Note de-identification is the removal of personal identifiers from an asynchronous specialist e-consult. In the NHS this exchange usually runs through the e-Referral Service Advice and Guidance route, where a GP asks a specialist without sending the patient to clinic. Art. 9(2)(h) of the UK GDPR is the gateway for that care, with DPA 2018 Schedule 1, Part 1, paragraph 2 as the matching condition. GMC guidance on confidentiality governs what the clinician may then share. anonym.plus keeps the clinical opinion and removes the names.
When this applies
A GP asks a specialist by message and gets written advice back. The thread names the patient and both clinicians. Sharing that advice as a teaching example is a secondary use, so the identifiers come out even though the original exchange was lawful care.
How anonym.plus handles it
- Bring the exchange into anonym.plus on your device.
- It marks the patient, requester, and specialist names.
- Consult dates, contacts, and identifiers get flagged too.
- Swap each one for a clear role label.
- Save the clean exchange on your device.
What you need to provide
- The exchange (DOCX, PDF, or message export).
- An operator: Replace keeps the advice readable.
- Optional role map for [SPECIALIST] / [PATIENT].
Patient data entity types detected
| Category | anonym.plus entity type | Example |
|---|---|---|
| Names | PERSON | Dr Ferreira → [SPECIALIST] |
| Names | PERSON | N. Oyelaran → [PATIENT] |
| Dates | DATE_TIME | asked 02 May → [DATE] |
| NHS number | NHS_NUMBER | NHS 610 204 5678 → [NHS_NO] |
| Contact | EMAIL_ADDRESS | referral email → [EMAIL] |
| Location | LOCATION | Dermatology dept → [DEPT] |
Compliance achieved
- Handles special category health content under UK GDPR Art. 9(1).
- The underlying exchange runs on the healthcare gateway in UK GDPR Art. 9(2)(h), with DPA 2018 Schedule 1, Part 1, paragraph 2 as the condition.
- Matches the sharing limits in GMC Confidentiality: good practice in handling patient information (2017).
- Respects Caldicott Principle 7: the duty to share for individual care is as important as the duty to protect confidentiality.
- Fits clinician-to-clinician workflows such as NHS e-Referral Service Advice and Guidance.
- Runs fully offline, so an exchange from another trust never leaves your machine.
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Limitations & cautions
An async exchange often quotes the requesting clinician's own wording. A job title or a rare condition can re-identify with no name present. Review those lines, and apply the motivated-intruder test to uncommon presentations before sharing.
Frequently asked questions
Should the specialist's name be removed as well?
It depends on the purpose. A clinician's name in a work context is their personal data too, but it is not the patient's, so removing it is not required by the same logic. Blinded teaching sets usually swap it anyway to keep the discussion about the reasoning. The tool can flag patient and clinician names together or apart.
Does Caldicott Principle 7 conflict with anonymising the note?
No. Principle 7 says the duty to share information for an individual's care matters as much as the duty to protect confidentiality. It applies to the live care exchange, which stays fully identified. Anonymisation applies to the copy reused for teaching or audit, where sharing names serves no care purpose.
Does the advice survive the swap?
Yes. The opinion, the reasoning, and the plan stay word for word. Only the identifiers change, so the exchange keeps its teaching value.