Medical records are central to almost every clinical negligence claim. They help establish what symptoms were reported, what investigations were carried out, what advice was given and how clinical decisions were made.

In July 2026, NHS England published guidance on preventing unlawful access to patient records. The guidance was mainly concerned with stopping staff from accessing records without a legitimate work reason. NHS England warned that inappropriate access could lead to disciplinary action, referral to regulators, or even criminal consequences.

The guidance also highlights a wider point: electronic health records usually create an audit trail. NHS England Digital’s guidance states that electronic health and care record systems keep logs of who has searched for and accessed records. In some systems, this may show who accessed a record, when they accessed it and which system or organisation they accessed it from.

For clinical negligence claims, that does not mean audit logs will be relevant as a matter of routine. In most cases, the clinical entries themselves will remain the key evidence. However, where there is a dispute about timing, access to information, record changes or post-incident review, audit information may help clarify the sequence of events.

What is an audit trail?

An audit trail is the digital record of activity within an electronic health record system.

The precise detail available will depend on the system being used. In broad terms, it may show when a record was searched for, viewed, updated or otherwise accessed. It may also identify the user or organisation involved.

This is becoming more important because modern patient care often takes place across several digital systems. A GP record, hospital record, imaging system, shared care platform and community care record may each hold different parts of the picture.

NHS England’s information governance guidance also notes that, in shared care, integrated record or API-enabled environments, audit information may be held across more than one system or organisation.

That point is useful for medico-legal work. If a case turns on who knew what and when, the relevant evidence may not always be limited to the records first disclosed.

When might this matter?

Clinical negligence claims often turn on small factual details.

For example:

• when an abnormal result was first reviewed
• whether a referral note was available to the treating team
• whether a record was accessed before or after a complaint was made
• whether an entry was created at the time or later amended
• whether relevant information was available across different care settings

The clinical record may answer these questions. In many cases, it will. But where the record is unclear, or where timing is disputed, audit information may provide useful context.

That needs to be framed carefully. An access log does not prove negligence, explain the clinical reasoning behind a decision or show that a clinician fully read or understood every part of a record.

What it may do, in the right case, is assist with chronology. It may help show whether information was available, whether it was accessed, or whether a record was reviewed at a particular point in time.

Access does not equal understanding

This is the main limitation.

Showing that a record was accessed does not automatically prove what a clinician saw, understood or decided. A user might open a record briefly. They might access it for an administrative reason. They might be reviewing several records as part of a wider workflow.

For that reason, audit trails should not be treated as a shortcut to liability. They should be considered alongside the clinical notes, witness evidence, policies, expert opinion and the wider factual background.

This is particularly important in clinical negligence claims, where the legal test remains focused on breach of duty and causation. The audit trail may help establish part of the factual background, but it does not replace expert medical evidence.

Why this matters for solicitors and experts

For solicitors, the practical point is not that audit logs should be requested in every case. That would be unnecessary and disproportionate.

The better point is that electronic record activity should be considered where it is genuinely relevant to the issues in dispute.

For example, if a case involves an alleged failure to act on a test result, it may be relevant to know when the result was available and whether it was accessed. If a note appears to have been amended after the event, the timing and nature of that change may matter. If care was shared between several organisations, it may be important to understand whether information was visible to the relevant clinicians at the relevant time.

Medical experts may also need this context. An expert asked to comment on the standard of care may need to know what information was available to the clinician when the decision was made. In some cases, audit information may help clarify that factual background before the expert gives an opinion.

A developing practical issue

The Government has also confirmed, in a July 2026 written parliamentary answer, that NHS trusts are required to maintain audit logs of access to patient information and that the proposed Single Patient Record is expected to strengthen audit trails where staff access records without due cause.

This reinforces the direction of travel. Healthcare records are becoming more connected, more digital and more traceable.

For clinical negligence claims, the core questions remain familiar: what happened, what should have happened, and whether any breach caused harm. Most cases will still turn on the clinical records, witness evidence and expert opinion.

But in the right case, the digital history behind the record may help answer an important factual question.

For solicitors, insurers and medical experts, the point is not to overcomplicate every claim. It is simply to recognise that an electronic medical record may contain more than the note visible on the page. Where timing, access or record changes are genuinely in issue, the audit trail may be part of the evidential picture.

Need support with medical record reviews or chronologies?

Clear, well-structured medical records can make a significant difference when assessing a clinical negligence claim.

UKExpertMedical provides medical record review and chronology services to help solicitors identify key events, missing information and important points in the patient timeline.

To discuss how we can support your next case, please contact our team.

Sources

• NHS England, “NHS warns ‘snooping’ staff face sack or prison for inappropriate access of patient data”, published 8 July 2026.
• NHS England, “Preventing unlawful access to patient records”, published 8 July 2026.
• NHS England Digital, “Stopping unlawful access to records guidance for health and care professionals”, last edited 15 July 2026.
• NHS England Digital, “Stopping unlawful access to records guidance for IG professionals”, last edited 8 July 2026.
• UK Parliament, written answer HL1530, “NHS Trusts: Electronic Patient Records”, answered 13 July 2026.