Accessing someone else’s information

As a parent, family member or carer, you may be able to access services for someone else. We call this having proxy access. We can set this up for you if you are both registered with us.

To requests proxy access:

• collect a proxy access form from reception from 10am to 6pm

Linked profiles in your NHS account

Once proxy access is set up, you can access the other person’s profile in your NHS account, using the NHS App or website.

The NHS website has information about using linked profiles to access services for someone else.

Our Appointment Cancellation Policy

You can cancel your appointment for non-nhs treatment with us at any time by telephoning the Practice and selecting the option for cancellation of appointments.

You must notify the Practice at least 24 hours (1 working day) before your appointment.

This allows us to run the clinic efficiently so someone else may take your appointment if you need to cancel.

You do not have to give a reason for cancellation.

There may be times when appointments are cancelled by The Chislehurst Medical Practice, if this happens no fee will be charged and we will always give you as much notice as possible of cancellation.

If you miss your appointment and have failed to notify the Practice 1 working day before your appointment you will be charged an administration fee of £30.  This will be taken from the debit/credit card details you supplied upon booking your appointment.

Issued:            28 June 2011

Review:           June 2014

The Surgery prides itself in maintaining professional standards. For certain examinations during consultations an impartial observer (a “Chaperone”) will be required.

This impartial observer will be a practice nurse who is familiar with the procedure and be available to reassure and raise any concerns on your behalf. If a nurse in unavailable at the time of your consultation then your examination may be re-scheduled for another time.

You are free to decline any examination or chose an alternative examiner or chaperone. You may also request a chaperone for any examination or consultation if one is not offered to you. The GP may not undertake an examination if a chaperone is declined.

The role of a Chaperone:

• Maintains professional boundaries during intimate examinations.

• Acknowledges a patient’s vulnerability.

• Provides emotional comfort and reassurance.

• Assists in the examination.

• Assists with undressing patients, if required.

View our full Chaperone Policy

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 wish for the matter to be settled as quickly, and as amicably, as possible.

To pursue a complaint please contact The Patient Services Manager details of how to pursue a complaint are available in our complaints leaflet (see link below)

We are continually striving to improve our service. Any helpful suggestions/feedback would be much appreciated and a suggestion box is located in the lobby and on the ‘contact us’ page of this website.

Complaints leaflet

The Health Service Ombudsman in England

The Parliamentary and Health Service Ombudsman website contains detailed information on raising a complaint about any aspect of the NHS in England.

The practice complies with Data Protection and Access to Medical Records legislation. Identifiable information about you will be shared with others in the following circumstances:

• To provide further medical treatment for you e.g. from district nurses and hospital services.
• To help you get other services e.g. from the social work department. This requires your consent.
• When we have a duty to others e.g. in child protection cases anonymised patient information will also be used at local and national level to help the Health Board and Government plan services e.g. for diabetic care.

If you do not wish anonymous information about you to be used in such a way, please let us know.

Reception and administration staff require access to your medical records in order to do their jobs. These members of staff are bound by the same rules of confidentiality as the medical staff.

The surgery data security policies are available should you wish to view them. Please ask a staff member.

Chislehurst Medical Practice will make a reasonable charge for providing information. The charges will vary according to how the information is made available but will include staff time; administration costs; printing or photocopying costs; postage and any other out of pocket expenses incurred by the Practice in the provision of this information. Charges will be advised upon receipt of the request and must be agreed before the information is provided.

https://www.bma.org.uk/advice/employment/fees/why-gps-charge-fees

As a general guide, charges are as follows:

• Via the General Practice/Primary Care Trust Web Site – Free of charge, although any charges for Internet Service provider and personal printing costs would have to be met by the individual.
• For those without Internet access, a single print-out as on the website would be available by personal application at Chislehurst Medical Practice. However, requests for multiple printouts, or for archived copies of documents which are no longer accessible or available on the web, may attract a charge for the retrieval.

View our Fees for Private Services – In line with recommended BMA rates

The ICO has published a new Model Publication Scheme that all public authorities are required to adopt.

Model Publication Scheme – further information

In June 1997 the NHS published guidelines relating to the priority treatment of war pensioners, and this was updated in December 2007. From 1st January 2008, all service veterans should receive priority access to NHS care for any condition which is likely to relate to their military service. This is also subject to fair treatment of all other patients based on clinical needs. Several special mental health schemes have also been established.

The purpose of this protocol is to raise awareness of the requirements in relation to veterans and to summarise the DoH guidance on the subject.

Many conditions do not become obvious until after a veteran has left military service, therefore all GPs should be aware of the government wish to prioritise care of this nature and consider the military aspects of a condition when diagnosing and referring to secondary care.

The July 2015 update to the NHS Constitution ensures that, in line with the Armed Forces Covenant, military veterans are supported, treated equally and receive the same standard of, and access to, healthcare as any other UK citizen in the area they live.

For those with concerns about their mental health who may not present for some time after leaving Service, they should be able to access services with health professionals who have an understanding of Armed Forces culture. Veterans who have lost a limb as a result of their service will be able to access prostheses that reflect their clinical need. Veterans receive their healthcare from the NHS and are encouraged to identify themselves to their GP as member of the Armed Forces Community.

Full Military Veteran Policy Protocol

Minuteful Kidney service for patients with diabetes (and/or other conditions)

The data is being processed for the purpose of delivery of a programme, sponsored by NHS Digital, to monitor urine for indications of chronic kidney disease (CKD) which is recommended to be undertaken annually for patients at risk of chronic kidney disease e.g., patients living with diabetes. The programme enables patients to test their kidney function from home. We will share your contact details with Healthy.io to enable them to contact you and send you a test kit.

This will help identify patients at risk of kidney disease and help us agree any early interventions that can be put in place for the benefit of your care. Healthy.io will only use your data for the purposes of delivering their service to you. If you do not wish to receive a home test kit from Healthy.io we will continue to manage your care within the Practice.

Healthy.io are required to hold data we send them in line with retention periods outlined in the Records Management code of Practice for Health and Social Care.

Further information about this is available at: https://lp.healthy.io/minuteful_info/.

Advice Notice Regarding Administration of Over the Counter Medication in Nurseries & Schools

Non-prescription/over the counter (OTC) medications DO NOT need a GP signature/authorisation in order for school/nursery/child-minder to give it.

The ‘Statutory Framework for the Early Years Foundation Stage,’ which governs institutions looking after and caring for children used to state that all medicines needed to be prescribed by a doctor, nurse or pharmacist. This has recently been amended to only state that prescribed medication needs this in written format.

The British Medical Association has advised that MHRA licences for medicine and classifies them when appropriate as OTC, based on their safety profile. This is to enable access to those medicines without authorisation from a GP which applies to both inside and outside an educational environment.

It is appropriate for OTC medicines to be administered by a member of staff in the nursery or school, or self-administered by the pupil during school hours, following written permission by the parents s they consider necessary.

It is a misuse of GP time to take up an appointment just to acquire a prescription for a medicine just to satisfy the needs of a nursery/school. This was agreed and supported by the Department of Childrens, School and families who confirmed in a letter aFP10 is not required unless it is a prescription drug.

We hope that this explains as a Practice why we will not be providing letters/prescriptions for medication available over the counter, for example, calpol so that your child’s nursery/school/child-minder can administer them.

We are grateful for your understanding.

The Partners

We are committed to giving you the best service we can. This is possible if we work together. Please help us to help you.

What We Will Do For You

• Treat you with courtesy and respect at all times.
• Uphold your absolute right to confidentiality in all medical matters. Your personal health information will only be shared with other health professionals involved in providing your care.
• Ensure your right to information and answers to all questions about your health.
• Give you information on the services we offer.
• Give you the most appropriate care by suitably qualified staff.
• Provide you with emergency care when you need it.
• Refer you to a consultant when your GP thinks it necessary.
• Refer you for a second opinion when you and your GP agree it is needed.
• Give you access to your medical records subject to the limitations of the law.
• Give you a full and prompt reply to any complaints you make about our services.
• Guarantee you access to a health professional within 24 hours.

What You Can Do For Us

• Please treat us with respect and courtesy at all times. Physical or verbal abuse will not be tolerated.
• Please tell us if you are unsure about the treatment we are offering you.
• Please request out-of-hours calls only in a genuine acute emergency.
• Please allow two working days for repeat prescriptions.
• Please try to keep appointments made and let us know as early as possible if you cannot attend.
• Please help reduce waiting time by letting the receptionist know if treatment or advice is to be requested for more than one patient during a surgery consultation. Remember: only one patient per appointment.
• Please telephone after 10.30am for results of investigations.
• Please ensure visits to see a doctor are within surgery times.
• Please try to help yourself by choosing sensible lifestyle measures.
• Please let us know when you change your name, address or telephone number.

If we fail to meet these standards please tell us so that we can improve our services.

WHAT IS A PRIVACY NOTICE?

A privacy notice is a statement that discloses some or all of the ways in which the practice gathers, uses, discloses and manages a patient’s data. It fulfills a legal requirement to protect a patient’s privacy.
Specific privacy notices can be found by clicking on the relevant link on the right hand side of this page

WHY DO WE NEED ONE?

To ensure compliance with the General Data Protection Regulation (GDPR), The Chislehurst Medical Practice must ensure that information is provided to patients about how their personal data is processed in a manner which is:

• Concise, transparent, intelligible and easily accessible;
• Written in clear and plain language, particularly if addressed to a child; and
• Free of charge

WHAT IS THE GDPR?

The GDPR replaces the Data Protection Directive 95/46/EC and is designed to harmonise data privacy laws across Europe, to protect and empower all EU citizens’ data privacy and to reshape the way in which organisations across the region approach data privacy. The GPDR came into effect on 25 May 2018.

HOW DO WE COMMUNICATE OUR PRIVACY NOTICE?

At The Chislehurst Partnership, the practice privacy notice is displayed on our website, through signage in the waiting room, and in writing during patient registration (by means of this leaflet). We will:

• Inform patients how their data will be used and for what purpose
• Allow patients to opt out of sharing their data, should they so wish

WHAT INFORMATION DO WE COLLECT ABOUT YOU?

We will collect information such as personal details, including name, address, next of kin, records of appointments, visits, telephone calls, your health records, treatment and medications, test results, X-rays, etc. and any other relevant information to enable us to deliver effective medical care.

HOW DO WE USE YOUR INFORMATION?

Your data is collected for the purpose of providing direct patient care; however, we can disclose this information if it is required by law, if you give consent or if it is justified in the public interest. The practice may be requested to support research; however, we will always gain your consent before sharing your information with medical research databases such as the Clinical Practice Research Datalink or others when the law allows.

MAINTAINING CONFIDENTIALITY

We are committed to maintaining confidentiality and protecting the information we hold about you. We adhere to the General Data Protection Regulation (GDPR), the NHS Codes of Confidentiality and Security, as well as guidance issued by the Information Commissioner’s Office (ICO).

RISK STRATIFICATION

Risk stratification is a mechanism used to identify and subsequently manage those patients deemed as being at high risk of requiring urgent or emergency care. Usually this includes patients with long-term conditions, e.g. cancer. Your information is collected by a number of sources, including The Chislehurst Medical Practice; this information is processed electronically and given a risk score which is relayed to your GP who can then decide on any necessary actions to ensure that you receive the most appropriate care.

INVOICE VALIDATION

Your information may be shared if you have received treatment, to determine which Clinical Commissioning Group (CCG) is responsible for paying for your treatment. This information may include your name, address and treatment date. All of this information is held securely and confidentially; it will not be used for any other purpose or shared with any third parties.

OPT-OUTS

You have a right to object to your information being shared. Should you wish to opt out of data collection, please contact a member of staff who will be able to explain how you can opt out and prevent the sharing of your information; this is done by registering a Type 1 opt-out, preventing your information from being shared outside this practice.

ACCESSING YOUR RECORDS

You have a right to access the information we hold about you, and if you would like to access this information, you will need to complete a Subject Access Request (SAR). Please ask at reception for a SAR form and you will be given further information. Furthermore, should you identify any inaccuracies; you have a right to have the inaccurate data corrected.

WHAT TO DO IF YOU HAVE ANY QUESTIONS

Should you have any questions about our privacy policy or the information we hold about you, you can:

1. Contact the practice’s data controller at The Chislehurst Medical Practice. GP practices are data controllers for the data they hold about their patients[1]
2. Write to the data controller at The Chislehurst Medical Practice, 42 High Street, Chislehurst, Kent BR7 5AQ
3. Ask to speak to the practice manager.

The Data Protection Officer (DPO) for The Chislehurst Medical Practice is Claire Clements based at South East London

National Data Opt Out

https://digital.nhs.uk/services/national-data-opt-out/supporting-patients-information-and-resources

COMPLAINTS

In the unlikely event that you are unhappy with any element of our data-processing methods, you have the right to lodge a complaint with The Chislehurst Medical Practice. For further details, visit chislehurstmedicalpractice.co.uk.

We regularly review our privacy policy and any updates will be published on our website and on posters to reflect the changes. This policy is to be reviewed on 31/1/24

Please note that all telephone calls are recorded.

The Chislehurst Partnership works hard to provide the public and patients with clear and accurate information relating to how their personal information is used by the organisation and publishes Privacy Notices on this website to inform service users of these uses.

These Privacy Notices help us to ensure that the use of your data is Fair, Lawful and Transparent in line with our organisational responsibilities under Data Protection Law.

Each notice provides a clear explanation of

• • the purpose for processing your data

• • the contact details for us and our Data Protection Officer

• • the lawful basis for processing your data

• • who your data may be shared with

• • your rights to object to the processing of your data

• • your rights to access your personal data and where appropriate to have it corrected

• • how long your data will be kept for

• • your right to complain to the Information Commissioners Office about how your data is processed

The Privacy Notices are designed to be Concise, Clear and Intelligible.  However, we would always welcome your questions regarding the use of your data if you feel this does not provide you with enough information or you would prefer any of the notices to be explained to you.

New updated data collection by NHS from GP Practices replaces the old GPES system from 1.7.21. Please use the link below for more information.

https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-collections/general-practice-data-for-planning-and-research/advice-for-the-public

Privacy Notice – Safeguarding

Privacy Notice – HR, Staffing, Employment, Recruitment and Training

Privacy Notice – Payments

Privacy Notice – Research

Privacy Notice – NHS Digital

Privacy Notice – Reporting Gunshot and Knife Wounds

Privacy Notice – Patient Participation or Engagement Group

Privacy Notice – Public Health

Privacy Notice – Patient Communications

Privacy Notice – National Screening and Reporting Programs

NEL Privacy Notice – National Fraud Initiative

Privacy Notice – Minuteful Kidney service for patients with diabetes

Privacy Notice – Litigations & Claims

Privacy Notice – The Driving and Licencing Authority (DVLA)

Privacy Notice – Direct Care -GP Connect

Privacy Notice – Direct Care

Privacy Notice – CQC

Privacy Notice – Direct Care – Emergencies

Privacy Notice – Access to Medical Records

Privacy Notice – Complaints, SARs and FOI

Privacy Notice – Covid-19 clinical risk assessment tool

Privacy Notice – How we use your information

Privacy Information Leaflet Patients

The Practice will undertake an access audit on an annual basis in order to determine that our services for the disabled remain current and appropriate.

 All staff are offered disability training within six months of appointment to ensure that they are able to assist with wheelchairs, partially sighted and blind patients as well as others with special needs.

Patient facilities include:-

• large font Practice Leaflet
• Clear signage
• Access for guide dogs and others assisting special needs

Disabled patients are able to make appointments using the online system as well as the telephone service and face to face access at reception.

Anyone requiring further information regarding our facilities and access can contact the Practice Manager on 020 8295 2464 or in writing.

Learning Disabilities

The Practice has a register of patients with learning disabilities. More information can be found here

What is a Learning Disability?

Don’t Miss Out on Joining the Learning Disability Register

DISABILITY ACCESS POLICY (Including Guide Dog Policy)

Introduction

This document provides the basis for the practice in assessing the needs of its disabled patients, or those with mobility or other requirements to ensure that their access to services is, as far as practicable, maximised.

New Patients

The practice website will contain a “text only” version of the information presented to aid access by the partially sighted.

The practice website will contain a section for those patients with a disability outlining the facilities available at the Practice and their ease of access to the building based on the findings of the Disability Access Audit (DDA). Consideration will be given to including photographs of relevant access points and facilities.

Disabled patients will be advised on new registration that they are able to telephone the practice from outside on arrival if they require any assistance in accessing the building or its services. Staff will be trained in the appropriate way to help with wheelchairs, partially or non-sighted patients, or those with other special needs.

Clinical staff will assist patients attending for a New Patient Visit including collecting them from the waiting area and escorting them to their consultation as appropriate. Patients benefiting from this will have a major alert message placed on the clinical system record.

Accessible Information Standard (NHS England)

Conforming to the Accessible Information Standard, part of the Health and Social Care Act 2012, is a requirement for practices in England as of July 31, 2016. It has been put in place to ensure people who have a disability, impairment or sensory loss are able to access and understand any information or communication support they need. The practice works to ensure that patients and service users, and their carers and parents, can access and understand the information they are given.

This includes making sure that people get information in different formats if they need it, for example in large print, braille, easy read or via email. The practice will also make sure that people get any support with communication that they need, for example support from a British Sign Language (BSL) interpreter, deafblind manual interpreter or an advocate.

The practice will:

• Ask people if they have any information or communication needs, and find out how to meet their needs.
• Record those needs clearly and in a set way.
• Highlight or flag the person’s file or notes so it’s clear that they have information or communication needs, and how to meet those needs.
• Share information about people’s communication needs with other providers of NHS and adult social care, when they have consent or permission to do so.
• Take steps to ensure that people receive information which they can access and understand, and receive communication support if they need it.

Training and Skills

The practice will keep a record of training courses available, for example signing courses, disability awareness, or patient handling, and will support staff willing to attend these. The Practice will seek to have a member of staff on hand with these skills as far as practicable and will maintain a suitable skills register as part of the routine training needs analysis.

All staff will be offered disability training as part of induction skills training within 6 months of recruitment.

Patient Facilities

The practice will:

• Provide large font practice leaflets
• Promote the Induction Loop system and provide staff training. Loop signs will be clearly displayed in Reception and patients will be asked to indicate if they wish to use this
• Loop refresher training will take place at least annually and within 1 month of new recruit induction.
• Ensure signage is clear and non-obstructive
• Allow guide or other assistance dogs into the premises
• Offer private room facilities if available, for patients who may have communication, reading, or writing difficulties
• Provide a spoken CD version of the practice leaflet
• Provide a spoken CD version of its website information
• Allow disabled patients to make appointments by unusual methods, e.g. text messages, on line booking, or letter. The practice will respond to these requests using the method most appropriate to the needs of the patient.

Checking and Recording

The practice will audit its facilities on an annual basis or at significant changes to the premises (see below).

The results will be recorded within a file maintained for the purpose along with any action plans or other documentation required. The file will maintain a summary report of the access facilities available to disabled patients as detailed above.

The practice will seek to establish contact with appropriate disabled patients with a view to an annual consultation with them regarding disability access, at which time the file will be provided to them for assessment and comments.

GUIDE DOGS / ASSISTANCE DOGS / HEARING DOGS POLICY

Introduction

It is unlawful for service providers to treat disabled people less favourably for a reason related to their disability, and “reasonable adjustments” for disabled people, such as providing extra help or making changes to the way they provide their services are now required. This includes adjustments to physical features of premises to overcome physical barriers to access for people with disabilities, and facilitating such visitors to use services.

The nature of general practice is such that guide dog / hearing dog (“assistance” dog) access is common and desirable. The purpose of this policy is to set out a few simple principles for dogs on the premises. It is not intended to cover the use of assistance dogs in relation to employees of the practice, which would encompass a wider range of disability employment law considerations.

General Considerations

• The practice welcomes assistance dogs. This includes dogs in training where a “walker” is in control of the dog rather than a disabled owner.
• The practice will manage the presence of assistance dogs without recourse to the owner and will pay particular attention to infection control and housekeeping whilst dogs are on the premises
• Physical contact with a dog by clinical staff will be resisted during consultations or examinations, and whilst a general surgery is in progress
• Hand washing or alcohol hand gel will be used by staff after any physical contact with a dog, whether during a consultation or not
• Care will be taken by clinical staff to identify other patients in the surgery list for that session who have been identified as potentially being adverse clinically to the presence of dogs. This will include patients who:
  • are allergic to dogs
  • are immunosuppressed
  • are phobic to dogs
  • have another medical reason.

Consideration will be given to allowing them to wait, or be seen, in an alternative room.

• Cleaning staff will be advised to pay particular attention to a room known to have accommodated a dog that day
• In the event of an incident involving a dog, a significant event record will be created where necessary.
• Owners of assistance dogs will be given the opportunity to “tour” the practice and the grounds with their assistance dog. This will enable the dog to become familiar with routes throughout the building, including those routes seldom used. This will include routes to and from:
  • Public / disabled toilets
  • Through fire exits and on to assembly areas
  • To usual GP and nurse rooms
  • Accessing and exiting the building by normal routes

 The opportunity for “refresher” practice will be offered on a regular basis

As part of the high level of training an assistance dog receives, there are unlikely to be any incidents giving rise to special concern, and the following aspects of these dogs on the premises are likely to be standard behaviour for these animals:

• Dog will remain on a lead and in close contact with the owner
• The dog will usually lie quietly with the owner when waiting to see a clinician and is trained to behave well in public places
• Dog is unlikely to foul any area not within its usual habit and is trained to go to toilet on command, and will be well-groomed (minimal loose hair)
• The dog will be in good health, physically fit, with vaccinations and care programme up to date
• The dog will wear a special identifying harness and collar tag
• Equal Opportunities Commission

Resources

• Equality Northern Ireland Equality and Human rights Commission – Making reasonable adjustments
• Employers and Service Providers – The DRC
• NHS Scotland Access Audit Toolkit: http://www.hfs.scot.nhs.uk/publications/access-audit-checklist-feb-2000.pdf‎

Text Messaging has become a key element in assisting with the delivery of care.

The Practice will opportunistically collect patient mobile telephone numbers as an alternative means of communication.

Patients over the age of 13 years must have an individual number attached to their record.

From March 2018 patients will be requested to consent specifically to the use of their mobile number for the purposes of health campaigns, health promotion and appointment reminders using either the patient registration form, a text message response or via a form that can be collected from Reception.

Patients MUST contact the practice if they change their mobile phone number. This will ensure there is no possibility of their confidentiality being breached.

The text messaging facility will be advertised to patients using:

• Patient in-house monitor displays
• Practice website
• Patient information leaflet
• The use of a sign-up form displayed within the leaflet rack
• Opportunistic encounters by reception staff and the clinical team

Text Messaging will utilise iplato and accurx .

Accurx can provide a secure facility for patients to respond to text messaging. Requests from clinicians for information/photos when agreed with the Practice will supply a secure response link.

Text messages will be used for:

• Appointment reminders direct from the clinical system
• Urgent messages regarding unavoidable appointment changes
• Requests from clinicians for information/photos where relevant to your care
• Links to connect to a video consultation
• Flu or other vaccination clinics for targeted eligible populations
• Chronic disease review invitations
• Blood pressure and cholesterol monitoring
• Smoking status updates
• Requests to contact the practice to arrange appointments or services. Test results will not be conveyed using text messages .Any information within the text message stating the reason for it being sent will be kept to a minimum.

If you prefer NOT to receive text reminders but still wish us to hold your mobile details please advise Reception.

The Chislehurst Partnership is aware from time to time that derogatory comments about the Practice and staff are posted on social media.

If any such posts are brought to our attention they could be viewed as a potential breakdown in the doctor-patient relationship, and may result in you being removed from our list.

We welcome all feedback, as it gives us the opportunity to review the services that we provide and where necessary or appropriate, make any changes or improvements. However, we would ask that rather than posting derogatory or hurtful comments about the practice or staff on social media, or if there are any aspects of the service that you are not entirely happy with, please speak to us about this or put your comments to us in writing giving us the opportunity to respond.

YOU WOULD NOT EXPECT TO READ DEROGATORY COMMENTS ABOUT YOURSELF AT YOUR OWN PLACE OF WORK, NEITHER DO WE.

INTRODUCTION

The Practice takes it very seriously if a member of staff is treated in an abusive or violent way.

The Practice supports the government’s ‘Zero Tolerance’ campaign for Health Service Staff. This states that GPs and their staff have a right to care for others without fear of being attacked or abused. To successfully provide these services a mutual respect between all the staff and patients has to be in place.

Our Practice staff aim to be polite, helpful, and sensitive to all patients’ individual needs and circumstances. They would respectfully remind patients that very often staff could be confronted with a multitude of varying and sometimes difficult tasks and situations, all at the same time. The staff understand that ill patients do not always act in a reasonable manner and will take this into consideration when trying to deal with a misunderstanding or complaint.

However, aggressive behaviour, be it violent or abusive, will not be tolerated and may result in you being removed from the Practice list and, in extreme cases, the Police being contacted.

In order for the practice to maintain good relations with their patients the practice would like to ask all its patients to read and take note of the occasional types of behaviour that would be found unacceptable:

• Using bad language or swearing at practice staff
• Any physical violence towards any member of the Primary Health Care Team or other patients, such as pushing or shoving
• Verbal abuse towards the staff in any form including verbally insulting the staff
• Racial abuse and sexual harassment will not be tolerated within this practice
• Persistent or unrealistic demands that cause stress to staff will not be accepted. Requests will be met wherever possible and explanations given when they cannot
• Causing damage/stealing from the Practice’s premises, staff or patients
• Obtaining drugs and/or medical services fraudulently
• We ask you to treat your GPs and their staff courteously at all times.
• Inappropriate posts on Social Media including (but not limited to) bullying/threatening or undermining remarks about staff
• Inappropriate Communications

The Legal Position

As a responsible employer, the Practice has a duty as a provider of NHS healthcare to protect the health, safety and welfare of staff under the Health & Safety at Work Act. This includes a risk assessment of violence towards staff and taking steps to mitigate this under the Management of Health and Safety at Work Regulations 1999.

Staff members who are victims of violent conduct or assault have the right to sue their employers for compensation if the risk of violence could have been reduced or removed completely, but the employers did not act upon this information.

Examples of security issues:

• Security of grounds and car parking
• Security of premises – incl. storage, “out of hours”
• CCTV
• Cash and staff – storing, handling and transferring
• Security Systems
• Security of equipment – medical devices, computers
• Communication of national security alerts
• Information records
• Contingency planning.
• Security of employees
• Staff working on their own
• (Staff can be lone workers when making domiciliary visits or within a hospital department e.g. out of hours)This list is not exhaustive. For example a lone working risk assessment must provide the lone worker full knowledge of the hazards and risks to which he or she is being exposed and what they must need to do will something go wrong. Other responsible persons must know the whereabouts of lone workers and what they are doing; Violence at Work

The practice acknowledges that there may be instances where violence and / or aggression forms part of a patient’s illness. In these circumstances, the issue will be discussed with the patient and form part of their care planning.

This information will be recorded in the patient’s medical record and flagged to ensure that members of staff are aware. In addition, where deemed necessary, appropriate support will be put in place, e.g. staff members do not see the patient alone.

Definition of Physical and Verbal Abuse and Violence:

Physical and verbal abuse includes:

• Unreasonable and / or offensive remarks or behaviour / rude gestures / innuendoes
• Sexual and racial harassment
• Threatening behaviour (with or without a weapon)
• Actual physical assault (whether or not it results in actual injury) includes being pushed or shoved as well as being hit, punched or attacked with a weapon, or being intentionally struck with bodily fluids or excrement.
• Attacks on partners, members of staff or the public
• Discrimination of any kind
• Damage to an employee’s or employer’s property

Social Media Policy

The Practice takes any bullying/threatening or undermining remarks about staff on social media very seriously and this will not be tolerated. Any such action may result in reporting the patient to the police in regard to sections 2, 2a, 4 or 4a Protection from Harassment Act 1997, or offences under the malicious Communications Act 1988 and Communications Act 2003.

Those accused of an offence under the malicious Communications Act 1988 and Communications Act 2003 are unlikely to be familiar with the legal system and unaware that what may have been thought of as an innocent message on social media can have life-changing consequences, including imprisonment.

• Potential Offences Under The Malicious Communications Act 1988 Under this area of law communication is defined as any person who sends a letter, electronic communication or article of any description to another person which conveys the following;
• A message that is indecent or grossly offensive
• A threat
• Information that is false and is known or believed to be false by the sender

This includes any article or electronic communication that is in whole, or part, of an indecent or grossly offensive nature The above only applies if the senders purpose or one of their purposes was to cause distress or anxiety to the recipient. The mental state of the sender is a key element of the offence and the prosecution must prove their case beyond reasonable doubt. In other words they must make the court or jury sure that a person intended, or one of the intentions was to cause distress or anxiety. A person found guilty could face a prison term not exceeding 2 years on indictment or up to 12 months custody at the Magistrates Court

• Potential Offences Under The Communications Act 2003
• A person sending any public electronic communications network a message that is grossly offensive or of an indecent, obscene or menacing character.
• A person causes any such message or content to be sent. A person can also be found guilty of an offence under the Communications Act if they intend to cause annoyance, inconvenience or needless anxiety to another by
• Sending a message that is known to be false via a public electronic communications network;
• Causing such a message to be sent; or
• Persistently making use of a public electronic communications network

Similar to offences under the Malicious Communications Act, one offence under the Communication Act 2003 requires the content of the message to be grossly offensive, indecent obscene or if a menacing character. However the mental element of the offence is broader as it includes circumstances where a person should have awareness or recognition that sending the message may create insult or risk of insult to the person to whom the message relates. In addition an offence will be committed under Section 127(2) of the Act where a person had specific intent to cause annoyance, inconvenience or anxiety with a message that is false.

The Practice supports the Zero Tolerance stance adopted by the NHS.

The HSE (Health and Safety Executive) defines work-related violence as:

“Any incident, in which a person is abused, threatened or assaulted in circumstances relating to their work”.

Violence and aggression towards a person may also be defined as:

“A physical contact with another person which may or may not result in pain or injury. The contact is uninvited and is an attempt to cause harm, injury or to intimidate. Non-physical aggression includes the use of language which causes offence or threatens the safety of a member of staff”.

Under the Health and Safety at Work Act 1974, the practice will also undertake the following measures to ensure a safe work environment:

• Carry our risk assessments to assess and review the duties of employees, identifying any “at risk” situations and taking appropriate steps to reduce or remove the risk to employees, particularly if they are working alone.
• Assess and review the layout of the premises to reduce the risk to employees where physically possible.
• Assess and review the provision of personal safety equipment, such as alarms.
• Develop surgery policies, procedures and guidelines for dealing with physical and verbal abuse.
• Provide support and counselling for victims, or refer to suitably qualified health professionals.
• Make employees aware of risks and ensure employee involvement in suitable training courses.
• Record any incidents on a Significant Event form and take any remedial action to ensure similar incidents are prevented in future.

REMOVAL FROM THE PRACTICE LIST

The removal of patients from our list is an exceptional and rare event and is a last resort in an impaired patient-practice relationship. We value and respect good patient-doctor relationships based on mutual respect and trust. When trust has irretrievably broken down, the practice will consider all factors before removing a patient from their list, and communicate to them that it is in the patient’s best interest that they should find a new practice. An exception to this is in the case of immediate removal on the grounds of violence e.g. when the Police are involved.

Removing other members of the household

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 to ensure the safety of practice staff.

The prospect of visiting patients that is the residence of a relative who is no longer a patient of the practice, or the risk of being regularly confronted by the removed patient, may make it difficult for the practice to continue to look after the whole family. This is more likely where the removed patient has been violent or displayed threatening behaviour, and keeping the other family members could put doctors or their staff at risk.