Document Control

A. Confidentiality Notice

This document and the information contained therein is the property of The Ridgeway Surgery. This document contains information that is privileged, confidential or otherwise protected from disclosure. It must not be used by, or its contents reproduced or otherwise copied or disclosed without the prior consent in writing from The Ridgeway Surgery.

B. Document Details

Organisation: The Ridgeway Surgery
Current Document Reviewed By: M Mydlova / Practice Manager
Date Reviewed: 14/01/25

C. Document Revision and Approval History

• 1.1. June 2022 – iQ Medical – M Mydlova: Reviewed and Unchanged
• 1.2. June 2023 – iQ Medical – M Mydlova: Reviewed and Unchanged
• 1.2. Jan 2025 – iQ Medical – M Mydlova: Reviewed and updated

Introduction

The Ridgeway Surgery is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times and the safety of everyone is of paramount importance.

This Chaperone Policy adheres to local and national guidance and policy – i.e.:- ‘NCGST Guidance on the role and effective use of chaperones in Primary and Community Care settings’.

The Chaperone Policy is clearly advertised through patient information leaflet, practice website and can be read at the practice upon request. A Poster is also displayed in the practice waiting area.

All patients are entitled to have a chaperone present for any consultation, examination or procedure where they consider one is required. The chaperone may be a family member or friend, but on occasions a formal chaperone may be preferred.

Patients are advised to ask for a chaperone if required, at the time of booking an appointment, if possible, so that arrangements can be made, and the appointment is not delayed in any way. The Healthcare Professional may also require a chaperone to be present for certain consultations.

All staff are aware of and have received appropriate information in relation to this Chaperone Policy.

All trained chaperones understand their role and responsibilities and are competent to perform that role.

There is no common definition of a chaperone, and their role varies considerably depending on the needs of the patient, the healthcare professional and the examination being carried out.

Their role can be considered in any of the following areas:

• Emotional comfort and reassurance to patients
• Assist in examination (e.g. during IUCD insertion)
• Assist in undressing
• Act as interpreter
• Protection to the healthcare professional against allegations (attack)

Checklist for consultations involving intimate examinations

• Chaperones are most often required or requested where a male examiner is carrying out an intimate examination or procedure on a female patient, but the designation of the chaperone will depend on the role expected of them, whether participating in the procedure or providing a supportive role.
• Establish there is a genuine need for an intimate examination and discuss this with the patient and whether a formal chaperone (such as a nurse) is needed.
• Explain to the patient why an examination is necessary and give the patient an opportunity to ask questions. The chaperone would normally be the same sex as the patient and the patient will have the opportunity to decline a particular person as a chaperone, if that person is considered not acceptable for any reason.
• Offer a chaperone or invite the patient to have a family member / friend present.
• If the patient does not want a chaperone, record that the offer was made and declined in the patient’s notes.
• Obtain the patient’s consent before the examination and be prepared to discontinue the examination at any stage at the patient’s request.
• Record that permission has been obtained in the patient’s notes.
• Once the chaperone has entered the room, they should be introduced by name and the patient allowed privacy to undress / dress. Use drapes / curtains where possible to maintain dignity. There should be no undue delay prior to examination once the patient has removed any clothing.
• Explain what is being done at each stage of the examination, the outcome when it is complete and what is proposed to be done next. Keep discussion relevant and avoid personal comment.
• If a chaperone has been present, record that fact and the identity of the chaperone in the patient’s notes.
• During the examination, the chaperone may be needed to offer reassurance, remain alert to any indication of distress but should be courteous at all times.
• Record any other relevant issues or concerns in the patient’s notes, immediately following the consultation.
• Chaperones should only attend the part of the consultation that is necessary – other verbal communication should be carried out when the chaperone has left.
• Any request that the examination be discontinued should be respected.
• Healthcare professionals should note that they are at an increased risk of their actions being misconstrued or misrepresented, if they conduct intimate examinations where no other person is present.

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.

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

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.

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)

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.

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.

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

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.

We make every effort to give the best service possible to everyone who attends our practice.

We aim to provide patients with the best care we can, but we will sometimes fall short of the mark. If you have any compliments, comments, concerns or complaints about our service, we want to hear from you. General feedback can be given via our comments book located in the reception area.

If you have a complaint to make, please do not be afraid to say how you feel. We welcome feedback to help us improve our standards, and we will do our best to address any concerns that you may have. Our complaints procedure meets the National criteria.

How to complain

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 formal complaint, we would like you to let us know as soon as possible by telephone call on 020 8523 7722, or by filling in the complaint form. The time limit for making a complaint is within 12 months of the events occurring or of you becoming aware of the matter complained about.

Complaints should be addressed to the practice manager. Alternatively, you may ask for a face-to-face or telephone appointment in order to discuss your concerns further. Our practice manager 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.

What we will do

We will acknowledge your complaint within 3 working days beginning with the day on which the complaint was made or, where that is not possible, as soon as reasonably practicable. Practice manager will contact you to agree how best to deal with it, and a reasonable timescale for doing so.

When we look into your complaint, we shall aim to:

• Find out what happened, what went wrong and why?
• Identify what we can do to make sure the problem does not happen again

Complaining on behalf of someone else

Please note that we keep strictly to the rules of the Data Protection Act 2018 and medical confidentiality. If you are complaining on behalf of someone else, we have to know that you have their permission to do so. We will require a note signed by the person concerned, giving consent for us to discuss with you aspects of their medical records, unless they are incapable (because of illness) of doing so.

Complaining to NHS North-East England

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.

However, this does not affect your right to approach the NHS North East London team who can be contacted at: nelondonicb.complaints@nhs.net, 020 8221 5750, Complaints Team, NHS North East London ICB, 4th Floor- Unex Tower, 5 Station Street, London E15 1DA.

HOW TO MAKE A COMPLAINT TO NHS ENGLAND

Complaining to the Ombudsman

If you remain dissatisfied after we (or NHS England) have dealt with your complaint you can complain direct to the Health Service Ombudsman.

The contact details are as follows: Millbank Tower, Millbank, London, SW1P 4QP, telephone: 0345 0154 033

HOW TO MAKE A COMPLAINT TO THE OMBUDSMAN

Complaints policy

Person responsible for review of this protocol: Practice Manager referred to in this instances as the Complaints Manager

• Date of last review: Apr 2022
• Date of next review: Apr 2023

Purpose

The protocol sets out the approach of The Ridgeway Surgery to the handling of complaints.

This Protocol is relevant to all employers and anyone who works at The Ridgeway Surgery, including non-clinical staff. Individuals trainig and visitors/observers on the premises must also adhere to this.

This protocol will be reviewed annually to ensure that it remains effective and relevant.

Importance of having a complaints procedure

In spite of the efforts of all staff, it is likely that a complaint will be made by a patient at some point. To reduce the anxiety and apprehension for both patients and staff, it is crucial to have a prodecude for handling complaints.

How complaints can be made

Complaints may be received in writing or orally. Where a patient is unable to communicate a complaint by either means on their own, then arrangements will be made to facilitate the giving of the patient.

Persons who can complain

Complaints can be made by patients, former patients, someone who is affected, or likely to be affected, by the action, omission or decision of individuals working at the practice, or by a representative of a patient who is incapable of making the complaint themselves.

When a complaint is made on behalf of a child, there must be reasonable grounds for the complaint being made by the representative rather than the child and the complaint must be being made in the best interests of the child. If this is not the case, then written notification of the decision not to investigate the complaint must be sent to the representative.

Time limit for making a complaint

Complaints can be made up to 12 months after the incident that gave rise to the complaint, or from when the complainant was made aware of it. Beyond this timescale it is at the discretion of the practice as to whether to investigate the matter.

Complaints should normally be resolved within 6 months. The practice standard will be 4 weeks for a response.

The Complaints Manager or lead GP has the discretion to extend the time limits if the complainant has good reason for not making the complaint sooner, or where it is still possible to properly investigate the complaint despite extended delay.

When considering an extension to the time limit it is important that the Complaints Manager or the GP takes into consideration that the passage of time may prevent an accurate recollection of events by the clinician concerned or by the person bringing the complaint. The collection of evidence, Clinical Guidelines or other resources relating to the time when the complaint event arose may also be difficult to establish or obtain. These factors may be considered as suitable reason for declining a time limit extension.

Persons responsible for handling complaints

Responsible Person: The Complaints Manager is The Practice Manager who is responsible for the supervision of the complaints procedure and for making sure that action is taken in light of the outcome of any investigation. The Complaints Manager is responsible for the handling and investigation of complaints.

Initial handling of complaints

1. When a patient wishes to make an oral complaint then the Complaints Manager is to arrange to speak to the complainant in private (via the telephone or face-to-face) to assess the complaint. Complaints Manager will acknowledge receipt of complaint (via the telephone or text message) within 3 working days.
2. The complaint should be resolved at this meeting/phone call if possible. If the complaint is resolved then it should be recorded in the complaints log and the implicated staff member is to be told about the details of the complaint.
3. When the complaint cannot be resolved the patient is to be asked to make a written complaint. The written complaint is to be recorded in the complaints log.
4. The Complaints Manager is to acknowledge a written complaint in writing within 3 working days, stating the anticipated date by which the complainant can expect a full response.

Investigation of complaint

1. The Complaints Manager is to discuss the complaint with the implicated member of staff to establish their recollection of events.
2. If the complaint is against the Complaints Manager, then the complaint is to be referred to the Partners for investigation.
3. The complainant is offered to come for a meeting to discuss the complaint with the Complaints Manager and asked if they would like to be accompanied at this meeting. If appropriate and with prior consent from the complainant the staff member complained about can be present at that meeting. Any outcomes of this meeting is recorded on Complaints Log.
4. The timescale to respond (maximum of 6 months) is to be agreed with the complainant at that meeting and documented in the complaints log.
5. The full response to the complainant is to be signed by the responsible person, and include:
   1. An explanation of how the complaint was considered.
   2. The conclusions reached in relation to the complaint and any remedial action that will be needed.
   3. Confirmation as to whether the practice is satisfied that any action has been taken or will be taken.
6. If it is not possible to send the complainant a response in the agreed period it is necessary to write to the complainant explaining why. Then a response is to be sent to the complainant as soon as is reasonably practicable.
7. If the complainant is dissatisfied with the handling of the complaint then they are to be advised to contact the Health Service Ombudsman and how to do so.

Recording complaints and investigations

A record must be kept of:

• Each complaint received;
• The subject matter of the complaint;
• The steps and decisions taken during an investigation;
• The outcome of each investigation;
• When the practice informed the complainant of the response period and any amendment to that period;
• Whether a report of the outcome of the investigation was sent to the complainant within the response period or any amended period.

Review of complaints

Complaints received by the practice are to be reviewed at staff meetings to ensure that learning points are shared.

A review of all complaints will be conducted annually by the Complaints Manager to identify any patterns that are to be reported to the Responsible Person.

The Complaints Manager will notify the Responsible Person of any concerns about a complaint leading to non-compliance. The Responsible Person will identify ways for the practice to return to compliance.

A report on complaints is to be submitted on request to Primary Care Trust (or replacement body) annually (year ending 31st March).

This report is to:

• Specify the number of complaints received;
• Specify the number of complaints which it was decided were well-founded;
• Specify the number of complaints which the practice has been informed have been referred to the Health Service Ombudsman;
• Summarise the subject matter of complaints received;
• Summarise any matters of general importance arising out of those complaints, or the way in which the complaints were handled;
• Summarise any matters where action has been or is to be taken to improve services as a consequence of those complaints.

This report is to be available to any person on request.

Publicity

The practice’s arrangements for dealing with complaints and how further information about these arrangements may be obtained by patients is to be publicised by the Complaints Manager. How to contact independent advocacy services and the right of patients to approach Primary Care Trusts with complaints is also to be publicised.

Unreasonable complainants

When faced by an unreasonable complainant staff will take action in accordance with page 34 of the DH’s Listening, responding, improving: a guide to better customer care guidance.

Confidentiality

All complaints must be treated in the strictest confidence.

Where the investigation of the complaint requires consideration of the patient’s medical records, the Complaints Manager must inform the patient or person acting on his/her behalf if the investigation will involve disclosure of information contained in those records to a person other than the Practice or an employee of the Practice.

The practice must keep a record of all complaints and copies of all correspondence relating to complaints, but such records must be kept separate from patients’ medical records.

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.

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.