Introduction

The Practice takes it very seriously if a member of staff or any of our patients are treated in an abusive or violent way.

The Practice supports the government’s ‘Zero Tolerance’ campaign for Health Service Staff. This states that GPs and their staff have a right to care for others without fear of being attacked or abused. To successfully provide these services a mutual respect between all the staff and patients has to be in place.

Our Practice staff aim to be polite, helpful, and sensitive to all patients’ individual needs and circumstances. They would respectfully remind patients that very often staff could be confronted with a multitude of varying and sometimes difficult tasks and situations, all at the same time.  The staff understand that ill patients do not always act in a reasonable manner and will take this into consideration when trying to deal with a misunderstanding or complaint.

However, aggressive behaviour, be it violent or abusive, will not be tolerated and may result in you being removed from the Practice list and, in extreme cases, the Police being contacted.

In order for the practice to maintain good relations with their patients the practice would like to ask all its patients to read and take note of the occasional types of behaviour that would be found unacceptable:

• Using bad language or swearing at practice staff
• Any physical violence towards any member of the Primary Health Care Team or other patients, such as pushing or shoving
• Verbal abuse towards the staff in any form including verbally insulting the staff
• Racial abuse and sexual harassment will not be tolerated within this practice
• Persistent or unrealistic demands that cause stress to staff will not be accepted. Requests will be met wherever possible and explanations given when they cannot
• Causing damage/stealing from the Practice’s premises, staff or patients
• Obtaining drugs and/or medical services fraudulently
• We ask you to treat your GPs and their staff courteously at all times

The Legal Position

As a responsible employer, the Practice has a duty as a provider of NHS healthcare to protect the health, safety and welfare of staff under the Health & Safety at Work Act. This includes a risk assessment of violence towards staff and taking steps to mitigate this under the Management of Health and Safety at Work Regulations 1999.

Staff members who are victims of violent conduct or assault have the right to sue their employers for compensation if the risk of violence could have been reduced or removed completely, but the employers did not act upon this information.

Examples of security issues:

• Security of grounds and car parking
• Security of premises – incl. storage, “out of hours”
• CCTV
• Cash and staff – storing, handling and transferring
• Security Systems
• Security of equipment – medical devices, computers
• Communication of national security alerts
• Information records
• Contingency planning.
• Security of employees
• Staff working on their own
• (Staff can be lone workers when making domiciliary visits or within a hospital department e.g. out of hours)

This list is not exhaustive.

For example a lone working risk assessment must provide the lone worker full knowledge of the hazards and risks to which he or she is being exposed and what they must need to do will something go wrong. Other responsible persons must know the whereabouts of lone workers and what they are doing.

Violence at Work

The practice acknowledges that there may be instances where violence and / or aggression forms part of a patient’s illness.  In these circumstances, the issue will be discussed with the patient and form part of their care planning.

This information will be recorded in the patient’s medical record and flagged to ensure that members of staff are aware. In addition, where deemed necessary, appropriate support will be put in place, e.g. staff members do not see the patient alone.

Definition of Physical and Verbal Abuse and Violence

Physical and verbal abuse includes:

• Unreasonable and / or offensive remarks or behaviour / rude gestures / innuendoes
• Sexual and racial harassment
• Threatening behaviour (with or without a weapon)
• Actual physical assault (whether or not it results in actual injury) includes being pushed or shoved as well as being hit, punched or attacked with a weapon, or being intentionally struck with bodily fluids or excrement.
• Attacks on partners, members of staff or the public
• Discrimination of any kind
• Damage to an employee’s or employer’s property

The Practice supports the Zero Tolerance stance adopted by the NHS

The HSE (Health and Safety Executive) defines work-related violence as:

“Any incident, in which a person is abused, threatened or assaulted in circumstances relating to their work”.

Violence and aggression towards a person may also be defined as:

“A physical contact with another person which may or may not result in pain or injury. The contact is uninvited and is an attempt to cause harm, injury or to intimidate. Non-physical aggression includes the use of language which causes offence or threatens the safety of a member of staff”.

Under the Health and Safety at Work Act 1974, the practice will also undertake the following measures to ensure a safe work environment:

• Carry our risk assessments to assess and review the duties of employees, identifying any “at risk” situations and taking appropriate steps to reduce or remove the risk to employees, particularly if they are working alone.
• Assess and review the layout of the premises to reduce the risk to employees where physically possible.
• Assess and review the provision of personal safety equipment, such as alarms.
• Develop surgery policies, procedures and guidelines for dealing with physical and verbal abuse.
• Provide support and counselling for victims, or refer to suitably qualified health professionals.
• Make employees aware of risks and ensure employee involvement in suitable training courses.
• Record any incidents on a Significant Event form and take any remedial action to ensure similar incidents are prevented in future.

Removal from the practice list

The removal of patients from our list is an exceptional and rare event and is a last resort in an impaired patient-practice relationship. We value and respect good patient-doctor relationships based on mutual respect and trust. When trust has irretrievably broken down, the practice will consider all factors before removing a patient from their list, and communicate to them that it is in the patient’s best interest that they should find a new practice. An exception to this is in the case of immediate removal on the grounds of violence e.g. when the Police are involved.

Removing other members of the household

Because of the possible need to visit patients at home, it may be necessary to terminate responsibility for other members of the family or the entire household to ensure the safety of practice staff.

The prospect of visiting patients that is the residence of a relative who is no longer a patient of the practice, or the risk of being regularly confronted by the removed patient, may make it difficult for the practice to continue to look after the whole family. This is more likely where the removed patient has been violent or displayed threatening behaviour, and keeping the other family members could put doctors or their staff at risk.

The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety.

In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.

The information collected about you when you use these services can also be used and provided to other organisations for purposes beyond your individual care, for instance to help with:

• improving the quality and standards of care provided
• research into the development of new treatments
• preventing illness and diseases
• monitoring safety
• planning services

This may only take place when there is a clear legal basis to use this information. All these uses help to provide better health and care for you, your family and future generations. Confidential patient information about your health and care is only used like this where allowed by law.

Most of the time, anonymised data is used for research and planning so that you cannot be identified in which case your confidential patient information isn’t needed.

You have a choice about whether you want your confidential patient information to be used in this way. If you are happy with this use of information you do not need to do anything. If you do choose to opt out your confidential patient information will still be used to support your individual care.

To find out more or to register your choice to opt out, please visit NHS: Your Data Matters.  On this web page you will:

• See what is meant by confidential patient information
• Find examples of when confidential patient information is used for individual care and examples of when it is used for purposes beyond individual care
• Find out more about the benefits of sharing data
• Understand more about who uses the data
• Find out how your data is protected
• Be able to access the system to view, set or change your opt-out setting
• Find the contact telephone number if you want to know any more or to set/change your opt-out by phone
• See the situations where the opt-out will not apply

You can also find out more about how patient information is used at:

• The Health Research Authority (which covers health and care research)
• Understanding Patient Data (which covers how and why patient information is used, the safeguards and how decisions are made)

You can select your opt-out by via the NHS website

You can change your mind about your choice at any time.

Data being used or shared for purposes beyond individual care does not include your data being shared with insurance companies or used for marketing purposes and data would only be used in this way with your specific agreement.

Health and care organisations have until 2020 to put systems and processes in place so they can be compliant with the national data opt-out and apply your choice to any confidential patient information they use or share for purposes beyond your individual care. Our organisation is currently’ compliant with the national data opt-out policy.

How The Ridgeway Surgery uses your information to provide you with healthcare

This practice keeps medical records confidential and complies with the General Data Protection Regulation.

We hold your medical record so that we can provide you with safe care and treatment.

We will also use your information so that this practice can check and review the quality of the care we provide. This helps us to improve our services to you.

• We will share relevant information from your medical record with other health or social care staff or organisations when they provide you with care. For example, your GP will share information when they refer you to a specialist in a hospital. Or your GP will send details about your prescription to your chosen pharmacy.
• Healthcare staff working in A&E and out of hours care will also have access to your information. For example, it is important that staff who are treating you in an emergency know if you have any allergic reactions. This will involve the use of your Summary Care Record. Find out more about SCR by clicking here or alternatively speak to your practice.
• You have the right to object to information being shared for your own care. Please speak to the practice if you wish to object. You also have the right to have any mistakes or errors corrected

Other important information about how your information is used to provide you with healthcare

Registering for NHS care

• All patients who receive NHS care are registered on a national database.
• This database holds your name, address, date of birth and NHS Number but it does not hold information about the care you receive.
• The database is held by NHS Digital, a national organisation which has legal responsibilities to collect NHS data.
• More information can be found here or the phone number for general enquires at NHS Digital is 0300 303 5678

Identifying patients who might be at risk of certain diseases

• Your medical records will be searched by a computer programme so that we can identify patients who might be at high risk from certain diseases such as heart disease or unplanned admissions to hospital.
• This means we can offer patients additional care or support as early as possible.
• This process will involve linking information from your GP record with information from other health or social care services you have used.
• Information which identifies you will only be seen by this practice.
• More information please speak to the practice.

Safeguarding

• Sometimes we need to share information so that other people, including healthcare staff, children or others with safeguarding needs, are protected from risk of harm.
• These circumstances are rare.
• We do not need your consent or agreement to do this.
• Please see our local policies for more information by picking up a leaflet from reception.

We are required by law to provide you with the following information about how we handle your information.

Data Controller contact details	The Ridgeway Surgery, 1 Mount Echo Avenue, Chingford E4 7JX
Data Protection Officer contact details	tbc
Purpose of the processing	To give direct health or social care to individual patients. For example, when a patient agrees to a referral for direct care, such as to a hospital, relevant information about the patient will be shared with the other healthcare staff to enable them to give appropriate advice, investigations, treatments and/or care. To check and review the quality of care. (This is called audit and clinical governance)
Lawful basis for processing	These purposes are supported under the following sections of the GDPR: Article 6(1)(e) ‘…necessary for the performance of a task carried out in the public interest or in the exercise of official authority…’; and Article 9(2)(h) ‘necessary for the purposes of preventative or occupational medicine for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services…” Healthcare staff will also respect and comply with their obligations under the common law duty of confidence
Recipient or categories of recipients of the processed data	The data will be shared with: healthcare professionals and staff in this surgery; local hospitals; out of hours services; diagnostic and treatment centres; or other organisations involved in the provision of direct care to individual patients.
Rights to object	You have the right to object to information being shared between those who are providing you with direct care. This may affect the care you receive – please speak to the practice. You are not able to object to your name, address and other demographic information being sent to NHS Digital. This is necessary if you wish to be registered to receive NHS care. You are not able to object when information is legitimately shared for safeguarding reasons. In appropriate circumstances it is a legal and professional requirement to share information for safeguarding reasons. This is to protect people from harm. The information will be shared with the local safeguarding service
Right to access and correct	You have the right to access your medical record and have any errors or mistakes corrected. Please speak to a member of staff or look at our ‘subject access request’ policy on the practice website We are not aware of any circumstances in which you will have the right to delete correct information from your medical record; although you are free to obtain your own legal advice if you believe there is no lawful purpose for which we hold the information and contact us if you hold a different view.
Retention period	GP medical records will be kept in line with the law and national guidance. Information on how long records are kept can be found on the NHS Digital website or speak to the practice.
Right to complain	You have the right to complain to the Information Commissioner’s Office. If you wish to complain please click here or call the helpline 0303 123 1113
Data we get from other organisations	We receive information about your health from other organisations who are involved in providing you with health and social care. For example, if you go to hospital for treatment or an operation the hospital will send us a letter to let us know what happens. This means your GP medical record is kept up-to date when you receive care from other parts of the health service.

How your information is shared so that this practice can meet legal requirements

The law requires The Ridgeway Surgery to share information from your medical records in certain circumstances. Information is shared so that the NHS or Public Health England can, for example:

• plan and manage services;
• check that the care being provided is safe;
• prevent infectious diseases from spreading.

We will share information with NHS Digital, the Care Quality Commission and local health protection team (or Public Health England) when the law requires us to do so. Please see below for more information.

We must also share your information if a court of law orders us to do so.

NHS Digital

• NHS Digital is a national body which has legal responsibilities to collect information about health and social care services.
• It collects information from across the NHS in England and provides reports on how the NHS is performing. These reports help to plan and improve services to patients.
• This practice must comply with the law and will send data to NHS Digital, for example, when it is told to do so by the Secretary of State for Health or NHS England under the Health and Social Care Act 2012.
• More information about NHS Digital and how it uses information can be found here

Care Quality Commission (CQC)

• The CQC regulates health and social care services to ensure that safe care is provided.
• The law says that we must report certain serious events to the CQC, for example, when patient safety has been put at risk.
• For more information about the CQC by click here

Public Health

• The law requires us to share data for public health reasons, for example to prevent the spread of infectious diseases or other diseases which threaten the health of the population.
• We will report the relevant information to local health protection team or Public Health England.
• For more information about Public Health England and disease reporting please click here

We are required by law to provide you with the following information about how we handle your information and our legal obligations to share data

Data Controller contact details	The Ridgeway Surgery, 1 Mount Echo Avenue, Chingford E4 7JX
Data Protection Officer contact details	tbc
Purpose of the processing	Compliance with legal obligations or court order.
Lawful basis for processing	The following sections of the GDPR mean that we can share information when the law tells us to. Article 6(1)(c) – ‘processing is necessary for compliance with a legal obligation to which the controller is subject…’ Article 9(2)(h) – ‘processing is necessary for the purpose of preventative…medicine…the provision of health or social care or treatment or the management of health or social care systems and services…
Recipient or categories of recipients of the processed data	The data will be shared with NHS Digital. The data will be shared with the Care Quality Commission The data will be shared with our local health protection team or Public Health England. The data will be shared with the court if ordered.
Rights to object and the national data opt-out	There are very limited rights to object when the law requires information to be shared but government policy allows some rights of objection as set out below. NHS Digital You have the right to object to information being shared with NHS Digital for reasons other than your own direct care. This is called a ‘Type 1’ objection – you can ask your practice to apply this code to your record. Please note: The ‘Type 1’ objection, however, will no longer be available after 2020. This means you will not be able to object to your data being shared with NHS Digital when it is legally required under the Health and Social Care Act 2012. The national data op-out model provides you with an easy way of opting-out of identifiable data being used for health service planning and research purposes, including when it is shared by NHS Digital for these reasons. Public Health Legally information must be shared under public health legislation. This means that you are unable to object. Care Quality Commission Legally information must be shared when the Care Quality Commission needs it for their regulatory functions. This means that you are unable to object. Court Order Your information must be shared if it ordered by a court. This means that you are unable to object.
Right to access and correct	You have the right to access your medical record and have any errors or mistakes corrected. Please speak to a member of staff or look at our ‘subject access request’ policy on the practice website – insert link. We are not aware of any circumstances in which you will have the right to delete correct information from your medical record; although you are free to obtain your own legal advice if you believe there is no lawful purpose for which we hold the information and contact us if you hold a different view
Retention period	GP medical records will be kept in line with the law and national guidance. Information on how long records are kept can be found on the NHS Digital website or speak to the practice.
Right to complain	You have the right to complain to the Information Commissioner’s Office. If you wish to complain please click here or call the helpline 0303 123 1113

NHS England require that the net earnings of doctors engaged in the practice is publicised and that the required disclosure is shown below. However it should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors working in the practice and should not be used for any judgement about GP earnings, nor to make comparisons with other practices.

The average pay for GPs working in the Ridgeway Surgery in the last financial year was £41,330 before tax and National Insurance.

This is for 4 full time GPs, 1 part time GP and 5 locum GPs who worked in the practice for more than six months.

For more information about this visit NHS Digital

As of 1st September 2021 your data will be shared with NHS Digital to help improve health, care and services.

Patient data from GP medical records kept by GP practices in England is used every day to improve health, care and services through planning and research, helping to find better treatments and improve patient care. The NHS is introducing an improved way to share this information – called the General Practice Data for Planning and Research data collection.

NHS Digital will collect, analyse, publish and share this patient data to improve health and care services for everyone.

This includes:

• informing and developing health and social care policy
• planning and commissioning health and care services
• taking steps to protect public health (including managing and monitoring the coronavirus pandemic)
• in exceptional circumstances, providing you with individual care
• enabling healthcare and scientific research

Any data that NHS Digital collects will only be used for health and care purposes. It is never shared with marketing or insurance companies.

READ MORE HERE

NHS Digital will not collect any patient data for patients who have already registered a Type 1 opt-out in line with current policy. If this changes patients who have registered a Type 1 opt-out will be informed.

If you do not want your patient data shared with NHS Digital, you can register a Type 1 opt-out with us. You can register a Type 1 opt-out at any time. You can also change your mind at any time and withdraw a Type 1 opt-out.

Data sharing with NHS Digital will start on 1st September 2021.

If you have already registered a Type 1 opt-out with your GP practice your data will not be shared with NHS Digital.

If you wish to register a Type 1 opt-out with your GP practice before data sharing starts with NHS Digital, this should be done by completing this form.

If you have previously registered a Type 1 opt-out and you would like to withdraw this, you can also use the form to do this.

If you register a Type 1 opt-out after your patient data has already been shared with NHS Digital, no more of your data will be shared with NHS Digital. NHS Digital will however still hold the patient data which was shared with us before you registered the Type 1 opt-out.

If you do not want NHS Digital to share your identifiable patient data with anyone else for purposes beyond your own care, then you can also register a National Data Opt-out (also known as a Type 2 opt out).

What do you need to do?

If you are happy for your data to be shared as above, and you have not previously opted out – you do not need to do anything.

Type 1 OPT-OUT – to stop sharing your details with NHS digital (or to opt back in, if you have previously opted out) – Complete this form 

Type 2 OPT-OUT (also known as National Data Opt-out) – if you do not want NHS Digital to share your identifiable patient data with anyone else for purposes beyond your own care (or to opt back in, if you have previously opted out)

You need to, either:

• Call 0300 303 5678
• or complete their online form

As a GP practice WE CANNOT opt you out of Type 2 (National Data Opt-out)

We share information when the law requires us to do so, for example, to prevent infectious diseases from spreading or to check the care being provided to you is safe.

• You have the right to be given a copy of your medical record.
• You have the right to object to your medical records being shared with those who provide you with care.
• You have the right to object to your information being used for medical research and to plan health services.
• You have the right to have any mistakes corrected and to complain to the Information Commissioner’s Office. Please see the practice privacy notice on the website or speak to a member of staff for more information about your rights.

Your Data Matters to the NHS

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

How your data is used

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

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

You have a choice

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

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

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

What do you need to do?

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

To find out more about the benefits of data sharing, how data is protected, or to make/change your opt-out choice visit NHS: Your Data Matters

The practice complies with data protection and access to medical records legislation. Identifiable information about you will be shared with others in the following circumstances:

• To provide further medical treatment for you e.g. from district nurses and hospital services.
• To help you get other services e.g. from the social work department. This requires your consent.
• When we have a duty to others e.g. in child protection cases anonymised patient information will also be used at local and national level to help the Health Board and Government plan services e.g. for diabetic care.

If you do not wish anonymous information about you to be used in such a way, please let us know.

Reception and administration staff require access to your medical records in order to do their jobs. These members of staff are bound by the same rules of confidentiality as the medical staff.

Freedom of Information

Information about the General Practioners and the practice required for disclosure under this act can be made available to the public. All requests for such information should be made to the practice manager.

Access to Records

In accordance with the Data Protection Act 1998 and Access to Health Records Act, patients may request to see their medical records. Such requests should be made through the practice manager and may be subject to an administration charge. No information will be released without the patient consent unless we are legally obliged to do so.