A request by a patient, or a request by a third party who has been authorised by the patient, for access under the GDPR (and DPA 2018) is called a subject access request (SAR). If you want to see your health records or wish a copy, you can write or call your Practice and then arrange a time to come in and read them. You don’t have to give a reason for wanting to see your records. There is no charge for this service.

It’s a good idea to state the dates of the records that you want to see – for example, from 2010-2017 – and to send the letter by recorded delivery or deliver it to the Practice (if you are requesting this in writing). You should also keep a copy of your letter for your records. The Practice, has up to 28 days to respond. If additional information is needed before copies can be supplied, the 28-day time limit will begin as soon as the additional information has been received.

The 28-day time-limit can be extended for two months for complex or numerous requests where the data controller (usually your practice) needs more time to collate and supply the data. You will be informed about this within 28 days and provided with an explanation of why the extension is necessary.

When writing/calling, you should say if you:

• want a copy as well as to see them (if you wish to see them your doctor or member(s) of staff will be present to assist you and explain any medical terms to you)
• want all or just part of them
• would like your records to be given to you in a format that meets your needs, and we will endeavour to accommodate your request
• If you request your records to be emailed, then we will secure your or your representative’s agreement (in writing or in email) that they accept the risk if sending unencrypted information to a non-NHS email address

You may also need to fill in an application form and give proof of your identity. The Practice has an obligation under the GDPR and DPA2018 to ensure that any information provided for the patient, can be verified.

Please note we never send original medical records because of the potential detriment to patient care should these be lost

Who may apply for access?

1(1) Patients with capacity

Subject to the exemptions listed in paragraph 1(6) (below) patients with capacity have a right to access their own health records via a SAR. You may also authorise a third party such as a solicitor to do so on your behalf. Competent young people may also seek access to their own records. It is not necessary for you to give reasons as to why they wish to access their records.

1 (2) Children and young people under 18

Where a child is competent, they are entitled to make or consent to a SAR to access their record.

Children aged over 16 years are presumed to be competent. Children under 16 in England, Wales and Northern Ireland must demonstrate that they have sufficient understanding of what is proposed in order to be entitled to make or consent to an SAR. However, children who are aged 12 or over are generally expected to have the competence to give or withhold their consent to the release of information from their health records.

In Scotland, anyone aged 12 or over is legally presumed to have such competence. Where, in the view of the appropriate health professional, a child lacks competency to understand the nature of his or her SAR application, the holder of the record is entitled to refuse to comply with the SAR.

Where a child is considered capable of making decisions about access to his or her medical record, the consent of the child must be sought before a parent or other third party can be given access via a SAR (see paragraph 1 (3) below)

1(3) Next of kin

Despite the widespread use of the phrase ‘next of kin’, this is not defined, nor does it have formal legal status. A next of kin cannot give or withhold their consent to the sharing of information on a patient’s behalf. As next of kin they have no rights of access to medical records. For parental rights of access, see the information above.

1(4) Solicitors

You can authorise a solicitor acting on your behalf to make a SAR. We must have your written consent before releasing your medical records to your solicitors acting. The consent must cover the nature and extent of the information to be disclosed under the SAR (for example, past medical history), and who might have access to it as part of the legal proceedings. Where there is any doubt, we may contact you before disclosing the information.

(England and Wales only – Should you refuse, your solicitor may apply for a court order requiring disclosure of the information. A standard consent form has been issued by the BMA and the Law Society of England and Wales. While it is not compulsory for solicitors to use the form, it is hoped it will improve the process of seeking consent).

The Practice may also contact you to let you know when your medical records are ready. If your solicitor is based within our area, then we may ask you to uplift them and deliver them to your solicitor. This is because we can no longer charge for copying and postage, so we would appreciate your help if you can do this, or alternatively ask your solicitor if they can uplift your medical records.

1(5) Supplementary Information under SAR requests

The purposes for processing data

The purpose for which data is processed is for the delivery of healthcare to individual patients. In addition, the data is also processed for other non-direct healthcare purposes such as medical research, public health or health planning purposes when the law allows.

The categories of personal data

The category of your personal data is healthcare data.

The organisations with which the data has been shared

Your health records are shared with the appropriate organisations which are involved in the provision of healthcare and treatment to the individual. Other organisations will receive your confidential health information, for example Digital or the Scottish Primary Care Information Resource (SPIRE) or research bodies such as the Secure Anonymised Linkage Databank (SAIL). (This information is already available to patients in our Practice privacy notices).

The existence of rights to have inaccurate data corrected and any rights of objection

For example, a national ‘opt-out’ model such as SPIRE etc.

Any automated decision taking including the significance and envisaged consequences for the data subject

For example, risk stratification.

The right to make a complaint to the Information Commissioner’s Office (ICO)

1(6) Information that should not be disclosed

The GDPR and Data Protection Act 2018 provides for a number of exemptions in respect of information falling within the scope of a SAR. If we are unable to disclose information to you, we will inform you and discuss this with you.

1(7)Individuals on behalf of adults who lack capacity

Both the Mental Capacity Act in England and Wales and the Adults with Incapacity (Scotland) Act contain powers to nominate individuals to make health and welfare decisions on behalf of incapacitated adults. The Court of Protection in England and Wales, and the Sheriff’s Court in Scotland, can also appoint deputies to do so. This may entail giving access to relevant parts of the incapacitated person’s medical record, unless health professionals can demonstrate that it would not be in the patient’s best interests. These individuals can also be asked to consent to requests for access to records from third parties.

Where there are no nominated individuals, requests for access to information relating to incapacitated adults should be granted if it is in the best interests of the patient. In all cases, only information relevant to the purposes for which it is requested should be provided.

1(8) Deceased records

The law allows you to see records of a patient that has died as long as they were made after 1st November 1991.

Records are usually only kept for three years after death (In England and Wales GP records are generally retained for 10 years after the patient’s death before they are destroyed).

Who can access deceased records?

You can only see that person’s records if you are their personal representative, administrator or executor.

You won’t be able to see the records of someone who made it clear that they didn’t want other people to see their records after their death.

Accessing deceased records

Before you get access to these records, you may be asked for:

• proof of your identity
• proof of your relationship to the person who has died

Viewing deceased records

You won’t be able to see information that could:

• cause serious harm to your or someone else’s physical or mental health
• identify another person (except members of NHS staff who have treated the patient), unless that person gives their permission
• If you have a claim as a result of that person’s death, you can only see information that is relevant to the claim.

1(9) Hospital Records

To see your hospital records, you will have to contact your local Hospital.

1(10) Power of attorney

Your health records are confidential, and members of your family are not allowed to see them, unless you give them written permission, or they have power of attorney.

A lasting power of attorney is a legal document that allows you to appoint someone to make decisions for you, should you become incapable of making decisions yourself.

The person you appoint is known as your attorney. An attorney can make decisions about your finances, property, and welfare. It is very important that you trust the person you appoint so that they do not abuse their responsibility. A legal power of attorney must be registered with the Office of the Public Guardian before it can be used.

If you wish to see the health records of someone who has died, you will have to apply under the Access to Medical Records Act 1990. You can only apply if you:

• are that person’s next of kin, are their legal executor (the person named in a will who is in charge of dealing with the property and finances of the deceased person),
• have the permission of the next of kin or have obtained written permission from the deceased person before they died.

To access the records of a deceased person, you must go through the same process as a living patient. This means either contacting the Practice or the hospital where the records are stored.

If you think that information in your health records is incorrect, or you need to update your personal details (name, address, phone number), approach the relevant health professional informally and ask to have the record amended. Some hospitals and GP surgeries have online forms for updating your details. If this doesn’t work, you can formally request that the information be amended under the NHS complaints procedure.

All NHS trusts, NHS England, CCGs, GPs, dentists, opticians and pharmacists have a complaints procedure. If you want to make a complaint, go to the organisation concerned and ask for a copy of their complaints procedure.

Alternatively, you can complain to the Information Commissioner (the person responsible for regulating and enforcing the Data Protection Act), at:

The Information Commissioner’s Office (ICO)
Wycliffe House,
Water Lane,
Wilmslow,
Cheshire,
SK9 5AF
Telephone: 01625 545745

If your request to have your records amended is refused, the record holder must attach a statement of your views to the record.

As part of this process, we want to get better at communicating with our patients. If you find it hard to read our letters or if you need someone to support you at appointments, please let us know. We are keen to hear from you if you have a visual or hearing impairment or another disability and would prefer to receive information in any of the following formats.

Please let us know if you, or someone you know has particular communication needs – you may have requirements that are not shown here.

All medical consultations, examinations and investigations are potentially distressing. Patients can find examinations, investigations or photography involving the breasts, genitalia or rectum particularly intrusive (these examinations are collectively referred to as “intimate examinations”). Also consultations involving dimmed lights, the need for patients to undress or for intensive periods of being touched may make a patient feel vulnerable.

Chaperoning is the process of having a third person present during such consultations to: provide support, both emotional and sometimes physical to the patient, and also to protect the doctor against allegations of improper behaviour during such consultations, and sometimes to provide practical support. Please ask clinician, if you want a chaperone.

Clinical governance encompasses quality assurance, quality improvement and risk and incident management.

However, we are aware that things can go wrong resulting in a patient feeling that they have a genuine cause for complaint. If this is so, we would wish for the matter to be settled as quickly, and as amicably, as possible.

To have your complaint investigated, you usually need to complain within 12 months of the event happening, or as soon as you first become aware of the issue you want to complain about.

The time limit can be extended in special circumstances.

In General

If you have a complaint to make, you can either contact the Practice Manager or ask the receptionist for a copy of our complaints Procedure. We endeavour to acknowledge any letter or complaints form within 3 working days of receiving it, and to deal with the matter as promptly as possible- usually within 20 working days- dependent on the nature of the complaint.

Who can complain

• Complainants can normally be current or former patients, or their nominated or elected representatives (who have given consent).
• Patients over the age of 16 whose mental capacity is unimpaired should normally complain themselves or authorise someone to bring a complaint on their behalf.
• Children under the age of 16 can also make their own complaint, if they’re able to do so.

If  the patient’s lack capacity to make decisions, their representative must be able to demonstrate sufficient interest in the patient’s welfare and be an appropriate person to act on their behalf. This could be a partner, relative or someone appointed under the Mental Capacity Act 2005 with lasting power of attorney.

Appropriate person

In certain circumstances, we need to check that a representative is the appropriate person to make a complaint.

• For example, if the complaint involves a child, we must satisfy ourselves that there are reasonable grounds for the representative to complain, rather than the child concerned.
• If the patient is a child or a patient who lacks capacity, we must also be satisfied that the representative is acting in the patient’s best interests.

If we are  not satisfied that the representative is an appropriate person, we cannot consider the complaint, giving the representative reasons for our decision in writing.

Time limits

A complaint must be made within 12 months, either from the date of the incident or from when the complainant first knew about it.

The regulations state that a responsible body should consider a complaint after this time limit if:

• the complainant has good reason for doing so, and
• it’s still possible to investigate the complaint fairly and effectively, despite the delay.

Procedure

We have a two stage complaints procedure. We will always try to deal with your complaint quickly. However if it is clear that the matter will need a detailed investigation, we will tell you and keep you updated on our progress.

Stage one – Early, local resolution

• We will try to resolve your complaint within five working days if we can.
• If you are dissatisfied with our response, you can ask us to consider your complaint at Stage two.

Stage Two – Investigation

• We will look at your complaint at this stage if you are dissatisfied with our response at Stage One.
• We also look at some complaints straight away at this stage, if it is clear that they are complex or need detailed investigation.
• We will acknowledge your complaint within three working days.
• We will give you out decision as soon as possible. This will be no more that 20 working days unless there is clearly a good reason for needing more time.

You can also make a complaint by visiting:

• Healthwatch Birmingham & Solihull- champion for health and social care

Complain to the Ombudsman

If you’re unhappy with the final response from the Practice you can take your complaint to the ombudsman.

The ombudsman is independent of the NHS and free to use. It can help resolve your complaint, and tell the NHS how to put things right if it has got them wrong.

The ombudsman only has legal powers to investigate certain complaints. You must have received a final response from the Practice before the ombudsman can look at your complaint.

The ombudsman will generally not look into your complaint if it happened more than 12 months ago, unless there are exceptional circumstances.

Address:
Parliamentary and Health Service Ombudsman Tower,
30 Millbank,
London,
SW1P 4QP
Phone: 0345 015 4033
email

Please be aware that our staff are bound to the NHS code of confidentiality. Our staff are therefore not permitted to discuss any of our patient’s medical history, this includes their registration status, without their written consent to do so.

Once we have received their written consent and verified this with the patient, then we can provide you with this information, this includes complaining on behalf of a patient, but excludes patients who are unable to act on their own behalf and already have a designated person or carer responsible for their medical care.

We therefore respectfully ask parents and guardians not to request information regarding their relatives or to complain on their behalf unless we have their written consent to do so.

This must be done on the basis of an explanation by a clinician.

Consent from a patient is needed regardless of the procedure, whether it’s a physical examination, organ donation or something else.

The principle of consent is an important part of medical ethics and the international human rights law.

Defining consent

For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

These terms are explained below:

• voluntary– the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family
• informed– the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn’t go ahead
• capacity– the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.

This is still the case even if refusing treatment would result in their death, or the death of their unborn child.

If a person doesn’t have the capacity to make a decision about their treatment, the healthcare professionals treating them can go ahead and give treatment if they believe it’s in the person’s best interests.

But clinicians must take reasonable steps to seek advice from the patient’s friends or relatives before making these decisions.

Read more about assessing the capacity to consent.

How consent is given

Consent can be given:

verbally– for example, by saying they’re happy to have an X-ray

in writing– for example, by signing a consent form for surgery

Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place – for example, holding out an arm for a blood test.

Consent should be given to the healthcare professional directly responsible for the person’s current treatment, such as:

• a nurse arranging a blood test
• a GP prescribing new medication
• a surgeon planning an operation

If someone is going to have a major medical procedure, such as an operation, their consent should ideally be secured well in advance, so they have plenty of time to obtain information about the procedure and ask questions.

If they change their mind at any point before the procedure, the person is entitled to withdraw their previous consent.

Consent from children and young people

If they’re able to, consent is usually given by patients themselves.

However, someone with parental responsibility may need to give consent for a child up to the age of 16 to have treatment.

Read more about the rules of consent applying to children and young people.

When consent isn’t needed

There are a few exceptions when treatment may be able to go ahead without the person’s consent, even if they’re capable of giving their permission.

It may not be necessary to obtain consent if a person:

• requires emergency treatment to save their life, but they’re incapacitated (for example, they’re unconscious) – the reasons why treatment was necessary should be fully explained once they’ve recovered
• immediately requires an additional emergency procedure during an operation – there has to be a clear medical reason why it would be unsafe to wait to obtain consent, and it can’t be simply for convenience
• with a severe mental health condition, such as schizophrenia, bipolar disorder or dementia, lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act 1983) – in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental illness
• requires hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act 1983) – the person’s nearest relative or an approved social worker must make an application for the person to be forcibly kept in hospital, and two doctors must assess the person’s condition
• is a risk to public health as a result of rabies, cholera or tuberculosis (TB)
• is severely ill and living in unhygienic conditions (under the National Assistance Act 1948) – a person who is severely ill or infirm and is living in unsanitary conditions can be taken to a place of care without their consent

Consent and life-sustaining treatments

A person may be being kept alive with supportive treatments – such as lung ventilation – without having made an advance decision, which outlines the care they would refuse to receive.

In these cases, a decision about continuing or stopping treatment needs to be made based on what that person’s best interests are believed to be.

To help reach a decision, the healthcare professionals responsible for the person’s care should discuss the issue with the relatives and friends of the person receiving the treatment.

They should consider, among other things:

• what the person’s quality of life will be if treatment is continued
• how long the person may live if treatment is continued
• whether there’s any chance of the person recovering

Treatment can be withdrawn if there’s an agreement that continuing treatment isn’t in the person’s best interests.

The case will be referred to the courts before further action is taken if:

• an agreement can’t be reached
• a decision has to be made on whether to withdraw treatment from someone who has been in a state of impaired consciousness for a long time (usually at least 12 months)

It’s important to note the difference between withdrawing a person’s life support and taking a deliberate action to make them die. For example, injecting a lethal drug would illegal.

Complaints

If you believe you’ve received treatment you didn’t consent to, you can make an official complaint, please write to the Practice Manager who will assist you with this process.

We endeavour to provide a first class service at all times. However, we acknowledge that at times things may go wrong and our service may fall below our expected levels.

In order to comply with Regulation 20 of the Health and Social Care Act 2008 (Regulations 2014) we pledge to:

• Have a culture of openness and honesty at all levels
• Inform patients in a timely manner when safety incidents have occurred which may affect them
• Provide a written and truthful account of the incident, explaining any investigations and enquiries made
• Provide a written apology
• Provide support if you are affected directly by an incident

Free Services

GP and nurse consultations in primary care, treatment provided by a GP and other primary care services are free of charge to all, whether registering as an NHS patient, or as a temporary patient, which is when the patient is in the area for more than 24 hours and less than 3 months.

For secondary care services, the UK’s healthcare system is a residence-based one, which means entitlement to free healthcare is based on living lawfully in the UK on a properly settled basis for the time being.

The measure of residence that the UK uses to determine entitlement to free NHS healthcare is known as ‘ordinary residence’. This requires non-EEA nationals subject to immigration control to also have the immigration status of indefinite leave to remain.

Individuals who are not ordinarily resident in the UK may be required to pay for their care when they are in England. However, some services and some individuals are exempt from payment.

The following NHS treatment is available to anyone:

• Treatment in an emergency (but not follow up treatment).
• Treatment of certain communicable diseases.
• Compulsory psychiatric treatment.

To qualify for other NHS treatments you must meet certain conditions which are outlined below.

EU Nationals

Foreign nations from EU member states have reciprocal arrangements for both dental and medical health care so can access the full range of NHS services.

Non EU nationals

Foreign nationals from non-EU countries have no automatic right to NHS healthcare (other than those outlined above). Students and visitors who are going to stay in the UK for less than 6 months would have to be seen as private patients and would have to pay for their treatment. It is therefore essential that you have medical insurance to pay for any Private treatment.

If you are not a student registered at a UK university and your are not going to stay in the UK for between six months and a year, it may be unlikely that you will be able receive free NHS treatment.

Be aware that a valid 6 month visa does not automatically confer the right to free NHS treatment.

Please note that registering with a GP does not give you automatic entitlement to access free NHS hospital treatment. It is therefore essential that you take out medical insurance for the duration of your visit prior to arrival in the UK.

If you are a student registered at a UK University (and you have documentary proof of this) and are going to stay in the UK for more than six months you will qualify for NHS treatment from the beginning of your stay and you (and your dependants) will be entitled to NHS treatment and you may register with a GP.

Medical emergencies

If you need immediate medical assistance (e.g. because of an accident) telephone 999. The call is free. An operator will ask you which emergency service you require (fire, police or ambulance). You will need to tell the emergency services what has happened and where you are. If someone is injured and needs to go to hospital an ambulance will arrive and take them to the nearest hospital with an emergency department.

If you need urgent treatment but are well enough to travel please make your own way to the nearest Accident and Emergency Department.

• to tell (you or your representative) the applicant whether we hold any information falling within the scope of their request; and
• to provide that information

We normally have 20 working days to respond to a request.

For a request to be valid under the Freedom of Information Act it must be in writing, Please submit your request to the Practice Manager. Any letter or email to a public authority asking for information is a request for recorded information under the Act.

All staff take responsibility for their own role in this and all staff receive regular training in their role in Infection Prevention and Control.

The policies, systems and processes in place in your Practice reflect our professional and legal responsibilities and follow recognised standards of good Practice. We evaluate our Practice on a regular basis, through audit, peer review and patient feedback and monitor the effectiveness of our quality assurance procedures.

Quality standards and procedures

In providing our patients with care of a consistent quality we will:

• Provide a safe and welcoming environment
• Ensure all members of our team are appropriately trained
• Provide patients with information about the Practice and the care available and ensure the patient understands the terms on which care is offered
• Explain all treatment options and agree clinical decisions with the patient(s), explaining the possible risks involved with each option
• Obtain valid consent for all treatment
• Refer to specialists for investigation or treatment as appropriate and without undue delay
• Maintain contemporaneous clinical records with an up to date medical history for all patients
• Provide secure storage of patients records to main confidentiality
• Explain the procedure to follow for raising a complaint about the service, identifying the Practice contact

In providing our team with care of a consistent quality we will:

• Provide a safe working environment through hazard identification and risk assessment
• Provide induction training for all new team members
• Provide job descriptions and contracts of employment
• Agree terms for all non-employed contractors working at the practice
• Maintain staff records ensuring kept as up to date as possible
• Ensure staff are notified where all Practice policies and procedures are stored and accessed

Possible grounds for consideration of removal include:

1. Physical violence to staff, doctors or other patients
2. Threat of violence to staff, doctors or other patients
3. Abusive or disruptive behaviour including under the influence of alcohol or drugs
4. Theft from surgery, staff, doctors or other patients
5. Criminal damage to surgery
6. Dangerous dogs posing a real or potential hazard on home visits
7. Altering documents eg prescriptions, insurance certificates
8. Defamation of doctors or staff
9. Misuse of appointments
10. Misuse of home visits
11. Moving outwith the area
12. Any other breakdown of the bond of trust between doctor and patient

It should be noted that if a patient does not attend for their appointment they will not be given another one for 48 hours. In the event of a patient not attending on three occasions they will receive a letter advising them that if they miss another appointment they will be removed from our Practice list.

In some cases we reserve the right to remove other members of the household. We will continue to be responsible for the patient’s medical care for a period of up to 8 days from the date of notification to our local health authority or until the patient registers with another doctor, whichever is the sooner.

We are committed to a best Practice which safeguards children and young people irrespective of their background, and which recognises that a child may be abused regardless of their age, gender, religious beliefs, racial origin or ethnic identity, culture, class, disability or sexual orientation.

The primary care team are  committed to working within agreed policies and procedures and in partnership with other agencies to ensure that the risks of harm to a child or young person are minimised. This work may include direct and indirect contact with children, (access to patient’s details, communication via email, text message/phone).

Our organisation is being supported by the CCG who have Designated Nurses and Doctors in post to offer professional expertise and advice regarding safeguarding matters.

Appropriate information sharing is an essential part of the provision of safe and effective care. Patients may be put at risk if those who provide their care do not have access to relevant, accurate and up-to-date information about them.

All staff have an ethical and legal duty to keep patient information confidential.

If you do not wish your health information shared please notify the Practice in writing, so we may update your record.

Your Summary Care Record

Care professionals in England use an electronic record called the Summary Care Record (SCR). This can provide those involved in your care with faster secure access to key information from your GP record.

What is an SCR?

If you are registered with a GP Practice in England, you will already have an SCR unless you have previously chosen not to have one.

It includes the following basic information:

• Medicines you are taking
•  Allergies you suffer from
•  Any bad reactions to medicines.

It also includes your name, address, date of birth and unique NHS Number which helps to identify you correctly.

What choices do you have?

You can now choose to include more information in your SCR, such as significant medical history (past and present), information about management of long term conditions, immunisations and patient preferences such as end of life care information, particular care needs and communication preferences.

If you would like to do this, talk to your GP Practice as it can only be added with your permission.

Remember, you can change your mind about your SCR at any time. Talk to your GP Practice if you want to discuss your option to add more information or decide you no longer want an SCR.

Vulnerable patients and carers

Having an SCR that includes extra information can be of particular benefit to patients with detailed and complex health problems. If you are a carer for someone and believe that this may benefit them, you could discuss it with them and their GP Practice.

Who can see my SCR?

Only authorised care professional staff in England who are involved in your direct care can have access to your SCR. Your SCR will not be used for any other purposes.

These staff:

• Need to have a Smartcard with a chip and passcode
•  Will only see the information they need to do their job
•  Will have their details recorded every time they look at your record

Care professionals will ask for your permission if they need to look at your SCR. If they cannot ask you because you are unconscious or otherwise unable to communicate, they may decide to look at your record because doing so is in your best interest. This access is recorded and checked to ensure that it is appropriate.

SCRs for children

If you are the parent or guardian of a child under 16, and feel they are able to understand this information you should show it to them. You can then support them to come to a decision about having an SCR and whether to include additional information.

Confidentiality

For information on how the NHS will collect, store and allow access to your electronic records visit NHS Choices.

Section 1 – What actions does the Practice consider to be unacceptable?

People may act out of character in times of trouble or distress. There may have been upsetting or distressing circumstances leading up to us being made aware of an issue or complaint.

We do not view behaviour as unacceptable just because a patient is forceful or determined. In fact, we accept that being persistent may sometimes be a positive advantage when pursuing an issue or complaint. However, we do consider actions that result in unreasonable demands on our Practice or unreasonable behaviour towards Practice staff to be unacceptable. It is these actions that we aim to manage under this Policy.

Section 2 – Aggressive or abusive behaviour

We understand that patients may be angry about the issues they have raised with the Practice. If that anger escalates into aggression towards Practice staff, we consider that unacceptable. Any violence or abuse towards staff will not be accepted. Violence is not restricted to acts of aggression that may result in physical harm. It also includes behaviour or language (whether verbal or written) that may cause staff to feel offended, afraid, threatened or abused. We will judge each situation individually and appreciate individuals who come to us may be upset.

Language which is designed to insult or degrade, is derogatory, racist, sexist, transphobic, or homophobic or which makes serious allegations that individuals have committed criminal, corrupt, perverse or unprofessional conduct of any kind, without any evidence, is unacceptable.

We may decide that comments aimed not at us, but at third parties, are unacceptable because of the effect that listening or reading them may have on our staff.

Section 3 – Unreasonable demands

A demand becomes unacceptable when it starts to (or when complying with the demand would) impact substantially on the work of the Practice. Examples of actions grouped under this heading include:

• Repeatedly demanding responses within an unreasonable timescale
• Repeatedly requesting early supplies of medication
• Repeatedly requesting further supplies of stolen medication, without the required Police Incident number
• Repeatedly ordering prescriptions out with the set timeframe
• Insisting on seeing or speaking to a particular member of staff when that is not possible
• Repeatedly changing the substance of an issue or complaint or raising unrelated concerns
• Repeatedly insisting on a course of medical treatment for which there is no clinical evidence
• Not ensuring that review appointment is in place, prior to ongoing medication finishing
• An example of such impact would be that the demand takes up an excessive amount of staff time and in so doing disadvantages other patients

Section 4 – Unreasonable levels of contact

Sometimes the volume and duration of contact made to our Practice by an individual causes problems. This can occur over a short period, for example, a number of calls in one day or one hour. It may occur over the life-span of an issue when a patient repeatedly makes long telephone calls to us, or inundates us with letters or copies of information that have been sent already or that are irrelevant to the issue.

We consider that the level of contact has become unacceptable when the amount of time spent talking to a patient on the telephone, or responding to, reviewing and filing emails or written correspondence impacts on our ability to deal with that issue, or with other Patients’ needs.

Section 5 – Unreasonable refusal to co-operate

When we are looking at an issue or complaint, we will ask the patient to work with us. This can include agreeing with us the issues or complaint we will look at; providing us with
further information, evidence or comments on request; or helping us by summarising their concerns or completing a form for us.

Sometimes, a patient repeatedly refuses to cooperate and this makes it difficult for us to proceed. We will always seek to assist someone if they have a specific, genuine difficulty complying with a request. However, we consider it is unreasonable to bring an issue to us and then not respond to reasonable requests.

Section 6 – Unreasonable use of the complaints process

Individuals with complaints about the Practice have the right to pursue their concerns through a range of means. They also have the right to complain more than once about the Practice, if subsequent incidents occur. This contact becomes unreasonable when the effect of the repeated complaints is to harass, or to prevent us from pursuing a legitimate aim or implementing a legitimate decision.

We consider access to a complaints system to be important and it will only be in exceptional circumstances that we would consider such repeated use is unacceptable – but we reserve the right to do so in such cases.

Section 7 – Examples of how we manage aggressive or abusive behaviour

• The threat or use of physical violence, verbal abuse or harassment towards the  Practice staff is likely to result in a warning from the Senior Management team. We may report incidents to the police. This will always be the case if physical violence is used or threatened
•  Practice staff will end telephone calls if they consider the caller aggressive, abusive or offensive.  Practice staff have the right to make this decision, to tell the caller that their behaviour is unacceptable and end the call if the behaviour persists
• We will not respond to correspondence (in any format) that contains statements that are abusive to staff or contains allegations that lack substantive evidence. Where we can, we will return the correspondence. We will explain why and say that we consider the language used to be offensive, unnecessary and unhelpful and ask the sender to stop using such language. We will state that we will not respond to their correspondence if the action or behaviour continues and may consider issuing a warning to the Patient

Section 8 – Examples of how we deal with other categories of unreasonable behaviour

We have to take action when unreasonable behaviour impairs the functioning of our Practice. We aim to do this in a way that allows a Patient to progress through our process. We will try to ensure that any action we take is the minimum required to solve the problem, taking into account relevant personal circumstances including the seriousness of the issue(s) or complaint and the needs of the individual.

Section 9 – Other actions we may take

Where a patient repeatedly phones, visits the Practice, raises repeated issues, or sends large numbers of documents where their relevance isn’t clear, we may decide to:

• limit contact to telephone calls from the patient about the issues raised at set times on set days
• restrict contact to a nominated member of the  Practice staff who will deal with future calls or correspondence from the patient about their issues
• see the patient by appointment only
• restrict contact from the patient to writing only regarding the issues raised.
• return any documents to the patient or, in extreme cases, advise the patient that further irrelevant documents will be destroyed.
• take any other action that we consider appropriate.

Where we consider continued correspondence on a wide range of issues to be excessive, we may tell the patient that only a certain number of issues will be considered in a given period and we ask them to limit or focus their requests accordingly.

In exceptional cases, we reserve the right to refuse to consider an issue, or future issues or complaints from an individual. We will take into account the impact on the individual and also whether there would be a broader public interest in considering the issue or complaint further. We will always tell the patient what action we are taking and why.

Section 10 – The process we follow to make decisions about unreasonable behaviour

• Any member of  the Practice staff who directly experiences aggressive or abusive behaviour from a Patient has the authority to deal immediately with that behaviour in a manner they consider appropriate to the situation and in line with this Policy
• With the exception of such immediate decisions taken at the time of an incident, decisions to issue a warning or remove patients from our Practice List are only taken after careful consideration of the situation by the Senior Management
• Wherever possible, we will give a patient the opportunity to change their behaviour or actions before a decision is taken

Section 11 – How we let people know we have made this decision

When a Practice employee makes an immediate decision in response to offensive, aggressive or abusive behaviour, the patient is advised at the time of the incident. When a decision has been made by Senior Management, a patient will always be given the reason in writing as to why a decision has been made to issue a warning (including the duration and terms of the warning) or remove them from the Practice list. This ensures that the patient has a record of the decision.

Section 12 – How we record and review a decision to issue a warning

We record all incidents of unacceptable actions by patients. Where it is decided to issue a warning to a patient, an entry noting this is made in the relevant file and on appropriate computer records.

Each quarter a report on all restrictions will be presented to our Senior Management Team so that they can ensure the policy is being applied appropriately. A decision to issue a warning to a patient as described above may be reconsidered either on request or on review.

Section 13 – The process for appealing a decision

It is important that a decision can be reconsidered. A patient can appeal a decision about the issuance of a warning or removal from the Practice list. If they do this, we will only consider arguments that relate to the warning or removal, and not to either the issue or complaint made to us, or to our decision to close a complaint.

An appeal could include, for example, a patient saying that: their actions were wrongly identified as unacceptable; the warning was disproportionate; or that it will adversely impact on the individual because of personal circumstances.

The Practice Manager or a GP Partner who was not involved in the original decision will consider the appeal. They have discretion to quash or vary the warning as they think best. They will make their decision based on the evidence available to them. They must advise the patient in writing that either the warning or removal still applies or a different course of action has been agreed. We may review the warning periodically or on further request after a period of time has passed. Each case is different.

This policy is subject to review.

Anyone verbally abusing either a member of staff or the public, or using inappropriate language, will be asked to leave the premises and requested to find another GP.

Anyone who is violent or causes damage will be removed from the list immediately.

Patients will also be removed from the list in the following circumstances:

• Violence and aggression towards staff or members of the public.
• Damage to Practice property or equipment.
• Change of residence to outside of the Practice area.
• Persistent misuse of the system.
• Patients who the doctors are unable to manage clinically e.g. breach of contract with doctor regarding use of prescribed medicine, break down in patient communication.

Patients who are disruptive and display aggressive and/or intimidating behaviour and refuse to leave the premises, staff are instructed to dial 999 for Police assistance, charges may then be brought against these individuals.