Practice Policies & Patient Information
Access Policy
In accordance with the Data Protection Act 1998 and Access to Health Records Act, patients may request to see their medical records.
Such requests should be made through the site manager and may be subject to an administration charge.
No information will be released without the patient consent unless we are legally obliged to do so.
Complaints Policy
What is a complaint?
Its’ recognised that this is not always easy to determine, however, it is usually when someone voices their dissatisfaction with the service provided and where a response is required.
Common causes of Complaint:
- Clinical care and treatment
- Failure to diagnose
- Attitude of health professional and/or staff
- Delay to visit/Unable to get an appointment/Not being seen on time
- Failure to refer
- Poor communication
- Breach of Confidentiality
- Practice Administration
What do Patients Want?
- To be listened to, to have their concerns taken seriously
- An apology
- An explanation of the events
- Reassurance that things will be put right
Who Can Complain?
- Anyone who is receiving or has received NHS treatment or services including minors i.e. under 16.
What to do if a patient makes a complaint:
Some complaints can be dealt with on the spot e.g. prescription not ready or sent to chemist in error, forms or letters not ready for collection etc.
Apologise to the patient and show empathy (let them know that you understand how they feel). Remember to stay calm and speak softly even if the patient is abusive.
Collect as much information as you can about the patient (name address telephone etc.) and their problem. Confirm the information with the patient.
Investigate the problem in an effort to try to identify possible solutions and if possible provide the patient with an explanation.
Agree with the patient a way forward. This can sometimes be difficult if patients are very upset and are not happy with any of your suggestions in which case it may useful to ask the patient how they would like to see the matter resolved.
Ensure that you follow through any agreed action and check that the patient is happy with the solution.
If you are unable to satisfy the patient please make the patient aware of the PALS (Patient Advice and Liaison Service) who may be able to help, particularly useful for patients who do not wish to make a formal complaint.
Provide the patient with a copy of the NHS Complaints Procedure, which can be located in the red complaints/suggestions file in reception.
Record the incident in the red complaints/suggestions file.
We can learn from our mistakes. The complaints will be reviewed and used as a tool to improve our services.
Complaints that are Not Easy to Resolve:
These include more serious complaints such as, complaints against a GP or member of staff, breach of confidentiality, clinical matters etc. These patients should be given a copy of the NHS complaints procedure and referred to the Practice Manager. If the complaint is about the practice manager, please refer to the Senior Partner.
Complaints Procedure
The practice operates an internal complaints procedure known as local resolution. The practice aims to give you a quick but thorough response to your complaint.
Anyone who is receiving or has received NHS treatment or services can make a complaint.
If you are unable to make your complaint yourself, then someone else such as a relative or a friend can complain for you. If you are aged 16 or over your representative will need your written consent.
If you are complaining on behalf of a patient that has died you will need to provide a letter of administration or proof that you are the executor of the will.
It is important to make your complaint as soon as possible after the problem arises.
- Complaints may be made verbally or in writing to the Practice Manager.
- Your complaint will be recorded and acknowledged within 3 working days.
- Your complaint will be investigated thoroughly and fairly.
- As per the NHS England Complaints Resolution guidelines;
- Inline with the NHS England’s complaints policy, we aim to respond within 40 working days. If no response is provided within six months, we will write to the complainant to explain the reasons for the delay and outline when they can expect to receive the response. At the same time, we will notify the complainant of their right to approach the PHSO without waiting for local resolution to be completed.
If we are unable to satisfy the complainant through local resolution, or the complainant is unhappy with our response, they have the right to take their complaint to the Health Service Ombudsman. The Ombudsman is independent of the government and the NHS. You can contact their helpline on 03450154033, email phso.enquiries@ombudsman.org.uk, fax 03000614000 or via post Millbank Tower, Millbank, London, SW1P 4QP. Further information about the Ombudsman is available at www.ombudsman.org.uk
Changes to making complaints from 1st July 2023
from 1 July 2023, the way members of the public make a complaint about primary care services to the commissioner is changing.
There are two ways members of the public can make a complaint:
- You can complain to the healthcare provider: for example, a GP surgery
- You can complain to the commissioner of the service
West London instead of NHS England.
They will need to do this by:
- Telephone: 020 3350 4567 (This is an automated service. Please leave a
message requesting a call back)
- E-mail: nhsnwl.complaints@nhs.net
- Writing to us at: Complaints Manager, NHS North West London, 15 Marylebone
Road, London NW1 5JD
Confidentiality & Medical Records
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 services 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 Policy makers and Government plan services e.g. for diabetic care.
If you do not wish that anonymous information about you 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.
DNA (Did not attend appointments) Policy
Patients failing to attend appointments is a huge and avoidable waste of valuable GP and Nurse appointments. Every year, on average, over 300 hours of appointment time is lost at the practice due to patients who “did not attend”; this is equivalent to us losing 1 hour of GP clinic every single day. Please help us to avoid this by cancelling your appointment in good time (preferably 24 hours ahead) so that we may offer your appointment to another patient who needs it. Mistakes do happen and the Practice understands that appointments can be forgotten about or overlooked. In such cases, the Practice will take into account the reason given by Patients. Patients not attending their appointments has serious implications on the healthcare system and on those who genuinely need appointments but do not get because of other people not attending their appointments. We have a strict policy for those who do not attend their pre-booked appointment and do not bother to cancel or inform the practice of their non attendance. To avoid all of this please ensure that you cancel your appointment in good time (and an absolute minimum of an hour before the appointment time. Anything cancelled after this time could still count as a DNA).Did Not Attend (DNA) Policy
The effect of DNAs is:
You can cancel your appointment in the following ways:
Important information when you miss your appointment (our DNA policy)
Freedom of Information
Information about the General Practitioners and the practice, required for disclosure under this act, can be made available to the public. All requests for such information should be made to the site manager.
General Practice Transparency Notice for GPES Data for Pandemic Planning and Research (COVID-19)
This practice is supporting vital coronavirus (COVID-19) planning and research by sharing your data with NHS Digital.
The health and social care system is facing significant pressures due to the coronavirus (COVID-19) outbreak.
Health and care information is essential to deliver care to individuals, to support health, social care and other public services and to protect public health.
Information will also be vital in researching, monitoring, tracking and managing the coronavirus outbreak.
In the current emergency it has become even more important to share health and care information across relevant organisations.
This practice is supporting vital coronavirus planning and research by sharing your data with NHS Digital, the national safe haven for health and social care data in England.
How NHS Digital will use and share your data
NHS Digital will analyse the data they collect and securely and lawfully share data with other appropriate organisations, including health and care organisations, bodies engaged in disease surveillance and research organisations for coronavirus response purposes only.
These purposes include protecting public health, planning and providing health, social care and public services, identifying coronavirus trends and risks to public health, monitoring and managing the outbreak and carrying out of vital coronavirus research and clinical trials.
The British Medical Association, the Royal College of General Practitioners and the National Data Guardian are all supportive of this initiative.
NHS Digital has various legal powers to share data for purposes relating to the coronavirus response.
It is also required to share data in certain circumstances set out in the COVID-19 Direction and to share confidential patient information to support the response under a legal notice issued to it by the Secretary of State under the Health Service (Control of Patient Information) Regulations 2002 (COPI Regulations).
Legal notices under the COPI Regulations have also been issued to other health and social care organisations requiring those organisations to process and share confidential patient information to respond to the coronavirus outbreak.
Any information used or shared during the outbreak under these legal notices or the COPI Regulations will be limited to the period of the outbreak unless there is another legal basis for organisations to continue to use the information.
Data which is shared by NHS Digital will be subject to robust rules relating to privacy, security and confidentiality and only the minimum amount of data necessary to achieve the coronavirus purpose will be shared.
Organisations using your data will also need to have a clear legal basis to do so and will enter into a data sharing agreement with NHS Digital. Information about the data that NHS Digital shares, including who with and for what purpose will be published in the NHS Digital data release register.
For more information about how NHS Digital will use your data please see the NHS Digital Transparency Notice for GP Data for Pandemic Planning and Research (COVID-19).
National Data Opt-Out
The application of the National Data Opt-Out to information shared by NHS Digital will be considered on a case by case basis and may or may not apply depending on the specific purposes for which the data is to be used.
This is because during this period of emergency, the National Data Opt-Out will not generally apply where data is used to support the coronavirus outbreak, due to the public interest and legal requirements to share information.
New Data Protection Regulations from May 2018 (GDPR)
Under the new data protection regulations introduced from 25th May 2018, we will continue to contact patients via text messages regarding the delivery of care if they have provided consent to do so.
If practices are sending messages about recommended treatment for the management of a specific health issue, then this is defined as providing appropriate care for patients, not marketing purposes.
If you would like to opt out of any future contact via text messaging, then please complete the form and indicate in the marked section.
Our legal basis for sharing data with NHS Digital
NHS Digital has been legally directed to collect and analyse patient data from all GP practices in England to support the coronavirus response for the duration of the outbreak.
NHS Digital will become the controller under the General Data Protection Regulation 2016 (GDPR) of the personal data collected and analysed jointly with the Secretary of State for Health and Social Care, who has directed NHS Digital to collect and analyse this data under the COVID-19 Public Health Directions 2020 (COVID-19 Direction).
All GP practices in England are legally required to share data with NHS Digital for this purpose under the Health and Social Care Act 2012 (2012 Act). More information about this requirement is contained in the data provision notice issued by NHS Digital to GP practices.
Under GDPR our legal basis for sharing this personal data with NHS Digital is Article 6(1)(c) – legal obligation. Our legal basis for sharing personal data relating to health, is Article 9(2)(g) – substantial public interest, for the purposes of NHS Digital exercising its statutory functions under the COVID-19 Direction.
Prescribing initiative by NWL
Reducing prescribing of medicines and products that can be purchased without a prescription
North West London CCGs’ Governing Bodies have approved the approach outlined in this letter to reducing prescribing of medicines and products that can be purchased without a prescription.
Clinical judgement should be used when considering whether it is acceptable to ask patients to purchase their medication, e.g. Paracetamol when required for headache can be purchased, and however regular full dose Paracetamol for chronic osteoarthritis may be less suitable for purchase due to the quantities involved.
The General Medical Council’s Good practice in prescribing and managing medicines and devices (2013) includes: “‘Prescribing’ is used to describe many related activities, including …….advising patients on the purchase of over the counter medicines and other remedies…….”
The approach outlined above, is consistent with (legally privileged) legal advice obtained for NWL CCGs.
NWL CCGs envisage aligning their approach with national guidance if and when such guidance is published.
A leaflet for patients about the approach outlined above and a range of relevant posters are available as follows:
Medicines that can be purchased without a prescription
Ordering repeat prescriptions online
Prescriptions Charges and Exemptions
The NHS prescription charge is a flat-rate amount which successive Governments have thought it reasonable to charge for those who can afford to pay for their medicines.
Extensive exemption and remission arrangements protect those likely to have difficulty in paying charges (NHS prescription and dental charges, optical and hospital travel costs).
If you think you may be exempt please ask for a medical exemption form from your pharmacist or doctor.
Prescription prepayment certificates (PPCs) offer real savings for people who need several items of medication on a regular basis.
You can also speak to your pharmacist for further information.
Charges
- Prescription (per item): £9.15
- 12-month prepayment certificate (PPC): £105.90
- 3-month PPC: £29.65
If you will have to pay for four or more prescription items in three months, or more than 15 items in 12 months, you may find it cheaper to buy a PPC .
To order a pre-payment certificate:
Telephone advice and order line 0845 850 0030
General Public – Buy or Renew a PPC On-line
There is further information about prescription exemptions and fees on the NHS website
Useful leaflets and posters
Medicines that can be purchased without a prescription
Ordering repeat prescriptions online
Privacy Policy
We understand how important it is to keep your personal information safe and secure and we take this very seriously.
We have taken steps to make sure your personal information is looked after in the best possible way, and we review this regularly.
Please read this privacy notice (‘Privacy Notice’) carefully, as it contains important information about how we use the personal and healthcare information we collect on your behalf.
Why we are providing this privacy notice
We are required to provide you with this Privacy Notice by Law. It explains how we use the personal and healthcare information we collect, store and hold about you. If you are unclear about how we process or use your personal and healthcare information, or you have any questions about this Privacy Notice or any other issue regarding your personal and healthcare information, then please do contact our Data Protection Officer (details below).
The Law says:
We must let you know why we collect personal and healthcare information about you;
We must let you know how we use any personal and/or healthcare information we hold on you;
We need to inform you in respect of what we do with it;
We need to tell you about who we share it with or pass it on to and why; and
We need to let you know how long we can keep it for.
The data protection officer
The Data Protection Officer at First Care Group Practice for our practices including Heathrow Medical Centre, Shakespeare Health Centre, The Pine Medical Centre, Willow Tree Surgery and Yeading Court Surgery is Jackie Quaif and can be contacted at:
jquaif@nhs.net
If you have any questions about how your information is being held;
If you require access to your information or if you wish to make a change to your information;
If you wish to make a complaint about anything to do with the personal and healthcare information we hold about you;
Or any other query relating to this Policy and your rights as a patient.
About Us
We, at First Care Group Practice are a Data Controller of your information. We are a group of five practices
Heathrow Medical Centre situated at 1 St Peter’s Way, Hayes UB3 5AB.
Shakespeare Health Centre situated at Elers Road,Hayes, UB8 1NY
The Pine Medical Centre situated at Fredora Avenue, Hayes, UB4 8RB
Willow Tree Surgery situated at 2 Jollys Lane, Hayes, Middlesex, UB4 9BG
Yeading Court Surgery situated at 1-2 Yeading Court, Masefield Lane, Hayes, Middlesex, UB4 9AJ
This means we are responsible for collecting, storing and handling your personal and healthcare information, when you register with us as a patient at one of our practices.
There may be times where we also process your information. That means we use it for a particular purpose and, therefore, on those occasions we may also be Data Processors. The purposes for which we use your information are set out in this Privacy Notice.
Information we collect from you
The information we collect from you will include:
Your contact details (such as your name and email address, including place of work and work contact details);
Details and contact numbers of your next of kin and/or people you designate as carers;
Your age range, gender, ethnicity, main language;
Details in relation to your medical history;
Appointment details (such as date, time and reason for your visit to the Surgery);
Medical notes and details of diagnosis and consultations with our GPs and other health professionals within the Surgery involved in your direct healthcare;
Details of telephone encounters (such as telephone recordings, date, time and phone number of calls) for training and quality purposes;
CCTV recordings of onsite encounters within public spaces for safety and security of all patients.
Information about you from others
We also collect personal information about you when it is sent to us from the following:
1. a hospital, a consultant or any other medical or healthcare professional, or any other person involved with your general healthcare;
2. Other government agencies (such as DVLA, Home office, firearms applications, court orders etc) involved with your general healthcare.
Your summary care record
Your summary care record is an electronic record of your healthcare history (and other relevant personal information) held on a national healthcare records database provided and facilitated by NHS England.
This record may be shared with other healthcare professionals and additions to this record may also be made by relevant healthcare professionals and organisations involved in your direct healthcare.
You may have the right to demand that this record is not shared with anyone who is not involved in the provision of your direct healthcare. If you wish to enquire further as to your rights, in respect of not sharing information on this record ,then please contact our Data Protection Officer.
Who we may provide your personal information to, and why
We may pass your personal information on to the following people or organisations, because these organisations may require your information to assist them in the provision of your direct healthcare needs. It therefore, may be important for them to be able to access your information in order to ensure they may properly deliver their services to you:
1. Hospital professionals (such as doctors, consultants, nurses, etc);
2. Out of hours professionals (such as doctors, nurses, etc);
3. Community professionals (such as Pharmacists, Dentists, Opticians, Nurses);
4. NHS Services commissioned by NHS Clinical Commissioning groups or NHS England (such as Extended Access Hub, Community Paediatric Services, Diabetic retinal screening, Child immunisations, Cervical Screening, etc)
5. Any other person that is involved in providing services related to your general healthcare, including mental health professionals.
Other people who we provide your information to
1. NHS Commissioners (such as Hillingdon Clinical Commissioning Group, NHS England);
2. Service providers (such as Hillingdon Primary Care Confederation);
3. Local authorities (such as London Borough of Hillingdon);
4. Community health services (such as Central North West London NHS Trust);
5. For the purposes of complying with the law e.g. Police, Solicitors, Insurance Companies;
Anyone you have given your consent to, to view or receive your record, or part of your record. Please note, if you give another person or organisation consent to access your record we will need to contact you to verify your consent before we release that record. It is important that you are clear, and understand how much and what aspects of your record you give consent to be disclosed.
Anonymised information
Sometimes we may provide information about you in an anonymised form. If we do so, then none of the information we provide to any other party , will identify you as an individual and cannot be traced back to you.
Your rights as a patient
The Law gives you certain rights to your personal and healthcare information that we hold, as set out below:
A. Access and Subject Access Requests
You have the right to see what information we hold about you and to request a copy of this information.
If you would like a copy of the information we hold about you, please email our Data Protection Officer. We will provide this information free of charge, however, we may in some limited and exceptional circumstances have to make an administrative charge for any extra copies if the information requested is excessive, complex or repetitive.
We have one month to reply to you and give you the information that you require. We would ask, therefore, that any requests you make are in writing and it is made clear to us what and how much information you require.
B. Online Access
You may ask us if you wish to have online access to your medical record. However, there will be certain protocols that we have to follow in order to give you online access, including written consent and the production of documents that prove your identity.
Please note that when we give you online access, the responsibility is yours to make sure that you keep your information safe and secure if you do not wish any third party to gain access.
C. Correction
We want to make sure that your personal information is accurate and up to date. You may ask us to correct any information you think is inaccurate. It is very important that you make sure you tell us if your contact details including your mobile phone number has changed.
D. Removal
You have the right to ask for your information to be removed. However, if we require this information to assist us in providing you with appropriate medical services and diagnosis for your healthcare, then removal may not be possible.
E. Objection
We cannot share your information with anyone else for a purpose that is not directly related to your health, e.g. medical research, educational purposes, etc. We would ask you for your consent in order to do this. However, you have the right to request that your personal and healthcare information is not shared by the Surgery in this way. Please note the Anonymised Information section in this Privacy Notice.
F. Transfer
You have the right to request that your personal and/or healthcare information is transferred, in an electronic form (or other form), to another organisation, but we will require your clear consent to be able to do this.
Third parties mentioned on your medical record
Sometimes we record information about third parties mentioned by you to us during any consultation. We are under an obligation to make sure we also protect that third party’s rights as an individual and to ensure that references to them which may breach their rights to confidentiality, are removed before we send any information to any other party including yourself. Third parties can include: spouses, partners, and other family members.
How we use the information about you
We use your personal and healthcare information in the following ways:
A. when we need to speak to, or contact other doctors, consultants, nurses or any other medical/healthcare professional or organisation during the course of your diagnosis or treatment or on going healthcare;
B. when we are required by law to hand over your information to any other organisation, such as the police, by court order, solicitors, or immigration enforcement.
We will never pass on your personal information to anyone else who does not need it, or has no right to it, unless you give us clear consent to do so.
Legal justification for collecting and using your information
The law says we need a legal basis to handle your personal and healthcare information.
CONTRACT: We have a contract with NHS England to deliver healthcare services to you. This contract provides that we are under a legal obligation to ensure that we deliver medical and healthcare services to the public.
CONSENT: Sometimes we also rely on the fact that you give us consent to use your personal and healthcare information so that we can take care of your healthcare needs.
Please note that you have the right to withdraw consent at any time, if you no longer wish to receive services from us.
NECESSARY CARE: Providing you with the appropriate healthcare, where necessary. The law refers to this as ‘protecting your vital interests’ where you may be in a position not to be able to consent.
LAW: Sometimes the Law obliges us to provide your information to an organisation (see above).
Special categories
The law states that personal information about your health falls into a special category of information because it is very sensitive. Reasons that may entitle us to use and process your information may be as follows:
PUBLIC INTEREST: Where we may need to handle your personal information when it is considered to be in the public interest. For example, when there is an outbreak of a specific disease and we need to contact you for treatment, or we need to pass your information to relevant organisations to ensure you receive advice and/or treatment;
CONSENT: When you have given us consent;
VITAL INTEREST: If you are incapable of giving consent, and we have to use your information to
protect your vital interests (e.g. if you have had an accident and you need emergency treatment);
DEFENDING A CLAIM: If we need your information to defend a legal claim against us by you, or by another party;
PROVIDING YOU WITH MEDICAL CARE: Where we need your information to provide you with medical and healthcare services
How long we keep your personal information
We carefully consider any personal information that we store about you, and we will not keep your information for longer than is necessary for the purposes as set out in this Privacy Notice.
Under 16s
There is a separate privacy notice for patients under the age of 16, a copy of which may be obtained on request.
If english is not your first language
If English is not your first language you can request a translation of this Privacy Notice. Please contact our Data Protection Officer.
Complaints
If you have a concern about the way we handle your personal data or you have a complaint about what we are doing, or how we have used or handled your personal and/or healthcare information, then please contact our Data Protection Officer.
However, you have a right to raise any concern or complaint with the UK information regulator, at the Information Commissioner’s Office:
www.ico.org.uk
Our website
The only website this Privacy Notice applies to is the Surgery’s website. If you use a link to any other website from the Surgery’s website then you will need to read their respective privacy notice. We take no responsibility (legal or otherwise) for the content of other websites.
Cookies
The Surgery’s website uses cookies. For more information on which cookies we use and how we use them, please see our Cookies Policy.
Security
We take the security of your information very seriously and we do everything we can to ensure that your information is always protected and secure. We regularly update our processes and systems and we also ensure that our staff are properly trained. We also carry out assessments and audits of the information that we hold about you and make sure that if we provide any other services, we carry out proper assessments and security reviews.
Text messaging and contacting you
Because we are obliged to protect any confidential information we hold about you and we take this very seriously, it is imperative that you let us know immediately if you change any of your contact details.
We may contact you using SMS texting to your mobile phone ,in the event that we need to notify you about appointments and other services that we provide to you involving your direct care. Therefore you must ensure that we have your up to date details. This is to ensure we are sure that we are actually contacting you and not another person.
Where to find our privacy notice
You may find a copy of this Privacy Notice in the Surgery’s reception, on our website, or a copy may be provided on request.
Changes to our privacy notice
We regularly review and update our Privacy Notice. This Privacy Notice was last updated on 24 May 2018.
Privacy Policy ©First Care Group Practice – including Heathrow Medical Centre, Shakespeare Health Centre, The Pine Medical Centre, Willow Tree Surgery and Yeading Court Surgery.
The type of personal data we are sharing with NHS Digital
The data being shared with NHS Digital will include information about patients who are currently registered with a GP practice or who have a date of death on or after 1 November 2019 whose record contains coded information relevant to coronavirus planning and research.
The data contains NHS Number, postcode, address, surname, forename, sex, ethnicity, date of birth and date of death for those patients.
It will also include coded health data which is held in your GP record such as details of:
- diagnoses and findings
- medications and other prescribed items
- investigations, tests and results
- treatments and outcomes
- vaccinations and immunisations
Your rights over your personal data
To read more about the health and care information NHS Digital collects, its legal basis for collecting this information and what choices and rights you have in relation to the processing by NHS Digital of your personal data, see:
Zero tolerance
A zero tolerance policy towards violent, threatening and abusive behaviour is now in place throughout the NHS. The doctors, nurses and staff in this practice have the right to do their work in an environment free from violent, threatening or abusive behaviour and everything will be done to protect that right. At no time will any such behaviour be tolerated in this practice. If you do not respect the rights of our staff we may choose to inform the police and make arrangements for you to be removed from our medical list.
Zero Tolerance Policy
Introduction
The NHS Zero Tolerance Zone is a nation-wide campaign to tackle violence and abuse, both physical and verbal, against all members of staff working in the NHS. Its two principal aims are: · To inform the public that violence against staff working in the NHS is unacceptable and the Government is determined to stamp it out · To inform all staff that violence and intimidation is unacceptable and is being tackled. The practice fully supports this campaign and its legal requirements to provide, as far as is reasonably practicable, conditions of working that are conducive to the prevention of and safe management of violence.
Background
In January 2000 the Department of Health (DOH) issued guidelines to Health Authorities to introduce local initiatives as part of a Zero Tolerance Campaign which addresses any incident where a General Practitioner (GP), or his/her staff are exposed to violent or abusive behaviour. As well as having a right to protect themselves, GPs have a duty, as employers, to protect their staff and as providers of a public service, those with reason to be on their premises. The DOH established the following definition for violence/abuse – “Any incident where a GP, or his or her staff, are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, wellbeing or health”. The definition does not define violence just as physical assault but also includes threats that challenge the “Safety, wellbeing or health of staff”.
Here are some examples of the breaches of the Zero Tolerance Policy;
- Behaviours that target a person based on their protected characteristic or belonging to a marginalised group. These can be intentional and unintentional and are based on biases either conscious and unconscious
- Any physical violence towards any member of the Primary Health Care Team or other patients, such as pushing or shoving
- Racial abuse and sexual harassment
- Causing damage/stealing from the Practice’s premises, staff or patients
- Obtaining drugs and/or medical services fraudulently
- Refusing appointments with an appropriate clinician for the presenting care need i.e. insisting on a GP appointment when seeing a pharmacist or nurse prescriber is most appropriate or refusing to see an available GP for your presenting care need when your preferred GP is unavailable
- Refusing to access the service in the appropriate manner i.e. sending emails/texts instead of using the NHS Digital approved digital consultation service
- Demanding a same day appointment for a routine clinical need – this deprives access to urgent care services for those who genuinely need it
- Contacting individuals directly via social media or personal email instead of through the practice contact channels
- Using bad language threatening or swearing at practice staff or other service users;
- Unnecessarily persistent or unrealistic service demands that cause disruption;
- Verbal, non-verbal and environmental slights, snubs and insults which communicate hostile, derogatory or negative messages;
Process
The practice operates a Zero Tolerance Policy towards any member of our staff or patients. Patients are expected to be considerate and act reasonably. Management cites but does not restrict, the following unacceptable behaviour within its Zero Tolerance Policy: · any display of a violent temper · shouting, raised voices, sarcasm, pointing fingers. · repeated or insistent points being made; not engaging with staff in a positive way; being pushy or trying to intimidate staff · hostile or aggressive behaviour · threats, swearing, spitting · any mention or display of any object that could be used as a weapon. Should a member of staff (or patient) feel that they have encountered behaviour that could be classed as unacceptable within the Practice Zero Tolerance Policy, a complaint should be made to the Practice Manager. Once the matter has been reviewed by the Practice Manager the person in question will be sent a formal warning letter, depending on the severity of the incident they may then be either sent a warning letter with behavioural agreement to be signed within 30 days of the warning letter been issued or be removed from the practice list. We will have no hesitation in having the patient removed from the building by the Police should his/her behaviour warrant it.
Police involvement
If an incident is taking place and staff feel that a Police presence is required, regardless of the circumstances, the Police will be called to deal with the incident. It is our responsibility to protect our staff and patients and therefore no hesitation will be made if a Police presence is required. If the patient has left the premises and there is no immediate danger, the Police will still be notified of the incident so it can be recorded for future reference. The GP will also keep a record of the incident.
Warning system
Following an incident where a complaint has been made about a patient’s behaviour a formal warning letter will be sent with a behavioural agreement to be signed within 30 days of the date of the warning letter. The letter will notify the person that their behaviour was unacceptable and will not be tolerated, if the person is a patient at the surgery they will be warned that they run the risk of being removed from our practice list if they do not sign the behavioural agreement within the specified time period. The letter will clearly state that if there is any reoccurrence of their behaviour in any way that they will be removed from the Practise list. A permanent record of the warning, including the date and reason for the warning, will be made and retained. Although this procedure will be generally applied, there may be occasions where the Management Team feel that an episode of behaviour is so serious that a patient will removed from the Practice list with immediate effect. Where this is the case, the police will usually have been called to attend the Practice and one or more members of staff or patients will have been threatened or attacked or narrowly avoided being attacked. It is important to remember that it is not the intention of the perpetrator that is relevant, rather than the perception that is generated by the actions and behaviour of the perpetrator that will generate the Practice response.
Removal from the Practice List
Removal of patients from this Practice list is an exceptional and rare event and is a last resort. The practice must respect the safety and wellbeing of their staff and patients, and if a patient at the surgery is unable to respect the staff and treat them with courtesy then it is in the best interest of the patient in question and, more importantly, our staff that they register elsewhere. If the decision to remove a patient from the practice list is made, NHS England will be notified either immediately (in case of serious breaches where a deregistration is to be processed within 24hours with or without a police reference as necessary) or on 8 days’ notice for the protection of other NHS staff members. If a patient is removed from the Practice list, they will also be banned from entering the Practice premises or contacting Practice staff in any way.
Notifying the Patient
The Practice will take steps to contact the patient to inform them of the action being taken. After having a formal consultation with our integrated care board, we advise patients that following a breach of zero tolerance threshold, where the breach is not warranting a removal, practice is more than happy to carry on providing the service as normal provided a behavioural agreement is signed. This means that the practice will be monitoring patients behavioural after they have signed the agreement for a period of 12 months and should there be a reoccurrence of the same, a deduction will be processed as appropriate. Practice warning letter clearly specifies about the 30 days’ time period for signing the behavioural agreement and the patient will be informed in writing to their home address or through a verified email. Failing to sign the behavioural agreement within the given time period will result in the de-registration of the patient and no further notifications will be sent. Once this decision has been made the deduction will not be revoked under any circumstances, and the subject will not be entertained by any staff member and will be only considered as harassment. Practice is not obliged to send removal notifications in cases of serious breaches where it is necessary to remove patients within 24 hours’ time period, however all necessary measures will be taken by the practice to inform the NHS health authority of the event so that they can contact the patient directly to
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. 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.