Practice Policies

We will always respect your privacy, dignity and your religious and cultural beliefs particularly when intimate examinations are advisable – these will only be carried out with your express agreement and you will be offered a chaperone to attend the examination if you so wish.

You may also request a chaperone when making the appointment or on arrival at the surgery (please let the receptionist know) or at any time during the consultation.

You can be assured that anything you discuss with any member of the surgery staff, whether doctor, nurse or receptionist, will remain confidential. Even if you are under 16, nothing will be said to anyone, including parents, other family members, care workers or teachers, without your permission. The only reason why we might want to consider passing on confidential information without your permission would be to protect either you or someone else from serious harm. In this situation, we would always try to discuss this with you first.

If you have any worries or queries about confidentiality, please ask a member of staff.

If you would like to discuss matters of a confidential nature, either with our receptionists or a member of the dispensary team, we have a side room available in reception for this purpose.

We need to hold personal information about you on our computer systems and in paper records to help us to look after your health needs, and your doctor is responsible for their accuracy and safe-keeping. Please help to keep your record up to date by informing us of any changes to your circumstances.

Doctors and staff in the practice have access to your medical records to enable them to do their jobs. From time to time information may be shared with others involved in your care if it is necessary. Anyone with access to your record is properly trained in confidentiality issues and is governed by both legal and contractual duty to keep your details private.

All information about you is held securely and appropriate safeguards are in place to prevent accidental loss.

In some circumstances we may be required by law to release your details to statutory or other official bodies, for example if a court order is presented, or in the case of public health issues. In other circumstance you may be required to give written consent before information is released – such as for medical reports for insurance, solicitors etc.

To ensure your privacy, we will not disclose information over the telephone or fax unless we are sure that we are talking to you. Information will not be disclosed to family, friends or spouses unless we have prior written consent, and we do not, leave messages with others.

You have a right to see your records if you wish. Please ask at reception if you would like further details about our patient information leaflet. An appointment may be required. In some circumstances a fee may be payable.

This practice is committed to preserving, as far as is practical, the security of data used by our information systems. This means that we will take all reasonable actions to;

Maintain the Confidentiality of all data within the practice by:

• Ensuring that only authorised persons can gain access to our systems
• Not disclosing information to anyone who has no right to see it

Maintain the integrity of all data within the practice by:

• Taking care over input
• Ensuring that all changes are reported and monitored
• Checking that the correct record is on the screen before updating
• Reporting all apparent errors and ensuring that they are resolved

Maintain the availability of all data by:

• Ensuring that all equipment is protected from intruders
• Ensuring that backups are taken at regular, predetermined intervals
• Ensuring that contingency is provided for possible failure or equipment theft and that any such contingency plans are tested and kept up to date

Additionally we will take all reasonable measures to comply with our legal responsibilities under:

• The Data Protection Act (2018)
• The Health and Safety at Work Act (1992)
• The Access to Health Records Act (1990)

The following IT systems are in use at the practice:

• Referral Management (using NHS numbers in referrals)
• Electronic Appointment Booking (the facility to book routine appointments online and, similarly, to cancel appointments
• Online booking of repeat prescriptions
• Summary Care Record (uploading details of your current medication and allergies to the national “spine” so that these are available for doctors involved in your care elsewhere)
• GP to GP transfers (the electronic transfer of records from practice to practice when you re-register
• Patient Access to records (the facility to view your medical records online).

If you are not already registered for online access and would like to be please complete our online form.

If you would like access to your medical records enabled or would like to opt out of the local or national summary care record, please contact reception.

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 Practice Managers, 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 ICB / PCSE 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 Practice Managers will write to the patient and explain the reasons for removal. See Appendix 1 for sample text.

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 Practice Managers 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.  ( THIS MAY NOT BE POSSIBLE IN SMALL PRACTICES)
• 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 Practice Managers 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 / Practice Manager.

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.

Our purpose is to provide people registered with the Practice with personal health care of high quality and to seek continuous improvement on the health status of the Practice population overall. We aim to achieve this by developing and maintaining a happy sound Practice which is responsive to people’s needs and expectations and which reflects whenever possible the latest advances in Primary Health Care.

We will do this by:

• Providing the highest standard of Medical Care and being committed to our patients needs
• Focusing on prevention of disease by promoting health and wellbeing and offering care and  advice to our patients
• Encouraging patients to consider lifestyle changes that would improve their general health and well-being
• Gaining consent where appropriate for any treatment or investigation
• Working in partnership with our patients, their families and carers towards a positive experience and understanding, involving them in all aspects of their healthcare and ensure they understand any treatment or investigation being offered
• Working in partnership with other agencies to tackle the causes of, as well as providing the treatment for ill health and where appropriate involving other professionals in the care of our patients
• Encouraging our patients to communicate with us by joining our Patient Group, talking to us, participating in surveys, and feeding back on the services we offer
• Acting with integrity and complete confidentiality
• Being courteous, approachable, friendly and accommodating
• Continuous improvement as a patient-centered service through decision-making and communication
• Providing a multidisciplinary healthcare team with a wide mixture of skills in order to provide excellent service provision and use of resources.
• Ensuring all healthcare professionals at the practice meet the required standards and maintain a programme of continuous professional development through continuous learning and training
• Monitoring and auditing services to improve our healthcare services
• Ensuring effective and robust information governance systems
• Having robust systems in place, which are reviewed regularly for the production of prescriptions, medication handling and safe storage of stocked medicines.
• Ensuring safe and effective services and environment
• Rigorously maintaining a high level of equipment cleanliness and generally throughout the premises to protect patients and staff against infection
• Regularly inspecting and maintaining equipment and premises to ensure they are safe and fit for purpose and take action to remedy any issues which arise
• Ensuring relevant staff are trained and competent to use of any equipment required for them to carry out their job
• Undertaking the necessary employment checks and following local procedures to protect vulnerable children and adults
• Maintaining and promoting an organisational culture where all staff and patients are treated with respect and dignity.
• Recruiting, retaining and developing a highly motivated and appropriately skilled workforce
• Guiding our employees to ensure that equality and diversity issues are at the heart of everything the practice does
• Ensuring all members of staff understand their roles and responsibilities
• Providing staff with the support, training, equipment and a safe environment to aid them in performing their job to the best of their ability.
• Considering, investigating and responding to complaints and suggestions in accordance to NHS guidelines.
• Having a zero tolerance of all forms of abuse
• Planning for and maintaining access to the practice’s services in the event of foreseeable threats which may affect service availability such as weather, failure of utilities or equipment, staff availability and damage to premises.
• Checking the accuracy and relevance of information being held by the practice by regularly auditing all aspects of record keeping from patient records to personnel files
• Operating on a financially sound basis

The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the 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.