Policies and Procedures

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

Patients are advised to ask for a chaperone if required, at the time of booking an appointment, so that arrangements can be made and the appointment is not delayed. However, if the request is not made until the time of the appointment, the Practice will always do its utmost to provide a formal chaperone if the patient has not brought a friend or relative with them.

On occasions, a doctor or nurse may also request a chaperone to be present. This should be discussed with the patient in advance of the appointment, if at all possible.

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

All the nurses and health care assistants are trained chaperones; they all 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)

More information can be found on the chaperone policy leaflet.

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.

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.

If you have a complaint or concern about the service you have received from the doctors or any of the staff working in this GP surgery, please let us know. This includes Primary Care Network staff working as part of our GP surgery. We operate a complaints procedure as part of an NHS system for dealing with complaints. Our complaints system meets national criteria.

View our Complaint Procedure Document.

How to complain

We hope that most problems can be sorted out easily and quickly when they arise and with the person concerned. For example, by requesting a face-to-face meeting to discuss your concerns.

If your problem cannot be sorted out this way and you wish to make a complaint, we would like you to let us know as soon as possible. By making your complaint quickly, it is easier for us to establish what happened. If it is not possible to do that, please let us have details of your complaint:

• Within 12 months of the incident that caused the problem; or
• Within 12 months of discovering that you have a problem.

Complaints should be addressed to the GP surgery team verbally or in writing to the Practice Manager. Alternatively, you may ask for an appointment with the GP surgery to discuss your concerns. They will explain the complaints procedure to you and make sure your concerns are dealt with promptly. Please be as specific as possible about your complaint.

If you would like to, please use our complaint template document.

What we will do

We will acknowledge your complaint within three working days. We will aim to have investigated your complaint within ten working days of the date you raised it with us. We will then offer you an explanation or a meeting with the people involved, if you would like this. When we investigate your complaint, we will aim to:

• Find out what happened and what went wrong.
• Make it possible for you to discuss what happened 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 does not happen again.

Complaining on behalf of someone else

We take medical confidentiality seriously. If you are complaining on behalf of someone else, we must know that you have their permission to do so. A note signed by the person concerned will be needed unless they are incapable (because of illness) of providing this.

Complaining to NHS England

We hope that you will use our Practice Complaints Procedure if you are unhappy. We believe this will give us the best chance of putting right whatever has gone wrong and an opportunity to improve our GP surgery.

However, if you feel you cannot raise the complaint with us directly, please contact NHS England. You can find more information on how to make a complaint at https://www.england.nhs.uk/contact-us/complaint/complaining-to-nhse/.

Unhappy with the outcome of your complaint?

If you are not happy with the way your complaint has been dealt with by the GP surgery and NHS England and would like to take the matter further, you can contact the Parliamentary and Health Service Ombudsman (PHSO). The PHSO makes final decisions on unresolved complaints about the NHS in England. It is an independent service which is free for everyone to use.

To take your complaint to the Ombudsman, visit the Parliamentary and Health Service Ombudsman website or call 0345 015 4033.

Need help making a complaint?

If you want help making a complaint, Healthwatch Norfolk can help you find independent NHS complaints advocacy services in your area.

The practice complies with the Data Protection Act.  All information about patients is confidential: from the most sensitive diagnosis, to the fact of having visited the surgery or being registered at the practice. All patients can expect that their personal information will not be disclosed without their permission except in the most exceptional of circumstances, when somebody is at grave risk of serious harm.

All members of the primary health care team (from reception to doctors) in the course of their duties will have access to your medical records. They all adhere to the highest standards of maintaining confidentiality.

As our reception area is a little public, if you wish to discuss something of a confidential nature please mention it to one of the receptionists who will make arrangements for you to have the necessary privacy.

What happens to my information?

We have a computer system called SystmOne which holds the medical records of all our patients. This is totally confidential and the only people who access the notes are those health professionals and administration staff who need to do so to assist with your care. If we need to refer you to the hospital for treatment then the information that is relevant to your care will be shared with those professionals who are being asked to help you.

Useful Websites

• Confidentiality NHS Code of Practice
• Confidentiality and Mental Health
• Confidentiality Guidance

During COVID-19 we may ask you to send a photograph of your bruise or skin condition that you are concerned about whilst we conduct virtual consultations. This photograph will be used by the clinician to determine any medical treatment necessary and will be added to your medical record.

Please note that as this is sent via email, it may not be secure and we therefore ask that you only include your NHS number alongside your photograph in the email. The photograph should only be of the area requested and no other person should be visible in the shot.

Fakenham Medical Practice recognises that many people in our society experience discrimination or lack of opportunity for reasons that are not fair. These include race, religion, creed, colour, national and ethnic origin, political beliefs, gender, sexual orientation, age, disability (including mental illness), HIV status, responsibility for dependants, geographical area, social class, income level and criminal record.

Fakenham Medical Practice is committed to a Policy of Equality of Opportunity which respects the identity, rights and value of each individual, be they a patient or a member of staff.

Please make the practice manager aware if you have any concerns that equality and diversity issues have not been respected.

• Have a publication scheme in place
• Allow public access to information held by public authorities.

The Act covers any recorded organisational information such as reports, policies or strategies, that is held by a public authority in England, Wales and Northern Ireland, and by UK-wide public authorities based in Scotland, however it does not cover personal information such as patient records which are covered by the Data Protection Act.

Public authorities include government departments, local authorities, the NHS, state schools and police forces.

The Act is enforced by the Information Commissioner who regulates both the Freedom of Information Act and the Data Protection Act.

The Surgery publication scheme

A publication scheme requires an authority to make information available to the public as part of its normal business activities. The scheme lists information under seven broad classes, which are:

• Who we are and what we do
• What we spend and how we spend it
• What our priorities are and how we are doing it
• How we make decisions
• Our policies and procedures
• Lists and registers
• The services we offer

You can request our publication scheme leaflet at the surgery.

Who can request information?

Under the Act, any individual, anywhere in the world, is able to make a request to a practice for information. An applicant is entitled to be informed in writing, by the practice, whether the practice holds information of the description specified in the request and if that is the case, have the information communicated to him. An individual can request information, regardless of whether he/she is the subject of the information or affected by its use. 

How should requests be made?

Requests must:

• Be made in writing (this can be electronically e.g. email/fax)
• State the name of the applicant and an address for correspondence
• Describe the information requested.

What cannot be requested?

Personal data about staff and patients covered under the Data Protection Act.

For more information see these websites:

• Legislation GOV.UK
• Information Commissioners Office

Your Information

Fakenham Medical Practice takes privacy seriously and we want to provide you with information about your rights, who we share your information with and how we keep it secure.

Please use the links below to find more information about the practice and data protection.

• Transparency
• CCTV
• Telephone Recording
• Case Finding (ECLIPSE)
• Information Sharing Norfolk and Waveney

Reports

Our practice has decided to outsource our medical reporting to MediData, who will process your medical report using their system, eMR.

What is eMR/MediData?

MediData is a NHS Digital accredited company who have developed a digital system called eMR, which enables GP practices to create digital, GDPR compliant medical reports.

eMR helps GP Surgeries with data security, speed and efficiency eMR also helps you to easily see your medical data, stay in control of it and decide who you
want to share it with.

MediData has worked hard to develop their NHS GP IT Futures accredited technology, eMR, which interfaces with our GP practice’s system to extract your medical record. This means you can receive a full copy of that information securely and share it with others as you wish, keeping your data safe.

If you wish to speak to a member of the MediData team regarding your medical report, or any concerns you may have regarding your data, please contact MediData directly on:

Phone – 0333 3055 774
Email – [email protected]

This practice is supporting vital coronavirus (COVID-19) planning and research by sharing your data with NHS Digital.

The health and social care system is facing significant pressures due to the coronavirus (COVID-19) outbreak. Health and care information is essential to deliver care to individuals, to support health, social care and other public services and to protect public health. Information will also be vital in researching, monitoring, tracking and managing the coronavirus outbreak. In the current emergency it has become even more important to share health and care information across relevant organisations. This practice is supporting vital coronavirus planning and research by sharing your data with NHS Digital, the national safe haven for health and social care data in England.

Our legal basis for sharing data with NHS Digital

NHS Digital has been legally directed to collect and analyse patient data from all GP practices in England to support the coronavirus response for the duration of the outbreak. NHS Digital will become the controller under the General Data Protection Regulation 2016 (GDPR) of the personal data collected and analysed jointly with the Secretary of State for Health and Social Care, who has directed NHS Digital to collect and analyse this data under the COVID-19 Public Health Directions 2020 (COVID-19 Direction).

All GP practices in England are legally required to share data with NHS Digital for this purpose under the Health and Social Care Act 2012 (2012 Act). More information about this requirement is contained in the data provision notice issued by NHS Digital to GP practices.

Under GDPR our legal basis for sharing this personal data with NHS Digital is Article 6(1)(c) – legal obligation. Our legal basis for sharing personal data relating to health, is Article 9(2)(g) – substantial public interest, for the purposes of NHS Digital exercising its statutory functions under the COVID-19 Direction.

The type of personal data we are sharing with NHS Digital

The data being shared with NHS Digital will include information about patients who are currently registered with a GP practice or who have a date of death on or after 1 November 2019 whose record contains coded information relevant to coronavirus planning and research. The data contains NHS Number, postcode, address, surname, forename, sex, ethnicity, date of birth and date of death for those patients. It will also include coded health data which is held in your GP record such as details of:

• diagnoses and findings
• medications and other prescribed items
• investigations, tests and results
• treatments and outcomes
• vaccinations and immunisations

How NHS Digital will use and share your data

NHS Digital will analyse the data they collect and securely and lawfully share data with other appropriate organisations, including health and care organisations, bodies engaged in disease surveillance and research organisations for coronavirus response purposes only. These purposes include protecting public health, planning and providing health, social care and public services, identifying coronavirus trends and risks to public health, monitoring and managing the outbreak and carrying out of vital coronavirus research and clinical trials. The British Medical Association, the Royal College of General Practitioners and the National Data Guardian are all supportive of this initiative.

NHS Digital has various legal powers to share data for purposes relating to the coronavirus response. It is also required to share data in certain circumstances set out in the COVID-19 Direction and to share confidential patient information to support the response under a legal notice issued to it by the Secretary of State under the Health Service (Control of Patient Information) Regulations 2002 (COPI Regulations).

Legal notices under the COPI Regulations have also been issued to other health and social care organisations requiring those organisations to process and share confidential patient information to respond to the coronavirus outbreak. Any information used or shared during the outbreak under these legal notices or the COPI Regulations will be limited to the period of the outbreak unless there is another legal basis for organisations to continue to use the information.

Data which is shared by NHS Digital will be subject to robust rules relating to privacy, security and confidentiality and only the minimum amount of data necessary to achieve the coronavirus purpose will be shared. Organisations using your data will also need to have a clear legal basis to do so and will enter into a data sharing agreement with NHS Digital. Information about the data that NHS Digital shares, including who with and for what purpose will be published in the NHS Digital data release register .

For more information about how NHS Digital will use your data please see the NHS Digital Transparency Notice for GP Data for Pandemic Planning and Research (COVID-19).

National Data Opt-Out

The application of the National Data Opt-Out to information shared by NHS Digital will be considered on a case by case basis and may or may not apply depending on the specific purposes for which the data is to be used. This is because during this period of emergency, the National Data Opt-Out will not generally apply where data is used to support the coronavirus outbreak, due to the public interest and legal requirements to share information.

Your rights over your personal data

To read more about the health and care information NHS Digital collects, its legal basis for collecting this information and what choices and rights you have in relation to the processing by NHS Digital of your personal data, see:

• The (NHS Digital GPES Data for Pandemic Planning and Research (COVID-19) Transparency Notice
• The NHS Digital Coronavirus (COVID-19) Response Transparency Notice
• The NHS Digital General Transparency Notice
• How NHS Digital looks after your health and care information

We aim to keep our surgery clean and tidy and offer a safe environment to our patients and staff. We are proud of our modern, purpose built practice and endeavour to keep it clean and well maintained at all times.

If you have any concerns about cleanliness or infection control, please report these to our Reception staff.

Our GPs and nursing staff follow our Infection Control Policy to ensure the care we deliver and the equipment we use is safe.

We take additional measures to ensure we maintain the highest standards:

• Encourage staff and patients to raise any issues or report any incidents relating to cleanliness and infection control. We can discuss these and identify improvements we can make to avoid any future problems.
• Carry out an annual infection control audit to make sure our infection control procedures are working.
• Provide annual staff updates and training on cleanliness and infection control
• Review our policies and procedures to make sure they are adequate and meet national guidance.
• Maintain the premises and equipment to a high standard within the available financial resources and ensure that all reasonable steps are taken to reduce or remove all infection risk.
• Use washable or disposable materials for items such as couch rolls, modesty curtains, floor coverings, towels etc., and ensure that these are laundered, cleaned or changed frequently to minimise risk of infection.
• Make alcohol hand rub gel available throughout the building.

As part of the commitment to more personalised care for patients, NHS Employers and the General Practitioners Committee of the British Medical Association have agreed that all patients will have a named accountable GP.

The named GP will:

• Take lead responsibility for ensuring that all appropriate services required under the contract with the practice are delivered to you
• Where required, based on the professional judgement of the ‘named’ GP, work with relevant associated health and social care professionals to deliver a multidisciplinary care package that meets your needs.
• Ensure that your physical and psychological needs are recognised and responded to by the relevant clinicians in the practice
• Ensure that patients over 75 years of age have access to a health check if requested, which is already a requirement of the GP contract regulations. ​​​

The practice will ensure that there is a named accountable GP assigned to each patient.

New patients will be allocated a GP at the time of registration.

Your named accountable GP will be the same as your usual GP however this does not affect your ability to see any GP of your choice as you currently do.

How can we help you?

• All patients, their families and carers will be treated with courtesy and respect, irrespective of their age, gender, ethnic origin, religious beliefs or the nature of their health concern.
• We accept our responsibility for protecting the confidentiality of patients and will comply with all relevant legislation in this regard.
• We will work in partnership with patients to deliver the best possible medical care and clinical outcomes.
• We will involve patients and listen to their opinions and views in all aspects of their care and treatment.
• If you make a complaint, we will investigate the full circumstances and make sure you receive an apology when this is appropriate. We will also make sure you are not discriminated against, or subjected to any negative impact as a result of your complaint.
• An urgent appointment with a doctor or nurse will be made available on the same day should a patient require one.
• We aim to see patients within 20 minutes of their appointment time. If you have waited longer than this please ask at reception for an explanation.
• Treatment and care will always be provided by a suitable and qualified person and no care or treatment will be provided without patient consent.
• Those involved in the care of patients will offer their names and ensure patients know how to contact them.
• We will provide full information about the services we offer and how to access them.
• We will take whatever time is necessary to help patients understand their conditions, treatment options and medication and will answer all questions openly and honestly.

How patients can help us

• Treat our staff with courtesy and respect, irrespective of their age, gender, ethnic origin, religious beliefs or role – they are all here to help.
• Be on time for each and every appointment made for you.
• Cancel any unwanted appointments in good time so that it can be allocated to others.
• Be aware of the needs of your fellow patients and keep noise levels to a minimum when visiting the surgery.
• Keep your children close by and well behaved when visiting the practice and do not let them play with any medical equipment in the consulting rooms.
• Be informed about your health and answer questions about your care openly and honestly.
• Let us know in good time if you are running late or are unable to attend.
• Request a home visit only if you are genuinely too unwell to visit the surgery.
• Make all requests for urgent or same day care as early in the day as possible.
• Stay by the phone number provided to make it easier for us to return your call.
• Do not smoke, drink alcohol or take recreational drugs on the premises or in the grounds of the practices.
• Do not bring your pets into the surgery – assistance dogs are permitted
• Use the wheelchairs available in the entrance lobby should you need assistance moving around the building and do not bring personal scooters into the building.

NHS England require practices to enable successful automated uploads of any changes to patient’s summary information, at least on a daily basis, to the summary care record (SCR).

Having your Summary Care Record (SCR) available will help anyone treating you without your full medical record. They will have access to information about any medication you may be taking and any drugs that you have a recorded allergy or sensitivity to.

Of course, if you do not want your medical records to be available in this way then you will need to let us know so that we can update your record. You can do this via the opt out form.

The practice confirms that your SCR is automatically updated on at least a daily basis to ensure that your information is as up to date as it can possibly be.

Any young person has the right to seek advice from a health professional, doctor or nurse on their own or with a friend without their parent or another adult knowing about it.

• We do not have the right to tell anybody about what you have discussed with us, without your permission. However some decisions may be difficult and mean that the support of a trusted adult is important. For this reason we do try to encourage you to discuss things with a trusted adult or parent where possible.
• When you are seen by a doctor or nurse, the decision to offer you treatment/medication without an adult being present depends on how happy we are that you fully understand a) what the treatment means and the advice given, b) the options that you have been given regarding different types of treatment c) whether or not you understand possible risks or side effects of the treatment and finally that you know to come back to us if you have any problems.
• Being able to agree to treatment on your own is not dependent on your age it is dependent on your understanding of what is being offered.

Young people in the care system often have worries about what information is being given to different people about them. Your information would only be shared with those who really need to know and with your knowledge and permission so that you have control over your own information.

• Limitations to confidentiality – this part is very important. We have what is called a ‘duty of care’ to you which means that we must be sure that you are safe and that decisions you are making or advice and treatment that we are giving is in the best interests of your health and wellbeing and that of other people.
• If the doctor or nurse that you are seeing has a concern that you may be in danger or putting others in danger we have a duty to disclose that information without your consent to an appropriate person who will look into the situation.
• People under the age of 13 years old are not legally capable of agreeing to have sex or be involved in sexual activity. This means that the nurse or doctor may feel that to protect you this information needs to be shared with an appropriate person. This would normally be done with your knowledge and the doctor or nurse would help support you through this time and fully explain the reasons why this is needed so that you understand.

Your Rights

We are committed to giving you the best possible service. This will be achieved by working together.

Help us to help you. You have a right to, and the practice will try to ensure that:

• You will be treated with courtesy and respect.
• You will be treated as a partner in the care and attention that you receive.
• All aspects of your visit will be dealt with in privacy and confidence.
• You will be seen by a clinician of your choice, subject to availability.
• In an emergency, out of normal opening hours, if you telephone the practice you will be given the number to receive assistance, which will require no more than one further call.
• You can bring someone with you, however you may be asked to be seen on your own during the consultation.
• Repeat prescriptions will normally be available for collection within two working days of your request. Visit our Prescriptions Room where you will be able to find your nearest pharmacies, request or review your medication and register for electronic prescribing.
• Information about our services on offer will be made available to you by way of news posts and newsletters on our site.
• You have the right to see your medical records or have a copy subject to certain laws.

Your Responsibilities

The NHS belongs to all of us. There are things that we can all do for ourselves and for one another to help it work effectively, and to ensure resources are used responsibly.

Therefore, we would respectfully request that you:

• Our Practice supports the NHS zero tolerance zone campaign. Please treat practice staff and other patients with the same consideration and courtesy you would like for yourself. Please understand that violence, or the causing of nuisance or disturbance on NHS premises, could result in prosecution.
• Please recognise that you can make a significant contribution to your own, and your family’s, good health and well being, and take personal responsibility for it.
• Please provide accurate information about your health, condition and status.
• Please participate in important public health programmes such as vaccinations.
• Please request home visits before 11:00, where possible.
• Please ensure that you order your repeat medication in plenty of time allowing 48 hours.
• Please ensure that you have a basic first aid kit at home and initiate minor illness and self-care for you and your family if you feel competent to do so.
• Please attend any specialist appointments that have been arranged for you or cancel them if your condition has resolved or you no longer wish to attend.
• Attend appointments on time, patients who are more than 10 minutes late for their appointment may not be seen.
• If you are unable to make your appointment or no longer need it, please give the practice adequate notice that you wish to cancel your appointment.
• An appointment is for one person only. Where another family member needs to be seen or discussed, another appointment should be made.
• Patients should make every effort to present at the practice to ensure the best use of nursing and medical time. Home visits should be medically justifiable and not requested for social convenience.
• Please inform us when you move home, change your name or telephone number, so that we can keep our records correct and up to date.
• Read the practice news and other information that we give you. They are there to help you use our services. If you do not understand their content please tell us.
• Let us have your views. Your ideas and suggestions whether complimentary or critical are important in helping us to provide a first class, safe, friendly service. If a family member or someone you are a carer for is a patient and unable to provide feedback, you are encouraged to give feedback about their experiences on their behalf.

We 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. We ask you to treat your doctors and their staff courteously and act reasonably.

All incidents will be followed up and you will be sent a formal warning after a second incident or removed from the practice list after a third incident if your behaviour has been unreasonable.

However, aggressive behaviour, be it violent or verbal abusive, will not be tolerated and may result in you being removed from the Practice list and, in extreme cases, the police will be contacted if an incident is taking place and the patient is posing a threat to staff or other patients.

Removal from the Practice List

A good patient-doctor relationship, based on mutual respect and trust, is the cornerstone of good patient care. The removal of patients from our list is an exceptional and rare event and is a last resort in an impaired patient-practice relationship. When trust has irretrievably broken down, it is in the patient’s interest, just as much as that of The Surgery, that they should find a new practice. An exception to this is on immediate removal on the grounds of violence e.g. when the police are involved.

Removing other members of the household

In rare cases, however, 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. The prospect of visiting patients where a relative who is no longer a patient of the practice by virtue of their unacceptable behaviour resides, or being regularly confronted by the removed patient, may make it too difficult for the practice to continue to look after the whole family. This is particularly likely where the patient has been removed because of violence or threatening behaviour and keeping the other family members could put doctors or their staff at risk.