Our Practice is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times; the safety of everyone is of paramount importance.

All medical consultations, examinations and investigations are potentially distressing. Patients can find examinations, investigations or photography involving the breasts, genitalia or rectum particularly intrusive (these examinations are collectively referred to as ‘intimate examinations’). Consultations involving dimmed lights, the need for patients to undress or intensive periods of being touched may also make a patient feel vulnerable.

Chaperoning is the process of having a third person present during such consultations to provide support, both emotional and sometimes physical, to the patient, to provide practical support to the Doctor as required, and also to protect the Doctor against allegations of improper behaviour during such consultations.

Please refer to our Chaperone Policy shown below for further information

Introduction

This Policy is designed to protect both patients and staff from abuse or allegations of abuse, and to assist patients in making an informed choice about their examinations and consultations.

Guidelines

Clinicians (male and female) will consider whether an intimate or personal examination of the patient (either male or female) is justified, or whether the nature of the consultation poses a risk of misunderstanding.

• The Clinician will give the patient a clear explanation of what the examination will involve
• They will always adopt a professional and considerate manner and be careful with humour as a way of relaxing a nervous situation, as it can easily be misinterpreted
• The patient will always be provided with adequate privacy to undress and dress
• A suitable sign will be clearly on display in each Consulting or Treatment Room offering the Chaperone Service.

The above guidelines are to remove the potential for misunderstanding. However, there will still be times when either the Clinician, or the patient, feels uncomfortable, and it would then be appropriate to consider using a Chaperone.

Patients who request a Chaperone will never be examined without a Chaperone being present. If necessary, where a Chaperone is not available, the consultation/examination will be rearranged for a mutually convenient time when a Chaperone can be present.

Complaints and claims have not been limited to Doctors treating/examining patients of the opposite gender – there are many examples of alleged assault by female and male doctors on people of the same gender.

Consideration will always be given by staff to the possibility of a malicious accusation by a patient, and a Chaperone organised if there is any potential for this.

There may be occasions when a Chaperone is needed for a home visit in which case the following procedure will be followed.

Who can act as a Chaperone?

A variety of people can act as a Chaperone in the practice, but staff undertaking a formal Chaperone role will have been trained in the competencies required. Where possible, Chaperones will be clinical staff familiar with procedural aspects of personal examination.

Where the Practice determines that non-clinical staff will act in this capacity, the patient will be asked to agree to the presence of a non-Clinician in the examination, and for confirmation that they are at ease with this. The staff member will be trained in the procedural aspects of personal examinations, be comfortable acting in the role of Chaperone, and be confident in the scope and extent of their role. They will also have received instruction on where to sit/stand and what to watch and listen for. A Chaperone will document in the patient notes that they were present, and detail any issues arising.

Confidentiality

• The Chaperone will only be present for the examination itself, with most of the discussion with the patient taking place while the Chaperone is not present.
• Patients are reassured that all Practice staff understand their responsibility not to divulge confidential information.

Procedure

• The Clinician will contact reception to request a Chaperone
• Where no Chaperone is available, a Clinician may offer to delay the examination to a date when one will be available, as long as the delay would not have an adverse effect on the patient’s health
• If a Clinician wishes to conduct an examination with a Chaperone present but the patient does not agree to this, the Clinician will explain clearly why they want a Chaperone to be present. The Clinician may choose to consider referring the patient to a colleague who would be willing to examine them without a Chaperone, as long as the delay would not have an adverse effect on the patient’s health
• The Clinician will record in the notes that the Chaperone is present, and identify the Chaperone
• The Chaperone will enter the room discreetly and remain in the room until the Clinician has finished the examination
• A Chaperone will attend inside the curtain/screened-off area at the head of the examination couch and observe the procedure
• To prevent embarrassment, the Chaperone will not enter into conversation with the patient or GP unless requested to do so, or make any mention of the consultation afterwards
• The Chaperone will make a record in the patient’s notes after examination. The record will either state that there were no problems, or give details of any concerns or incidents that occurred. The Chaperone must be aware of the procedure to follow if any concerns require to be raised
• The patient can refuse a Chaperone, and if so this must be recorded in the patient’s medical record.

We make every effort to give the best service possible to everyone who attends our Practice.

However, we are aware that things can go wrong, resulting in a patient feeling that they have a genuine cause for complaint. If this is so, we would like the matter to be settled as quickly, and as amicably, as possible.

To have your complaint investigated, you need to complain within 12 months of the event happening, or as soon as you first become aware of the issue you want to complain about.

The time limit can be extended in special circumstances.

Interpreting Service

We can arrange for a meeting with the Complaints Manager and an interpreter for any patient whose first language is not English and needs help with their complaint.

How to make a compliment or complaint

Whether you are happy or unhappy with the care and treatment that you have received, please get in touch and let us know your views.

Receiving compliments and complaints is important to ensuring good quality local healthcare in our Practice – helping us to find out more about what we’re getting right and what we can improve.

We hope this will help you to make your feelings and experiences known to the appropriate people. Should you have a complaint we hope this page will give you more information about what to do, who to contact and what happens next.

How do I raise a concern / informal complaint?

You can speak to any member of staff initially with your complaint. This gives you the opportunity to resolve any concern you may have without it going through a formal process.

Most complaints are best resolved within the practice and these should be made via the Complaints Manager.

Formal Complaint

What we will do

We will contact you about your complaint within three working days and offer to discuss with you the best way to investigate it, including the time scales for a reply. We will aim to offer you an explanation within that time frame or a meeting with the people involved.

• Find out what happened and what went wrong
• Invite you to discuss the problem with those involved, if you would like this
• Apologise where this is appropriate
• Identify what we can do to make sure that the problem does not happen again.

If you feel you do not want to contact the surgery directly, then you can contact the NHS Complaints team on:

NHS England,
PO Box 16738,
Redditch,
B97 9PT

If you are making a complaint please state: ‘For the attention of the complaints team’ in the subject line.

Contact Information

In General

If you have a complaint to make, you can either contact the Complaints Manager or ask a receptionist for a copy of our Complaints Procedure. We will endeavour to:

1. acknowledge any letter or Complaints Form within 3 working days of receiving it.
2. deal with the matter as promptly as possible – usually within 20 working days – dependent on the nature of the complaint.

Who can complain

• Complainants may be current or former patients, or their nominated or elected representatives (who have been given consent to act on the patients behalf).
• Patients over the age of 16 whose mental capacity is unimpaired should normally complain themselves or authorise someone to bring a complaint on their behalf.
• Children under the age of 16 can also make their own complaint, if they’re able to do so.

If a patient lacks capacity to make decisions, their representative must be able to demonstrate sufficient interest in the patient’s welfare and be an appropriate person to act on their behalf. This could be a partner, relative or someone appointed under the Mental Capacity Act 2005 with lasting power of attorney.

Appropriate person

In certain circumstances, we need to check that a representative is the appropriate person to make a complaint.

• For example, if the complaint involves a child, we must satisfy ourselves that there are reasonable grounds for the representative to complain, rather than the child concerned.
• If the patient is a child or a patient who lacks capacity, we must also be satisfied that the representative is acting in the patient’s best interests.

If we are not satisfied that the representative is an appropriate person we will not consider the complaint, and will give the representative the reasons for our decision in writing.

Time limits

A complaint must be made within 12 months, either from the date of the incident or from when the complainant first knew about it.

The regulations state that a responsible body should only consider a complaint after this time limit if:

• the complainant has good reason for doing so, and
• it’s still possible to investigate the complaint fairly and effectively, despite the delay.

Procedure

We have a two stage complaints procedure. We will always try to deal with your complaint quickly however if it is clear that the matter will need a detailed investigation, we will notify you and then keep you updated on our progress.

Stage one – Early, local resolution

• We will try to resolve your complaint within five working days if possible.
• If you are dissatisfied with our response, you can ask us to escalate your complaint to Stage Two.

Stage Two – Investigation

• We will look at your complaint at this stage if you are dissatisfied with our response at Stage One.
• We also escalate some complaints straight to this stage, if it is clear that they are complex or need detailed investigation.
• We will acknowledge your complaint within 3 working days and we will give you our decision as soon as possible. This will be no more that 20 working days unless there is clearly a good reason for needing more time to respond.

Complain to the Ombudsman

If, after receiving our final decision, you remain dissatisfied you may take your complaint to the Ombudsman.

The Ombudsman is independent of the NHS and free to use. It can help resolve your complaint, and tell the NHS how to put things right if it has got them wrong.

The Ombudsman only has legal powers to investigate certain complaints. You must have received a final response from the Practice before the Ombudsman can look at your complaint and it will generally not look into your complaint if it happened more than 12 months ago, unless there are exceptional circumstances.

Address:
Parliamentary & Health Service Ombudsman,
Tower 30,
Millbank,
London,
SW1P 4QP

Phone: 0345 015 4033

Email the Ombudsman

Other organisations that can help you make a complaint about health services

Confidentiality

All complaints will be treated in the strictest confidence.

Where the investigation of the complaint requires consideration of the patient’s medical records, we will inform the patient or person acting on his/her behalf if the investigation will involve disclosure of information contained in those records to a person other than the Practice or an employee of the Practice.

We keep a record of all complaints and copies of all correspondence relating to complaints, but such records will be kept separate from patients’ medical records.

Statistics and reporting

The Practice must submit to the local primary care organisation periodically/at agreed intervals details of the number of complaints received and actioned.

Give feedback or make a complaint

You can complain to a member of staff at the NHS service you went to, such as a GP surgery or hospital, or you can complain to the organisation in charge.

Consent to treatment is the principle that a person must give permission before they receive any type of medical treatment, test or examination and is generally requested on the basis that an explanation of the required treatment, test or procedure has been received from a Clinician.

Consent from a patient is needed regardless of the procedure, whether it’s a physical examination, organ donation or something else.

The principle of consent is an important part of medical ethics and international human rights law.

Defining consent

For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

These terms are explained below:

• voluntary– the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family
• informed– the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn’t go ahead
• capacity– the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected. This is still the case even if refusing treatment would result in their death, or the death of their unborn child.

If a person doesn’t have the capacity to make a decision about their treatment, the Healthcare Professionals treating them can go ahead and give treatment if they believe it’s in the person’s best interests.

Clinicians must however take reasonable steps to seek advice from the patient’s friends or relatives before making these decisions.

Read more about assessing the capacity to consent.

How consent is given

Consent can be given:

• verbally– for example, by saying you are happy to have an X-ray
• in writing– for example, by signing a Consent Form for surgery to be performed

Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place – for example, holding out an arm for a blood test.

Consent should be given to the Healthcare Professional directly responsible for the person’s current treatment, such as:

• a Nurse arranging a blood test
• a GP prescribing new medication
• a Surgeon planning an operation

If someone is going to have a major medical procedure such as an operation, their consent should ideally be secured plenty of time in advance, so that they have time to obtain information about the procedure and ask questions.

If a patient changes their mind at any point before the procedure, they are entitled to withdraw their previous consent.

Consent from children and young people

If they’re able to, consent is usually given by patients themselves. However, someone with parental responsibility may need to give consent for a child up to the age of 16 to have treatment.

Read more about the rules of consent applying to children and young people.

When consent isn’t needed

There are a few exceptions when treatment may be able to go ahead without the person’s consent, even if they’re capable of giving their permission.

It may not be necessary to obtain consent if a person:

• requires emergency treatment to save their life, but they’re incapacitated (for example, they’re unconscious) – the reasons why treatment was necessary should be fully explained once they’ve recovered
• immediately requires an additional emergency procedure during an operation – there has to be a clear medical reason why it would be unsafe to wait to obtain consent, and it can’t be simply for convenience
• with a severe mental health condition such as schizophrenia, bipolar disorder or dementia, lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act 1983) – in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental illness
• requires Hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act 1983) – the person’s nearest relative or an approved Social Worker must make an application for the person to be forcibly kept in Hospital, and two Doctors must assess the person’s condition
• is a risk to public health as a result of rabies, cholera or tuberculosis (TB)
• is severely ill and living in unhygienic conditions (under the National Assistance Act 1948) – a person who is severely ill or infirm and is living in unsanitary conditions can be taken to a place of care without their consent

You can always talk to the clinician providing you with care if you have any concerns in relation to consent.

Consent and life-sustaining treatments

A person may be being kept alive with supportive treatments – such as lung ventilation – without having made an advance decision based on information which outlined the care that they may have refused to receive.

In these cases, a decision about continuing or stopping treatment needs to be made based on what that person’s best interests are believed to be.

To help reach a decision, the Healthcare Professionals responsible for the person’s care should discuss the issue with the relatives and friends of the person receiving the treatment.

They should consider, among other things:

• what the person’s quality of life will be if treatment is continued
• how long the person may live if treatment is continued
• whether there’s any chance of the person recovering

Treatment can be withdrawn if there’s an agreement that continuing treatment isn’t in the person’s best interests.

The case will be referred to the Courts before further action is taken if:

• an agreement can’t be reached
• a decision has to be made on whether to withdraw treatment from someone who has been in a state of impaired consciousness for a long time (usually at least 12 months)

It’s important to note the difference between withdrawing a person’s life support and taking a deliberate action to make them die. For example, injecting a lethal drug would illegal.

Complaints

If you believe you’ve received treatment you didn’t consent to, you can make an official complaint, please write to the Complaints Manager, who will assist you with this process.

We share a common purpose with our partners in health and social care – and that is to provide high quality care and ensure the best possible outcomes for the people who use our services. Promoting improvement is at the heart of what we do.

We endeavour to provide a first class service at all times but sometimes things go wrong and our service may fall below our expected levels.

In order to comply with Regulation 20 of the Health and Social Care Act 2008 (Regulations 2014) we pledge to:

• Have a culture of openness and honesty at all levels
• Inform patients in a timely manner when safety incidents have occurred which may affect them
• Provide a written and truthful account of the incident, explaining any investigations and enquiries made
• Provide a written apology
• Provide support if you are affected directly by an incident.

For a number of years, work has been ongoing to improve the way that medical records are made available to treating clinicians. Our main computer system is called SystmOne which has the advantage of enabling information to be shared between certain health professionals, and where necessary their support staff.

Enhanced data sharing model (EDSM) enables us, with your consent, to share your medical records with those in the NHS who are involved in your care. NHS staff can only access shared information if they are involved in your care and records are kept showing who has accessed your medical records.

As the scheme has been designed to enhance patient care, you have been automatically opted in.

For some time we have shared information for children for child protection reasons and also for patients under the care of the district nursing team. This has helped clinicians to make decisions based upon a wider knowledge of the patient and also helps to reduce the number of times that patients or family members are asked the same question. In short it assists clinicians to provide more ‘joined up care’.

If I agree, who can see my records?

EDSM allows clinicians treating you, who have access to SystmOne to view and in some cases update your medical records. Locally this includes the walk-in centre, many departments at local hospitals (including A&E) and community services, such as the district nursing team. It is anticipated that over time more health services will be able to benefit from EDSM.

Clinicians outside of the surgery who wish to access your medical records will ask for your consent to do so and will need to have been issued with a NHS smartcard. This is a chip and pin card – similar to a bank card.

Can I opt out or pick and choose who sees my record?

Yes, you can. Under EDSM there are two levels of consent. The first is to agree to sharing your medical records out. This is your agreement that records maintained by your GP can be seen, subject to your authority at the time, by clinicians working outside of the surgery. The second is agreeing to share your records in. This means that your GP can see the records made by other health professionals who have access to EDSM.

However, as the treating clinician needs to ask your permission to see your records at the beginning of each period of care you are in control of who can see your medical information.

I can see the benefits of the other people treating me seeing my notes, but what if there is a matter that I want to stay just between me and my doctor?

You can ask for any consultation to be marked as private, this means that viewing is restricted to the surgery, but allows the rest of the record to be viewed by whoever else is treating you. It is your responsibility to ask for a consultation to be marked as private.

Haven’t I agreed/disagreed to do this before?

EDSM may seem very similar to patients as the summary care record which went live some years ago. The summary care record contains only a very small part of your record that is available to be seen by clinicians who might be treating you in A&E departments, walk in centres or if you register temporarily somewhere else within the UK.

Can I change my mind?

Yes, you can always change your mind and amend who you consent to see your records. For instance you can decline to share your records out from the surgery, but if you build up a relationship with the physiotherapist who is treating you and they asked you if they could look at an x-ray report, you could give your consent at that point for them to view your records. You will be referred back to us to change your preference, so the physio treating won’t be able to see your records instantly, but should be able to by, the next time of your next appointment.

If I decline what happens in an emergency?

In the event of a medical emergency, for instance if you were taken unconscious to A&E, and the clinician treating you feels it is important to be able to see your medical records he is able to override any consents set.

However, the doctor has to give a written reason for doing so. Where this happens an audit is undertaken by the local Caldicott Guardian (the person with overall responsibility for Data Protection compliance).

Can anyone else see my medical records?

On a daily basis, we get requests from insurance companies to either have copies of medical records or excerpts from patients’ medical records. This requires your signed consent.

Occasionally we are asked for information from the medical records for legal reasons and we will only provide information when legally required to do so.

Any questions?

If you have any questions or wish to opt out, please contact reception.

You are free to change your mind at any time. Information about you and the care you receive is shared, in a secure system, by healthcare staff to support your treatment and care.

Our Policy is designed to ensure and promote equality and inclusion, supporting the ethos and requirements of the Equality Act 2010 for all visitors to our Practice.

We are committed to:

• ensuring that all visitors are treated with dignity and respect
• promoting equality of opportunity between men and women
• not tolerating any discrimination or perceived discrimination against, or harassment of, any visitor for reason of age, sex, gender, marital status, pregnancy, race, ethnicity, disability, sexual orientation, religion or belief
• providing the same treatment and services (including the ability to register with the Practice) to any visitor irrespective of age, sex, marital status, pregnancy, race, ethnicity, disability, sexual orientation, medical condition, religion or belief
• This Policy applies to the general public, including all patients and their families, visitors and contractors

Procedure

Discrimination by the Practice or Visitors / patients against you

If you feel discriminated against:

• You should bring the matter to the attention of the Practice Manager
• The Practice Manager will investigate the matter thoroughly and confidentially within 14 working days
• The Practice Manager will establish the facts and decide whether or not discrimination has taken place, and advise you of the outcome of the investigation within 14 working days
• If you are not satisfied with the outcome, you should raise a formal complaint through our Complaints Procedure

Discrimination against our Practice staff

The Practice will not tolerate any form of discrimination or harassment of our staff by any visitor. Any visitor who expresses any form of discrimination against or harassment of any member of our staff will be required to leave the Practice premises immediately. If the visitor is a patient they may also, at the discretion of the Practice Management, be removed from the Practice list if any such behaviour occurs.

GPs are often asked to make Mental Capacity Assessments for patients.

These assessments can be requested for a variety of different reasons.

As GPs it is an essential part of our role that we are able to perform capacity assessments which relate to decisions regarding medical investigations, treatment and care. However capacity assessments relating to overall welfare, finances and property are often more complex and sit outside our expertise.

The level of risk and responsibility linked to capacity assessments can be extremely high. Decisions such as whether someone’s house is sold or how their life savings are spent can depend on capacity assessments.

It is therefore essential that adequate time and attention is dedicated to these assessments. It is also essential that those carrying out these assessments for legal purposes are highly trained and experienced in this area.

Legal capacity assessments do not fall within the NHS duties of GPs. Some GPs do agree to perform these assessments privately at a fee, but many others feel the risks of doing so are too high or that the time needed to perform an adequate assessment is not available to them. There are other professionals who can perform mental capacity assessments including solicitors and psychiatrist.

As a surgery we do not feel we have the capacity to offer Mental Capacity Assessments for legal purposes for our patients. To do so would require significant resources being diverted from our core duties as a health care provider. It would also pose a significant legal and financial risk to our GPs. We feel there are other professionals available with more appropriate training, legal protection and expertise who can perform these assessments.

We realise that this practice policy may cause some inconvenience to our patients but hope you can understand that our priority must be to our core NHS duties as a health care provider. If, in the future, the funding crisis in General Practice is adequately addressed by government we may find ourselves able to reconsider our position.

As part of the NHS commitment to providing more personalised care, from June 2015 all practices are required to provide all their Patients with a named GP who will have overall responsibility for the care and support that our surgery provides.

• This will not impact your experience at the practice, the provision of appointments, your treatment, or which GP you can see
• You may wonder why your allocated GP is not necessarily the one you see most regularly. Please be assured that you can still access all of our medical team in exactly the same way as before
• Having a named GP does not guarantee you will always be seen by that GP
• Please note that the GP responsible for your care may be subject to change and reallocation in the future

You do not need to take any further action, but if you have any questions or wish to know your named GP, please speak to a member of the reception team.

What does ‘accountable’ mean?

This is largely a role of oversight, with the requirements being introduced to reassure patients that they have one GP within the practice who is responsible for ensuring that this work is carried out on their behalf.

What are the named GP’s responsibilities to 75s and over?

This is unchanged from 2014-2015; for patients aged 75 and over the named accountable GP is responsible for:

• Working with relevant associated health and social care professionals to deliver a multi-disciplinary care package that meets the needs of the patient
• Ensuring that these patients have access to a health check as set out in section 7.9 of the GMS Contract Regulations.

Does the requirement mean 24-hour responsibility for patients? No. The named GP will not:

• Take on vicarious responsibility for the work of other doctors or health professional
• Take on 24-hour responsibility for the patient, or have to change their working hours The requirement does not imply personal availability for GPs throughout the working week
• Be the only GP or clinician who will provide care to that patient

Can patients choose their own named GP

In the first instance, patients should simply be allocated a named GP. However, if a patient requests a particular GP, reasonable efforts should be made to accommodate their preference, recognising that there are occasions when the practice may not feel the patient’s preference is suitable.

Do patients have to see the named GP when they book an appointment with the practice?

No. Patients can and should feel free to choose to see any GP or nurse in the practice in line with current arrangements. However, some practices may see this change as a way to encourage and promote a greater degree of continuity of care for patients.

At Redlands we have a Facebook page which provides a range of useful information for our patient population.
Redlands has a duty to maintain patient confidentiality and to safeguard vulnerable patients. You can help us to achieve this by adhering to the code of conduct outlined in this policy.

Patients of Redlands Primary Care are expected to adhere to the following code of conduct at all times:

• The organisation requires all users of portable devices to use them in a courteous and considerate manner, respecting their fellow patients. Portable devices are not to be used during consultations, except when agreed with your clinician.
• Patients are not permitted to disclose any patient-identifiable information about other patients, unless they have the express consent of that patient.
• Whilst not encouraged, patients may record their consultation, but this should be agreed with your clinician. This recording will solely be for your own purpose.
• Patients must not post any material that is inaccurate, fraudulent, harassing, embarrassing, obscene, defamatory, or unlawful. Any such posts on the organisation Facebook page will be deleted and the post reported.
• Patients are not permitted to take photographs in the waiting room or areas where other patients are present, nor are photographs of staff permitted to be taken.
• Patents must not post comments on social media that identify any staff.
• Defamatory comments about our team are not to be shared on any social media platform. Legal advice will be sought, and the appropriate action taken against any patient who posts defamatory comments
• We ask if you have a complaint to please contact the Complaints Manager in the first instance. We would be grateful if patients could be pro-active in reporting any incidents of this nature to the Complaints Manager.

Prescribing Policy For Patients Travelling Abroad

This policy outlines the procedure for patients travelling abroad for short and long periods of time.

NHS Policy

By law, the NHS ceases to have responsibility for the medical care of patients when they leave the UK. In addition GPs are not required by their terms of service to provide prescriptions for the treatment of a condition that is not present and may arise while the patient is abroad.

The NHS does accept responsibility for supplying ongoing medication for temporary periods abroad of up to 3 months. However, if a person is going to be abroad for more than 3 months, then they are only entitled (at NHS expense) to a sufficient supply of regular medication in order to get to their destination, where they should the find an alternative supply of that medication.

Patients residing abroad for a period of more than 3 months will be removed from the registered patient list.

Redlands Primary Care Policy

Travelling out of the country for less than 3 months
For patients who inform us they will be out of the country for less than 3 months, we will provide sufficient medicines for an existing condition (e.g. asthma, diabetes…) for the period while the patient is away where it is safe to do so. Drugs that require frequent monitoring may not be prescribed where there are safety concerns. 1 months supply only will be issued for drugs normally available over the counter, such as paracetamol.

Travelling out of the country for more than 3 months
Patients who inform us they will be leaving the country for more than 3 months will be prescribed sufficient medication to enable them to make alternative arrangements at their destination (up to 3 months supply where safe to do so).

They will also be removed from our patient list. We will be pleased to re-register patients on their return to residence in the UK and can reassure patient that their electronic notes are kept with NHS England.

Patients and relatives should not seek medication for themselves while they are abroad as this constitutes NHS fraud.

Prescriptions for medicines in case of illness while abroad

GPs will only prescribe NHS prescriptions in this case for exacerbations of pre-existing illnesses, e.g., antibiotics for patients who have frequent infections secondary to an underlying lung condition.

GPs may provide private prescriptions if it is clinically appropriate and they can be self-administered safely without medical assessment while abroad. These prescriptions are not free.

Patients should be aware that some drugs commonly prescribed in the UK may be illegal in certain countries and you should check with that countries embassy before you travel.

Mid Devon Primary Care Network

Since the NHS was created in 1948, the population has grown, and people are living longer. Many people are living with long term conditions such as diabetes and heart disease or suffer with mental health issues and may need to access their local health services more often.

To meet these needs, practices have begun working together and with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas in primary care networks.

Primary care networks (PCNs) build on the core of current primary care services and enable greater provision of proactive, personalised, coordinated and more integrated health and social care. Clinicians describe this as a change from reactively providing appointments to proactively care for the people and communities they serve. Where emerging PCNs are in place in parts of the country, there are clear benefits for patients and clinicians.

Primary care networks are based on GP registered lists, typically serving natural communities of around 30,000 to 50,000. They should be small enough to provide the personal care valued by both patients and GPs, but large enough to have impact and economies of scale through better collaboration between practices and others in the local health and social care system.

PCNs form a key building block of the NHS long-term plan. Bringing general practices together to work at scale has been a policy priority for some years for a range of reasons, including improving the ability of practices to recruit and retain staff; to manage financial and estates pressures; to provide a wider range of services to patients and to more easily integrate with the wider health and care system. In addition, PCN funding provides the opportunity to recruit a more diverse skill mix into general practice, through recruitment of roles such as first contact physiotherapists, social prescribers and physician assistants.

This privacy policy explains what personal information is held about our patients and how it is collected and processed.

Please view our Privacy Policy.

Anybody in England, whether a resident or overseas visitor, may access primary care services at a GP Practice without charge. No documents are required to register with a GP; however, to facilitate the registration process we would request that two forms of identification are produced, ideally if possible, one should be photographic, and one must contain your address. You may be asked to sign a Practice Form to give your permission for us to retain these documents with your electronic patient record.

These documents may be used to confirm your details with our local Health Authority. This also helps to ensure the correct matching of your details to any existing NHS record, enabling previous medical records to transfer smoothly between practices. We appreciate your assistance in this matter.

Types of acceptable photographic evidence:

• Passport
• Drivers Licence
• Official ID card from Public Services body; or
• Student matriculation card (current year)

Other documents for proof of residency that are acceptable are:

• Recent utility bill (within last 3 months)
• Council Tax document
• Television Licence
• Payslips (last two months)
• Rent book/agreement (Public Body or Private Landlord)
• Bank Statement (Name and address section only required)
• Solicitors Letter (Clearly showing your name and address)

If you are unable to provide photographic evidence then we would request you provide one of the above and one of the following:

• Birth Certificate
• Marriage Certificate
• Divorce Annulment Papers

If you are unable to provide any documentation, then we may still register you. However we may need to contact our Registration Department first, to verify your information with them, and ensure your medical records are not delayed in being transferred to the Practice. This will normally involve a phone call between you, our Registration Department and ourselves. Alternatively we may also email/write to them directly in which case we will require your consent for us to do so.

If you have any questions regarding NHS entitlement, or our Registration Policy please contact the Practice.

INTRODUCTION

There may be circumstances when it would be considered reasonable, or in the best interests of the patient, to remove patients from the list.

The purpose of this policy, therefore, is to define the practice guidelines for removal of a patient from the practice list and to ensure that any concerns about removing patients from the list are dealt with fairly.

SITUATIONS WHICH JUSTIFY REMOVAL

Violence

When a patient:-

• Is physically violent or threatening towards a doctor, practice staff or other patients on the practice premises.
• Causes physical damage to practice premises or other patient’s property.
• Gives verbal abuse or makes threats towards the doctor, practice staff or other patients.
• Gives racist abuse, orally or physically.
• Is violent or uses or condones threatening behaviour to doctors (or some other members of the primary health care team) while visiting the patient’s home. Such behaviour may involve the patient, a relative, a household member, or pets (such as unchained dogs).

Crime & Deception

Where a patient:-

• Fraudulently obtains drugs for non-medical reasons.
• Deliberately lies to the doctor or other member of the primary health care team (e.g. by giving a false name or false medical history) in order to obtain a service or benefit by deception.
• Attempts to use the doctor to conceal or aid any criminal activity.
• Steals from practice premises.

Distance

• Where a patient has moved out of the designated practice area and has failed to re-register with another GP.

Embarkation

• Where a patient has moved abroad for a period of 3 months or more.
• Failure to attend pre-booked appointments.
• Where a patient fails to attend pre-booked appointments on a number of occasions during a given period.
• Irretrievable breakdown of the Doctor/Nurse-Patient relationship.
• Where a patients behaviour falls outside of that which is normally considered reasonable and leads to an irretrievable breakdown of the doctor-patient relationship.

PROCEDURE FOR REMOVAL

Violence / Crime and Deception

Any incident involving violence, crime or deception will be immediately reported to the Management Team, who will complete an incident report and bring to the attention of the practice partners. Staff involved should also make a written statement at the time as further evidence.  It may be so serious that the police may need to be contacted.

If it is that serious then the patient can be removed immediately by contacting the Commissioning Group / Registration Department advising them of the incident and giving them a log number that the police have given.

For less serious matters.

Each case will be discussed with all involved in the surgery and a partner. A majority agreement will be reached.  If it is to remove the patient it can be done under the 8 day rule.

The Commissioning Group and Registration Department will need to be contacted and a brief outline given.

Following that agreement, the Management Team will write to the patient and explain the reasons for removal.

The Registration Department should then deduct the patient in the normal way.

Distance

On notification that the patient is no longer living within the practice boundary, a letter will be sent to the patient advising of the need to re-register within 28 days elsewhere.

Notification will be sent to the Registration Department after 28 days if the patient has not been deducted by the Registration Department as they have not registered elsewhere.

Embarkation

On notification that the patient has moved abroad the patient will be removed from the Practice list within 3 months of that notification.

Failure to attend pre-booked appointments

If a patient continually fails to attend pre-booked appointments, they will be reviewed and if deemed necessary a warning letter will be sent to the patient, advising them that a further occurrence could risk removal from the practice.

Warning letters are valid for a period of 12 months. Removal based on warnings greater than 12 months old will be invalid – in this case a further formal warning and period of grace will be required.

If the patient fails to attend another appointment, the matter will be discussed at a practice meeting and a majority agreement will be reached as to whether the patient will be removed from the practice list.

Following agreement the Management Team will write to the patient and explain the reasons for removal.

Guidance on removing patients due to irretrievable breakdown of the doctor – patient relationship.

Occasionally patients persistently act inconsiderately and their behaviour falls outside that which is normally considered to be reasonable. In such circumstances there may be a complete breakdown in the doctor-patient relationship.

Steps to be taken within the Practice

• Inform all appropriate members of the practice about the problem.
• The patient and possible reasons for the patient’s behaviour (e.g. disagreeableness, cultural differences, mental illness, and personality disorder) will be discussed at a practice meeting.

Steps to be taken with the patient

• Inform the patient, either personally or in writing, that there is a problem.
• Explain the nature of the problem to the patient.
• Obtain the patient’s perspective and interpretation of the situation.
• Obtain advice of a Medical Defence Organisation.

Steps to be taken if discussion fails to resolve the problem

• Suggest that another GP within the practice might better fit with the patient’s needs and expectations.
• Steps to be taken in actually removing the patient.
• Inform the appropriate Registration Department in writing of your decision.
• Inform the patient in writing of the decision and the reason for removal from the list.
• Explain to the patient that he or she will not be left without a GP.
• Give the patient information on how to begin the process of registering with another GP.

Family Members

When a decision is made to remove a patient from the practice list, the removal may well be extended to other members of the family or household.

Removing other members of the household

If the behaviour of one member of a household or family has led to their removal, this does not mean that the removal of other family members should automatically follow. An explicit discussion, whilst protecting the confidentially of the removed patient, with other family members about the problem and the doctor’s concerns will often obviate the need for any further action.

In rare cases, however, because of the possible need to visit patients at home it may be necessary to terminate responsibility for other members of the family or the entire household. The prospect of visiting patients where a relative who is no longer a patient of the practice by virtue of their unacceptable behaviour resides, or being regularly confronted by the removed patient, may make it too difficult for the practice to continue to look after the whole family.

This is particularly likely where the patient has been removed because of violence or threatening behaviour and keeping the other family members could put doctors or their staff at risk.

The practice should always consider how it would look to outside observers if a family were to be summarily removed from the list, in haste, without explanation for a single misdemeanour or disagreement with one family member.

The Management Team will write to the family / household offering an explanation for the removal. They will be allowed 4 weeks to re-register rather than being removed from the practice list immediately.

Responsibility

Responsibility for implementing and monitoring the policy rests with the Practice Partners / Management Team.

The practice re-affirm its commitment to do everything possible to protect staff, patients and visitors from unacceptable behaviour and their zero tolerance of any incident that causes hurt, alarm damage or distress.

A request by a patient, or a request by a third party who has been authorised by the patient, for access under the GDPR (and DPA 2018) is called a Subject Access Request (SAR). If you want to see your health records, or wish a copy, please complete a Practice Subject Access Request Form which you can complete online or please contact the Practice and we will provide you with our paper format. Contact will, subsequently, be made by the Practice to arrange a time for you to come in and collect or read them. You don’t have to give a reason for wanting to see your records and there is no charge for this service. You will however be required to produce proof of identity before being allowed to read them.

The Practice has up to 28 days to respond to your request. If additional information is needed before copies can be supplied, the 28-day time limit will begin as soon as the additional information has been received.

The 28 day time limit can be extended for two months for complex or numerous requests where the data controller (usually your Practice) needs more time to collate and supply the data. You will be informed about this within 28 days and provided with an explanation of why the extension is necessary.

When writing/calling, you should say if you:

• want a copy of your healthcare records as well as to see them (if you wish to see them your Doctor or member of staff will be present to assist you and explain any medical terms to you)
• want all or just part of them
• would like your records to be given to you in a specific format that meets your needs, and we will endeavour to accommodate your request
• If you request your records to be emailed, then we will secure you or your representative’s agreement (in writing or by email) that they accept the risk of sending unencrypted information to a non-NHS email address

You may also need to fill in an Application Form and give proof of your identity. The Practice has an obligation under the GDPR and DPA2018 to ensure that any information provided for the patient can be verified.

Please note we never send original medical records because of the potential detriment to patient care should these be lost

Who may apply for access?

1(1) Patients with capacity

Subject to the exemptions listed in paragraph 1(6) (below) patients with capacity have a right to access their own health records via a SAR. You may also authorise a third party such as a Solicitor to do so on your behalf. Competent young people may also seek access to their own records. It is not necessary for them to give reasons as to why they wish to access their records.

1(2) Children and young people under 18

Where a child is competent, they are entitled to make or consent to a SAR to access their record.

Children aged over 16 years are presumed to be competent. Children under 16 in England, Wales and Northern Ireland must demonstrate that they have sufficient understanding of what is proposed in order to be entitled to make or consent to an SAR.However, children who are aged 12 or over are generally expected to have the competence to give or withhold their consent to the release of information from their health records. In Scotland, anyone aged 12 or over is legally presumed to have such competence. Where, in the view of the appropriate health professional, a child lacks competency to understand the nature of his or her SAR application, the holder of the record is entitled to refuse to comply with the SAR. Where a child is considered capable of making decisions about access to his or her medical record, the consent of the child must be sought before a parent or other third party can be given access via a SAR (see paragraph 1 (3) below)

1(3) Next of kin

Despite the widespread use of the phrase ‘next of kin’, this is not defined, nor does it have formal legal status. A next of kin cannot give or withhold their consent to the sharing of information on a patient’s behalf. As next of kin they have no rights of access to medical records. For parental rights of access, see the information above.

1(4) Solicitors

You can authorise a Solicitor acting on your behalf to make a SAR. We must have your written consent before releasing your medical records to your acting Solicitors. The consent must cover the nature and extent of the information to be disclosed under the SAR (for example, past medical history), and who might have access to it as part of the legal proceedings. Where there is any doubt, we may contact you before disclosing the information. (England and Wales only – should you refuse, your Solicitor may apply for a court order requiring disclosure of the information. A standard consent form has been issued by the BMA and the Law Society of England and Wales. While it is not compulsory for Solicitors to use the form, it is hoped it will improve the process of seeking consent).

The Practice may also contact you to let you know when your medical records are ready. If your Solicitor is based within our area, then we may ask you to uplift them and deliver them to your Solicitor. This is because we can no longer charge for copying and postage, so we would appreciate your help if you can do this, or alternatively ask your Solicitor if they can uplift your medical records.

1(5) Supplementary Information under SAR requests

The purposes for processing data

The purpose for which data is processed is for the delivery of healthcare to individual patients. In addition, the data is also processed for other non-direct healthcare purposes such as medical research, public health or health planning purposes when the law allows.

The categories of personal data

The category of your personal data is healthcare data.

The organisations with which the data has been shared

Your health records are shared with the appropriate organisations which are involved in the provision of healthcare and treatment to the individual. Other organisations will receive your confidential health information, for example Digital or the Scottish Primary Care Information Resource (SPIRE) or research bodies such as the Secure Anonymised Linkage Databank (SAIL). (This information is already available to patients in our Practice privacy notices).

The existence of rights to have inaccurate data corrected and any rights of objection

For example, a national ‘opt-out’ model such as SPIRE etc.

Any automated decision including the significance and envisaged consequences for the data subject

For example, risk stratification.

The right to make a complaint to the Information Commissioner’s Office (ICO)

1(6) Information that should not be disclosed

The GDPR and Data Protection Act 2018 provides for a number of exemptions in respect of information falling within the scope of a SAR. If we are unable to disclose information to you, we will inform you and discuss this with you.

1(7) Individuals on behalf of adults who lack capacity

Both the Mental Capacity Act in England and Wales and the Adults with Incapacity (Scotland) Act contain powers to nominate individuals to make health and welfare decisions on behalf of incapacitated adults. The Court of Protection in England and Wales, and the Sheriff’s Court in Scotland, can also appoint Deputies to do so. This may entail giving access to relevant parts of the incapacitated person’s medical record, unless health professionals can demonstrate that it would not be in the patient’s best interests. These individuals can also be asked to consent to requests for access to records from third parties.

Where there are no nominated individuals, requests for access to information relating to incapacitated adults should be granted if it is in the best interests of the patient. In all cases, only information relevant to the purposes for which it is requested should be provided.

1(8) Deceased records

The law allows you to see records of a patient that has died as long as they were made after 1st November 1991.

Records are usually only kept for three years after death (in England and Wales GP records are generally retained for 10 years after the patient’s death before they are destroyed).

Who can access deceased records?

You can only see that person’s records if you are their personal representative, administrator or executor.

You won’t be able to see the records of someone who made it clear that they didn’t want other people to see their records after their death.

Accessing deceased records

Before you get access to these records, you may be asked for:

• proof of your identity
• proof of your relationship to the person who has died

Viewing deceased records

You won’t be able to see information that could:

• cause serious harm to your or someone else’s physical or mental health
• identify another person (except members of NHS staff who have treated the patient), unless that person gives their permission
• If you have a claim as a result of that person’s death, you can only see information that is relevant to the claim.

1(9) Hospital Records

To see your Hospital records, you will have to contact your local Hospital.

1(10) Power of attorney

Your health records are confidential, and members of your family are not allowed to see them, unless you give them written permission, or they have power of attorney.

A lasting power of attorney is a legal document that allows you to appoint someone to make decisions for you, should you become incapable of making decisions yourself.

The person you appoint is known as your attorney. An attorney can make decisions about your finances, property, and welfare. It is very important that you trust the person you appoint so that they do not abuse their responsibility. A legal power of attorney must be registered with the Office of the Public Guardian before it can be used.

If you wish to see the health records of someone who has died, you will have to apply under the Access to Medical Records Act 1990. You can only apply if you:

• are that person’s next of kin, are their legal executor (the person named in a will who is in charge of dealing with the property and finances of the deceased person),
• have the permission of the next of kin or have obtained written permission from the deceased person before they died.
• To access the records of a deceased person, you must go through the same process as a living patient. This means either contacting the Practice or the Hospital where the records are stored.

If you think that information in your health records is incorrect, or you need to update your personal details (name, address, phone number), approach the relevant health professional informally and ask to have the record amended. Some Hospitals and GP Surgeries have online forms for updating your details. If this doesn’t work, you can formally request that the information be amended under the NHS complaints procedure.

All NHS trusts, NHS England, CCGs, GPs, Dentists, Opticians and Pharmacists have a complaints procedure. If you want to make a complaint, go to the organisation concerned and ask for a copy of their complaints procedure.

Alternatively, you can complain to the Information Commissioner (the person responsible for regulating and enforcing the Data Protection Act), at:

The Information Commissioner’s Office (ICO)
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
Telephone: 01625 545745

If your request to have your records amended is refused, the record holder must attach a statement of your views to the record.

We believe that patients have a right to be heard, understood and respected. We work hard to be open and accessible to everyone. Occasionally, the behaviour or actions of individuals using our Practice makes it very difficult for us to deal with their issue or complaint. In a small number of cases the actions of individuals become unacceptable because they involve abuse of our staff or our process. When this happens we have to take action to protect our staff, and must also consider the impact of the individuals behaviour on our ability to do our work and provide a service to others. This Policy explains how we will approach these situations.

Section 1 – What actions does the Practice consider to be unacceptable?

People may act out of character in times of trouble or distress. There may have been upsetting or distressing circumstances leading up to us being made aware of an issue or complaint. We do not view behaviour as unacceptable just because a patient is forceful or determined. In fact, we accept that being persistent may sometimes be a positive advantage when pursuing an issue or complaint. However, we do consider actions that result in unreasonable demands on our Practice or unreasonable behaviour towards Practice staff to be unacceptable. It is these actions that we aim to manage under this Policy.

Section 2 – Aggressive or abusive behaviour

We understand that patients may be angry about the issues they have raised with the Practice. If that anger escalates into aggression towards Practice staff, we consider that unacceptable. Any violence or abuse towards staff will not be accepted. Violence is not restricted to acts of aggression that may result in physical harm. It also includes behaviour or language (whether verbal or written) that may cause staff to feel offended, afraid, threatened or abused. We will judge each situation individually, and appreciate individuals who come to us may be upset.

Language which is designed to insult or degrade, is derogatory, racist, sexist, transphobic, or homophobic or which makes serious allegations that individuals have committed criminal, corrupt, perverse or unprofessional conduct of any kind, without any evidence, is unacceptable.

We may decide that comments aimed not at us, but at third parties, are unacceptable because of the effect that listening or reading them may have on our staff.

Section 3 – Unreasonable demands

A demand becomes unacceptable when it starts to (or when complying with the demand would) impact substantially on the work of the Practice. Examples of actions grouped under this heading include:

• Repeatedly demanding responses within an unreasonable timescale
• Repeatedly requesting early supplies of medication
• Repeatedly requesting further supplies of stolen medication, without the required Police Incident number
• Repeatedly ordering prescriptions outwith the set timeframe
• Insisting on seeing or speaking to a particular member of staff when that is not possible
• Repeatedly changing the substance of an issue or complaint or raising unrelated concerns
• Repeatedly insisting on a course of medical treatment for which there is no clinical evidence
• Not ensuring that a review appointment is in place, prior to ongoing medication finishing
• An example of such impact would be that the demand takes up an excessive amount of staff time and in so doing disadvantages other patients

Section 4 – Unreasonable levels of contact

Sometimes the volume and duration of contact made to our Practice by an individual causes problems. This can occur over a short period, for example, a number of calls in one day or one hour. It may occur over the life-span of an issue when a patient repeatedly makes long telephone calls to us, or inundates us with letters or copies of information that have been sent already or that are irrelevant to the issue. We consider that the level of contact has become unacceptable when the amount of time spent talking to a patient on the telephone, or responding to, reviewing and filing emails or written correspondence impacts on our ability to deal with that issue, or with other Patients’ needs.

Section 5 – Unreasonable refusal to co-operate

When we are looking at an issue or complaint, we will ask the patient to work with us. This can include agreeing with us the issues or complaint we will look at; providing us with further information, evidence or comments on request; or helping us by summarising their concerns or completing a form for us.

Sometimes, a patient repeatedly refuses to cooperate and this makes it difficult for us to proceed. We will always seek to assist someone if they have a specific, genuine difficulty complying with a request. However, we consider it is unreasonable to bring an issue to us and then not respond to reasonable requests.

Section 6 – Unreasonable use of the complaints process

Individuals with complaints about the Practice have the right to pursue their concerns through a range of means. They also have the right to complain more than once about the Practice, if subsequent incidents occur. This contact becomes unreasonable when the effect of the repeated complaints is to harass, or to prevent us from pursuing a legitimate aim or implementing a legitimate decision. We consider access to a complaints system to be important and it will only be in exceptional circumstances that we would consider such repeated use is unacceptable – but we reserve the right to do so in such cases.

Section 7 – Examples of how we manage aggressive or abusive behaviour

• The threat or use of physical violence, verbal abuse or harassment towards the Practice staff is likely to result in a warning from the Senior Management Team. We may report incidents to the Police – this will always be the case if physical violence is used or threatened.
• Practice staff will end telephone calls if they consider the caller aggressive, abusive or offensive. Practice staff have the right to make this decision, to tell the caller that their behaviour is unacceptable and end the call if the behaviour persists.
• We will not respond to correspondence (in any format) that contains statements that are abusive to staff or contain allegations that lack substantive evidence. Where we can, we will return the correspondence. We will explain why and say that we consider the language used to be offensive, unnecessary and unhelpful and ask the sender to stop using such language. We will state that we will not respond to their correspondence if the action or behaviour continues and may consider issuing a warning to the Patient.

Section 8 – Examples of how we deal with other categories of unreasonable behaviour

We have to take action when unreasonable behaviour impairs the functioning of our Practice. We aim to do this in a way that allows a Patient to progress through our process. We will try to ensure that any action we take is the minimum required to solve the problem, taking into account relevant personal circumstances including the seriousness of the issue(s) or complaint and the needs of the individual.

Section 9 – Other actions we may take

Where a patient repeatedly phones, visits the Practice, raises repeated issues, or sends large numbers of documents where their relevance isn’t clear, we may decide to:

• limit contact to telephone calls from the patient at set times on set days, about the issues raised
• restrict contact to a nominated member of the Practice staff who will deal with future calls or correspondence from the patient about their issues
• see the patient by appointment only
• restrict contact from the patient to writing only regarding the issues raised
• return any documents to the patient or, in extreme cases, advise the patient that further irrelevant documents will be destroyed
• take any other action that we consider appropriate

Where we consider continued correspondence on a wide range of issues to be excessive, we may tell the patient that only a certain number of issues will be considered in a given period and ask them to limit or focus their requests accordingly. In exceptional cases, we reserve the right to refuse to consider an issue, or future issues or complaints from an individual. We will take into account the impact on the individual and also whether there would be a broader public interest in considering the issue or complaint further. We will always tell the patient what action we are taking and why.

Section 10 – The process we follow to make decisions about unreasonable behaviour

• Any member of  the Practice staff who directly experiences aggressive or abusive behaviour from a Patient has the authority to deal immediately with that behaviour in a manner they consider appropriate to the situation and in line with this Policy
• With the exception of such immediate decisions taken at the time of an incident, decisions to issue a warning or remove patients from our Practice List are only taken after careful consideration of the situation by the Senior Management
• Wherever possible, we will give a patient the opportunity to change their behaviour or actions before a decision is taken

Section 11 – How we let people know we have made this decision

When a Practice employee makes an immediate decision in response to offensive, aggressive or abusive behaviour, the patient is advised at the time of the incident. When a decision has been made by Senior Management, a patient will always be given the reason in writing as to why a decision has been made to issue a warning (including the
duration and terms of the warning) or remove them from the Practice list. This ensures that the patient has a record of the decision.

Section 12 – How we record and review a decision to issue a warning

We record all incidents of unacceptable actions by patients. Where it is decided to issue a warning to a patient, an entry noting this is made in the relevant file and on appropriate computer records. Each quarter a report on all restrictions will be presented to our Senior Management Team so that they can ensure the policy is being applied appropriately. A decision to issue a warning to a patient as described above may be reconsidered either on request or on review.

Section 13 – The process for appealing a decision

It is important that a decision can be reconsidered. A patient can appeal a decision about the issuance of a warning or removal from the Practice list. If they do this, we will only consider arguments that relate to the warning or removal, and not to either the issue or complaint made to us, or to our decision to close a complaint.

An appeal could include, for example, a patient saying that: their actions were wrongly identified as unacceptable; the warning was disproportionate; or that it will adversely impact on the individual because of personal circumstances.

The Practice Manager or a GP Partner who was not involved in the original decision will consider the appeal. They have discretion to quash or vary the warning as they think best. They will make their decision based on the evidence available to them. They must advise the patient in writing that either the warning or removal still applies or a different course of action has been agreed. We may review the warning periodically or on further request after a period of time has passed. Each case is different.

Attending a busy GP Practice as a patient can be an anxious and worrying time for you. We aim to make your time here as short and as simple as possible and the following should help to explain what you, as a patient, can expect from our staff and what we, the staff, can expect from you.

Your Doctor’s Responsibilities

• To treat you with respect and courtesy at all times
• To treat you as an individual, and to discuss with you the care and treatment we can provide
• To give you full information on the services we offer
• To give you the most appropriate care by suitably qualified staff
• To provide you with emergency care when you need it
• To refer you to a suitable Consultant when necessary
• To give you access to your health records, subject to any limitations in the law

Your Responsibilities as a Patient

• To treat all staff with respect and courtesy at all times
• To tell us if you are unsure about the treatment we are offering you
• To ask for a home visit only when you are unable to attend the Practice through illness or infirmity
• To request such a visit before 10am, if possible
• To ask for an out-of- hours visit only when necessary
• Please ensure that you order your repeat medication in plenty of time allowing 48 working hours for your request to be processed
• To keep to your appointment time (note: if you are more than 10 minutes late for your appointment you may not be seen)
• To notify us at least 24 hours prior to an appointment if you cannot attend
• To notify us of any changes to your personal details (e.g. name, address, telephone number, mobile numbers etc).

ZERO TOLERANCE

It is our policy to be helpful and polite to all our patients regardless of age, ethnic origin, disability, gender or sexual orientation. We expect the same courtesy from our patients. Discriminatory, unsocial, threatening, violent or abusive behaviour towards staff, other patients or the premises will not be tolerated. The Practice will take action in these circumstances, which may involve the Police and result in the removal of the patient from our Practice list.

In England, please refer to NHS Constitution your rights and responsibilities for further information.

The NHS operate a Zero Tolerance Policy with regard to violence and abuse and the Practice has the right to remove violent patients from their list with immediate effect, in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.

Where patients are disruptive and display aggressive and/or intimidating behaviour and refuse to leave the premises, staff are instructed to dial 999 for Police assistance, and charges may then be brought against these individuals.