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GOODWOOD COURT MEDICAL CENTRE & THE EATON CENTRE PROTOCOLS - LIST OF CONTENTS INTRODUCTION * (cl(Click on the red asterisk to jump to the appropriate section)Patient ProtocoClickls ( PP) *PP 1 – Appointments *PP 2 – Patient’s Record Summarisation *PP 3 – All patient contact must be recorded *PP 4 – Correspondence, Reports and Investigation Results *PP 5 – Protection and use of patient records *PP 6 – Prescriptions *PP 7 – Messages and requests for visits *PP 8 – Clinician’s availability by telephone *PP 9 – Out-of-hours service *PP 10 – Carers *PP 11 – Patient’s removal from the Practice List. *PP 12 – Death of Patients *PP 13 –Statistical Techniques & Patients Surveys *PP 14 – COMPLAINTS *PP 15 – Locums *Clinical Protocols (CP) *CP 2 – Smoking cessation *CP 3 – Phlebotomy *CP 4 – Child Abuse *CP 5 – Cervical Cytology *Picture guides are available from the Royal College of Psychiatrists ( www.rcpsych.ac.uk) *Keeping Healthy 'Down Below' *Cytology Result Code Descriptions *Cytology Action Code Descriptions *Cytology Infection Code Descriptions *CP 6 – Pre-conceptual care *CP 7 – Emergency Contraception *CP 8 – Purchasing & Control of Drugs *CP 9 – Contraceptive implant fitting & removal *CP 10 – Minor Surgery *CP 11 – Exposure to Blood Borne viruses *CP12 - Management of the collapsed patient and anaphylactic shock *CP 13 Clinical Protocol - Asthma *CP14 Clinical Protocol – Dementia *CP15 Clinical Protocol – Mental Health *CP16 – Child Health Surveillance *CP17– Depression *Depression screening and monitoring *Administration Protocols (AP) *AP 1 – Information Security *AP 2 – Staff Employment Policies *AP2A Managing Stress at Work *AP 2B – Dealing with Drug and Alcohol Abuse *AP 3 – Violence and Aggression in the Workplace *AP 4 – Induction Training *AP 5 – Staff Appraisal *AP 6 – Training in life support skills *AP 7 – Hepatitis B Staff Immunisation *AP 8 – Significant Events *AP 9 – Hazardous Waste Disposal *AP 10 – Infection Control (Instrument Sterilisation) *AP 11 – Computer System Backup Policy *AP 12 – Risk Assessment & Equipment Calibration *AP 13 – Handling and recording of cash *AP 14 – Dealing with tradesmen *AP-15 Policy for the prevention of Fraud within the practice and within the NHS *AP 16 – Afore ye go! *AP 17 - Smartcard Policy *AP 18 – Maintaining Patient Demographic Details *AP 19 – COMPUTER DOWNTIME POLICY *AP20 - Fire Risk Assessment *AP20A FIRE CHECK LIST – WEEKLY *AP21 – MEDICATION REVIEW PROTOCOL *AP22 – WASTE RECYCLING PROTOCOL *
(1) Organisation Structure Goodwood Court Medical Centre and its branch surgery, The Eaton Centre, aims to provide a Quality Service to its patients promoted by the continuous efforts of its Practitioners, Locums or Deputies, Management, Staff and any Health Authority or NHS Staff attached to the Practice. This service will be maintained through appropriately selected, trained and motivated staff, by regular audits and reviews by the Quality Team and by monitoring patient views through Surveys. All who work at the Practice carry a responsibility to delivery a quality service. The Core Team consists of General Practitioners, Practice Nurses, Receptionists, Administration, Housekeeping and the Practice Development Team. Attached to the Practice are Midwives, District Nurses, Counsellor, Community Nurses, Social Care Workers and Complementary Therapists. (2) The Running of the Surgery The running of the Surgery is conducted in accordance with the General Medical Council (GMC) guidelines. Refer to GMC – Professional Conduct and Discipline: Fitness to Practice. Each Practitioner provides a minimum of 15 ten minute appointments per session. In the event of all these spaces being filled the other Practitioners are informed and, if necessary, be willing to see extra patients. All consultations and treatment are recorded on the patient’s computer record. The surgeries house other practitioners offering dentistry services and podiatry. Patients wishing to make appointments with any of these practitioners are able to do so during normal surgery hours. The Surgery opening hours are Goodwood Court Eaton Centre Monday 08.00 to 20.00 08.00 to 14.00 Tuesday 08.00 to 20.00 08.00 to 14.00 Wednesday 08.00 to 20.00 08.00 to 14.00 Thursday 08.00 to 20.00 08.00 to 14.00 Friday 08.00 to 18.30 08.00 to 14.00 Weekend & Bank Holidays Closed Closed
(3) The Practice Commitment to Patients "We promise to Offer you an appointment the same day with a doctor if you have a problem that you feel is urgent. Provide access to medical cover 24 hours a day every day(not necessarily provided by ourselves). Make authorised repeat prescriptions available by 0800 hours the following working morning if requested on our computer request slip by 1900 Monday to Friday". "We endeavour to Keep to within 20 minutes of your appointment time. Deal with all requests for medical reports within 7 days. Obtain the best service we can for you from the hospital sector. Answer your telephone call courteously within one minute." "To help us to help you, we ask that you Inform us of any good or bad aspects of our service. Come along to the surgery rather than request a home visit. Keep yourself as healthy as possible by taking advantage of the screening and preventive services that we have to offer. Be polite to our staff and others in the waiting room. (3) Aims & Provisions of this Manual This manual covers the provision, encouragement and maintenance of an efficient and respected medical practice for the patients of the surgery and to manage patient expectations by providing a clear statement of what the practice offers. The manual describes a framework in which all staff are trained and motivated to provide a friendly, courteous and efficient service in a happy environment where they feel protected from the hazards of their job and are treated fairly and well. This manual formalises the standards by which the practice is run and is in accordance with Quality Standards BS EN ISO 9002:9004 and in line with the guidelines set out in the New GMS Contract. The manual does not claim to cover all the services provided however it is specific and detailed. The protocols by which the Medical Practice adheres to are split into three areas. They are Patient Protocols (PP), Clinical Protocols (CP) and Administration Protocols (AP).
PP 1 – Appointments PP 2 – Patients record summarisation PP 3 – All patient contact must be recorded PP 4 – Correspondence, Reports and Investigation Results PP 5 – Protection and use of patient records PP 6 – Prescriptions PP 7 – Messages and requests for visits PP 8 – clinicians availability by telephone PP 9 – Out-of-hours service PP 10 – Carers PP 11 – Patient’s removal from the Practice List PP 12 – Death of Patients PP 13 –Statistical Techniques & Patients Surveys PP 14 – Complaints procedures PP 15 – Locums
Last updated 12/07/2008Objective The aim is to minimise patient’s delay in waiting to consult a practitioner and to make optimum use of the hours available. Appointments, requests, messages and general enquiries must be handled quickly and courteous.
Procedure Appointments may be made by telephone or in person during the same hours as the practice’s opening hours or 18.30 whichever is the earlier (see Introduction). For emergency appointments outside these hours see PP 9. Patients must ring 0844 477 0925 for appointments at Goodwood and 01273 733620 for appointments at Eaton. All calls to Eaton are answered by main reception. Caller to Goodwood are given six choices; 1 for appointments and enquiries, 2 for chiropody, 3 for repeat prescription, 4 for test results and 5 for new registration. Alternatively callers may just hold. If the caller has chosen a number it flashes on the receptionist’s telephone. It simply forewarns the receptionist what the call is about. Ideally all calls should be answered by the third ring. Callers must not be put on hold without first asking what the call is about in case it is an emergency. Telephone calls should not jeopardise patient confidentiality (see protocol PP6 on patient conidentiality. Therefore DO NOT ask for any medical details or justification. In addition it should not be possible for the call to be overheard in the waiting room or corridor. Please DO NOT say, "is it urgent for today?" as that implies the need for the patient to justify the appointment. If the caller is being difficult or awkward, suggest that they call later or that you will ring them back when you are less busy. Ensure that you do so. If the patient’s own doctor is fully booked, offer an appointment with another doctor in the practice. If the other doctor is also fully booked, offer an appointment with one of the doctors at the other surgery. If all doctors are fully booked and the patient requires to see a doctor that session, then their own doctor (first choice) or any other doctor may see them at the end of surgery or squeezed in between existing appointments. If the case is deemed by the patient not to require a same-day appointment, the patient will be asked to make an appointment for the following day. If the caller demands an appointment with their own doctor but there is no appointment available, and they are unwilling to see another practitioner, then the case is deemed not to be urgent and an appointment with their doctor is fixed for another day. Please try to check patient’s contact details whenever possible and update the screen with the latest information. If an address has changed, please ensure that all patients of the same family have their addresses updated All appointments are for 10 minutes although the frequency of booking may increase when doctors are absent. The receptionist will always offer the earliest slot first. If a patient asks for a double appointment ensure that this is at the doctor’s request. If it is not, a double appointment will be refused. If a doctor cancels his surgery, the receptionist will try to reallocate his appointments with another doctor as close to the original time as possible. If this is not possible the patient will be rung and informed of the new time, similarly if the appointment is now with another doctor at the other surgery (Goodwood or Eaton). If a patient asks for an appointment with the nurse the receptionist should ask, sensitively, the purpose of the appointment as this determines the amount of time required. The reason for the appointment must be recorded on the Appointments System. If a nurse cancels her surgery, the receptionist will only reallocate her appointments if the treatment required can be administered by the other nurse. Nurses specialise in various treatment and not all of them do everything. Practice nurses hold clinic for routine blood tests, injections, cervical smear tests, vaccinations, dressings, ear syringing, lifestyle checks and a variety of health promotion issues. Should a patient request an appointment with the nurse as well as the doctor, the nurse’s appointment will be fixed first and the doctor’s booked 10 minutes one or the other side of the nurse’s appointment. Each appointment will be crossed referenced and each will be marked off when the patient arrives. Assuming that the nurse is available, appointments may be booked into the future without limit. The same is true of all the doctors apart from those on Fridays. The Friday schedule is released on Friday morning. If a doctor has not opened his appointment book for the coming four weeks, and a patient requires an appointment in advance, then the patient should be asked to re-contact the practice at a suitable time when the appointment book has been opened; the appropriate clinician should be asked to open his/her book.
PP 2 – Patient’s Record Summarisation Reference Records 15 & 18 Last updated 12/07/2008Objective The practice is paper-light. This means that all practitioners and staff rely upon the computer for day to day entry and retrieval of medical information. New clinical information arising after the patient has registered with the clinic is entered on the computer by the clinician as it arises. All historical information has to be entered ‘in bulk’ though not necessarily by a clinician within two weeks of receipt of information from the previous practitioner.
Procedure New patients are asked to complete a registration form which has been adapted and modified from a NHS FP1. The information from this form is entered onto the computer by Dr Higson and this generates a new patient number. Form FP1 is then transmitted electronically to the PCSS who will forward the patient’s notes after they have received them from the patient’s previous doctor. Occasionally the PCSS may need chasing up if a doctor requires the notes urgently. All new patients will be asked to provide information regarding their past medical history and other important personal information by means of a New Patient Questionnaire. All information will be entered onto the computer database by Dr Higson, Ms Miriam Corfield or Ms Ann Long. Dr Higson will also code ethinicity and make recommendations in the electronic record if specific requirements are needed for the new patient health check. Children under the age of 16 years will have information entered regarding their parents/guardians using the "family members" facility in the information screen of the patient computer record All new patients will undergo a health check by Debbie Miller who enters all her findings onto the computer database. All new medical records received by the practice (see 1 above) are collated chronologically to A4 format by Dr Higson or by Ms Miriam Corfield All new medical records, if not summarised by Dr Higson, will be passed to Ms Miriam Corfield or Mrs Ann Long for clinical summarising. All data is summarised in date order. Minimum information included in a summarisation process comprises; All significant clinical morbidity Smoking and Alcohol consumption if information available Significant family history if available Childhood immunisations if the patient is a child Last cervical cytology result if patient is a female All current drugs (must be entered by medical practitioner) with coding to morbidity Other information such as "carer status" "living will" etc All drug allergies Ms Miriam Corfield, Mrs Ann Long or Dr Nigel Higson will enter the information from paper records onto the clinical computer database with reference to Dr Higson with any queries on terminology. After entering clinical data a Read Code (code: 9311.) will be entered to indicate that the records have been summarised. The morbidity code ‘Lloyd George Collated & Summarised’ appears on the computer record. Also 9344. is entered to show notes summarised. All A4 Files which have been summarised will be placed on the records shelving at Goodwood Court Medical Centre or The Eaton Centre All new patients’ records will be entered on the computer within 2 weeks of arrival of the notes at the practice. Form Z68, note of new acceptance, is eventually received from PCSS either electronically or on paper. Upon receipt the patient’s computer record status is altered from Registered to Registered Approved. Ensure that the original date of registration has remained the same. All historical paper records of patients registered at the Goodwood Court Medical Centre or The Eaton Centre starting have been fully summarised onto the practice computer database Training All training on clinical summarising is given by Dr Higson. Audit Once every twelve months a computer generated audit of numbers of records summarised is undertaken by Dr Higson. Quality Control Random case note selection will take place on a monthly basis by Dr Higson who will check the quality of summarisation by comparing computer listed morbidity to actual. External references The practice will take note of the recommendations of "Good Practice Guidelines for Electronic Records- version 3" as published by the GPC and Department of Health.
PP 3 – All patient contact must be recorded Last reviewed 12/07/2008
Objective: Patient contact must be recorded to ensure that the practice meets the recommendations of the ‘Good Medical Practice for General Practitioners’ and the Medical Defence Organisations. It ensures that informed decisions are based on up to date records. Procedure: All patient contact with the practice must be recorded, this includes GP appointed nurses. An entry in the patient’s Clinical Records must be made in the following circumstances. This list may not be exhaustive. Following a visit to the surgery Following advice given over the telephone Following a visit to the patient’s home Following a visit to the patient’s home by other doctors out-of-hours Following a report received from hospital or consultant Following a visit to the nurse for travel or other vaccination Following a visit to the nurse for investigative treatment e.g. Blood Test, ECG, Asthma Check, BP etc. All nurses must update the patient’s record after each consultation and note the reason for the visit. Any prescribed medication must be entered on the iSoft System. Where possible the clinical record should include a description of the presenting problem, a diagnosis where possible –coded by using an appropriate Read Code – and if medication is prescribed, this should be linked to the appropriate morbidity. The entry should be structured such that each individual problem is identified with the same entry number and any continuing medical conditions should be coded as "on going problems" in order to create a problem-oriented record. If the condition is likely to need further intervention, a management plan should be entered onto the clinical record. Attention should be given to the note PROMPT system which reminds the practitioner when certain activities need to be undertaken for a particular patient
PP 4 – Correspondence, Reports and Investigation Results Last updated 12/07/2008Objective: To ensure that correspondence is dealt with in a quick, courteous and efficient manner and that records are kept of it for future reference. Patients must be informed of the results of any medical tests and investigation undertaken. The patient’s clinical record must be updated as soon as possible. Procedure: All correspondence, hospital reports and investigation results received by Goodwood Court Surgery is opened and date stamped. Correspondence received at The Eaton Centre is similarly date stamped and forwarded to Goodwood Court daily. All correspondence is then passed to Dr Higson, his cover doctor, or other appropriate member of staff on the day it is received for review. Where possible, Dr Higson etc will review all correspondence on the same day it is received. The doctor will enter the result onto the computer system or will pass it to a trained member of staff (Mrs Ann Long) for scanning and appropriate entry. Once this has been carried out the report is passed to reception for filing or shredded by the doctor for confidentiality. Reports are filed by Centre (Goodwood or Eaton) for easy retrieval until they are placed in the patient’s file. Should the patient need to be recalled due to an adverse result, then the patient will be contacted by letter, which will be written at the time by Dr Higson. Blood pathology results are received electronically by the practice on a daily basis by transmission at approximately 1910hrs. These are imported into the practice clinical software system as they are reviewed by Dr Higson. Dr Higson will import and review these results on a daily basis. In his absence, Dr Williamson has responsibility for reviewing the results and actioning when necessary If the test is abnormal and Dr Higson or his cover doctor is unable to interpret the test, the test result will be passed to the doctor with whom the patient is registered or who ordered the test in order that appropriate action is taken. Patients are advised to telephone the Surgery between 14.00 and 16.00 hours in order to determine whether their test results have been received prior to making an appointment with the clinician who ordered their test. All patients who have a sample of blood or other body fluid/tissue taken should be advised that it is their responsibility to contact the practice for the result. The Receptionist may give out results to the patient only without any interpretation, and should consist only of the information indicated on the computer. Patients requiring further information should be referred to their doctor. Where an abnormality is detected which is USUALLY highlighted by a "red spot" next to the test result, the patient should be asked to make an appointment to discuss the results with the doctor who organised the investigation, or failing that, their own registered doctor In the case of cervical smear test, the nurse taking the test will advise the patient the smear result may not be received by the practice for six to eight weeks and that a written result will be forwarded to them by the Primary Care Support Services. When the Cervical Cytology result is received it will be reviewed by Dr Higson or his cover doctor, who will enter the result in the clinical database and the recall updated for the next cervical smear. If an earlier than normal recall is indicated, then the recall date is also entered onto a separate Excel database in order to ensure that patients are recalled appropriately. As before Dr Higson will pass the report to reception for filing in the patient’s record. If the cervical cytology result indicates that the patient is being sent an appointment for a colposcopy, then Dr Higson will enter a three month recall entry both on the clinical system and on the excel spreadsheet as failsafe Requests for information on or by a patient or Private Reports should be answered within 7 days. On receipt of a request for a private report, the receptionist will enter onto the computer records that a request has been received. The patient’s records will be extracted and a letter sent to the patient advising of the receipt of the request – offering the patient access to the report. The request and notes will then be passed to Dr Higson for completion. See AP 1, information Security. Ms Miriam Corfield coordinates all private medical reports and examinations If the patient has expressed a wish to view the report prior to its despatch, then Dr Higson will keep the report for the statutory 21 days prior to despatch. The patient will be contacted, if possible, to inform him or her that the report is available for viewing. After completion of the report Dr Higson will generate any appropriate invoice and the package passed back to the receptionist with instruction to photocopy the report. The original is despatched, the copy affixed to the patient’s notes. An entry is made on the computer record, on the day of the posting, that the report has been sent. Copies of medical examination reports undertaken for patients not registered with the Practice are kept in a file within the filing cabinets in reception at Goodwood for a period of 12 months. After this period, the reports are shredded. If notes go missing and are not awaiting collation, a search should be made. If this proves unsuccessful the relevant patient’s doctor should be informed and new medical records for that patient set up. Computer records are available as a back up should any notes become permanently lost. Outgoing Post Whenever possible the post is to be taken to a separate room (e.g. Room 8) to be sorted, enveloped and stamped. This should be done in the late morning by Ms Angela Bryant or her deputy. Post should also be sorted into that which goes through hospital "mail collection" and that which goes into the general Royal Mail. Staff should note that Orthopaedic Referrals go into a special "white" envelope which is posted to an orthopaedic management centre (these are logged with the names of the patients to whom the referral refers). The post must be weighed whenever more than a couple of sheets of paper are to be placed in a DL or C5 envelope. A new scale has been purchased for the purpose. Large items or bulky post must have correct postage for a "small packet or large envelope" applied – see Royal Mail size guide. Wherever possible C5 or smaller should be used rather than A4 The correct postage must be applied and to do this please access the Royal Mail website at http://sg.royalmail.com/servlet/acedispatcher?funcId=100&AceApplication=consignia&pageId=framset or simply go to www.royalmail.com, click on Send and Receive Mail, then click on Postal Calculator under ‘Other Tools’. There is normally a smaller amount of post generated in the evening. Please check it visually to see if anything is urgent. If so please deal with it and post it in time to make the last collection of the day (6.30 pm from corner of Lorna Road). All other evening post can wait till the following day. To summarise, post is to be taken to a letterbox at lunchtime. Evening posting is only necessary if there is urgent post. The Post Book previously maintained by Reception need not be kept any longer.
PP 5 – Protection and use of patient records Last updated 12/07/2008NHObjective: Under the Data Protection Act, patients are entitled to know what information we hold about them, why seek it and how we may use it. This protocol outlines our model response to patients who ask. Procedure: A. Why we seek, keep and use information. These are the points to bear in mind when dealing with a patient’s query. We ask for information so that the patient can receive proper care and treatment. We keep this information, together with details of care given, because it may be needed in future. We may use some of this information for other reasons: for example, to help us protect the health of the public generally. It may also be needed to help educate tomorrow's clinical staff and to carry out medical and other health research for the benefit of everyone. Sometimes the law requires us to pass on information: for example, to notify a birth. The NHS Central Register for England & Wales contains basic personal details of all patients registered with a general practitioner. The Register does not contain clinical information. The patient may be receiving care from other people as well as the NHS. So that we can all work together for the benefit of the patient we may need to share some information. We only ever use or pass on information if people have a genuine need for it in the patient’s and everyone's interests. Whenever we can we shall remove details which identify the patient. The sharing of some types of very sensitive personal information is strictly controlled by law. Anyone who receives information from us is also under a legal duty to keep it confidential. Only with the patient’s agreement will relatives, friends and carers be kept up to date with the progress of the treatment given. There are other reasons, perhaps less obvious, why information may be needed. These are: Managing and planning our Practice and the NHS in general in order to (a) make sure that our services can meet future needs, (b) pay the doctor, nurse, dentist, or other staff, and the hospital for the care they provide, (c) audit accounts and prepare statistics on our Surgery’s performance and activity where steps will be taken to ensure the patient cannot be identified, (d) investigate complaints or legal claims. Helping staff to review the care they provide to make sure it is of the highest standard. Training and educating staff although the patient can choose whether or not to be involved personally. Taking part in research approved by the Local Research Ethics Committee. If anything to do with the research would involve the patient personally, they will be contacted to see if they are willing. If patients would like to know more about how we use information about them, they can speak to the doctor in charge of their care or to Dr Higson if he is not the patient’s doctor. B. Privacy and confidentiality of medical records. Anyone working for the NHS has a legal duty to keep information about the patient confidential. The patient’s medical record is a life-long history of consultations, illnesses, investigations, prescriptions and other treatments. The doctor-patient relationship sits at the heart of good general practice and is based on mutual trust and confidence. The story of that relationship over the years is the patient’s medical record. The GP is responsible for the accuracy and safe-keeping of all medical records. The patient can help us to keep it accurate by informing us of any change in name, address, marital status and by ensuring that we have full details of important medical history. If a patient moves to another area or changes GP, we will send the medical records to the local Health Authority to be passed on to the new practice. The medical record is marked closed. All closed records are periodically deleted by iSoft. C. The patient’s right to privacy Patients have a right to keep their personal health information confidential between them and their doctor. This applies to everyone over the age of 16 years and in certain cases to those under sixteen. The law does impose a few exceptions to this rule, but apart from those, patients have a right to know who has access to their medical record. D. Who else may see a patient’s records? There is a balance between privacy and safety, and we will normally share some information about a patient with others involved in health care, unless the patient asks us not to. This could include doctors, nurses, therapists and technicians involved in the treatment or investigation of a medical problem. Our practice nurses, district nurses, midwives and health visitors all have access to the medical records of their patients. It is our policy to try to have a single medical and nursing record for each patient. We firmly believe that this offers the best opportunity for delivering the highest quality of care from a modern primary care team. Our practice staff need to notify the health authority of registration and claim details and perform various filing tasks on the medical records. All our doctors, nurses and staff have a legal, ethical and contractual duty to protect privacy and confidentiality of patients. E. Where else do we send patient information? We are required by law to notify the Government of certain infectious diseases (e.g. meningitis, measles but not AIDS) for public health reasons. The law courts can also insist that GPs disclose medical records to them. Doctors cannot refuse to cooperate with the court without risking serious punishment. We are often asked for medical reports from solicitors. These will always be accompanied by the patient's signed consent for us to disclose information. We will not normally release details about other people that are contained in our records (e.g. wife, children, parents etc) unless we also have their consent. Often the patient may be unaware what is present in their medical records – hence we will do our best to contact the patient, even if authority to disclose without review is initially given, to advise that a report request has been received and offering access to review Three or four times a year a "backup" tape of the computer clinical database is sent to the clinical software company in order to check the integrity of the data backup process. The tape is despatched suitably protected by Royal Mail Special Delivery and receipt is notified by the software company to the practice. If the tape is not received, a full investigation is launched with Royal Mail to determine the whereabouts of the package. Once the data check has been completed the software company erase the data from the tape before returng the tape by post. The software company does NOT access the content of patient records. The practice is currently seeking ways of encrypting the patient data prior to future despatch but is awaiting guidance from the NHS information technology team for this. Limited information is shared with health authorities to help them organise national programmes for public health such as childhood immunisations, cervical smear tests and breast screening. GPs must keep the health authorities up to date with all registration changes, additions and deletions. Social Services, the Benefits Agency and others may require medical reports from time to time. These will often be accompanied by the patient’s signed consent to disclose information. Failure to cooperate with these agencies can lead to patients' loss of benefit or other support. However, if we have not received a signed consent we will not normally disclose information. Life Assurance companies frequently ask for medical reports on prospective clients from the GP. These are always accompanied by a signed consent form. GPs must disclose all relevant medical conditions unless the patient asks us not to do so. In that case, we would have to inform the insurance company that we have been instructed not to make a full disclosure to them. Patients have the right, should they request it, to see reports to insurance companies or employers before they are sent. We will endeavour to advise patients when a request for a report has been received with a recommendation that the patient examines the content of any report before it is forwarded to the requesting party – whether or not prior consent to send "unseen" has been given by the patient.
From time to time a consultant will request sight of a patient’s records. On these occasions, the records will be taken out of their wallet and replaced with a card, indicating the date that the records were removed and the name and address of the consultant who requested them. A print out of the computer records of the patient will be placed in the file. Upon their return, the medical records are placed back in their wallet. F. How can a patient find out what is in their medical records? We are required by law to allow patients access to their medical records. If a patient wishes to see his records, he must contact Dr Higson for advice. All requests to view medical records should be made in writing. We are allowed by law to charge a small fee to cover our administration and costs. We have a duty to keep our medical records accurate and up to date. The patient must feel free to correct any errors of fact which may have crept into our medical records over the years. G. What we will not do To protect privacy and confidentiality, we will not normally disclose any medical information over the telephone or by fax unless we are sure who we are talking to. This means that we will not normally disclose test results over the phone and may wish to call the patient back to ensure that we are talking to the right person. This also means that we will not disclose information to family, friends or colleagues about any medical matters at all, unless we know that we have the patient’s consent to do so. Staff will not disclose any details at all about patients over the telephone - they are instructed to protect the patient’s privacy above all else! Finally, if a patient has any further queries, comments or complaints about privacy and / or medical records, they must contact Dr Higson or talk to their own GP.
Last reviewed 5/7/2008 Objective: The aim is to offer fast, efficient processing of prescription requests and for these to be prepared only by those who are authorised to do so.
Procedure: Repeat Prescriptions Repeat prescription requests can be received by post, delivered in person or sent via email through a hyperlink from the practice website which is www.goodwoodcourt.org. Requests should, whenever at all possible, be made on the pre-printed request slip issued by the practice- if not, then additional time may be required by the practice to process the request as further checks will need to be made. Requests received at The Eaton Centre are couriered to Goodwood every day after surgery. Repeat prescription requests are covered by the need for confidentiality. It is important that they are kept securely at all times especially during transportation between surgeries. A secure "letterbox" is available at the entrance of Goodwood Court Medical Centre for patients to leave the request 24 hours a day. All repeat prescription requests are placed in the repeat prescription clip sited in the reception area. All repeat prescriptions are prepared by Dr Higson or in his absence by Dr Williamson. Dr Higson will review the repeat prescription request for compliance to ensure that the medication is currently appropriate to the patient’s recorded medical needs. A signed prescription will be issued and placed ready for the receptionist to sort in alphabetical order each morning at 8 am. They are placed in a Prescriptions Box held on reception ready for collection. It is the aim of the practice that all prescriptions received by 8 pm; Monday to Friday will be available for collection by 8am the following working day. If a prescription is urgently required, perhaps because the patient has run out of medication, every effort will be made to have the prescription ready on the day of request. If no doctor is available and the patient requires an "immediate" prescription to replace regular medication, then the patient can be advised that he can obtain an emergency supply of medications from his pharmacy (for which he/she will have to pay) Prescription requests received by post are returned to the patient by post provided they have enclosed a sae. They are posted the day after receipt unless there has been a query. If a sae has not been enclosed, the prescription will be collected by the patient from Goodwood Court. Prescription requests received by email are read and dealt with by Dr Higson. They will be collected by the patient or representative from Goodwood Court. Prescriptions requests handed in at Eaton will be collected from Goodwood when they are ready. Before giving the patient his or her prescription, the receptionist checks the address of the patient to minimise mistakes due to similar names. Prescriptions to be handed to a Pharmacy will be recorded daily by the receptionist in a record book/folder and will be passed to the appropriate pharmacy agent who will sign to say that the prescriptions have been collected. Any pharmacy can collect prescriptions from Goodwood Court if they provide a list of the patients for whom they have been instructed to collect. When ready these prescriptions are placed in one envelope ready for collection. The Prescription Box should be checked every month and any prescriptions not collected within 6 weeks of issue should be returned to the patient’s doctor. The practice reserves the right to charge patients the costs of postage or faxing the prescription when not considered clinically urgent and when it is purely for the convenience of the patient Prescription issued following consultation. Each doctor is allowed by the System to issue and authorise prescriptions during patient consultation. See AP 1 ‘Information Security’, Section A, Bullet Point 5. The Senior Practice Nurse, Sister Elaine Higson is authorised to prescribe medication in accordance with the Nurse Prescriber’s Formulary. If Sister Elaine wishes to prescribe a medication which is outside the Nurse Prescriber’s Formulary, she will ask one of the doctors to help. Due to system limitations outside the influence of the Practice, Sister Elaine hand writes all her prescriptions but updates the patient’s computer record with a note of the medicine prescribed. If a non prescribing nurse feels that some medication is appropriate, she will discuss the case with one of the doctors or Sister Elaine Higson who will prescribe if necessary. Any drug prescribed should be "linked" with an appropriate morbidity whenever possible District Nurses may also prescribe medication from within bounds of the Nurse Prescriber’s Formulary. If this happens, the surgery will be informed by fax or letter which is used to update the patient’s clinical record.
PP 7 – Messages and requests for visits Last reviewed 6/7/2008 Objective: The system for message-taking must minimise or eliminate the risk of error or oversight. Patients are made to feel welcome when they contact the surgery. Requests, queries and comments are handled in a courteous and efficient manner. Procedure: Patients in need of medical attention who are unable to attend the surgery may request a home visit. Patients should be encouraged to request a home visit before 11 am on the day of the visit is required – pre-booking home visits is not normal practice. The patient will normally receive a visit from his or her own doctor. In the absence of their own doctor working that session, then visits will be covered by any of the other doctors on duty. It is usual practice for the doctor to telephone the person requesting the visit at the end of the morning surgery to gather appropriate information and to decide whether or not a visit is appropriate or whether another means of fulfilling expectations can be implemented A Message Book will be maintained, one for each doctor in the practice. All messages whether left by telephone or personal visit, will be written in these books. The duty receptionist takes down the name, address, telephone number and the message together with the name of the patient’s own GP and enters these details into the massage book for that doctor. The time of the call should also be noted The person taking the message has the responsibility of prioritising these messages and the doctor’s advice may be sought immediately if in his or her opinion the case is urgent. In these cases the message will still be recorded in the Message Book. The Message Book will be regularly reviewed by the doctor concerned during the course of the day. At the end of morning surgery, each GP will attend to his or her own visits. Any further requests for visits made during the day will be passed to the patient’s own doctor or covering doctor for the day. If an ‘urgent’ message is received for a doctor who is away, the case will be referred to the doctor on duty but the message will still be entered in the Message Book of the doctor who is away. If the case in not urgent, it will not be referred to the doctor on duty but simply entered in the relevant book. Each day, the Receptionist must ensure that all messages taken the day before have been actioned and cleared or there is good reason for being left outstanding. All records of visits are recorded on the patient’s computer record as soon as the visiting practitioner returns to the medical centre.
The Message Book will be laid out as follows.
PP 8 – Clinician’s availability by telephone Reference; Information 3 Last updated 6/7/2008
Objective: To ensure that all patient contact is treated with the degree of urgency that it deserves but that no request to speak to a doctor or nurse is dismissed. Consideration is to be given as to whether it is appropriate to interrupt another patients consultation
Procedure: A member of the reception team receives a call from a patient asking to speak to the doctor or nurse. The receptionist will enquire from the patient what the call is about. The receptionist will assess the urgency of the request and she will; (a) If need be, disrupt a consultation and put the call through to the doctor or nurse. (b) Take a message and the doctor will return the call in between consultations. (c) Rely on her experience and suggest that the patient rings for an ambulance or other appropriate service If a patient has requested to speak to the nurse but the nurse is away or unavailable, the patient will be asked to ring again at an appropriate time. This is to ensure that patient confidentiality is maintained particularly where the patient rings from work but does not always have the freedom to talk privately. Doctor Higson is reluctant to take non-urgent calls during surgery so as not to disrupt consultations and in this case patients will be asked to ring back after surgery or they may book specific telephone consultations. However please be aware that Doctor Higson wants to be told at the first opportunity if there has been a request for a home visit. If appropriate staff can use the Screen Messaging system to alert practitioners of calls or enquiries – this is often less intrusive than a telephone call to a consultation and the practitioner can offer give an answer to a query without disrupting an ongoing consultation When interrupting a consultation please be aware of the following; (a) Patient confidentiality, (b) The patient in the consultation room may have an equally pressing problem and may resent being interrupted and (c) Subsequent appointments may run late. If the reason for speaking to the doctor is not considered urgent, the receptionist will make a note in the Message Book and the doctor will ring back when he or she is less busy. Each case is different and common sense must prevail.
Last updated 18/8/2007 Objective: Patients are offered 24 hour cover, 7 days a week. When seen by other doctors out-of-hours the patient’s clinical records must be updated in a timely manner. Procedure: South East Health (formerly Brightdoc) is a commercial out-of-hours cooperative service. It undertakes all out-of-hours visits. NHS Direct is an organisation under the NHS which provides 24 hour telephone advice and support to callers. When the Surgery closes, the practice answerphone automatically comes on. It gives the caller a number of options; contact NHS Direct, contact your local pharmacist for advice or contact Brightdoc (also now known as South East Health). When the Surgery opens in the morning, the answerphone automatically comes off and the receptionist will take calls personally. Each day the practice may receive a fax or a note for each visit made by the out-of-hours service. These are bundled up by Reception and passed to Doctor Higson for review. If Doctor Higson is away, the notes will be passed to Doctor Williamson for his perusal. In this case all documentation will be retained for review by Doctor Higson upon his return. All communications are then passed for scanning to Ms Ann Long If a case needs to be followed up, the out-of-hours doctor will have told the patient to contact the clinic in the morning. This advice is marked on the note or fax sent to the clinic. Responsibility rests with the patient to do so. The patient’s computer records are updated by Dr Higson or by a trained member of practice staff. Although the content of the visit note, if legible, is entered as a free-text entry, there should also be a linked morbidity code indicating ‘out-of-hours cooperative’. All notes or faxes received from Brightdoc are filed by Centre (Goodwood or Eaton) and by doctor for easy retrieval until they are permanently filed in the patient’s records. The Out-of-Hours software system allows GPs to prime the out of hours database with information which might be of particular value to a colleague who is unfamiliar with the patient, or indicate special requirements for handling out-of- hours calls. This facility will typically be used to warn of patients who might be abusive or violent, and those who may be over demanding. It is also valuable where a patient may have an obscure medical condition, or for terminal care or intra-partum cases where the patient’s own GP wishes to be alerted in the event of any call. Use the form below and submit a completed copy under confidential cover to the out-of-hours manager. You will find a blank copy of the form on Word in Clinical/Torex/DOCSTORAGE/JOHN C/Forms/Brightdoc Fax Form.doc. Make sure to include the patient’s telephone number where there is one as this is the primary source of reference on the system’s database. All messages will carry a review date when they will be referred back to the Surgery for consideration of renewal. Confidential when completed MESSAGE TO BE FAXED TO SOUTHEAST HEALTH ON 687735 From Goodwood Court Medical Centre Tel; 0844 477 0925: Fax; 0844 884 0152. Ask for Doctor Higson
Reference; Management 9 Last updated 6/7/2008 Objective: To ensure that the practice identifies patients and their carers and provides help and support as required.
Procedure: The doctor, practice nurse, district nurse or the receptionist may recommend or assist a patient in procuring care help. Where the clinician considers it appropriate, the patient may be asked if they have a carer. If the answer is yes the Clinical Notes Screen is updated using code 918F. The Patient Information Screen is also updated by completing the Notes Box. The information will include the name of the carer and their contact number. Similarly, if the patient is a carer, an entry is made in the Clinical Notes Screen using code 918G. The name of the patient cared for, their contact number and any other data deemed relevant is entered in the Notes Box in the Patient Information Screen. If the carer requires help, he or she will be referred to one of a number of organisations, such as Crossroads (Care for Carers) 01273 273344, Health Advisor Service for Older People 01273 242229 or The Brighton & Hove Federation of Disabled People 01273 295710. He or she will also be referred to the Social Services for a Carer Assessment 01273 295555. If a patient requires a carer, he or she will be referred for a social services assessment. Reception Team members may refer to the social services either at the request of the doctor or the patient. When this happens a free text note is added to the patient’s clinical notes. At the beginning of each practice year, the practice will write to all those coded as carers (918G.) and cared-for (918F.) to request updated information and to advise them of the availability of a Care Assessment. A specimen letter is on the last page of this protocol. Patients may organise their own carer needs and reception will assist with names of organisations and contact details. If a relative of a patient asks reception for assistance in organising help for a parent etc, only self help will be offered. Reception must not do the organising as the patient consent is unknown. The GP will be told of the request. This practice only requires a verbal consent from the patient before a carer organisation is contacted. In most cases a written consent would be impractical. There are three types of carers. These are Carer, Parent Carer and Young Carer. A carer is anybody who looks after a relative or friend who needs support because of age, physical disability, learning disability or illness including mental illness. A parent carer is a parent of a disabled child. These parents often see themselves as parents rather than carers but their child will have additional care needs and may be entitled to additional services. A young carer is a person under the age of 18 who has caring responsibilities for another family member who is either unwell physically or mentally or who is disabled. As soon as any clinician becomes aware that a child is a young carer, a letter will be sent to the child’s school informing them of this fact giving details of doctor’s names, address of surgery and contact telephone numbers. The following link concerns Attendance Allowance: http://www.dwp.gov.uk/lifeevent/benefits/attendance_allowance.asp#what The following is a sample list of organisations that provide help to carers and those in need of care. Crossroads Care Attendant Scheme (based at Hove Polyclinic) Tel 242022 Age Concern Crisis Line Tel 328555 (between 8am & 6pm) Brighton & Hove Disability Association Tel 203016 or 208934 Carer’s Centre, Community Base, 3rd Floor, 113-117 Queens Road, Brighton BN1 3XG, Helpline Tel 273344 Office Tel 234045. (Supports non-paid carers with emotional support, sitting-in, advocacy etc). St. John’s Ambulance (Private Ambulance Service) County Office 01903 235599 Wheelchair Hire & Medical Aids (Southwick) 413999, (Worthing) 01903 505346 British Red Cross for Wheelchairs and Daily Living Aids 731208 Direct Mobility Hire 0208 807 9830, M & B 01323 721223, Southern 01323 641798, WRVS Meals on Wheels 410117 Community Transport 505888 The following private organisations (paying) provide care across a wide spectrum. Allied Healthcare (Robert Anderson) Tel 278730 Care UK (Laura Head) Tel 626161 Carewatch (Terry Playford & Chrissie James) Tel 207111 Community Careline Services (Joan Papworth) Tel 309393 Goldsborough Home Care Ltd (Heather Bennett) Tel 624373 Halifax Care (Anne Halifax) Tel 695444 Independent Living Organisation (Debbie Fielding) Tel 728674 Plan Personnel (Anna Matthews) Tel 203586 Prime Care (Michaela Allen) Tel 01323 491975 or 01273 677314 Sussex Homecare (Sarah Yaxley) Tel 770202 Dr. Nigel Higson, Dr. John Williamson Dr. Milind Jani & Dr Janet Wilson General Medical Practitioners Goodwood Court Medical Centre & The Eaton Centre 52 Cromwell Road Hove BN3 3ER Fax 0844 884 0152 Tel 0844 477 0925 www.goodwoodcourt.org surgery@goodwoodcourt.org NAME AND ADDRESS Dear ____________________ According to our records, we have information to say that you are either a Carer or someone in receipt of the services of a Carer. If this is incorrect, please advise us. We will write to you annually to ensure that the information we have is correct and to advise you of additional services which may be available to you. Please would you confirm in writing the following information: If you are a Carer – Please advise us of the name of the person for you care, their contact telephone number and address. This is to ensure that we are able to make arrangements for that person in case you become unwell or we have to admit you suddenly to hospital. If you work for an agency, please advise us of the name and contact phone number for the relevant Agency Supervisor. If you are in receipt of care Please advise us of the name, telephone number and address of your carer (s) in order that we can contact them if necessary If you receive care from an Agency, please advise us of the name and contact phone number for the relevant Agency Supervisor
Every Carer and person in receipt of care can approach Social Services for a Care Assessment – the relevant department can be contacted on Brighton 295555. Our Health Advisor for the Elderly can be contacted on Brighton 242229 and our District Nurses on ___________. Other services are available to assist with care – please feel free to contact us for advice Dr Higson and Team, Goodwood Court Medical Centre
PP 11 – Patient’s removal from the Practice List. Last reviewed 6/7/2008 Objective: To ensure that the patient is given a reason for the removal from the Practice List together with information on how to find a new one and to provide a simple efficient way of dealing with medical records when a patient is removed. Procedure: Reasons for removal from the Practice List There are six main reasons why a patient may be removed from the Practice List. These are: (a) Physical or verbal violence, (b) The patient moves away from the Practice’s catchments area, (c) Breakdown of patient / doctor relationship, (d) History of failure to attend appointments or general abuse of system, (e) The patient moves to another practice, (f) The patient dies. This is considered under PP12. Who can decide to remove a patient from the list It is the doctors in the Practice who instigate the removal in scenarios (a) to (d). They will decide with Dr Higson if a patient must be removed from the Practice List. In cases (e) and (f) it is the patient who forces the issue. Process for removing a patient from the list Once the decision has been made to remove a patient, a letter is sent to the Primary Care Organisation with a copy to the patient. The letter will give the patient’s identification details and the reason(s) for the removal. (This is generated automatically within the "referral" letter option in the clinical software and a copy is retained in the clinical computer record) It is the Primary Care Support Service’s responsibility to write to the patient informing him or her of the decision taken by the Practice and why. They will assist the patient in finding a new practice in the area by giving all relevant details. Notwithstanding this, the Practice also sends the patient a letter explaining the removal and how to find a new doctor.
Change of address If the patient has moved away from the practice catchments area, the practice may not know this until; (a) The patient tells the practice, (b) The practice refers a patient to hospital or a consultant at which point the address is checked. (c) A Green Card, Form FP69, is received from the NHS. Green Card, Form FP69 The NHS occasionally calls up some individuals for check ups etc. If their letter is returned undelivered, they will generate a Green Card and send it to the Practice. Upon receipt, the Reception staff will record on the card the date that the patient last visited the Practice and return it to the NHS. If the card refers to a foreign student, that student’s clinical record is closed automatically on expiry of the due warning period noted on the greencard. If the card refers to a regular patient, a freetext note is entered on that patient’s record and the next time that patient contacts the Surgery, the address is checked and updated. If the new address falls outside the catchments area, the patient will be asked to move to another clinic. Procedure for dealing with a patient’s medical records. A daily request for patient records and closure of patient’s records may be received electronically from the ESBHPCSS. If an electronic request is not possible the ESBHPCSS sends Form FP22 to the Practice each Friday. Names contained on this list relate to patients of an individual doctor in the Practice. Working from the list, the reception staff retrieve the medical records and cancel the patient on the computer system giving the reasons for the cancellation. A full computer print out for each patient is produced giving a summary of past medical history, a full chronological history of contacts and any drug or medication received. All documents produced are boxed up and await collection by the PCSS courier when they call on Friday. Goodwood Court Medical Centre & The Eaton Centre Dr.Nigel Higson, Dr.John Williamson Dr.Milind Jani & Dr S Janet Wilson General Medical Practitioners 52 Cromwell Road Hove BN3 3DX fax: 0844 884 0152 tel:0844 477 0925 www.goodwoodcourt.org surgery@goodwoodcourt.org
_longdate
Ms S Turner Patient Services East Sussex Brighton and Hove Primary Care Support Services 36 Friars Walk Lewes
Dear Sue Re: _patienttitle _patientforenames _patientsurname _patientdofb _patientaddress1 _patientaddress2 _patientaddress3 _patientaddress4 _patientpostcode NHS number: _patientnhs
Please would you remove the above patient from our medical list for the following reason: Failure to attend one or more booked appointments Abuse or violent behaviour Moved outside of practice area Breakdown of Patient-Doctor relationship With many thanks
Dr.Nigel Higson
Goodwood Court Medical Centre & The Eaton Centre Dr.Nigel Higson, Dr.John Williamson Dr.Milind Jani & Dr S Janet Wilson General Medical Practitioners 52 Cromwell Road Hove BN3 3DX www.goodwoodcourt.org surgery@goodwoodcourt.org
_longdate
_patienttitle _patientinitials _patientsurname _patientaddress1 _patientaddress2 _patientaddress3 _patientaddress4 _patientaddress5 _patientpostcode Dear _patienttitle _patientsurname
A request has been sent to the East Sussex Brighton and Hove Primary Care Support Services (ESBHPCSS) to ask for your name to be removed from our medical lists. This is for the following reason: Failure to attend one or more booked appointments Abusive or violent behaviour Moved outside of practice area Breakdown of Patient-Doctor relationship You will only be able to receive medical care from us for a further seven days after which time you will need to seek the help of another medical practice. If you have difficulty finding another medical practice, then you should contact the PCSS on 01273 485300 who will be able to give you a list of medical practices in the area or who will allocate your name to a doctor. You will be unable to re-register with the practice while living outside the practice area
Sincerely _reggptitle _reggpsurname
Last updated 6/7/2008 Objective: To ensure that relevant team members are informed about patients who have died. The aim is to avoid possible embarrassment and distress. Please note that this Protocol does not deal with the doctor’s duties relating to death but with the handling of death notification received by the Practice staff. Procedure: It is highly likely that a member of the reception team will be the first to receive notification of a patient’s death. Irrespective of who first gets to know, the procedure for disseminating the information is the same; A Death Notification Form must be completed. Make an entry in the relevant doctor’s message book to ensure that the doctor’s action is recorded. The Form will be available on the Practice intranet site but until access is improved, a master copy of form will be kept in Reception and photocopied as required. The form is also on Word at; clinical\torex\DOCSTORAGE\JOHN C\Forms\Notification of Death Form.doc The person taking the notification call must fill in as much of the form as possible before passing it to the relevant doctor for completion. The doctor will decide who needs to be informed of the death and will indicate his decision by ticking the appropriate boxes on the form. If the District Nurses, Health Advisors or Health Visitors are to be circulated, the form will be returned to the reception team for faxing as appropriate. If the patient’s doctor in unavailable, the person who took the notification call will pass the form to the next available doctor for a decision. Staff who have read the form will initial it. It is assumed that District Nurses, Health Advisors and Health Visitors have seen the form as a result of having successfully faxed it across to them. Once the Form has been seen by all concerned it will be placed in the Patient’s File. Update the patient’s clinical records. Prepare for transfer the deceased patient’s clinical records to the PCSS by following bullet points 10 to 12, PP11. Goodwood Court Surgery & The Eaton Centre 52 Cromwell Road, Hove BN3 3ER Tel 0844 477 0925 Fax 0844 884 0152 Notification of Death of Patient This is to advise you that we have been informed of the death of: Surname: Forename: Date of Birth: GP: Date of death: Cause and place of death: Date Notification Received:
PP 13 –Statistical Techniques & Patients Surveys Reference PE 2, 3 & 4 Last reviewed 6/7/2008 Objective: Statistical Techniques help to compare achievement with Quality & Outcomes targets. Trends are measured by periodic analysis of current and past performances. They also provide a measure of the performance of providers. The new GMS contract is based on the involvement of the public in service planning and delivery. This involvement is recognised as a key indicator of quality and responsiveness. Patient Surveys provide active patient involvement in primary care by seeking out patient views and progressing to a situation in which patients have a role in planning, implementing and reviewing change and service improvement initiatives.
Procedure: The analysis of performance indicators consist of; Patient complaints and patient satisfaction Surveys of patients referred for hospital treatment Clinical activity in areas listed under Quality & Outcomes, Appendix A of the new GMS contract. Clear reasons must be stated as to why feedback from patients is required, specifying; How and why patients are selected for survey How many patients are targeted How many respond What use is made of the information and the ways in which it is used and why. The Annual Patient Survey ensures that the basis of the service standards is met and that patients are receiving the kind of treatment they can reasonably expect from the practice. Improvement in patient experience is expected in these 5 areas; Improving access and waiting Building closer relationships More information, more choice A clean, comfortable, friendly place to be Safe, high quality, joined-up care. Regular audits ensure that the practice is playing a full part in needs assessment and care management procedures for individual patients where required and meeting its obligations under community care legislation. Surveys are carried out through either one of the commercial services - CFEP – UK Surveys, Telephone 01392 252740; GPAQ on-line- or by in house analysis. When patients are requested to complete a questionnaire, it is important that the recipient is made aware of the purpose of the research. Periodically, the Surgery targets patients registered with the practice informing them of various clinics, screening and health promotions available to them at one or the other of the medical centre. See Protocol CP4. In order to avoid contravention of regulations laid down by the General Medical Council (GMC) and the British Medical Association (BMA), the Practice adheres to "Guidelines to Doctors on Advertising – Appendix 1" From time to time the Practitioners agree to distribute information on an unsolicited basis to homes within the geographical catchment area. When this occurs it is important to ensure that no individual or group of patients is singled out to receive such information and that the distribution is not carried out in such a way as to put the recipients under pressure. In addition, the information contained must inform the receiver that the service offered applies only to patients registered with the Practice. Where unsolicited leaflet drops relate to advertising the practice, in order to encourage the receiver to join the practice, it is good practice for a copy of the proposed leaflet to be forwarded to one of the defence indemnity organisations for clearance or modification if necessary, before distribution takes place. All advertising material must contain a reference number which patients will be asked to quote when responding to facilitate advertising effectiveness analysis. All staff should be aware of the contents of any advertising venture and in particular to be prepared to deal with requests for services detailed therein.
Responsible Complaints Manager: Mrs Wendy Pell-Stevens Responsible Clinician: Dr John Williamson Last updated: 12 December 2006 What is a complaint? A complaint is defined as an expression of dissatisfaction (written or verbal) about a practice, practitioner, function, decision or contracted service. Examples of complaints include concerns about the quality of service provided, the following of procedures and good practice, the behaviour of a member of staff and the accuracy or appropriateness of clinical records Complaints should normally be made within six months of the situation arising or of the matter coming to the attention of the person complaining. The practice can consider complaints after this time if it is felt there are good reasons for the delay of the able grounds to do so. The practice complaints manager will advise patients, carers, members of the public and staff colleagues, what is, and what is not, a complaint and which process any complaint should be handled through.
The aim of the complaints policy The aims of the complaints procedure are: the resolution of the complaint to the satisfaction of the complainant while being scrupulously fair to the staff/practitioner. to provide an apology when things have gone wrong to ensure an improvement of the quality of the work of the Practice rather than the apportionment of blame Who can handle complaints at the Practice ? The Practice is keen to ensure that complaints are handled within this policy and its timescales so whilst a member of practice staff may investigate and respond to the complaint they MUST inform the Practice Complaint Manager that they are doing so. On resolution of the complaint they MUST also send ALL of correspondence to the Practice Complaints Manager. This is so that the Practice Complaints Manager can keep the correspondence in a secure area and also record that the complaint has been handled within the required procedures and timescales.
National regulations which apply This policy is based on statutory document "2004 No. 1768 The National Health Service (Complaints) Regulations" issued in July 2004 by the Department of Health (DH) and "2006 No. 2084 The National Health Service (Complaints)Amendment Regulations" issued in September 2006 by the DH The Practice’s complaints procedure There are three main stages in managing a complaint. The hope is that all complaints will be resolved in the first stage, but there are two additional stages to ensure that the complainant has a chance to escalate their complaint if they still remain dissatisfied. At any stage, the Complaints Manager may choose to refer the complaint straight to the Healthcare Commission or the NHS Ombudsman if she / he feels that the complaint warrants early independent investigation. Under Section 8(3) of the above Act, the Complaints Manager needs to determine if a complainant had sufficient interest in the welfare of a (deceased) patient and is a suitable person to act as representative. Regrettably this is imprecise and requires the Complaints Manager to undertake enquiries which may not be appropriate. 1: is the complainant a 1st or 2nd degree relative of the patient? 2: Does/did the complainant have power of attorney or is he an executor of the estate? 3: Did the complainant live with the patient? 4: Did the patient appoint the complainant as "next of kin" in medical records? 5: Did the patient involve the complainant in his medical care (ie did the patient invite the complainant to be present during consultations)? 6: Did the patient refer to the existence of complainant as a friend or representative during consultations? 7: Do the patient’s relatives believe the complainant to be a significant person in the patient’s life? 8: Has the complainant provided proof that he represents the patient? Positive answers to any of these would perhaps persuade the complaints manager that the complainant could be considered a "suitable" complainant; negative answers to all these queries would suggest that the complainant may not be a "suitable complainant" If the determination is that the complainant is "unsuitable", then the practice complaint manager will inform the complaint of the situation giving full reasons for the decision.
Local Resolution - The first stage of any complaint should be handled between the complainant and the person or organisation that the complainant is dissatisfied with or about. This stage is called ‘Local Resolution’.The complained against will also be informed at this stage of the nature of complaint that has been made against them. It may be appropriate to invite a complainant or complained against to meet with practice staff (with or without the assistance of an independent lay conciliator) to address outstanding queries, either initially or following an exchange of correspondence. Complainants and complained against should be supported at meetings if they wish e.g. by a friend, relative, carer, advocate or Independent Complaints Advocacy Service (ICAS) officer.
The investigating Manager can write, fax or e-mail, requesting to view all relevant documentation from any body or individual involved in the complaint. The request must state what document and why it is relevant. Confidential information can only be requested if the complainant has given written consent. If an individual or organisation is unwilling to share important information the NHS Ombudsman can be called upon to force the information to be shared. The Ombudsman would then take over the case. Using patient personal health records - Patient personal health records (the notes kept by their GP) should only be used in the investigation with the permission of the patient. The personal health records should be kept separate from the complaint records at all times and should be returned to their original place of storage as soon as this aspect of the investigation has been completed. Reporting the outcomes of the investigation - All complaints and complained against should receive a formal, final, Local Resolution response (via letter, e-mail or fax) within 25 (with expectation of working to 10 days) working days of receipt. The nature of the complaint raised by the complainant The nature of the investigation undertaken by the Practice The conclusions reached by the Practice What action has been taken by the Practice to resolve the complaint An apology, if appropriate What action will be taken to avoid such situations arising again That the complainant has the right to refer the complaint to HCC for independent review within two months of the receipt of the letter. If a response cannot be sent within 25 working days, a holding letter (via letter, e-mail or fax) should be sent giving the reason for the delay. With the agreement of the complainant, time spent in conciliation is discounted for the purposes of monitoring timescales. Letters responding to complaints will address all points raised by the complainant. They will be succinct, jargon-free, courteous in tone and clear on clinical issues.
Complex Complaints - If the complaint involves other NHS trusts, the local authority or other large bodies it will be deemed to be a ‘complex complaint’. In this instance the Complaints Manager should always handle the complaint. Within 10 working days Complaints Manager should: Obtain written consent from the complainant to pass their complaint on to the other organisation notify the other organisation’s complaints manager and they should decide who is the most appropriate body to handle the complaint. The decision should be immediately communicated to the complainant. If the complaint is to be handled by the Complaints Manager it will proceed as per this policy whilst keeping the other body and the complainant closely informed. If the complaint is to be handled by the other body the Complaints Manager must ensure that the Practice remains closely informed and implements the outcomes of the complaint if it impacts on the work the Practice. Complaints involving a local authority - If the complaint is solely about, or involves, issues normally covered by a local authority then the complainant should be informed that this complaint (or element of the complaint) must only be handled by the relevant local authority. If the complainant is unhappy about giving consent for the Practice to pass their issue onto the local authority the Practice Complaints Manager must inform the complainant that the complaint (or element of the complaint) will not be handled by the Practice and must be passed, by the complainant, directly to the relevant local authority for investigation and response.
Management of complaints files 1. It is important to keep a comprehensive and well-maintained record of a complaint that has been received, investigated and responded to. This ensures that: • healthcare staff can work with maximum efficiency, retrieving and reviewing information quickly • there is greater protection of information • there is an ‘audit trail’ which allows any document to be traced to a named individual at a given date/time, and any amendment to be similarly traced • anyone following up the complaint, or dealing with it following personnel or organisational change, can see what has been done, or not done, and why • any decisions made can be reconfirmed or reconsidered at a later date • healthcare organisations can draw on the experiences of people who have cause to complain about services in their work to improve services • healthcare organisations can be seen to be transparent in their dealings with people who complain about services • healthcare organisations can account for their work to the people they serve • healthcare organisations can meet their obligations under access to records legislation 2. Sound professional practice in complaints file management will help secure swift, honest and comprehensive resolution of complaints about health services. 3. A complaint file has the same status as any other created by a healthcare organisation. It is a public record, its contents are confidential and an individual (usually the designated complaints manager) is responsible for making sure that it is maintained to an appropriate standard. 4. Once the need for a file has been identified, the complaints manager should create one and mark it with the name of the complainant (not the name of the patient, unless they are the same person). The date on which the file was created should be clear. It should also bear a reference that marks its place in the file library maintained by the complaints manager. 5. The file should include all important and relevant information in a legible form so that it can be read easily and reproduced when required. The file maintained by the complaints manager should include: a) A summary sheet recording significant events in the management of the complaint b) A full and legible copy of the relevant sections of the clinical records and communications sheets. The clinical record for a patient who is alive should be copied and the original returned to the record store as soon as possible. c) A copy of any earlier clinical record that may be relevant to the complaint. d) All written correspondence between the trust and the complainant, and with any other person or organisation about matters related to the complaint e) Any notes from telephone or other conversations (for example records of telephone or face-to-face conversations regarding the progress of the complaint that required a fuller note than an entry on the summary sheet). f) The report of the investigation into the complaint. g) Notes from any meetings concerning the complaint (including meetings with the complainant, with independent experts, the outcome of conciliation meetings). h) A copy of the response sent to the complainant by the practice. i) A summary of any action taken in response to the complaint and/or evidence of changes made as a direct consequence of the complaint. j) A record of any follow up communications with the complainant describing the effect of any changes made as the result of the investigation. 8. Since the complaints manager may not investigate the complaint personally, it is likely that the investigator will open a personal working file. The working file should include: a) The text of the complaint made in the first place and any papers that carry any subsequent clarification or amendment to the complaint. b) A copy of any information given to the complainant (by the PALS service, the complaints manager or the investigator) about the investigation process and who will be involved in it. c) A list of staff involved in the events complained about, including full name, role and contact details. d) Any statements from staff involved in the events complained about or who witnessed the events. e) Records of any interviews with people (i.e. staff, other patients or members of the public) involved in the events complained about or who witnessed the events. f) Notes made in the course of the investigation. g) A copy of the report of the investigation into the complaint and/or the draft response to be sent to the complainant by the practice. 6. All these papers should be sent to the complaints manager at the end of the investigation for inclusion in the file held centrally. 7.. Whatever the medium, the file contents should be: • kept in a secure environment (lockable cabinets, fireproof cabinet for original clinical records, password protected electronic files), designated for the purpose • accessible only to those directly responsible for investigating and responding to the complaint • kept up to date • shared between those who need to use them, rather than copied and so increase the risk of compromising confidentiality 8. The minimum recommended period for retaining a complaint file is presently 10 years from the date on which action was completed. The principles outlined in paragraph 7 above apply equally to remote storage and retrieval. Files must be disposed of under confidential conditions. 9. The complaints received will be reviewed quarterly by the Complaints Manager and Complaints Clinician who will summarise all into a complaints log in order to identify any persistent themes. The log and comments will be distributed to all practice clinicians and administrative staff 10. An annual summary of complaints will be forwarded to the Primary Care Support Services at 36 Friars Walk, Lewes, on an annual basis
Complaints.
Please note: Wendy is responsible for maintaining a Complaints Log for both Eaton and Goodwood. Anyone who receives a verbal complaint from a patient or indeed wishes to complain about a patient must let Wendy Pell-Stevens know. Please do this by completing an Action Summary Sheet kept in the 2nd drawer down in the RHS cabinet in Reception. Wendy will log the complaint and bring it to Dr Williamson’s attention. Letters of complaint received in the post must also be passed to Wendy for logging and forwarded to Dr Williamson as soon as possible. No need to complete an Action Summary Sheet for these. All complaints must be acknowledged as soon as possible and formally replied to within 10 working days. Please see Complaints Procedure Protocol PP14. This logging process must not be allowed to delay the process. Please report every complaint 02/11/05
INFORMATION FOR PATIENTS/OTHER INTERESTED PARTIES Introduction: If you have a complaint or concern about the service you have received from the doctors or any of the staff working in this practice, please let us know. We operate a practice complaints procedure as part of a NHS wide system for dealing with complaints. Our system meets the national criteria. Guidance on a "good complaints process" can be found at: http://www.healthcarecommission.org.uk/_db/_documents/04022289.pdf
We hope that most problems can be sorted out easily and quickly, often at the time they arise and with the person concerned. If your problem cannot be sorted out in this way and you wish to make a complaint, we would like you to let us know as soon as possible, ideally on the day. This is because the sooner we know about a problem, the easier it will be for us to establish what happened. In any event, please let us have details of your complaint: Within 6 months of the incident that caused the problem; or Within 6 months of discovering that you have a problem, providing this is within 12 months of the incident. Complaints should be addressed to the Practice Complaints Manager, Mrs W Pell-Stevens. Alternatively, you may ask for an appointment with Mrs W Pell-Stevens to discuss your concerns. She will explain the complaints procedure to you and will make sure that your concerns are dealt with promptly. It will be a great help if you are as specific as possible about your complaint.
We will acknowledge your complaint within two working days and aim to have looked into your complaint within ten working days of the date when you raised it with us. If the complaint is raised on behalf of another person – ie not directly by the patient – the complaints manager will apply the following tests to determine whether the complainant is a "suitable complainant" under the NHS complaints procedure section 8(3): 1: is the complainant a 1st or 2nd degree relative of the patient? 2: Does/did the complainant have power of attorney or is he an executor of the estate? 3: Did the complainant live with the patient? 4: Did the patient appoint the complainant as "next of kin" in medical records? 5: Did the patient involve the complainant in his medical care (ie did the patient invite the complainant to be present during consultations)? 6: Did the patient refer to the existence of complainant as a friend or representative during consultations? 7: Do the patient’s relatives believe the complainant to be a significant person in the patient’s life? 8: Has the complainant provided proof that he represents the patient? If the complaints manager determines that the complainant is not a suitable complainant then the Manager will write to the complainant informing him/her of the outcome and further options. We shall then be in a position to offer you an explanation, or a meeting with the people involved. When we look into your complaint, we shall: Find out what happened and what went wrong. Make it possible for you to discuss the problem with those concerned, if you would like this. Make sure you receive an apology, where this is appropriate. Identify what we can do to make sure the problem doesn't happen again.
Please note that we keep strictly to the rules of medical confidentiality. If you are complaining on behalf of someone else, we have to know that you have his or her permission to do so. A note signed by the person concerned will be needed to authorize you to complain on their behalf. See section above regarding "suitable complainant"
We hope that, if you have a problem, you will use our practice complaints procedure. We believe this will give us the best chance of putting right whatever has gone wrong and an opportunity to improve our practice. If for any reason you feel that the practice complaints procedure has not resolved your problem, then another step to take is to contact the local PALS (Patient Advice and Liaison Service), which is based at Prestamex House, 171-173 Preston Road, Brighton 01273 545337 Responsible Manager Martin Campbell Brighton and Hove City Teaching Primary Care Trust Prestamex House 171-173 Preston Road Brighton BN1 6AG tel: 01273 545337 email: martin.campbell@bhcpct.nhs.uk textphone: 01273 545449 However should you feel you cannot raise your complaint with us or you are dissatisfied with the result of our investigation. You should contact the Health Care Commission
If you feel that we have been unable to answer your complaint to you satisfaction or feel that there are other issues which are beyond the remit of our practice complaint procedure, then you may contact the Health Care Commission – A Statutory organisation – for advice and consideration of further investigation http://www.healthcarecommission.org.uk/contactus/complaints/complainaboutthenhs.cfm
The Health Care Commission’s address is: 5th Floor Peter House Oxford Street Manchester M1 5AX 02074489100 Fax: 02074489180 Goodwood Court Medical Centre & The Eaton Centre Comments, Complaints and Suggestions Form Please write in BLOCK CAPITALS - use this form to make any comments you wish about our services Your Name:_________________________________________ Your Address (so that we can acknowledge your comments) ____________________________________________________________________________________________________ Date: _______________________ Practitioner or Service _________________________________ Your Comment or Complaint
You will receive a prompt reply. Please feel free to use an additional sheet if necessary. We would also be grateful if you could score some specific aspects of our services: NB: 1= LOW score 5 = HIGH score Receptionist - Manner & efficiency 1 2 3 4 5 Contacting the Surgery by Phone 1 2 3 4 5 Convenience of Appointments 1 2 3 4 5 Punctuality of Appointment 2 3 4 5 Waiting Room Comfort 1 2 3 4 5 Comments Please use the form overleaf either to make specific comments or to complete the questionnaire on key service areas. All comments will be passed to Mrs.Wendy Pell-Stevens who will ensure that they are actioned and that you receive a reply if appropriate. All procedural comments are discussed at our regular Quality Team Meeting Complaints We sincerely hope that it will not be the case, but you may feel in certain circumstances that the service you have received is not up to the standards that you feel you are entitled to receive. If this is the case, PLEASE TELL US. If the complaint is of a clinical matter, then please write to the practitioner concerned. If it is in regard to standards of service, please complete the form overleaf and send it to us at Goodwood Court. Mrs Pell-Stevens will ensure that your views are noted, investigated and a reply sent to you. As with comments we undertake to make a prompt reply, investigating the complaint and letting you know the action undertaken. If you are not completely satisfied we can advise you of the next most appropriate step. GOODWOOD COURT MEDICAL CENTRE - where medical care and quality of service help us to care for you, your parents and your children.
Our Practice Commitment We promise to: offer you an appointment the same day with a doctor if you have a problem that YOU feel is urgent. provide medical cover 24 hours a day EVERY DAY make authorised repeat prescriptions available by 8am the following day if requested by 8pm (Monday to Friday) We will endeavour to: keep to within 20 minutes of your appointment time deal with all requests for medical reports within 48 hours (Monday to Friday) obtain the best service we can for YOU from the Hospital sector answer your telephone call courteously within one minute. To help us to help you, we ask that you: Inform us of any good or bad aspects of our service Come along to the Surgery rather than request a home visit Keep yourself as healthy as possible by taking advantage of the screening and preventive services that we have to offer
Goodwood Court Medical Centre 52 Cromwell Road Hove BN3 3ER Comments Suggestions Complaints
To help us to offer you the very best in all-round health care we need to know what you think - when you are pleased with our services and when you are less satisfied. YOUR COMMENTS INFLUENCE OUR POLICIES Many thanks in advance for taking the trouble to complete this form.
SUMMARY OF COMPLAINTS RECEIVED DURING YEAR
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