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    Practice Policies

    • Treating Patients With Dignity

      INTRODUCTION

      The Human Rights Act 1998 gives legal effect in the UK to the fundamental rights and freedoms contained in the European Convention on Human Rights. These rights not only impact matters of life and death, they also affect the rights you have in your everyday life: what you can say and do, your beliefs, your right to a fair trial and other similar basic entitlements. You have the responsibility to respect other people’s rights, and they must respect yours.

       

      PURPOSE

      This Dignity and Respect, Policy sets out our commitment to treating all people with equality & diversity, valuing the diversity of all:

      To ensure that staff employed by Beehive Surgery treat patients, the public and colleagues with dignity and respect. The Practice advocates a culture of care that respects the privacy, dignity, culture and individuality of all patients under its care and staff.

      To ensure privacy and dignity are fundamental within our core values and governance strategy.

       

      DUTIES

      This policy applies to all employees at Beehive Surgery irrespective of profession, grade, position or contract, and any staff contracted to provide a service to Beehive Surgery on a temporary basis.

      Members of Staff require support, development and education to ensure that they are appropriately skilled, that in spite of the pressures of the modern NHS they treat individuals with compassion and in a dignified and respectful way.

      The Practice Manager has overall responsibility to ensure compliance with this policy, with delegated responsibility being passed to the Team Leaders of each staff group.

       

      It is the responsibility of each staff member to:

      Ensure that the privacy and dignity of all patients, members of the public and work colleagues are respected.

      Adhere to the principles set out in this policy.

      Beehive Surgery expects that all staff support people with the same respect they would want for themselves or a member of their family. People should be treated in a courteous and considerate manner, at all times.

      Beehive Surgery expects staff to treat each person as an individual. The attitude and behaviour of managers and staff help to preserve an individual’s identity. Staff should agree with people about how they would like to be addressed. Staff should take the time to assess and understand a person’s individual needs.

      Beehive Surgery expects all staff to respect people’s right to privacy. Areas of sensitivity which relate to modesty, gender, culture or religion and basic manners are fully respected.

      Beehive Surgery expects all staff to ensure people feel able to complain without fear of retribution. * People have access to the information and advice they need. Members of Staff support people to raise their concerns and complaints with the appropriate person. Concerns and complaints are respected and answered in a timely manner.

      Beehive Surgery expects all staff working with patients to assist people to maintain confidence and a positive self-esteem. The care and support provided should encourage individuals to participate as far as they feel able. Care should be aimed to develop the self-confidence of the person receiving services, actively promoting well-being.

      Beehive Surgery expects all staff working with patients to act to alleviate people’s loneliness and isolation. Staff should help people receiving services to feel valued as members of the community.

      Beehive Surgery expects all staff working with patients to enable people to maintain the maximum possible level of independence, choice and control. People receiving services should be helped to participate as partners in decision-making about the care and support they receive. People should be encouraged and supported to take responsibility for managing their care themselves in conjunction with, when needed, care staff and other information and support services

      Beehive Surgery expects all staff working with patients to listen and support people to express their needs and wants. People should be provided with information in a way that enables them to reach agreement

      Beehive Surgery expects all staff to engage with family members and carers as care partners. Relatives and carers experience a welcoming ambience and are able to communicate with staff and managers as contributing partners.

       

      It is the responsibility of Line Managers to also ensure that:

      Members of Staff have received training / education in interpersonal skills / customer care / communication and/or Dignity and Respect.

      They provide a good role model in their own attitude and behaviour.

      All systems of care are patient focused and person centered and not task orientated.

      Members of Staff are supported to participate in training and service development.

      Implement the principles set out in this policy.

      Promote and encourage positive attitudes and behaviours within its culture and aim to eliminate the risk of any patients, staff and the general public suffering a negative experience.

      Ensure that any problems in relation to standards and guidelines on privacy and dignity in our care of patients is monitored and reported through the incident reporting, complaints or clinical governance processes and for staff, through the human resources procedures.

      Promote and support a culture of “zero tolerance” of all forms of abuse.

      Beehive Surgery recognises that abuse can take many forms including physical, emotional, financial, sexual, institutional, neglect and discriminatory.

    • Information Governance Policy

      WHY WE NEED AN INFORMATION GOVERNANCE POLICY

      The practice handles ever-increasing amounts of information. Timely and accurate information is crucial both for the clinical decision-making and efficient management of services and resources. It plays a key part in clinical governance, service planning and performance management. It is therefore of paramount importance that information is efficiently managed in Beehive Surgery , and that we have appropriate policies and procedures to provide a robust framework for information management.

      The Beehive Surgery recognises the need for an appropriate balance between openness and confidentiality in the management and use of information. The practice supports the principles of corporate governance and recognises its public accountability, but equally places importance on confidentiality, the security of personal information about patients and staff. The practice also recognises the need to share patient information with other health organisations and other agencies in a controlled manner consistent with the interests of the patient and, in some circumstances, the public interest.

      The reasons for sharing information may include:

      Delivery of effective personal care, treatment and advice (for example data sharing agreements between organisations, reviewed in the IG meeting)

      Assuring and improving the quality of care, treatment and advice

      Monitoring and protecting public health, safety and well being

      Risk Management

      To avoid duplication of information gathering

      Investigating complaints or actual/potential legal claims

      Teaching/staff development

      To safeguard children and vulnerable adults (refer to Policy for Safeguarding for details of relevant information sharing requirements)

      The practice has assigned responsibility for information governance to a team which consists of:

      Caldicott Guardian : partner

      Information governance lead : Partner

      Information governance officer : Practice Manager

      Quality assurance officer: Practice Manager

      Medical records champions

      Patient information champion

      The practice believes that accurate, timely and relevant information is essential to deliver the highest quality health care. As such it is the responsibility of all clinicians and managers to ensure the quality of information available in the organisation and to make best use of that information in decision-making.

      There are 4 key interlinked strands to the information governance policy:

      Openness

      Legal compliance

      Information security

      Quality assurance

       

      1. OPENNESS

      There will always be conflict between what is considered to be confidential information and the need to be open to facilitate the smooth management of care and treatment of patients and to maintain the safety of staff. Staff should give careful consideration to how information/data is handled and ensure that any information that is produced, or given to a third party is not in breach of the Data Protection Act

      Non-confidential information on the practice and its services is available to the public through the practice website, practice leaflets and via NHS England

      The practice have established and maintains a policy to ensure compliance with the Freedom of Information Act

      Patients are able to request access to their medical records

      The practice has written procedures and arrangements for handling queries and complaints from patients and the public

      Our statement on confidentiality & freedom of information with regards to how it affects patients is displayed on our website and included in new patient registration pack

       

      2. LEGAL COMPLIANCE

      The practice regards all identifiable personal information relating to patients as confidential

      The practice regards all identifiable personal information relating to staff as confidential except where national policy on accountability and openness requires otherwise

      The practice has established and maintain policies to ensure compliance with the Data Protection Act, Human Rights Act and the common law confidentiality

      The practice has established and maintain policies for the controlled and appropriate sharing of patient information with other agencies, taking account of relevant legislation (e.g. Health and Social Care Act, Crime and Disorder Act, Protection of Children Act)

       

      3. INFORMATION SECURITY

      The Beehive Surgery ensures that all personal information is kept in a secure environment, where access is controlled, and security measures are in place. This includes electronic capture and storage, manual paper records, video and audio recordings, and any images, however created,

      The practice has established and maintain policies for the effective and secure management of its information assets and resources

      The practice promotes confidentiality and data security to its staff through policies, procedures and training

      The practice has established and maintains a Significant Event reporting procedure and monitors and investigates all reported instances of actual or potential breaches of confidentiality and security

       

      4. INFORMATION QUALITY ASSURANCE

      The practice has established and maintains a policy for information quality assurance and the effective management of records. This includes clear protocols for processing, scanning and coding clinical data coming into the practice.

      Managers are expected to take ownership of, and seek to improve, the quality of information within their services

      Wherever possible, information quality is assured at the point of collection

      The practice promotes information quality and effective records management through policies, procedures, staff induction and staff training

       

      PRINCIPLES IN THE USE OF CONFIDENTIAL INFORMATION – CALDICOTT GUIDELINES

      The purpose of this section is to outline a local code of conduct on the use of confidential information to ensure that patient or personal identifiable data is used and disclosed in an adequate manner according to the Caldicott Principles Data Protection Act and the Freedom of Information Act.

      The Practice has appointed a Caldicott Guardian.

      All Practice Staff, both clinical and non-clinical must adhere to all Policies and Procedures concerning Information Governance and Confidentiality.

       

      CONFIDENTIALITY POLICY

      The practice has a comprehensive confidentiality policy which is mandatory reading for new employees and on the staff reading list.

      This policy covers areas including all aspects of communication including verbal, email, written documents, faxing both in and outgoing and post.

      It also covers issues relating to working away from the office, and the principles of maintaining confidentiality and management of confidential waste, internet use and maintenance and security of passwords.

      The policy refers to relevant legal tools and the practice’s right to monitor use of the internet.

      The policy gives staff information of how to report breaches in confidentiality or information governance.

      The policy covers user of email, including etiquette, offensive emails and confidentiality.

       

      FIREWALL AND VIRUS PROTECTION 

      The Firewall and Virus Protection of the computer system is the responsibility of Greater Manchester Commissioning Support Unit who maintain the Practice IT systems.

       

      ANTIVIRUS

      The Internet is a major source of computer viruses the effects of which can range from a minor irritant to a major disaster and all have costs involved in their eradication.

      Although the IT network has background antivirus defences it is still essential for users to specifically check files and mail prior to opening. In the event that a user suspects a virus infestation they must stop using that machine, and contact the IT Help Desk.

       

      TRAINING 

      All staff will be given training on information governance and confidentiality at induction and as part of the ongoing training schedule. If a member of staff requires further training they will discuss this with their line manager or team leader.

      Staff with line management responsibility should ensure that the staff working for them are aware of the above principles and make training available if required.

       

      SECURITY BREACHES

      An Information Security incident is defined as any event which has resulted, or could result in: 

      the disclosure of confidential information to any unauthorised individual

      the integrity of the system or data being put at risk

      the availability of the system or information being put at risk

      an adverse impact, for example: embarrassment to the NHS; threat to personal safety or privacy; legal obligation or penalty; financial loss; disruption of activities

      Types of incidents that should be recorded include:

      computer misuse;

      computer virus activity

      confidentiality breach

      records related incident

      theft or loss of records

      System abuse or infiltration

      This list is not exhaustive

    • Confidentiality Policy

      INTRODUCTION 

      The purpose of this Confidentiality Policy is to lay down the principals that must be observed by all who work at Beehive Surgery and have access to person-identifiable information or confidential information. All members of staff need to be aware of their responsibilities for safeguarding confidentiality and preserving information security.

      All employees working in the NHS are bound by a legal duty of confidence to protect personal information they may come into contact with during the course of their work. This is not just a requirement of their contractual responsibilities but also a requirement within the common law duty of confidence and the Data Protection Act 1998. It is also a requirement within the NHS Care Record Guarantee, produced to assure patients regarding the use of their information.

      It is important that Beehive Surgery protects and safeguards person-identifiable and confidential business information that it gathers, creates, processes and discloses, in order to comply with the law, relevant NHS mandatory requirements and to provide assurance to patients and the public.

      This policy sets out the requirements placed on staff when sharing information within the NHS and between NHS and non NHS organisations.

      Person-identifiable information is anything that contains the means to identify a person, e.g. name, address, postcode, date of birth, NHS number and must not be stored on removable media unless it is encrypted as per current NHS Encryption Guidance or a business case has been approved by the Information Governance Manager.

      Confidential information within the NHS is commonly thought of as health information; however, it can also include information that is private and not public knowledge or information that an individual would not expect to be shared. It can take many forms including patient level health information, employee records, occupational health records, etc. It also includes Beehive Surgery confidential business information.

      Information can relate to patients and staff (including temporary staff), however stored. Information may be held on paper, CD/DVD, USB sticks, computer file or printout, laptops, palmtops, mobile phones, digital cameras or even heard by word of mouth.

       

      ROLES AND RESPONSIBILITIES

      THE PARTNERS

      Have overall responsibility for strategic and operational management, including ensuring that Beehive surgery’s policies comply with all legal, statutory and good practice guidance requirements.

      THE CALDICOTT GUARDIAN

      The Caldicott Guardian is responsible for ensuring implementation of the Caldicott Principles with respect to patient-identifiable information.

      INFORMATION GOVERNANCE LEAD

      The Information Governance lead will be responsible for overseeing the development and implementation of Information Governance at Beehive surgery and ensure that the Practice complies with supporting the Legal and NHS Mandatory Framework with regards to Information Governance.

      The Information Governance lead is responsible for providing advice on request to any member of staff and ensuring that training is provided for all staff groups to further understand the principles and their application.

      PRACTICE MANAGER

      The Practice manager is responsible for ensuring that the contracts of all staff (permanent and temporary) are compliant with the requirements of the policy and that confidentiality is included in inductions for all staff.

      TEAM LEADERS

      Team Leaders are responsible for ensuring that the policy and its supporting standards and guidelines are built into local processes and that there is on-going compliance. They must ensure that any breaches of the policy are reported, investigated and acted upon.

      ALL STAFF

      Confidentiality is an obligation for all staff. Staff should note that they are bound by the Confidentiality: NHS Code of Practice 2003. There is a Confidentiality clause in their contract and that they are expected to participate in induction, training and awareness raising sessions carried out to inform and update staff on confidently issues.

      Any breach of confidentiality, inappropriate use of health or staff records, or abuse of computer systems and misuse of smart cards is a disciplinary offence, which could result in dismissal or termination of employment contract, and must be reported.

      PRINCIPLES

      All members of staff must ensure that the following principles are adhered to:

      • Person-identifiable or confidential information must be effectively protected against improper disclosure when it is received, stored, transmitted or disposed of.
      • Access to person-identifiable or confidential information must be on a need-to-know basis.
      • Disclosure of person identifiable or confidential information must be limited to that purpose for which it is required.
      • Recipients of disclosed information must respect that it is given to them in confidence.
      • If the decision is taken to disclose information, that decision must be justified and documented.
      • Any concerns about disclosure must be discussed with the employee’s Line Manager, Operations Manager or Caldicott Guardian. Information about this process is outlined in the Policy for Whistleblowing.
      • Beehive surgery is responsible for protecting all the information it holds and must always be able to justify any decision to share information.
      • Person-identifiable information, wherever possible, must be anonymised by removing as many identifiers as possible whilst not unduly compromising the utility of the data.
      • Access to rooms and offices where terminals are present or person-identifiable or confidential information is stored must be controlled. Where appropriate doors must be locked with keys, keypads or accessed by swipe card. In mixed office environments measures should be in place to prevent oversight of person-indefinable information by unauthorised parties.
      • All staff should clear their desks at the end of each day. In particular they must keep all records containing person-identifiable or confidential information in recognised filing and storage places that are locked.

      Unwanted printouts containing person-identifiable or confidential information must be put in a confidential waste bin. Discs, tapes, printout and fax messages must not be left lying around but be filed and locked away when not in use.

    • Complaints Policy

      BEEHIVE SURGERY

      AUGUST 2017

      COMPLAINTS PROCEDURE 

      Introduction 

      The purpose of the policy is to ensure that all patients (or their representatives) who have the cause to complain about their care or treatment can have freely available access to the process and can expect a truthful, full and complete response and an apology where appropriate. Complainants have the right not to be discriminated against as the result of making a complaint and to have the outcome fully explained to them. The process adopted in the practice is fully compliant with the relevant NHS Regulations (2009) and guidance available from defence organisations, doctors` representative bodies and the Care Quality Commission. Everyone in the practice is expected to be aware of the process and to remember that everything they do and say may present a poor impression of the practice and may prompt a complaint or even legal action.

      The general principle of the practice in respect of all complaints will be to regard it first and foremost as a learning process, however in appropriate cases and after full and proper investigation the issue may form the basis of a separate disciplinary action.  In the case of any complaint with implications for professional negligence or legal action, the appropriate defence organisation must be informed immediately.

       

      Procedure 

      Availability of information

      The practice will ensure that there are notices advising on the complaints process conspicuously displayed in all reception/waiting areas and that leaflets containing sufficient details for anyone to make a complaint are available without the need to ask. The practice website and any other public material (Practice Leaflet etc.) will similarly provide this information and also signpost the complainant to the help available through the NHS Complaints Advisory Service.

       

      Who can a formal complaint be made to?

      ONLY TO – either the practice   -OR -  NHS England

      In the event of anyone not wishing to complain to the practice they should be directed to make their complaint to NHSE at:

      By telephone: 03003 11 22 33

      By email: england.contactus@nhs.net

      By post: NHS England, PO Box 16738, Redditch, B97 9PT

      In those cases where the complaint is made to NHS England, the practice will comply with all appropriate requests for information and co-operate fully in assisting them to investigate and respond to the complaint.

       

      Who can make a complaint?

      A complaint can be made by or, with consent, on behalf of a patient (i.e. as a representative); a former patient, who is receiving or has received treatment at the Practice; or someone who may be affected by any decision, act or omission of the practice.

      A Representative may also be

      • by either parent or, in the absence of both parents, the guardian or other adult who has care of the child; by a person duly authorised by a local authority to whose care the child has been committed under the provisions of the Children Act 1989;  or by a person duly authorised by a voluntary organisation by which the child is being accommodated
      • someone acting on behalf of a patient/ former patient who lacks capacity under the Mental Capacity Act 2005 (i.e. who has Power of Attorney etc.) or physical capacity to make a complaint and they are acting in the interests of their welfare
      • someone acting for the relatives of a deceased patient/former patient

      In all cases where a representative makes a complaint in the absence of patient consent, the practice will consider whether they are acting in the best interests of the patient and, in the case of a child, whether there are reasonable grounds for the child not making the complaint on their own behalf.  In the event a complaint from a representative is not accepted, the grounds upon which this decision was based must be advised to them in writing.

       

      Who is responsible at the practice for dealing with complaints?

      The practice “Responsible Person” is Dr Vineet Kalhan.  They are charged with ensuring complaints are handled in accordance with the regulations, that lessons learned are fully implemented, and that no Complainant is discriminated against for making a complaint.

      The practice “Complaints Manager” is Dr Vibha Gupta Practice manager  and they have been delegated responsibility for managing complaints and ensuring adequate investigations are carried out.  (N.B. they can be the same person but the Responsible Person must be a Partner, who may then delegate the complaints management role to someone else – omit or amend as per practice choice)

       

      Time limits for making complaints

      The period for making a complaint is normally:
      (a) 12 months from the date on which the event which is the subject of the complaint occurred; or

      (b) 12 months from the date on which the event which is the subject of the complaint comes to the complainant’s notice.

      The practice has discretion to extend these limits if there is good reason to do so and it is still possible to carry out a proper investigation.  The collection or recollection of evidence, clinical guidelines or other resources relating to the time when the complaint event arose may also be difficult to establish or obtain. These factors may be considered as suitable reasons for declining a time limit extension, however that decision should be able to stand up to scrutiny.

       

      Action upon receipt of a complaint

      A) Verbal Complaints:  It is always better to try and deal with the complaint at the earliest opportunity and often it can be concluded at that point. A simple explanation and apology by staff at the time may be all that is required (NB Practices should decide whether this can only be done by senior staff rather than all staff and delete or amend here as appropriate).

      A verbal complaint need not be responded to in writing for the purposes of the Regulations if it is dealt with to the satisfaction of the complainant by the end of the next working day, neither does it need to be included in the annual Complaints Return. The practice will however record them for the purposes of monitoring trends or for Clinical Governance and that record will be kept and monitored by Practice manager .Verbal complaints not formally recorded will be discussed when trends or issues need to be addressed and at least annually, with minutes of those discussions kept.

      If resolution is not possible, the Complaints Manager will set down the details of the verbal complaint in writing and provide a copy to the complainant within three working days. This ensures that each side is well aware of the issues for resolution. The process followed will be the same as for written complaints.

      B) Written Complaints:  On receipt, an acknowledgement will be sent within three working days which offers the opportunity for a discussion (face-to-face or by telephone) on the matter.  This is the opportunity to gain an indication of the outcome the complainant expects and also for the details of the complaint to be clarified. In the event that this is not practical or appropriate, the initial response should give some indication of the anticipated timescale for investigations to be concluded and an indication of when the outcome can be expected.

      It may be that other bodies (e.g. secondary care/ Community Services) will need to be contacted to provide evidence. If that is the case, then a patient consent form will need to be obtained at the start of the process and a pro-forma consent form included with the initial acknowledgement for return.

      If it is not possible to conclude any investigations within the advised timescale, then the complainant must be updated with progress and revised time scales on a regular basis. In most cases these should be completed within six months unless all parties agree to an extension.

       

      The Investigation

      The practice will ensure that the complaint is investigated in a manner that is appropriate to resolve it speedily and effectively and proportionate to the degree of seriousness that is involved.

      The investigations will be recorded in a complaints file created specifically for each incident and where appropriate should include evidence collected as individual explanations or accounts taken in writing.

       

      Final Response

      This will be provided to the complainant in writing (or email by mutual consent) and the letter will be signed by the Responsible Person or Complaints manager under delegated authority.  The letter will be on headed notepaper and include:

      • An apology if appropriate (The Compensation Act 2006, Section 2 expressly allows an apology to be made without any admission of  negligence or breach of a statutory duty)
      • A clear statement of the issues, details of the investigations and the findings, and clear evidence-based reasons for decisions if appropriate
      • Where errors have occurred, explain these fully and state what has been or will be done to put these right or prevent repetition. Clinical matters must be explained in accessible language
      • A clear statement that the response is the final one and the practice is satisfied it has done all it can to resolve the matter at local level
      • A statement of the right, if they are not satisfied with the response, to refer the complaint to the Parliamentary and Health Service Ombudsman,  Millbank Tower, Millbank,  London, SW1P 4QP or visit the ‘Making a complaint page‘  at  https://www.ombudsman.org.uk/make-a-complaint (to complain online or download a paper form).  Alternatively the complainant may call the PHSO Customer Helpline on 0345 015 4033 from 8:30am to 5:30pm, Monday to Friday or send a text to their ‘call back’ service: 07624 813 005

       

      The final letter should not include:

      • Any discussion or offer of compensation without the express involvement and agreement of the relevant defence organisation(s)
      • Detailed or complex discussions of medical issues with the patient’s representative unless the patient has given informed consent for this to be done where appropriate.

       

      Annual Review of Complaints

      The practice will produce an annual complaints report to be sent to the local Commissioning Body (NHSE) and will form part of the Freedom of Information Act Publication Scheme.

      The report will include:

      • Statistics on the number of complaints received
      • The number considered to have been upheld
      • Known referrals to the Ombudsman
      • A summary of the issues giving rise to the complaints
      • Learning points that came out of the complaints and the changes to procedure, policies or care which have resulted

      Care must be taken to ensure that the report does not inadvertently disclose and confidential data or lead to the identity of any person becoming known.

      Confidentiality
      All complaints must be treated in the strictest confidence and the practice must ensure that the patient etc. is made aware of any confidential information to be disclosed to a third party (e.g. NHSE).

      The practice must keep a record of all complaints and copies of all correspondence relating to complaints, but such records must be kept separate from patients’ medical records and no reference which might disclose the fact a complaint has been made should be included on the computerised clinical record system.

      Unreasonable or Vexatious Complaints

      Where a complainant becomes unreasonable or excessively rude or aggressive in their promotion of the complaint, some or all of the following formal provisions will apply and must be communicated to the patient by the Responsible Person in writing:

      • The complaint will be managed by one named individual at senior level who will be the only contact for the patient
      • Contact will be limited to one method only (e.g. in writing)
      • Place a time limit on each contact
      • The number of contacts in a time period will be restricted
      • A witness will be present for all contacts
      • Repeated complaints about the same issue will be refused unless additional material is being brought forward
      • Only acknowledge correspondence regarding a closed matter, not respond to it
      • Set behaviour standards
      • Return irrelevant documentation
      • Detailed records will be kept of each encounter

       

      Complaints involving Locums

      It is important that all complaints made to the practice regarding or involving a locum (Doctor, Nurse or any other temporary staff) are dealt with by the practice and not passed off to a Locum Agency or the individual locum to investigate and respond. The responsibility for handling and investigating all complaints rests with the Practice.

      Locum staff should however be involved at an early stage and be advised of the complaint in order that they can provide any explanations, preferably in writing.  It would not be usually appropriate for any opinions to be expressed by the Practice on Locum staff. Providing their factual account along with any factual account from the practice is the best way to proceed.

      The practice will ensure that on engaging any Locum, the Locum Agreement will include an assurance that they will participate in any complaint investigation where they are involved or can provide any material evidence.  The practice will ensure that there is no discrepancy in the way it investigates or handles complaints between any Locum staff and either practice Partners, salaried staff, students or trainees or any other employees.

       

      “Informal complaints” (NB practices may wish to decide if this section is one they wish to adopt)

      The collection of data about informal complaints – often referred to as “grumbles” – is a good tool for identifying trends for low-level dissatisfaction with services or the way they are offered to patients.

      Staff are encouraged to raise these issues at practice meetings and in addition a book will be kept in Reception for everyone to note when a negative comment or feedback is made to them by a patient.

      The book will be checked periodically (at least monthly) by the Complaints Manager to identify trends for discussion and possible amendment of procedures or targeted training needs.

       

      Practice Resources

      Complaint Form [*]

      Complaint Review Form (for annual review) [*]

      Complaints Procedure Leaflet (Patient information) [*]

      Complaints – Third Party Consent Form [*]

       

      References

      Local Authority Social Services & National Health Service Complaints (England) Regulations 2009 – S.I. 209, No.309

      NHS Complaints Procedure (England only): Guidance for Primary Care, BMA August 2015

      Medico-legal guide to the NHS Complaints Procedure, M.D.U.  2012

      NHS Complaints in England – Regulations & Principals, M.P.S 2013

      NHS England Complaints policy;

      https://www.england.nhs.uk/wp-content/uploads/2015/01/nhse-complaints-policy.pdf

    • Consent Policy

      CONSENT POLICY

      BEEHIVE SURGERY

      1.0 Introduction

      It is good practice to have a comprehensive consent policy that provides specific guidelines for both patients and clinicians when treatment takes place in a clinical setting.

       

      2.0 Aims and Objectives

      To provide guidance for all clinicians and staff in the surgery to ensure that adequate documentation is in place for consent purposes. It is essential that the documentation will give legal support.

       

      3.0 Consent Requirements

      There are various situations when consent is required and different forms will be used for each.

      Explicit consent is given by an individual agreeing actively, either orally or in writing, to a particular use or disclosure of information. If the consent is given orally this should be recorded in the individual records wherever possible. Once the consent form is signed and dated, it will be scanned into the patient file and the paper document will be shredded.

      Implied consent is given when an individual takes action in the knowledge that in doing so he or she has incidentally agreed to a particular use or disclosure of information.

      3.1 Minor Surgery

      Consent for minor surgery will also include treatment such as cryotherapy, joint injections, removal of lumps and bumps and sub-dermal insertion.  See App 1

      3.2 Vaccinations

      3.2.1 Child Immunisations

      The parent/guardian of the child will have already signed for consent with the Health Visitor. In the event that a child is accompanied by a different third party, consent would need to be obtained.

      3.2.2 Vaccinations for residents of Care Homes/Nursing Homes etc.

      In the event of mass vaccinations being carried out in a nursing home, consent of the patients (or representative) would need to be obtained prior to the visit. See App 2

      3.2.3 Travel Vaccinations

      Pharmaceutical companies will produce a form for patients to complete prior to the GP visit detailing their travel arrangements. The form is then passed onto a clinician who will assess the vaccinations required. Once the form has been completed with current meds/allergies etc. and details of vaccinations to be given, the patient signs a consent form.

      3.3 Summary Care Record

      For the Summary Care Record, the consent model has now changed to one of Implied Consent (see point 3 above for definitions)  Patients are now required to specifically opt out if they do not wish to have a SCR.

      3.4 Photography

      Photography is used primarily when a patient has a dermatological condition for which it is necessary to monitor progress. The photographs can also be used in a referral to a consultant. The patient will be asked to give consent prior to the photographs being taken. See App 5

      3.5 Training

      If the practice is a training practice, all patients will need to consent to their consultation being taped. The form for this is provided by the Deanery and fully explains the reason for the recording.  See App 6

      3.6 Carers

      In a situation where a carer is nominated by a patient, the Carer’s details will be added to the patient record and consent will be required from both the patient and Carer. Reference should also be made in the Carer’s record.

      3.7 Third Party

      A patient’s third party is somebody who will act on behalf of a child, vulnerable adult or any other person nominated by the patient.

      3.7.1 Children

      In 1983 the judgement from case  laid out criteria for establishing whether a child under has the capacity to provide consent to treatment; the so-called ‘Gillick test’. It was determined that children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options.

      If a child passes the Gillick test, he or she is considered ‘Gillick competent’ to consent to that medical treatment or intervention. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. Additionally, a child may have the capacity to consent to some treatments but not others. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. Therefore each individual decision requires assessment of Gillick competence.

      If a child does not pass the Gillick test, then the consent of a person with parental responsibility (or sometimes the courts) is needed in order to proceed with treatment.

      The ‘Fraser guidelines’ specifically relate only to contraception and sexual health. They are named after one of the Lords responsible for the Gillick judgement but who went on to address the specific issue of giving contraceptive advice and treatment to those under 16 without parental consent.

      The House of Lords concluded that advice can be given in this situation as long as:

      1. He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
      2. He/she cannot be persuaded to tell her parents or to allow the doctor to tell them
      3. He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
      4. His/her physical or mental health is likely to suffer unless he/she received the advice or treatment
      5. The advice or treatment is in the young person’s best interests.

      Health professionals should still encourage the young person to inform his or her parent(s) or get permission to do so on their behalf, but if this permission is not given they can still give the child advice and treatment. If the conditions are not all met, however, or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality.

      Fraser guidelines originally just related to contraceptive advice and treatment but, following a case in 2006, they now apply to decisions about treatment for sexually transmitted infections and termination of pregnancy.

      Under13: There is no lower age limit for Gillick competence or Fraser guidelines to be applied. That said, it would rarely be appropriate or safe for a child less than 13 years of age to consent to treatment without a parent’s involvement. When it comes to sexual health, those under 13 are not legally able to consent to any sexual activity, and therefore any information that such a person was sexually active would need to be acted on, regardless of the results of the Gillick test.

      Children 16-17: Young people aged 16 or 17 are presumed in UK law, like adults, to have the capacity to consent to medical treatment. However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court. This is because we have an overriding duty to act in the best interests of a child. This would include circumstances where refusal would likely lead to death, severe permanent injury or irreversible mental or physical harm.

      3.7.2 Vulnerable Adults

      The principles of the MCA and DoLS,

      • Individuals are presumed to have capacity.
      • All practical steps must be taken to support someone in decision-making.
      • A person is not to be treated as lacking capacity merely through making an unwise decision.
      • An action taken on behalf of a person must be in their best interests.
      • Regard must be had as to whether an act or decision is the least restrictive of a person’s rights and freedoms.

      The MCA prohibits blanket decision-making on behalf of people with capacity issues and introduces a functional test of capacity that is time and decision specific.

      It requires everyone who cares for or treats people with capacity issues to respect their individual rights and to act in their best interests when making decisions on their behalf.

      For example, if a patient suffers from early stage dementia, and needs to make a decision on whether to have the flu jab, the GP should make every effort to communicate the pros and cons of having the treatment when the patient is most alert. This is so that the patient can make a decision.

      A GP becomes the decision-maker only if the patient lacks the capacity to make that decision for them and has not made an LPA granting an attorney or attorneys the power to make decisions about medical treatment. GPs must make the decision for the patient in their best interests and need to know when they can and cannot disclose confidential information.

      GP to be aware of following issues:

      • Independent mental capacity advocates (IMCAs).
      • The ability for adult patients to make a lasting power of attorney (LPA).
      • The establishment of a new Court of Protection.
      • Court-appointed deputies. GPs need to be aware of people appointed to these roles and when to involve them in decision-making about patients who lack capacity.

      DoLS are essential to protect people who are unable to make decisions about their care and whose liberty has been deprived. DoLS still only apply to care homes and hospitals. However, if someone is being deprived of their liberty in community settings, local authorities are now encouraged to apply to the Court of Protection for authorisation. With the recognition that deprivation of liberty is widespread in the community too, it has become more important than ever for GPs to be confident with how and when these safeguards apply. Health and social care professionals have a duty to reduce the risk of depriving people of their freedom, keeping their best interests central to planning and providing care. When this is unavoidable authorisation must be sought and any restrictions must be regularly reviewed.

      3.7.3 Other

      There may be a variety of circumstances where a third party would be required by the patient. If a patient wishes to nominate a third party to discuss their care or obtain results, this should be noted in the patient file with consent from the patient.

      3.8 Verbal Consent

      There are some instances where verbal consent from the patient would be deemed sufficient. Examples would be:

      • Presence of a Medical Student
      • Chaperone presence
      • Routine vaccinations
      • Permission to disclose patient attendance to another person
      • Text message reminders for appointments

      3.9 Request for Information

      Certain legally recognised bodies can request patient information and/or patient records including Solicitors, Insurance Companies, Police, Foster Agencies etc.

      Applications for the information will usually come through the post and will include signed consent from the patient. It is advisable to go back for renewal of consent after a 12 month period.

      The exception to this process is the Police, who do not necessarily need consent from the patient. In line with the requirements of the Data Protection Act, when the Police ask for information they must have a legal reason for asking. They must produce legal documentation, which must be signed by the officer presenting and by a supervising officer.

       

      4.0 Governance Arrangements

      This policy will be approved by the Senior Management Team. The Practice Manager will be responsible for notifying all staff of the process, ensuring all staff have up to date copies of the document and that the staff are following the processes documented within.

      Other than if extenuating circumstances arise, this policy will be reviewed 2 years from the date of publication.

      Any amendments to the original policy will require sign off by the Senior Management Team, before implementation.

       

      Appendix 1

      BEEHIVE SURGERY

      PATIENT CONSENT FORM

      (for medical treatment, immunisation, investigation or operation)

      This form can also be used for a parent or guardian to give consent for treatment to be given to a young person

      PATIENT’S DETAILS 

      Surname: ……………………………………………………..…………………………………………

      First Names: ……………………………………………………………………………………..…….

      Date of Birth: ……………….……..………     Male/Female: ……………….…..……………

       

      THIS SECTION FOR COMPLETION BY THE CLINICIAN

      This form has been prepared for the treatment, immunisation, investigation or operation detailed below:

      ……………………………………………………………………………………..……………

       

      ……………………………………………………………………………………..……………

       

      ……………………………………………………………………………………..……………

      I confirm that I have explained the above treatment, immunisation, investigation or operation to the patient, and such options as are appropriate such as the type of anaesthetic (if any) proposed, in terms that in my judgement are suited to their understanding and/or these have been explained to a parent or guardian of the patient.

       

      Signature of clinician: ………………………………………….  Date: ………………………

      Name of clinician completing the procedure:  ..………………………………….………

       

       THIS SECTION FOR COMPLETION BY THE PATIENT / PARENT / GUARDIAN

      1.        I am the patient / parent / guardian (delete as necessary) See * below for information about consent for children.

      2.        I agree to the procedure(s) proposed on this form and the clinician named on this form has explained this to me.

      3.        I agree to have the type of anaesthetic that has been explained to me.

      4.        I understand that any procedure, in addition to that described on this form, will only be carried out if it proves to be necessary and in my best interests and can be justified for medical reasons.

      5.        I have explained to the clinician about any procedures listed below which I would not wish to be carried out without the opportunity to consider them first.  These include:

       

      …………………………………………………………………………………………….……………………

      6.        I have notified the clinician of the following allergies/medications which I am currently taking which may be relevant to my treatment:

       

      ……………………………………………………………………………………………………………………

       

      Signature of Patient/Parent/Guardian: ………………………………………..………………….

       

      Full Name of Patient/Parent/Guardian: ………………………………………..………….……..

       

      Address (if not the same as patient): ………………………………..……………………………..

       

      ………………………………………………………………………………….

       

      If the treatment is for a child and if the child wishes to sign this form, he/she may do so here; see * below for information about consent for children:

      I agree to have the treatment I have been told about.

       

      Signature ……….……………………..…………………………..     Date ………………..……………

       

      Note to clinician: A patient has the legal right to grant or withhold consent prior to this procedure.  Patients should be given sufficient information in a way they can understand, about the proposed treatment and the possible alternatives.  The patient’s consent to the procedure should be recorded on this form.

      Note to Patient: The clinician should explain the proposed treatment and any alternatives.  You can ask questions and seek further information.  You have the right to refuse this treatment.  You may ask for a relative, friend or nurse to be present.

      Statement of interpreter (where appropriate):  I have interpreted the information above to the patient to the best of my ability and in a way in which I believe s/he can understand.

       

      Signed ………………………….…………………….    Date ………………..…………….

       

      Name  …………………..……………………………………………………….………………

       

      This form, once completed, must be kept with the patient’s medical records.

      * Consent for children

      Everyone aged 16 or more is presumed to be competent to give consent for themselves, unless the opposite is demonstrated. This is clarified under the Fraser Guidelines. If a child under the age of 16 has “sufficient understanding and intelligence to enable him/her to understand fully what is proposed” (known as Gillick Competence), then he/she will be competent to give consent for him/herself. Young people aged 16 and 17, and legally ‘competent’ younger children, may therefore sign this  Form for themselves, but may like a parent to countersign as well. If the child is not able to give consent for him/herself, someone with parental responsibility may do so on his/her behalf by signing accordingly on this Form.

       

      Appendix 2

      BEEHIVE SURGERY

      VACCINATION CONSENT

      PATIENT’S DETAILS 

      Surname : …………………………………………………………………………….

      Forename: ……………………………………………………………………………

      Date of Birth: ………………………………………………………………………..

      NHS No: ………………………………………………………………………………..

      Address: ………………………………………………………………………………..

      Name of vaccination/s being administered:…………………………..

      ………………………………………………………………………………………………

      ………………………………………………………………………………………………

       

      PLEASE COMPLETE ALL QUESTIONS Please tick
      Yes No Unsure
      Have you had a temperature in the last 2 days?
      Do you have any serious allergies or anaphylaxis?
      Do you eat eggs?
      Are you pregnant?
      Have you ever had an injection against Flu/pneumonia before?Have you been vaccinated this year?

       

      FOR NURSE USE ONLY
      Please circle action and record reasons as appropriate: Proceed/Defer/No Action

      Reason for deferring……………………………………………………………………

      CONSENT

      I confirm that I am the above patient or the parent/legal guardian/personal representative of the above named patient and give my consent to receive the vaccinations listed above.  I confirm that the reasons for, and the possible side effects of the vaccine/s have been explained to me.

       

      Signature: ………………………………………           Date: ………………………………

       

      Name of Nurse/Immuniser: …………………………………………….………………..

       

      Signature:………………………………………….     Date: ………………..………………

       

      Appendix 3

      BEEHIVE SURGERY

      CONSENT FORM

      (For photographing dermatological conditions)

      PATIENT’S DETAILS

      Surname:- ……………………………………………………………………….………………………

       

      First Name(s):- ……………………………………………………………….………………………..

       

      Date of Birth:- …………………………………….    Male/Female:- ……………………………

       

      THIS SECTION IS FOR COMPLETION BY THE GP

      This form has been prepared for the purpose of photographing the area of skin detailed below:-

      …………………………………………………………………………………….

      I can confirm that I have explained the purpose for the photograph to the patient, and who the photograph will be shown to, in terms that in my judgement are suited to their understanding and/or these have been explained to a parent or guardian of the patient.

       

      Signature of GP:- …………..…………………….……..     Date:- …….………………..

      Name of GP Completing the Procedure:-  Dr ……………………………………….

       

      THIS SECTION IS FOR COMPLETION BY THE PATIENT/PARENT/GUARDIAN

      1)     I am the patient/parent/guardian (delete as necessary)

      2)     I agree to the photograph(s) proposed on this form and the doctor named on this form has explained this to me.

       

      Signature for Patient/Parent/Guardian ………………………………………………..

       

      Full Name of Patient/Parent/Guardian …………………………………………………

       

      Address (if not the patient) …………………………………………….…………………..

       

      …………………………………………………………………………………………..…………….

      NOTE TO GP:- A patient has the legal right to grant or withhold consent prior to this photograph.  Patients should be given sufficient information in a way they can understand, about the proposed photograph and the possible alternatives.  The patient’s consent to the photograph should be recorded on this form.

      NOTE TO PATIENT:- The doctor should explain the proposed photograph and any alternatives.  You can ask questions and seek further information. You have the right to refuse this photograph.  You may ask for a relative, friend or nurse to be present.

       

      Appendix 6

      Patient’s consent form for video-recording of consultations

      This video shall be used for assessment purposes for Doctors in training, as part of their General Practice Vocational Training, for Summative Assessment for General Practice and as part of the Assessment procedure for doctors seeking membership of the Royal College of General Practitioners.

       

      Place of video recording……………………………………   Date……………………………

       

      Patient’s Name……………………………………………………………………………………….

       

      Consent to Video Recording for Assessment Purposes 

      • We are hoping to make video recordings of some of the consultations between patients and Dr………………………, whom you are seeing today.
      • The video is ONLY of you and the doctor talking together. No intimate examination will be done in front of the camera. All video recordings are carried out according to guidelines issued by the General Medical Council.
      • The video will be seen only by doctors involved in the assessment of doctors as part of their training for General Practice. The tape will be stored securely and treated as confidentially as any other medical record. The tape will be erased as soon as practicable and in any event within one year.
      • Dr……………………… is responsible for the security and confidentiality of the video recording. If the tape is to leave the premises it will be sent by registered post or personal messenger.
      • You do not have to agree to your consultation with the doctor being recorded. If you want the camera turned off, please tell Reception – this is not a problem, and will not affect your consultation in any way.
      • Even if you give permission now, you may change your mind later. You may ask for the camera to be switched off at any time. If, after leaving the building, you would prefer that the tape is not used, please contact the receptionist or doctor who will ensure that your consultation is erased from the tape.
      • But if you do not mind your consultation being recorded, we are grateful to you. Improving the assessment of GPs should lead to a better service to patients.
      • If you wish, you may view the tape recording.
      • If you consent to this consultation being recorded, please sign below. Thank you very much for your help.

       

      Signed………………………………………………………    Date………………..…………….…

       

      Signature(s) of any accompanying person(s)……………………………………………..

       

      NB: After you have finished seeing the doctor, please sign below to confirm that you are still happy to have the recording used.

       

      Signed………………………………………………………             Date……………………