPs 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.

Non-regulated healthcare workers

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 HCP
• 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

Supervisors

At times HCPs 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.

Role-based access controls

For any agreed episode of reflective practice, access should be limited to the information necessary for each specific role. HCPs 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.

Governing access and mitigating risk

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 HCP provided to the person
• the HCP 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 HCP 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.

Transparency for patients and service users

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

• the HCP 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 HCP engaging in reflective practice has a legitimate relationship, past or present, with the patient or service user for the provision of their care
• the HCP can 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:

Common law duty of confidentiality

To satisfy the common law duty of confidentiality, HCPs 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.

Broader organisational or system learning

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.

UK General Data Protection Regulation (GDPR)

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

Further information

British Medical Association - Reflecting on your practice

General Medical Council - Reflective practice learning materials

Nursing and Midwifery Council - Supporting information for reflection in nursing and midwifery practice (PDF)

Royal College of Nursing - Revalidation requirements: Reflection and reflective discussion

The Health and Care Professions Council (HCPC) - Reflective practice

Social Work England - Reflection

National Data Guardian – Reflective practice