Practice Policies & Patient Information

Candidate privacy Notice

Chaperones

Children’s Privacy Notice

Confidentiality

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.

Freedom of Information

The ICO has published a new Model Publication Scheme that all public authorities are required to adopt by 1st January 2009.

Consent

The purpose of this protocol is to set out the Practice’s approach to consent and the way in which the principles of consent will be put into practise. It is not a detailed legal or procedural resource due to the complexity and nature of the issues surrounding consent.

Where possible, a clinician must be satisfied that a patient understands and consents to a proposed treatment, immunisation or investigation. This will include the nature, purpose, and risks of the procedure, if necessary by the use of drawings, interpreters, videos or other means to ensure that the patient understands, and has enough information to give ‘Informed Consent’.

Implied Consent

Implied consent will be assumed for many routine physical contacts with patients. Where implied consent is to be assumed by the clinician, in all cases, the following will apply:

An explanation will be given to the patient what he / she is about to do, and why.
The explanation will be sufficient for the patient to understand the procedure.
In all cases where the patient is under 18 years of age a verbal confirmation of consent will be obtained and briefly entered into the medical record.
Where there is a significant risk to the patient an “Expressed Consent” will be obtained in all cases (see below).

Expressed Consent

Expressed consent (written or verbal) will be obtained for any procedure which carries a risk that the patient is likely to consider as being substantial. A note will be made in the medical record detailing the discussion about the consent and the risks. A Consent Form [*] may be used for the patient to express consent (see below).

Obtaining Consent

Consent (Implied or Expressed) will be obtained prior to the procedure, and prior to any form of sedation.
The clinician will ensure that the patient is competent to provide a consent (16 years or over) or has “Gillick Competence” if under 16 years. Further information about Gillick Competence and obtaining consent for children is set out below.
Consent will include the provision of all information relevant to the treatment.
Questions posed by the patient will be answered honestly, and information necessary for the informed decision will not be withheld unless there is a specific reason to withhold. In all cases where information is withheld then the decision will be recorded in the clinical record.
The person who obtains the consent will be the person who carries out the procedure (i.e. a nurse carrying out a procedure will not rely on a consent obtained by a doctor unless the nurse was present at the time of the consent).
The person obtaining consent will be fully qualified and will be knowledgeable about the procedure and the associated risks.
The scope of the authority provided by the patient will not be exceeded unless in an emergency.
The Practice acknowledges the right of the patient to refuse consent, delay the consent, seek further information, limit the consent, or ask for a chaperone.
Clinicians will use a Consent Form [*] where procedures carry a degree of risk or where, for other reasons, they consider it appropriate to do so (e.g. malicious patients).
No alterations will be made to a Consent Form once it has been signed by a patient.
Clinicians will ensure that consents are freely given and not under duress (e.g. under pressure from other present family members etc.).
If a patient is mentally competent to give consent but is physically unable to sign the Consent Form [*], the clinician should complete the Form as usual, and ask an independent witness to confirm that the patient has given consent orally or non-verbally.

Other aspects which may be explained by the clinician include:

Details of the diagnosis, prognosis, and implications if the condition is left untreated
Options for treatment, including the option not to treat.
Details of any subsidiary treatments (e.g. pain relief)
Patient experiences during and after the treatment, including common or potential side effects and the recovery process.
Probability of success and the possibility of further treatments.
The option of a second opinion

Immunisations

Informed consent must be obtained prior to giving an immunisation. There is no legal requirement for consent to immunisation to be in writing and a signature on a consent form is not conclusive proof that consent has been given, but serves to record the decision and discussions that have taken place with the patient, or the person giving consent on a child’s behalf.

Consent for Children

Everyone aged 16 or more is presumed to be competent to give consent for themselves, unless the opposite is demonstrated. If a child under the age of 16 has “sufficient understanding and intelligence to enable him/her to understand fully what is proposed” (known as Gillick Competence), then he/she will be competent to give consent for him/herself. Young people aged 16 and 17, and legally ‘competent’ younger children, may therefore sign a Consent Form ^[*] for themselves, but may like a parent to countersign as well.

For children under 16 (except for those who have Gillick Competence as noted above), someone with parental responsibility should give consent on the child’s behalf by signing accordingly on the Consent Form ^[*].

More information about Gillick Competence is at http://www.firstpracticemanagement.co.uk/misc_info/Fraser.htm

Covid-19 Privacy Notice

Data Security and protection toolkit

GDPR

Your Data Matters to the NHS

Information about your health and care helps us to improve your individual care, speed up diagnosis, plan your local services and research new treatment.

In May 2018, the strict rules about how this data can and cannot be used were strengthened. The NHS is committed to keeping patient information safe and always being clear about how it is used.

You can choose whether your confidential patient information is used for research and planning.

To find out more visit: nhs.uk/your-nhs-data-matters

GP Net Earnings

GP Publication of Earnings 2022/23

Practice: Clifton Medical Practice

Accounts Year End: 30 June 2022

NHS England require that the net earnings of doctors engaged in the practice is publicised, and the required disclosure is shown below.

However it should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors spend working in the practice, and should not be used to form any judgement about GP earnings, nor to make any comparison with any other practice.

All GP Practices are required to declare the mean earnings (e.g. average pay) for GPs working to deliver NHS services to patients at each practice.

The average pay for GPs working in Clifton Medical Practice during the year ended 30 June 2022 was £55,446 before tax and national insurance. This is for 0 full time GPs, 6 part time GPs and 3 locum GPs who worked in the practice for more than 6 months.

Information Sharing

Named GP

Patient Advice

Your Data Matters to the NHS

Information about your health and care helps us to improve your individual care, speed up diagnosis, plan your local services and research new treatments. The NHS is committed to keeping patient information safe and always being clear about how it is used.

How your data is Used

Information about your individual care such as treatment and diagnosis is collected about you whenever you use health and care services. It is also used to help us and other organisations for research and planning such as research into new treatments, deciding where to put GP clinics and planning for the number of doctors and nurses in your local hospital. It is only used in this way when there is a clear legal basis to use the information to help improve health and care for you, your family and future generations.

Wherever possible we try to use data that does not identify you, but sometimes it is necessary to use your confidential patient information.

You Have a Choice

You do not need to do anything if you are happy about how your information is used. If you do not want your confidential patient information to be used for research and planning, you can choose to opt out securely online or through a telephone service. You can change your mind about your choice at any time.

Will choosing this opt-out affect your care and treatment?

No, choosing to opt out will not affect how information is used to support your care and treatment. You will still be invited for screening services, such as screenings for bowel cancer.

What do you need to do?

If you are happy for your confidential patient information to be used for research and planning, you do not need to do anything.

To find out more about the benefits of data sharing, how data is protected, or to make/change your opt-out choice visit www.nhs.uk/your-nhs-data-matters.

Download a copy of the patient leaflet

Privacy Notice

Suggestions & Complaints

Complaints

In order to give you the best service possible, we would welcome any suggestions. If you are unhappy with any aspect of our service, or treatment, please tell us by contacting the Practice Manager.

Full details of our complaints procedure are available from our reception.

Suggestions

In order to give you the best service possible, we would welcome any suggestions. If you are unhappy with any aspect of our service, or treatment, please contact our Practice Manager.

Full details of primary medical services in this area can be obtained from the NHS website: www.nhs.uk

Received good service?

If you are happy with the service, please ask for a form from reception so that your comments can be recorded or add a comment to NHS choices: www.nhs.uk

Complaints leaflet

Download our complaints leaflet

Zero Tolerance Policy

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.

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

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 out 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 a 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 a patient that is the resident 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.

Call Recording

The call recording has been released as the result of a UKGDPR Article 15 Sir request, for personal use only, this recording should not be posted on social media. 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 also 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 sender’s 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 their intentions was, to cause distress or anxiety.

A person found guilty could face a prison term not exceeding two years on indictment or up to 12-month custody at the Magistrates’ Court.

Potential Offences Under The Communications Act 2003

Offences that fall under section 127 of the Communications Act 2003 include the following:

A person sending any public electronic communications network a message or other content 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 a message to be ‘grossly offensive’, ‘indecent’, ‘obscene’ or of 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 a 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 false message.