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general practitioner. Owned by the
Secretary of State for Health, the Lloyd George record stayed with the individual's GP, wherever they moved to in the UK, and hence contain a person's lifelong health record. Continuation cards can be inserted inside. These have the date of printing in the bottom right-hand corner.
174:
folders. Medical record-keeping varied among practices, from solely using Lloyd George records, to adapting them, to using a combination of Lloyd George and A4, to, in a few cases, moving to computer records. Effective use of Lloyd George records was seen as requiring an almost obsessional attention to detail.
136:
Lloyd George envelopes are beige-coloured card wallets and measure 130 mm × 180 mm (5.1 in × 7.1 in) with red or blue markings for male or female patients, respectively. One was allocated for every individual in the UK population, from birth and upon registration with a
195:
or rubber bands. In 1974, a recommendation to replace the small envelopes with larger A4 folders, came from a joint working party of the Health
Departments for England, Wales and Scotland, health authorities and general practitioners. The envelopes were phased out in the late twentieth century and
190:
In the latter part of the twentieth century, as record keeping became more detailed and hospital interventions resulted in more documentations, the Lloyd George envelopes became increasingly bulky. Whether hospital letters should be inserted into the envelopes folded with the writing on the inside
38:
in the United
Kingdom to record and store medical information on their patients. They were produced in beige card, and distributed to general practices until January 2021. Envelopes for male patients have red print, those for female patients blue print. Each measures 130 mm × 180 mm
173:
In the 1970s and 80s the debate about whether the Lloyd George record had any advantage in switching to A4 folders was a major issue. Hospital letters typically arrived in an A4 form and needed to be folded to fit into a Lloyd George envelope, whereas new sheets were easily added into the larger
165:
The limited space to document details reflected, to some extent, the type of medicine practised in the early twentieth century. People's expectations, limited medical knowledge, short consultation times, and limited medical tests all contributed to the brief notes that were made by general
61:
The records provided an easy to visualise summary, prevented unnecessary lengthy note making, and could be carried in a doctor's coat pocket when out on a home visit. However, limited writing space resulted in brief inconsistent record keeping, and encouraged illegible handwriting.
65:
From the 1950s, as record keeping became more detailed and hospital interventions resulted in more correspondences, the relatively small Lloyd George envelopes became increasingly bulky. They were phased out in the late twentieth century and replaced to some extent with
153:
Recorded detail varied between physicians, and ranged from documenting every illness to omitting major surgical procedures. Not all doctors even utilised the inserted summary card, until after 1990 when financial incentives to treat longterm conditions such as
140:
The Lloyd George record has been seen by some to have a certain sense of privacy, with notes tucked away in the wallet, unlike being visible on a computer screen. Their small size was seen by some as "easy to handle". The notes generally served as an
191:
for confidentiality, or outside for easy visibility, was just one matter for debate. For people with longterm conditions, the envelopes became full, frequently requiring joining envelopes together, which was typically done using
166:
practitioners, which discouraged detail and encouraged illegible handwriting. It also led to the use of acronyms, such as "FLK" for "funny looking kid", and "TATT" for "tired all the time". Recording treatment of
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for the doctor. They provided an easy to visualise summary, prevented unnecessary lengthy note making and could be carried in the doctor's coat pocket when out on a home visit.
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Between 1911 and the formation of the NHS in 1948, the record-keeping cards were in general use by health boards. The envelopes were introduced during the
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The NHS stopped issuing new envelopes for first-time registrations in
January 2021. Since then, no further Lloyd George envelopes are produced.
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would be shortened to "ST.Pen", for example, without any elaboration on a person's history, examination findings, or drug doses.
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mostly replaced with A4 folders, and eventually digitised with the adoption of computerised medical records.
109:. Its creation has been seen as the beginning of the development of a nationally compatible records system.
55:
35:
19:
913:
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Patient and Staff Voices in
Primary Care: Learning from Dr Ockrim and her Glasgow Medical Practice
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31:
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Lloyd George envelopes stacked in box: compact, with insertion cards and folded hospital letters
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introduced a card to record medical information for low-income male workers who paid into
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453:"13. Achievements in record keeping: the use of information management and technology"
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folders, and eventually digitised with the adoption of computerised medical records.
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39:(5.1 in × 7.1 in) and has provision for additional inserts.
816:
521:
411:
372:
708:
Ethics in
General Practice: A Practical Handbook for Personal Development
329:"The new new general practice: the changing philosophies of primary care"
159:
116:. Their size was based on their storage in the large number of available
648:
956:
858:"'Archaic' and risky patient records still used by most GP practices"
565:
Health
Management Information Systems: A Handbook for Decision Makers
155:
181:
127:
85:
77:
18:
42:
Lloyd George cards were first used for workers who paid into
737:"7. Understanding our discipline: the growth of informatics"
595:
General
Practice Under the National Health Service 1948-1997
593:. In Loudon, Irvine; Horder, John; Webster, Charles (eds.).
962:
The
Journal of the Royal College of General Practitioners
653:
The
Journal of the Royal College of General Practitioners
500:
The Journal of the Royal College of General Practitioners
681:
Lewis and Buchan: Clinical Negligence: A Practical Guide
304:
General Practice Under the NHS: Past, Present and Future
132:
Lloyd George envelopes (red for males, blue for females)
493:"A medical record folder for the Lloyd George envelope"
773:"Innovations in medical records in the United Kingdom"
626:. Abingdon, Oxon: Radcliffe Publishing. pp. 2–3.
940:"1948–1957: Establishing the National Health Service"
54:
and continued in use following the formation of the
876:"Lloyd George envelopes & paper records | PCSE"
30:, named after the British former prime minister
777:British Medical Journal (Clinical Research Ed.)
463:. Abingdon: Radcliffe Publishing. p. 155.
293:
291:
289:
287:
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678:Buchan, Andrew; Lewis, Charles James (2012).
327:Livingstone, A; Widgery, D (3 October 1990).
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568:. McGraw-Hill Education (UK). p. 272.
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484:
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396:"Atomic data: James Mackenzie Lecture 2015"
50:. The envelopes were introduced during the
300:"5. Information management and technology"
223:Lloyd George envelopes held by rubber band
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788:
511:
427:
362:
344:
235:Lloyd George envelopes held by Sellotape
705:Orme-Smith, Anne; Spicer, John (2018).
597:. Oxford: Clarendon Press. p. 10.
400:The British Journal of General Practice
246:
201:
684:. Bloomsbury Publishing. p. 468.
743:. Radcliffe Publishing. p. 122.
541:. Boca Raton: CRC Press. p. 38.
491:Floyd, CB; White, DH (January 1986).
7:
101:, a scheme introduced following the
46:, a scheme introduced following the
955:Goodridge, D. M. G. (April 1982).
741:The Very Stuff of General Practice
14:
649:"General practice record folders"
461:A Celebration of General Practice
23:Lloyd George envelope with insert
771:Jones, F. A. (31 October 1981).
228:
216:
204:
16:Paper wallets used by UK doctors
912:. 30 June 2017. Archived from
831:"Written Answers To Questions"
739:. In Moreton, Philippa (ed.).
647:Pierry, A. A. (1 March 1986).
624:The Challenge for Primary Care
1:
306:. CRC Press. pp. 57–60.
957:"An Analysis of Fat Folders"
535:Collins, Kenneth E. (2023).
394:Sullivan, Frank (May 2016).
258:. 8 October 1912. p. 2.
120:during the First World War.
34:, are paper wallets used by
910:People's History of the NHS
856:Talora, Joe (5 June 2023).
591:"Introduction and overview"
107:Chancellor of the Exchequer
103:National Insurance Act 1911
90:National Insurance Act 1911
48:National Insurance Act 1911
1015:
256:Coventry Evening Telegraph
790:10.1136/bmj.283.6300.1164
711:. CRC Press. p. 42.
99:National Health Insurance
44:National Health Insurance
346:10.1136/bmj.301.6754.708
186:GP records in A4 folders
999:National Health Service
906:"Lloyd George envelope"
589:Morrell, David (1998).
298:Sherifi, James (2022).
56:National Health Service
862:Health Service Journal
618:Starey, Nigel (2003).
187:
133:
91:
83:
28:Lloyd George envelopes
24:
412:10.3399/bjgp16X685153
254:"Topics of the day".
185:
131:
89:
81:
36:general practitioners
22:
562:Smith, Jack (1999).
880:pcse.england.nhs.uk
783:(6300): 1164–1165.
451:Neary, Joe (2003).
984:David Lloyd George
916:on 22 January 2024
886:on 22 January 2024
835:Hansard.parliament
406:(646): e368–e370.
188:
134:
95:David Lloyd George
92:
84:
82:David Lloyd George
32:David Lloyd George
25:
837:. 19 January 1988
750:978-1-85775-390-5
718:978-1-315-34851-3
691:978-1-84766-673-4
633:978-1-85775-569-5
575:978-0-335-20565-3
548:978-1-032-43901-3
470:978-1-85775-923-5
339:(6754): 708–710.
313:978-1-000-62557-8
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942:. Nuffield Trust
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890:26 November
841:26 November
149:Limitations
978:Categories
946:3 December
241:References
989:Envelopes
799:0267-0623
665:0035-8797
420:0960-1643
355:0959-8138
193:Sellotape
735:(1999).
438:27127292
381:12411559
160:diabetes
817:6794804
808:1507365
522:3701688
513:1960341
459:(ed.).
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373:2224242
364:1664070
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74:Origin
496:(PDF)
455:. In
377:S2CID
948:2023
922:2023
892:2023
843:2023
813:PMID
795:ISSN
745:ISBN
713:ISBN
686:ISBN
661:ISSN
628:ISBN
599:ISBN
570:ISBN
543:ISBN
518:PMID
465:ISBN
434:PMID
416:ISSN
369:PMID
351:ISSN
308:ISBN
158:and
803:PMC
785:doi
781:283
508:PMC
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333:BMJ
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