The purpose of this policy is to provide information on the patient’s rights to view medical records prepared on his / her behalf in connection with insurance or employment.

The rights of patients are governed within the Data Protection Act 1998 will apply.

Provisions

• The patient must be aware of, and must give consent to, the preparation and release of a medical report. Reports should not be prepared where a GP becomes aware that the patient is not aware of the request, for example in subsequent requests by insurance companies unrelated to an existing consented application.
• Anyone applying to the practice for a medical report relating to an individual for employment of insurance purposes must make the person aware and gain his/her consent to do this. They must also inform the individual that they may withhold their consent if they wish and of their other rights under the Act detailed below.
• Patients may decline consent at any time prior to release of information.
• Where a patient indicates in the consent to the applicant that he/she wishes to view the report prior to its dispatch to the enquirer, the enquirer/applicant must notify the GP of this fact at the time that the application is made.  At the same time, they must notify the individual that the application has been made.
• The report must not be released unless the individual has then had access to it or until 21 days have passed since receiving the application and there has been no contact from the individual to make arrangements to see the report.
• Where an application contains no mention of the individual wishing to have access to the report before it is sent, but the practice subsequently receives a request from the individual to view the report before it is sent, then the wishes of the patient must be met.
• The practice will advise patients wishing to view their reports that the report is available to view once it has been prepared. The patient will be advised that they have 21 days to make arrangements to view this (from the date of receiving a request to view) before it will be sent.
• The practice will encourage patients to view reports promptly. A copy will be provided, where requested.
• Where a patient disagrees with any part of the report because he/she believes it to be incorrect or misleading, he/she can request amendment. The GP will determine whether the amendment can be made. If an amendment is not appropriate the patient may attach a statement of his/her views to the report for dispatch. Requests to amend must be made in writing.
• Where a patient disagrees with part of the report, and an amendment or an attached note is considered to be inadequate or unacceptable by the patient, then the patient may refuse consent for the report to be sent, and this refusal will be accepted.
• Copy reports will be retained for 6 months following issue, during which time a copy will be provided to the patient if required.
• A copy of the report will be scanned onto the patient electronic record or a copy held within the medical record
• Patients may request access to any medical report relating to him/herself which the GP has supplied for employment or insurance purposes in the previous six months.  Access includes making a copy of the report available for inspection or supplying a copy of the report

Exemptions

A GP is not obliged to give access to a medical report (or any part of it) when disclosure would in the opinion of the practitioner:

• Cause serious harm to the physical or mental health of the individual or others
• Indicate the intentions of the medical practitioner towards the individual
• Identify a third person, who has not consented to the release of that information or who is not a health professional involved in the individual’s care

Access to medical records and data protection

The Access to Health Records Act 1990 and the Access to Medical Reports Act 1988 gave individuals the right of access, subject to certain exceptions, to health information recorded about themselves, and, in certain circumstances, about others, within manual records. The Data Protection Act (DPA) 1998 came into force in March 2000 and repealed most of the 1990 Access to Health Records Act.  All applications for access to records, whether paper based or electronic, of living persons are now made under the DPA 1998. In February 2010 the DoH published amended guidance applicable in England to encompass best practice covering the above legislative process, replacing previous guidelines issued in July 2002 and June 2003. Practices are recommended to refer to these guidelines where an access request is received.

For deceased persons, applications are made under sections of the 1990 Access to Health Records Act which has been retained.  These sections provide the right of access to the health records of deceased individuals for their personal representative and others having a claim under the estate of the deceased. Please refer to separate policy for further details.

The Access to Medical Reports Act 1988 covers the rights of individuals to access medical reports prepared about them for employment or insurance purposes.

Under section seven of the DPA, patients have the right to apply for access to their health records.  Provided that the fee has been paid and a written application is made by one of the individuals referred to below, the practice is obliged to comply with a request for access subject to certain exceptions (see below).  However, the practice also has a duty to maintain the confidentiality of patient information and to satisfy itself that the applicant is entitled to have access before releasing information.

The Access to Health Records Act (AHRA) 1990 provides certain individuals with a right of access to the health records of a deceased individual. These individuals are defined under Section 3(1)(f) of that Act as, ‘the patient’s personal representative and any person who may have a claim arising out of the patient’s death’. A personal representative is the executor or administrator of the deceased person’s estate.

A form designed for use by patients and their representatives is contained within the document Guidance for Access to Health Records Requests (DoH February 2010). This is accessible from the link within the Resources section below. See also Access to Medical Record Application form below.

Applications

An application for access to health records may be made in any of the circumstances explained below.

The patient

Wheatfield Surgery has a policy of openness with regard to health records and health professionals are encouraged to allow patients to access their health records on an informal basis.  This should be recorded in the health record itself. The Department of Health’s Code of Practice on Openness in the NHS as referred to in HSG (96) 18 Protection and Use of Patient Information will still apply to informal requests.

Such requests are usually made for a reason, and will always be in writing. There is no requirement to allow immediate access to a record of any type.  The patient may have concerns about treatment that they have received, how they have been dealt with or may be worried that something they have said has been misinterpreted. Members of staff are encouraged to try to understand and allay any underlying concerns that may have contributed to the request being made and offer an opportunity of early resolution.

Children and young people

Children over the age of 13 are generally considered to have the capacity to give or withhold consent to release medical records. In Scotland, there is a legal assumption that this is the case, but not in England, Wales or Northern Ireland where those under 16 should demonstrate that they have the capacity to make these decisions. Where the child is considered to be capable, then their consent must be sought before access is given to a third party.

The law regards young people aged 16 or 17 to be adults in respect of their rights to confidentiality. Access can be refused by the health professional where they consider that the child does not have capacity to give consent / decline decisions.

Individuals with parental responsibility for an under 18 year old will have a right to request access to those medical records (Scotland under 16). Access may be granted if access is not contrary to the wishes of the competent child.  Not all parents have parental responsibility. A person with parental responsibility is either:

• The birth mother
• The birth father (if married to the mother at the time of child’s birth or subsequently) if both are on the birth certificate
• An individual given parental responsibility by a court

Parental responsibility is not lost on divorce. If parents have never been married only the mother has automatic parental responsibility, however the father may subsequently “acquire” it.

If the appropriate health professional considers that a child patient is Gillick competent (i.e. has sufficient maturity and understanding to make decisions about disclosure of their records) then the child should be asked for his or her consent before disclosure is given to someone with parental responsibility.

If the child is not Gillick competent and there is more than one person with parental responsibility, each may independently exercise their right of access. Technically, if a child lives with, for example, its mother, and the father applies for access to the child’s records, there is no “obligation” to inform the mother. In practical terms, however, this may not be possible and both parents should be made aware of access requests unless there is a good reason not to do so.

In all circumstances good practice dictates that a Gillick competent child should be encouraged to involve parents or other legal guardians in any treatment/disclosure decisions.  The data controller may refuse access to the record where the information contained in it could cause serious harm to the patient or another person.

Patient representatives

A patient can give written authorisation for a person (for example a solicitor or relative) to make an application on their behalf.  The practice may withhold access if it is of the view that the patient authorising the access has not understood the meaning of the authorisation.

Court representatives

A person appointed by the court to manage the affairs of a patient who is incapable of managing his or her own affairs may make an application.  Access may be denied where the GP is of the opinion that the patient underwent relevant examinations or investigations in the expectation that the information would not be disclosed to the applicant.

Children and family court advisory and support service (CAFCASS)

Where CAFCASS has been appointed to write a report to advise a judge in relation to child welfare issues, Wheatfield Surgery would attempt to comply by providing factual information as requested.

Before records are disclosed, the patient or parents consent (as set out above) should be obtained.  If this is not possible, and in the absence of a court order, the practice will need to balance its duty of confidentiality against the need for disclosure without consent where this is necessary:

• To protect the vital interests of the patient or others
• To prevent or detect any unlawful act where disclosure is in the substantial public interest (e.g. serious crime)
• Because seeking consent would prejudice those purposes

The relevant health professional should provide factual information and their response should be forwarded to a member of the Child Protection Team who will approve the report.

Chapter 8 review

All Chapter 8 Review requests for information should be immediately directed to the Primary Care Organisation Child Protection Manager who would co-ordinate the Chapter 8 Review in accordance with national and local Area Child Protection Committee Guidance.  More information on Chapter 8 reviews can be found at: Serious Case Reviews (SCRs) – Every Child Matters

Amendments to or deletions from records

If a patient feels information recorded on their health record is incorrect then they should firstly make an informal approach to the health professional concerned to discuss the situation in an attempt to have the records amended. If this avenue is unsuccessful then they may pursue a complaint under the NHS Complaints procedure in an attempt to have the information corrected or erased. The patient has a ‘right’ under the DPA to request that personal information contained within the medical records is rectified, blocked, erased or destroyed if this has been inaccurately recorded.

He or she may apply to the Information Commissioner but they could also apply for rectification through the courts.  The GP practice, as the data controller, should take reasonable steps to ensure that the notes are accurate and if the patient believes these to be inaccurate, that this is noted in the records.  Each situation will be decided upon the facts and the practice will not be taken to have contravened the DPA if those reasonable steps were taken.  In the normal course of events, however, it is most likely that these issues will be resolved amicably.

Further information can be obtained from the Information Commissioner at:

Wycliffe House,
Water Lane,
Wilmslow,
Cheshire
SK9 5AF,

Telephone: 0303 123 1113 or 01625 545745.

Process

Online access to medical records (England)

Since April 2014, practices have been obliged to give patients the opportunity to view online information equating to their Summary Care Record (SCR) as part of the 2014-2015 GP contract. From March 31, 2016, it is a contractual obligation to give patients online access to coded information held in their medical records, including medication, allergies, illnesses, immunisations and test results. Patients will need to register online with the practice in order to gain access to this information.

Checks should be carried out to ascertain the patient’s identity, see Appendix B. The following checks should be undertaken:

• Checking photo ID and proof of address, for example, a passport or driving licence and a bank statement or council tax statement.
• If the patient has no ID but is well known to the surgery, a member of staff may be able to confirm their identity.
• If the patient has no ID and is not well known to the surgery, the ability to answer questions about the information in their GP record may confirm that the record is theirs.

GP software will be configured to offer all coded data by default, but GPs will be provided with the tools to withhold coded information where they judge it to be in the patient’s interests or where there is reference to a third party.

The practice has the option to offer comprehensive online patient records. There are circumstances where a GP may believe it is not in the best interests of the patient to share all information in the record, for example where it could cause harm to their physical or mental health, or if it contains information about a third party.

The practice is only expected to meet the above requirements for patient online access to their record when they have been provided with the GPSoC-approved and funded IT systems. Where systems are not yet available, the practice will publish a statement of intent to provide this facility.

Proxy access

Proxy Access refers to giving a third party access to online services on behalf of a patient. Family members or carers can access a patient’s medical records online only in circumstances where the patient has consented to this, or if the patient lacks capacity AND the applicant can provide evidence that they have been granted the power to manage the patient’s affairs. Patients will be advised about the risks associated with doing this as part of their access application.  Proxy access is the recommended alternative to sharing login details.

A person with parental responsibility who wishes to access some or all of the records of a competent child aged between 13 and 16 should only be allowed to do so if the child or young person consents, and it does not go against the child’s best interests. If the records contain information given by the child or young person in confidence you should not normally disclose the information without their consent. For further information about Parental Responsibility, please see the Children and Young People section, found above.

A person with parental responsibility for a child aged under 13 normally has automatic rights to access a child’s records – although not all parents have parental responsibility. Proxy access for people with parental responsibility to a child’s record is a practice-level decision.

Coercion

The availability of online services carries the risks of users being subject to coercion, as patients could be vulnerable to being forced into sharing confidential information from their record against their will. In cases where this is believed to be a possibility, online access to medical records can be denied. This should be discussed privately with the patient before a final decision over whether to deny access is taken.

As part of their request to access their medical records online or allow proxy access to a third party, the person submitting the request should provide a statement confirming that they have not been coerced into doing so.

Applications for access to medical records

GP practices receive applications for access to records via a number of different sources, for example:

• Patients’ solicitors
• Patients & relatives
• Patient carers
• Parents of patients under 16 years old

Requests should be in writing, with a patient signature. Email requests are valid for the purposes of the DPA, however the practice will need to be satisfied that a valid signature exists prior to disclosure or release. Where a solicitor or other representative is making the request, ensure that you have patient-signed consent, and sufficient information to clearly identify the patient.

Notification of requests

Practices should treat all requests as potential claims for negligence.  Good working practice would be to keep a central record of all requests in order to ensure that requests are cross-referenced with any complaints or incidents and that the deadlines for response are monitored and adhered to.

Requirement to consult appropriate health professional

It is the GP’s responsibility to consider an access request and to disclose the records if the correct procedure has been followed.  Before the practice discloses or provides copies of medical records the patient’s GP must have been consulted and he / she checked the records and authorised the release, or part-release.

Grounds for refusing disclosure to health records

The GP should refuse to disclose all or part of the health record if he / she is of the view that:

• Disclosure would be likely to cause serious harm to the physical or mental health of the patient or any other person.
• The records refer to another individual who can be identified from that information (apart from a health professional). This is unless that other individual’s consent is obtained or the records can be anonymised or it is reasonable in all the circumstances to comply with the request without that individual’s consent, taking into account any duty of confidentiality owed to the third party.
• The request is being made for a child’s records by someone with parental responsibility or for an incapacitated person’s record by someone with power to manage their affairs, and the:
  • Information was given by the patient in the expectation that it would not be disclosed to the person making the request.
  • The patient has expressly indicated it should not be disclosed to that person.

Informing of the decision not to disclose

If a decision is taken that the record should not be disclosed, a letter must be sent by recorded delivery to the patient or their representative stating that disclosure would be likely to cause serious harm to the physical or mental health of the patient, or to any other person.  The general position is that the practice should inform the patient if records are to be withheld on the above basis.  However, the GP could decide not to inform the patient if the appropriate health professional thinks that telling the patient:

• Will effectively amount to divulging that information, or;
• This is likely to cause serious physical or mental harm to the patient or another individual

In either of these cases, an explanatory note should be made in the file.

The decision can only be taken by the GP and an explanatory note should be made in the file.  Although there is no right of appeal to such a decision, it is the practice’s policy to give a patient the opportunity to have their case investigated by invoking the complaints procedure. The patient must be informed in writing that assistance will be offered to them if they wish to do this.  In addition, the patient may complain to the Information Commissioner for an independent ruling on whether non-disclosure is proper.

Disclosure of the record

Once the appropriate documentation has been received and sufficient identification has been produced to satisfy the data controller that disclosure may be made, disclosure may be approved, the copy of the health record may be sent to the patient or their representative in a sealed envelope by recorded delivery.  The record should be sent to a named individual, marked confidential, for addressee only and the sender’s name should be written on the reverse of the envelope.  Originals should not be sent. It may be good practice to check with the patient that all of the information requested is needed, before fulfilling the request, although there is no requirement under the Act to specify the extent of the requested information as part of the application procedure.

Where viewing is requested, a date may be set for the patient to view by supervised appointment. Where parts of the record are not to be released or to be viewed (i.e. they are restricted) an explanation does not have to be given, however the reasons for withholding should be documented. An explanation of terminology, abbreviation etc. must be given if requested. It is good practice for viewings to be supervised by a clinician (e.g. a nurse) who can explain items if needed. Where a non-clinician (e.g. receptionist) does this then no explanation must be offered. Explanation requests should be then referred to a clinical staff member.

Confidential information should not be sent by fax and never by email unless via an encrypted service such as from one NHS Mail account to another NHS Mail account.

A note should be made in the file of what has been disclosed to whom and on what grounds.

Where information is not readily intelligible an explanation (e.g. of abbreviations or medical terminology) must be given.

Where an access request has been fulfilled, a subsequent identical or similar request does not have to be again fulfilled unless a “reasonable” time interval has elapsed.

Charges and timescales

Please note: Under the GDPR, in effect from 25 May 2018, the right to submit a Subject Access Request and receive the information without undue delay is shortened to within 1 month. An extension of 2 months can be allowed if necessary taking into account the complexity of the request. A fee cannot be charged unless the request is “manifestly unfounded or excessive”, in which case a fee may be charged or the request refused.

The DPA states that fees should be paid in advance. Charges are set out in the Data Protection (Subject Access) (Fees and Miscellaneous Provisions) Regulations 2000.

Copies of records should be supplied within 21 days of receiving a valid and complete access request. In exceptional circumstances, it may take longer. The original Access to Health Records Act 1990 required requests to be complied with within 21 days where the record had been amended within 40 days, however the new Data Protection Act which replaced this required 40 days for all requests.

Ministers gave a commitment to parliament that 21 days would be retained for the NHS. 21 days is therefore the required standard, 40 days may apply in some exceptional circumstances, and if this is to be the case the patient should be advised prior to expiry of the initial 21 day period.

Where further information is required by the practice to enable it to identify the record required or validate the request, this must be requested within 14 days of receipt of the application and the timescale for responding begins on receipt of the full information.

The practice is not required to provide all the information requested if this would involve disproportionate effort. This however would only apply in very exceptional circumstances and may need to be justified to the Information Commissioner in the event of a dispute.   At the same time, however, the GP has discretion not to charge for copies should he / she choose to do so.

Appropriate health professional

The Data Protection (Subject Access Modification) (Health) Order 2000 specifies the appropriate health professional to deal with access matters is:

• The current or most recent responsible professional involved in the clinical care of the patient in connection with the information aspects which are the subject of the request.
• Where there is more than one such professional, the most suitable is to advise on the information which is the subject of the request.

Safe haven

Confidential medical records should not be sent by fax unless there is no alternative.  If a fax must be sent, it should include the minimum information and names should be removed and telephoned through separately.

All staff should be aware that safe haven procedures apply to the sending of confidential information by fax, for whatever reason. That is, the intended recipient must be alerted to the fact that confidential information is being sent. The recipient then makes a return telephone call to confirm safe and complete receipt. A suitable disclaimer, advising any unintentional recipient to contact the sender and to either send back or destroy the document, must accompany all such faxes. A suitable disclaimer is shown below:

Warning: The information in this fax is confidential and may be subject to legal professional privilege.  It is intended solely for the attention and use of the named addressee(s).  If you are not the intended recipient, please notify the sender immediately.  Unless you are the intended recipient or his/her representative you are not authorised to, and must not, read, copy, distribute, use or retain this message or any part of it. 

Patients living abroad

For former patients living outside of the UK and whom once had treatment for their stay here, under the DPA 1998 they still have the same rights to apply for access to their UK health records.  Such a request should be dealt with as someone making an access request from within the UK.  Original records should not be given to a patient to take outside the UK. The GP may agree to provide a summary, or otherwise the request is subject to a normal access request under these provisions.

Requests made by telephone

No patient information may be disclosed to members of the public by telephone.  However, it is sometimes necessary to give patient information to another NHS employee over the telephone. Before doing so, the identity of the person requesting the information must be confirmed.

This may best be achieved by telephoning the person’s official office and asking to be put through to their extension. Requests from patients must be made in writing.

Requests made by the police

In all cases the practice can release confidential information if the patient has given his/her consent (preferably in writing) and understands the consequences of making that decision.  There is, however, no legal obligation to disclose information to the police unless there is a court order or this is required under statute (e.g. Road Traffic Act).

The practice does, however, have a power under the DPA and Crime Disorder Act to release confidential health records without consent for the purposes of the prevention or detection of crime or the apprehension or prosecution of offenders.  The release of the information must be necessary for the administration of justice and is only lawful if this is necessary:

• To protect the patient or another persons vital interests.
• For the purposes of the prevention or detection of any unlawful act where seeking consent would prejudice those purposes and disclosure is in the substantial public interest (e.g. where the seriousness of the crime means there is a pressing social need for disclosure).

Only information which is strictly relevant to a specific police investigation, should be considered for release and only then if the police investigation would be seriously prejudiced or delayed without it.  The police should be asked to provide written reasons why this information is relevant and essential for them to conclude their investigations.

Requests for insurance purposes

Insurance companies may seek to obtain full medical records through the use of Subject Access Requests (SAR) under the Data Protection Act 1998. After seeking clarification from ICO, the BMA advises that upon receiving a SAR from an insurance company, practices should contact the patient to explain the implications of such a request and the extent of the disclosure.

The ICO is also clear that GPs should provide the SAR information to the patient themselves, rather than directly to the insurance company.

The ICO’s Subject Access Code of Practice states that ‘If you think an individual may not understand what information would be disclosed to a third party who has made a SAR on their behalf, you may send the response directly to the individual rather than to the third party. The individual may then choose to share the information with the third party after having had a chance to review it.’

It is however expected that insurance companies will stop requesting SARs and revert to requesting medical reports. Practices are able to apply a fee for completion of these reports, in line with the work associated, and should seek to agree the fee with the requestor in advance of completion.

Requests from third parties for non-insurance purposes

Under the Data Protection Act, individuals are entitled to make a SAR via a third party, such as solicitors who are acting in civil litigation cases for patients. These parties should obtain consent from the patient using the form that has been agreed with the BMA and the Law Society:

• Consent form (England & Wales)
• Consent form (Scotland)

The ICO Code of Practice states that ‘In these cases, you need to be satisfied that the third party making the request is entitled to act on behalf of the individual, but it is the third party’s responsibility to provide evidence of this entitlement. This might be a written authority to make the request or it might be a more general power of attorney’.

Court proceedings

You may be ordered by a court of law to disclose all or part of the health record if it is relevant to a court case (for example by a Guardian ad litem).

Wheatfield Surgery is committed to providing a safe, comfortable environment, where the safety of patients and staff is of paramount importance.

A key issue to be addressed is the need for patients experiencing consultations, examinations, and investigations, to be safe and to experience as little discomfort and distress as possible.

Equally health professionals are at an increased risk of their actions being misconstrued or misrepresented if they conduct examinations where no other person is present, and must minimise the risk of false accusations of inappropriate behaviour.

This policy presents principles and outlines the procedures that should be in place for appropriately chaperoning patients during examinations, investigations and care.

Responsibilities

Guidance on chaperoning is for the protection of both patients and healthcare professionals. All clinicians and others working on their behalf have a duty to consider chaperoning issues as they relate to their work, and to work in accordance with the following principles.

Principles of good practice

Patients may find any examination distressing, particularly if these involve the breasts, genitalia or rectum (known as “intimate examinations”). Also, consultations involving dimmed lights, close proximity to patients, the need for patients to undress and being touched, may make a patient feel vulnerable.

Chaperoning may help reduce distress, but must be used in conjunction with respectful behaviour, which includes explanation, informed consent, and privacy.

Consent

In attending a consultation, it is assumed that a patient is seeking treatment and therefore is consenting to necessary examinations. However, before proceeding with an examination, healthcare professionals should always seek to obtain, by word or gesture, some explicit indication that the patient understands the need for examination and agrees for it to take place.

What is a chaperone?

A chaperone is present as a safeguard for both parties, patient and healthcare professionals, and is a witness to the conduct and the continuing consent of the procedure.

The precise role of the chaperone varies depending on the circumstances. It may include providing a degree of emotional support and reassurance to patients, but more commonly incorporates:

• Providing protection to healthcare professionals against unfounded allegations of improper behaviour.
• Assisting in the examination or procedure, for example handing instruments during IUCD insertion.
• Assisting with undressing, dressing and positioning patients.

Under no circumstances should a chaperone be used to reduce the risk of attack on a health professional.

Who may chaperone?

Chaperones may be termed ‘formal’ and ‘informal’.

Informal chaperones

Many patients feel reassured by the presence of a familiar person, and this request in almost all cases should be accepted. This informal chaperone may not necessarily be relied upon to act as a witness to the conduct or continuing consent of the procedure.

Under no circumstances should a child be expected to act as a chaperone. However, if the child is providing comfort to the parent, and will not be exposed to unpleasant experiences, it may be acceptable for them to stay. It is inappropriate to expect an informal chaperone to take part in the examination, or to witness the procedure directly.

Formal chaperones

A ‘formal’ chaperone implies a clinical health care professional, such as a nurse or a healthcare assistant. This individual will have a specific role to play in terms of the consultation and this role should be made clear to both the patient and the chaperone.

It is important that chaperones have had sufficient training to understand the role expected of them, and that they are not expected to undertake a role for which they have not been trained for.

Protecting the patient from vulnerability and embarrassment means that the chaperone would usually be of the same sex as the patient. There will be occasions when this is difficult to achieve.

If the patient is requesting a male chaperone, then a male GP can be called upon to act as the chaperone, or the patient can be offered to re-book their appointment with a male GP.

The patient should always have the opportunity to decline a particular person as a chaperone if that person is not acceptable to them for any justifiable reason.

Training for chaperones

Members of staff who undertake a formal chaperone role should undergo training.

This should include an understanding of:

• What is meant by the term chaperone.
• The specific details of different types of intimate examinations.
• The rights of the patient.
• Their role and responsibility.
• Policy and mechanism for raising concerns.

Offering a chaperone

The relationship between a patient and healthcare professionals is based on trust. A practitioner may have no doubts about a patient they have known for a long time and feel it is not necessary to offer a formal chaperone. However, this should not detract from the fact that any patient is entitled to a chaperone if they feel one is required.

It is good practice to offer all patients a chaperone of the same sex for any examination or procedure. If the patient is offered and does not want a chaperone, it is important to record that the offer was made and declined.

Staff should be aware that intimate examinations might cause anxiety for both male and female patients, whether or not the examiner is of the same gender.

If a chaperone is refused, a healthcare professional cannot usually insist that one is present. However, there may be cases where the practitioner may feel unhappy to proceed, for example where there is a significant risk of the patient displaying unpredictable behaviour, or making false accusations.

In this case, the practitioner must make his/her own decision and carefully document this with the details of any procedure undertaken.

Where a chaperone is needed but not available

If the patient has requested a chaperone and none are available at that time, the patient must be given the opportunity to reschedule their appointment within a reasonable timeframe (this may include simple waiting in the practice until a member of staff is available).

If the seriousness of the condition would dictate that a delay is inappropriate, then this should be explained to the patient and recorded in their notes. A decision to continue or otherwise must be jointly reached.

In cases where the patient is not competent to make an informed decision, then the healthcare professional must use their own clinical judgement, and be able to justify this course of action. The decision and rationale should be documented in the patient’s notes.

It is acceptable for a healthcare professional to perform an intimate examination without a chaperone if the situation is life threatening or speed is essential in the care or treatment of the patient. This should also be recorded in the patient’s notes.

Issues specific to children

Children and their parents or guardians must receive an explanation of the procedure in order to obtain their co-operation and understanding. If a minor presents in the absence of a parent or guardian, the healthcare professional must ascertain if they are capable of understanding the need for an examination.

In these cases it is advisable for a formal chaperone to be present for any intimate examinations.

In situations where abuse is suspected, great care and sensitivity must be used to allay fears of repeat abuse. In these situations healthcare professionals should refer to the local child protection policies, and seek advice from the Child Protection Lead/Team as necessary.

Issues specific to religion, ethnicity, culture and sexual orientation

All patients undergoing examinations should be allowed the opportunity to limit the degree of nudity by, for example, uncovering only that part of the anatomy that requires investigation.

Some patient’s ethnic, religious, cultural background and sexual orientation can make intimate examinations particularly difficult. For example, Muslim and Hindu women may have a strong cultural aversion to being touched by men other than their husbands, or a lesbian woman or likewise a gay man, may possibly have an aversion to intimate examinations being performed by the opposite gender.

These considerations should be taken into account and discussed, not presumed. We must recognise that each individual has very different needs and before the procedure these should be mutually agreed with the healthcare professional.

Issues specific to people with learning difficulties and mental health problems

For patients with learning difficulties or mental health problems that affect capacity, a familiar individual, such as a family member or carer may be the best chaperone. A simple and sensitive explanation of the technique is vital. This patient group is a vulnerable one, and issues may arise with physical examination.

Adult patients with learning difficulties or mental health problems who resist an examination or procedure must be interpreted as refusing to give consent and the procedure must be abandoned.

In life-saving situations the healthcare professional should use their clinical judgement. Where possible the matter should be discussed with a member of the mental health care team.

Non english speaking patients

In the situation of a non-English speaking patient being examined the use of an independent interpreter should be enlisted. The use of a formal chaperone may still be appropriate with the interpreter in the room. A family member or interpreter should not be used as a formal chaperone.

Lone working

Where a healthcare professional is working in a situation away from other colleagues, for example during a home visit, the same principles for offering and use of chaperones should apply.

The healthcare professional may be required to risk assess the need for a formal chaperone and should not be deterred by the inconvenience or complexity of making the necessary arrangements. In all instances the outcome must be documented.

Patient confidentiality

In all cases where the presence of a chaperone may intrude in a confiding clinician-patient relationship, their presence should be confined to the physical examination. Communication between the healthcare professional and the patient should take place before and after the examination or procedure.

Communication and record keeping

The key principles of communication and record keeping will ensure that the healthcare professional and patient relationship is maintained and act as a safeguard against formal complaints, or in extreme cases, legal action.

The most common cause of patient complaints is the failure in communication between both parties, either in the practitioner’s explanation or the patients understanding in the process of examination or treatment.

It is essential that the healthcare professional explains the nature of the examination and offers them a choice whether to continue.

Chaperoning in no way removes or reduces this responsibility. Details of the examination, including the presence or absence of a chaperone and the information given, must be documented in the patient’s clinical record. The records should make clear from the history that the examination was necessary.

In any situation where concerns are raised or an incident has occurred this should be dealt with immediately in accordance with the Incident Reporting Procedure.

Complaints procedure

If you would like to make a complaint, please do so in writing addressed to the manager (Michaela Campbell) as soon as possible after the event.

Please use our Feedback Triage to contact the practice directly or email the surgery on wheatfield.surgery@nhs.net with your relevant personal information.

We will acknowledge your complaint in writing within 3 working days and aim to have looked into the matter within 10 working days. When the investigation takes place, you may be invited to meet with the person(s) concerned to attempt to resolve the issue.

We will keep you informed as the investigation progresses and once complete, your complaint will be determined and a final response will be sent to you. If you are dissatisfied with the response, you have a right to escalate the matter further. If you wish to approach the Ombudsman, the contact details are as follows:

The Parliamentary and Health Service Ombudsman
Millbank Tower
Millbank
London
SW1P 4QP

Tel: 0345 0154033

Website: www.ombudsman.org.uk 

If you are a registered patient, you are able to complain about your own care. You cannot complain about someone else’s treatment without their written consent.

You may also approach PALS for help or advice. The Patient Advice and Liaison Service (PALS) is based at NHS Bedfordshire to provide confidential advice and support, helping you to sort out any concerns you may have about the care we provide, guiding you through the different services available from the NHS

NHS Bedfordshire
Gilbert Hitchcock House
21 Kimbolton Road
Bedford MK40 2AW

Praise procedure

If you would like to praise the surgery as a whole or an individual staff member, please do so by one of the following:

• In writing 
• On the NHS Choices website

This will then be discussed at our next Clinical Governance meeting in which all staff members attend. We appreciate all praise that we receive from patients as well as other organisations.

Complaining on behalf of someone else

We keep to the strict rules of medical and personal confidentiality. If you wish to make a complaint and are not the patient involved, we will require the written consent of the patient to confirm that they are unhappy with their treatment and that we can deal with someone else about it.

Please ask at reception for the complaints form which contains a suitable authority for the patient to sign to enable the complaint to proceed.

Where the patient is incapable of providing consent due to illness or accident it may still be possible to deal with the complaint. Please provide the precise details of the circumstances which prevent this in your covering letter.

Please note that we are unable to discuss any issue relating to someone else without their express permission, which must be in writing, unless the circumstances above apply.

We may still need to correspond direct with the patient or may be able to deal direct with the third party, and this depends on the wording of the authority provided.

Any information given to anyone at the surgery is confidential. It will not be shared with anybody without your consent unless there is a medical need. We treat any breach of confidentiality with great seriousness. As a result of this, we can only give information to patients and not to any third party.

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.

Wheatfield Surgery have a ‘do not attend’ policy to ensure that patients are followed up and are aware they cannot ‘not attend’ appointments without cancelling their appointment in advance, as it’s unfair on other patients that cannot obtain an appointment.

Reception run a report on a daily basis that shows us who did not attend their appointment’s the day before. This list is then checked against the appointment ledger to ensure there wasn’t a genuine reason for the no show, i.e. admitted to hospital etc.

The remaining list is then read coded as ‘DNA letter sent to patient’, and sent a letter informing them of the affect on the surgery by not attending their appointment’s and that it isn’t fair on other patients. It also mentions that it is important they attend their own appointments to be reviewed on a regular basis.

Wheatfield Surgery holds a three-strike policy. If the patient receives a DNA letter three times within a 12-month period they will be removed from the surgery list and informed.

The secretary also sends letters to patients who do not attend their appointments at the hospital or community services. They are informed of the seriousness of this and asked to make an appointment with their usual GP to follow up from this.

We also have a DNA board in the waiting area which informs patients how many appointments were missed and how many hours of time this equates too.

The following policy sets out a possible approach to the Freedom of Information (FOI) Act 2000 by the practice.

Introduction

The Freedom of Information (FOI) Act was passed in 2000, and replaced the Open Government Code of Practice that has been in place since 1994. The Act gives the public a general right of access to all types of recorded information held by public authorities.

The Act places a statutory obligation on all public bodies to publish details of all recorded information that they hold and to allow, with a few exceptions, the general public to have access to this information on request.

The practice recognises the importance of the Act, and it will ensure that appropriate systems are put in place to publicise what recorded information is kept by the practice, and how this information can be accessed on request by the general public.

1.0 The FOI act

The main features of the Act are:

• A general right of access to information held by public authorities.
• Exemptions from the duty to provide information.
• A requirement on public authorities to exercise discretion; they may have to disclose information even when exempt under the Act (the ‘public interest test’).
• Arrangements in respect of costs and fees.
• A duty on public authorities to adopt publication schemes.
• Arrangements for enforcement and appeal.
• A duty to provide advice and assistance to people who wish to make, or have made requests for information.
• Codes of practice.

The UK legislation is wholly retrospective, and applies to all information held by public authorities regardless of its date.

The Act is overseen by the Information Commissioner, who will have the power to issue enforcement notices and, if needs be, initiate court proceedings to ensure compliance.

The practice recognises its corporate responsibility under the Act to provide the general right of access to information held. The overall responsibility for this policy is with Dr Sanjay Sharma.

2.0 Employee responsibilities

All employees will, through appropriate training and responsible management:

• Observe all forms of guidance, codes of practice and procedures about the storage, closure, retention and disposal of documents and records.
• Be aware that ultimately the general public may have access to any piece of information held within the practice and must pay due regard to how they record information as part of their normal duties.
• On receipt of an information request immediately notify the IG/FOI lead.
• Provide information promptly when requested from the IG/FOI lead.
• Understand that breaches of this policy may result in disciplinary action, including dismissal.

3.0 Organisation responsibilities

The practice will:

• Comply with the FOI Act and sees it as an opportunity to enhance public trust and confidence in the practice.
• Ensure that there is always one person with overall responsibility for FOI.
• Maintain a comprehensive ‘Publication Scheme’ that provides information which is readily accessible without the need for a formal FOI Act request.
• Seek to satisfy all FOI Act requests promptly and within 20 working days. However, if necessary we will extend this timescale to give full consideration to a public interest test. If we do not expect to meet the deadline, we will inform the requester as soon as possible of the reasons for the delay and when we expect to have made a decision.
• Continue to protect the personal data entrusted to us, by disclosing it only in accordance with the Data Protection Act 2018.
• Provide advice and assistance to requesters to facilitate their use of FOI Act. We will publish our procedures and assist requesters to clarify their requests so that they can obtain the information that they require.
• Work with the Clinical Commissioning Group, NHS England, the local Area Team and other bodies with whom we work to ensure that we can meet our FOI Act obligations, including the disclosure of any information that they hold on our behalf.
• Apply the exemptions provided in the FOI Act and, where qualified exemptions exist, the practice will disclose the information unless the balance of public interest lies in withholding it.
• Consult with third parties before disclosing information that could affect their rights and interests. However, according to the FOI Act, the practice must take the final decision on disclosure.
• Charge for information requests in line with the FOI Act fees regulations or other applicable regulations, including the Data Protection Act 2018.
• Record all FOI Act requests and our responses and will monitor our performance in handling requests and complaints.
• Ensure that all staff are aware of their obligations under FOI Act and will include FOI Act education in the induction of all new staff.

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, before tax and National Insurance, for GPs working in Wheatfield Surgery in the last financial year was £99,139.

The number of full time GPs that this relates to is 3. The number of part time GPs that this relates to is 5. The number of locum GPs working in the practice for over six months, that this relates to is 0.

We aim to keep our surgery clean and tidy and offer a safe environment to our patients and staff. We are proud of our modern, purpose built practice and endeavour to keep it clean and well maintained at all times.

If you have any concerns about cleanliness or infection control, please report to our reception staff either in person or via our online contact form.

Our GPs and nursing staff follow our Infection Control Policy to ensure the care we deliver and the equipment we use is safe.

We take additional measures to ensure we maintain the highest standards:

• Encourage staff and patients to raise any issues or report any incidents relating to cleanliness and infection control. We can discuss these and identify improvements we can make to avoid any future problems.
• Carry out an annual infection control audit to make sure our infection control procedures are working.
• Provide annual staff updates and training on cleanliness and infection control.
• Review our policies and procedures to make sure they are adequate and meet national guidance.
• Maintain the premises and equipment to a high standard within the available financial resources and ensure that all reasonable steps are taken to reduce or remove all infection risk.
• Use washable or disposable materials for items such as couch rolls, modesty curtains, floor coverings, towels etc., and ensure that these are laundered, cleaned or changed frequently to minimise risk of infection.
• Make alcohol hand rub gel available throughout the building.

We have allocated a named accountable GP for all of our registered patients. If you do not know who your named GP is, please ask a member of our reception team. Unfortunately, we are unable to notify patients in writing of any change of GP due to the costs involved.

We offer the facility for patients to view online, export, or print, any summary information from their records relating to medications, allergies and adverse reactions.

Patient’s rights

We are committed to giving you the best possible service. This will be achieved by working together. Help us to help you. You have a right to, and the practice will try to ensure that:

• You will be treated with courtesy and respect.
• You will be treated as a partner in the care and attention that you receive.
• All aspects of your visit will be dealt with in privacy and confidence.
• You will be seen by a doctor of your choice subject to availability.
• In an emergency, out of normal opening hours, if you telephone the practice you will be given the number to receive assistance, which will require no more than one further call.
• You can bring someone with you, however you may be asked to be seen on your own during the consultation.
• Repeat prescriptions will normally be available for collection within two working days of your request. You can request your repeat prescriptions via our online form.
• Information about our services on offer will be made available to you by way of posters, notice boards and newsletters.
• You have the right to see your medical records or have a copy subject to certain laws.

Patient’s responsibilities

With these rights come responsibilities and for patients we would respectfully request that you:

• Treat practice staff and doctors with the same consideration and courtesy that you would like yourself. Remember that they are trying to help you.
• Please ensure that you order your repeat medication in plenty of time allowing 48 working hours. You can use the Repeat Prescriptions Request form to request your repeat prescriptions.
• Please ensure that you have a basic first aid kit at home and initiate minor illness and self-care for you and your family.
• Please attend any specialist appointments that have been arranged for you, or cancel them by using the Cancel an Appointment forms if your condition has resolved or you no longer wish to attend.
• Please follow up any test or investigations done for you with the person who has requested the investigation.
• Attend appointments on time and check in with reception.
• Patients who are more than 20 minutes late for their appointment may not be seen.
• If you are unable to make your appointment or no longer need it, please give the practice adequate notice that you wish to cancel through our online form. Appointments are heavily in demand, and missed appointments waste time and delay more urgent patients receiving the treatment they need.
• An appointment is for one person only. Where another family member needs to be seen or discussed, another appointment should be made. Please visit our Consulting Room to book an appointment.
• Patients should make every effort to present at the surgery to ensure the best use of nursing and medical time. Home visits should be medically justifiable and not requested for social convenience. Please visit our Home Visits page for further information.
• Please inform us via our Change Personal Details form when you move home, change your name or telephone number, so that we can keep our records correct and up to date.
• Read the practice leaflets and other information that we give you. They are there to help you use our services. If you do not understand their content please tell us.
• Let us have your views by completing our Feedback form. Your ideas and suggestions whether complimentary or critical are important in helping us to provide a first class, safe, friendly service in pleasant surroundings.

NHS Constitution

The NHS Constitution establishes the principles and values of the NHS in England. For more information see these websites:

Wheatfield Surgery is committed to taking all reasonable precautions necessary to ensure the health, safety, welfare and wellbeing of its employees, patients and visitors. We endeavours to ensure that all employees are protected from physical and verbal abuse while they are working.

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 staff are aware. In addition, where deemed necessary, appropriate support will be put in place, e.g. staff member does 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 employee’s or employer’s property.

The practice supports the NHS policy of zero tolerance which defines violence as:

“Any incident where staff are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, well-being or health”.

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”.

Types of difficult / angry patients

• Withdrawn, secretive, vague – limits information as a form of control.
• Critical – everything is wrong, bad.
• Intimidating – highly sarcastic, cutting.
• Sad sack – dwell on all the misfortunes, make others feel guilty.

Anger can be a common and normal reaction

• Often due to a loss of control, feelings of powerlessness.
• Can sometimes be justified – e.g. due to late/missed diagnosis, medical errors, fatalities, poor quality care, inadequate pain control, excessive waiting times, rudeness, etc.

How you might recognise when someone is angry:

• Raised voice/shouting.
• Flushed face.
• Wild gesticulations.
• Angry words.
• Rigid body.
• Withdrawal.
• Sarcasm.
• Dismissive comments.
• Gritted teeth, clenched jaw.

Policy

This document sets out our policy for dealing with violence and aggression whether it is committed by or against any patient, visitor, or person working in the practice.

This policy applies throughout the practice premises, including car parks, grounds and any outbuildings.