Where to Store an Advance Directive in Northern Ireland
A perfectly drafted ADRT that nobody can find in an emergency is worse than not having one at all — it creates a false sense of security while offering zero protection. Northern Ireland has no centralised registry for advance directives and no Tell Us Once-style notification system. An ADRT can be recorded in your GP-held Key Information Summary and shared through the Northern Ireland Electronic Care Record with your consent, but you should not assume every emergency team will see the full document automatically.
Storage and distribution is entirely your responsibility, and the margin for error is small.
The GP Surgery (Most Important Copy)
Your GP surgery is the single most important storage location. When you're admitted to hospital, the admitting team will often check your GP records for existing care plans. When paramedics attend your home, they may contact your surgery for background. When a clinical team needs to verify whether a patient has an advance directive, the electronic health record is the first place they look.
After you finalise your ADRT:
- Deliver a certified copy to your GP surgery. Phone ahead to make a specific appointment for this — don't rely on handing it to a receptionist and hoping it reaches the right person.
- Ask the practice manager to scan the document into your electronic health record. A paper copy sitting in a physical file at the surgery offers no benefit when out-of-hours teams access your records electronically.
- Request an emergency alert flag on your patient profile. This places a prominent notice in your GP record so that clinicians accessing it — whether your regular GP, a locum, or an out-of-hours service — can see that an ADRT exists and retrieve the document.
- Confirm the upload. Ask for verbal or written confirmation that the document has been successfully scanned and the alert placed. Follow up if you don't receive confirmation within two weeks.
The Hospital Trust
If you're under active specialist care at any of Northern Ireland's five Health and Social Care Trusts — Belfast, South Eastern, Northern, Southern, or Western — provide a copy to your treating team separately. Hospital electronic systems and GP electronic systems don't always share information seamlessly, particularly during emergency admissions outside normal hours.
Give the document to:
- Your named consultant or their secretary
- The ward manager if you're an inpatient
- The palliative care team if you've been referred to one
Ask them to note its existence in your hospital record. When you're transferred between departments or admitted through A&E, the document needs to be accessible without requiring someone to phone your GP surgery and wait for a faxed copy.
Your Home
Paramedics arriving at your home in an emergency won't have access to your GP records immediately. Several practical measures can bridge this gap:
Lions Club "Message in a Bottle" scheme. This widely used scheme in Northern Ireland involves placing a container in your fridge containing key medical information including details of your ADRT.
Medical ID on your phone. Both iPhone (Health app → Medical ID) and Android (Safety → Emergency Information) allow you to store emergency medical information that's accessible from the lock screen without a passcode. Note that you have an advance directive and where it's stored.
A summary card in your wallet or bag. A small card stating "I have a valid Advance Decision to Refuse Treatment — contact my GP surgery at [phone number]" gives any clinician an immediate path to your full document.
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Trusted People
At least two people who are likely to be contacted in a medical emergency should know:
- That your ADRT exists
- Where the original is stored
- Which GP surgery holds the electronic copy
- What treatments you've refused
These should include your named next of kin, your EPA attorney (if you have one), and ideally one other trusted person. Give each a certified copy of the document so they can produce it physically if electronic systems fail.
What Not to Do
Don't rely solely on a filing cabinet at home. If you're admitted through A&E after a collapse in a public place, nobody is going to send someone to your house to check your filing system.
Don't store the original in a solicitor's safe. Solicitors' offices aren't open at 2am on a Saturday. Your living will needs to be findable within minutes, not business hours.
Don't assume one copy is enough. A single copy at your GP surgery fails if the electronic system is down, if you're admitted to a hospital in a different Trust area, or if paramedics need to make CPR decisions before they can access any records.
The Distribution Log
Keep a written record of every copy you've distributed — who received it, the date it was delivered, and the format (paper or digital). This log serves a dual purpose: it helps you update everyone if you revise the document, and it provides evidence that the ADRT was properly communicated if its validity is ever questioned.
Our Northern Ireland Advance Decision to Refuse Treatment guide includes a structured distribution log, a GP registration checklist, and emergency access protocols designed for NI's fragmented health record system.
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