If you wish to join this outstanding GP practice please come in and see us – it will only take 5-10 minutes to register.
We provide a full range of medical services including:
– Cervical Smears
– Travel Vaccinations
– Children’s Immunisations
– Family Planning / Contraception Advice
– Dedicated clinics for Asthma and Diabetes patients
With access to Physio, Smoking Cessation, Speech Therapy, Diabetes Services, Foot Health, Health Visitors, District Nurses and Social Workers.
Chaperones
The Surgery prides itself in maintaining professional standards. For certain examinations during consultations an impartial observer (a “Chaperone”) can be requested.
This impartial observer will be a practice Nurse or Health Care Assistant who is familiar with the procedure and be available to reassure and raise any concerns on your behalf. If a nurse is unavailable at the time of your consultation then your examination may be re-scheduled for another time.
You are free to decline any examination or choose an alternative examiner or chaperone. You may also request a chaperone for any examination or consultation if one is not offered to you. The GP may not undertake an examination if a chaperone is declined.
The role of a Chaperone:
• Maintains professional boundaries during intimate examinations.
• Acknowledges a patient’s vulnerability.
• Provides emotional comfort and reassurance.
• Assists in the examination.
• Assists with undressing patients, if required.
Confidentiality
We take looking after your medical records seriously, from data about your appointments to information related to a sensitive diagnosis. The practice complies with the Data Protection Act 2018 and is GDPR compliant. Our staff are fully trained to understand their legal and professional duty of confidence to you and your information is held securely. We will only share relevant information with other health professionals whose job is to provide your care when they prove both their identity and role. If we share your full record we will ask your permission first, other than in exceptional circumstances where there is grave risk to life, or where the law requires it.
You can find out more about the information we hold on you and your choices about how you share it by reading the A3 poster on display in our reception, or by visiting:
www.hammersmithfulhamccg.nhs.uk
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.
Under 16s:
The duty of confidentiality owed to a person under 16 is as great as the duty owed to any other person. Young people aged under 16 years can choose to see health professionals, without informing their parents or carers. If a GP considers that the young person is competent to make decisions about their health, then the GP can give advice, prescribe and treat the young person without seeking further consent.
However, in terms of good practice, health professionals will encourage young people to discuss issues with a parent or carer. As with older people, sometimes the law requires us to report information to appropriate authorities in order to protect young people or members of the public.
Useful Websites:
• Confidentiality NHS Code of Practice
Disability Access
If you have any special needs please let our staff know so that we can help and ensure you get the same support in the future.
Disabled Parking – Blue Badge Scheme:
The Blue Badge scheme is for people with severe mobility problems. It allows Blue Badge holders to park close to where they need to go.
Blind/Partially Sighted
If you or family members are blind or partially sighted we can give you large print of our practice leaflet upon request. Please ask Reception for further information.
For more advice and support for blind people please see the following websites:
Guide Dogs
Guide dogs are welcome at the surgery but we ask that you be aware of other patients and staff who may have an allergy or fear of dogs.
Further Information:
Other Disability Websites
Freedom of Information
The Freedom of Information Act creates a right of access to recorded information and obliges a public authority to:
- 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 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 Data Protection Act.
For more information see these websites:
GDPR / Statement of Intent
GDPR / Statement of Intent – May 2018 Update
Under the new GDPR regulation which comes in effect on 25th May 2018 we may need to ask your permission to provide you with information about health care services which are not related to your direct care. You will also be asked to express a preference in choosing services such as your designated pharmacy for prescriptions. You can find out more about the information we hold on you and your choices about how you share through:
- The A3 Privacy Notice poster on display in our reception, or online by visiting:
- www.hammersmithfulhamccg.nhs.uk
- Privacy Notice Poster (Information coming soon)
- Detailed Privacy Notice Document (Information coming soon)
Infection Control Statement
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
Named GP
We have allocated a Named Accountable GP for all of our registered patients. If you do not know who your named GP is, please ask a member of our reception team. Unfortunately, we are unable to notify patients in writing of any change of GP due to the costs involved.
New Patient Policy
Where it is clinically appropriate and practical to register, we now accept new registration from patients who work in the local area but reside outside of our registration area. Patients registered this way would not be entitled to home visit from the practice, however they will be able to contact NHS 111 in order to be seen by a practice closer to where they live.
For further information about this type of registration, please contact us on 0203 474 6400 or feel free to come into the practice.
Non-NHS Work
What is non-NHS work and why is there a fee?
The National Health Service provides most health care to most people free of charge, but there are exceptions: prescription charges have existed since 1951 and there are a number of other services for which fees are charged.
Sometimes the charge is because the service is not covered by the NHS, for example, providing copies of health records or producing medical reports for insurance companies, solicitors or employers.
The Government’s contract with GPs covers medical services to NHS patients but not non-NHS work. It is important to understand that many GPs are not employed by the NHS; they are self-employed and they have to cover their costs – staff, buildings, heating, lighting, etc. – in the same way as any small business.
In recent years, however, more and more organisations have been involving doctors in a whole range of non-medical work. Sometimes the only reason that GPs are asked is because they are in a position of trust in the community, or because an insurance company or employer wants to ensure that information provided to them is true and accurate.
Examples of non-NHS services for which GPs can charge their own NHS patients are:
- accident/sickness certificates for insurance purposes
- school fee and holiday insurance certificates
- reports for health clubs to certify that patients are fit to exercise
- private prescriptions for travel purposes
Examples of non-NHS services for which GPs can charge other institutions are:
- life assurance and income protection reports for insurance companies
- reports for the Department for Work and Pensions (DWP) in connection with
- disability living allowance and attendance allowance
- medical reports for local authorities in connection with adoption and fostering
- copies of records for solicitors
Do GPs have to do non-NHS work for their patients?
With certain limited exceptions, for example a GP confirming that one of their patients is not fit for jury service, GPs do not have to carry out non-NHS work on behalf of their patients. Whilst GPs will always attempt to assist their patients with the completion of forms, they are not required to do such non-NHS work.
Is it true that the BMA sets fees for non-NHS work?
The British Medical Association (BMA) suggest fees that GPs may charge their patients for non-NHS work (i.e. work not covered under their contract with the NHS) in order to help GPs set their own professional fees. However, the fees suggested by them are intended for guidance only; they are not recommendations and a doctor is not obliged to charge the rates they suggest.
Why does it sometimes take my GP a long time to complete my form?
Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy workload and paperwork takes up an increasing amount of their time. Our GPs do non-NHS work out of NHS time at evenings or weekends so that NHS patient care does not suffer.
I only need the doctor’s signature – what is the problem?
When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. In order to complete even the simplest of forms, therefore, the doctor might have to check the patient’s ENTIRE medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the Police.
If you are a new patient we may not have your medical records so the doctor must wait for these before completing the form.
What will I be charged?
It is recommended that GPs tell patients in advance if they will be charged, and what the fee will be. It is up to individual doctors to decide how much they will charge. The surgery has a list of fees based on these suggested fees which is available on request.
What can I do to help?
- Not all documents need a signature by a doctor, for example passport applications. You can ask another person in a position of trust to sign such documents free of charge. Read the information that comes with these types of forms carefully before requesting your GP to complete them.
- If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them at the same time to speed up the process.
- Do not expect your GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this may cost more. Usually non-NHS work will take 2 weeks.
For further information on the non NHS services that we provide, please visit our Private Services List and Fees page.
Safeguarding (Adults and Children)
Vulnerable Adults
Introduction
The purpose of this document is to set out the policy of the Practice in relation to the protection of vulnerable adults. Further guidance may be available on local inter-agency procedures via the Primary Care Organisation and / or Social Services.
What is a vulnerable adult?
The definition is wide, however this may be regarded as anyone over the age of 18 years who may be unable to protect themselves from abuse, harm or exploitation, which may be by reason of illness, age, mental illness, disability or other types of physical or mental impairment.
Those at risk may live alone, be dependent on others (care homes etc.), elderly, or socially isolated.
Forms of Abuse
- Neglect – ignoring mental or physical needs, care, education, or basic life necessities or rights
- Bullying – family, carers, friends
- Financial – theft or use of money or possessions
- Sexual – assault, rape, non-consensual acts (including acts where unable to give consent), touching, indecent exposure
- Physical – hitting, assault, man-handling, restraint, pain or forcing medication
- Psychological – threats, fear, being controlled, taunts, isolation
- Discrimination – abuse based on perceived differences and vulnerabilities
- Institutional abuse – in hospitals, care homes, support services or individuals within them, including inappropriate behaviours, discrimination, prejudice, and lack of essential safeguards
Abuse may be deliberate or as a result of lack of attention or thought, and may involve combinations of all or any of the above forms. It may be regular or on an occasional or single event basis, however it will result in some degree of suffering to the individual concerned.
Abuse may also take place between one vulnerable adult and another, for example between residents of care homes or other institutions.
Indications
- Bruising
- Burns
- Falls
- Apparent lack of personal care
- Nervousness or withdrawn
- Avoidance of topics of discussion
- Inadequate living conditions or confinement to one room in their own home
- Inappropriate controlling by carers or family members
- Obstacles preventing personal visitors or one-to-one personal discussion
- Sudden changes in personality
- Lack of freedom to move outside the home, or to be on their own
- Refusal by carers to allow the patient into further care or to change environs
- Lack of access to own money
- Lack of mobility aids when needed
Action Required
Where abuse of a vulnerable adult is suspected the welfare of the patient takes priority. In deciding whether to disclose concerns to a third party or other agency the GP will assess the risk to the patient.
- Ideally the matter should be discussed with the patient involved first, and attempt made to obtain consent to refer the matter to the appropriate agency. Where this is not possible, or in the case of emergency where serious harm is to be prevented, the patient’s doctor will balance the need to protect the patient with the duty of confidentiality before deciding whether to refer.
- The patient should usually be informed that the doctor intends to disclose information, and advice and support should be offered.
- Where time permits, the medical defence organisation will be telephoned before any action is taken.
Due regard will be taken of the patient’s capacity to provide a valid consent.
In assessing the risk to the individual, the following factors will be considered:
- Nature of abuse, and severity
- Chance of recurrence, and when
- Frequency
- Vulnerability of the adult (frailty, age, physical condition etc.)
- Those involved – family, carers, strangers, visitors etc.
- Whether other third parties are also at risk (other members of the same household may being abused at the same time)
Subject to the local procedures in force, consideration will be given to;
- Report to Social Services Mental Health team
- Report to Police
- Report to CCG lead
Contact List:
– Police – Emergency: 999 / Non-Emergency: 101
– Adult Support Services / Safeguarding Adult: 020 8753 4198 – Option 3
– Adult Support Services (out of hours) / Adult Protection Officer: 020 8748 8588
– Community Mental Health – Claybrook Centre: 020 7386 1348 / Glenthorne Road: 020 8483 1979 / 24-hour Crisis Helpline: 0300 1234 244
– Age Concern: 020 7386 9085
– Social Services: 0845 313 3935
– MIND Hammersmith and Fulham: 020 7471 0580
– Hammersmith and Fulham Child and Adult Mental Health Services (CAMHS): 020 8483 1979
– Drug Misuse: 020 3315 6111
– Medical Defence Organisation: MDU – Via doctor/nurse or management membership details
– Hammersmith and Fulham Clinical Commissioning Group (CCG) 87-91 Newman Street, London, W1T 5EY: 020 3350 4000
– NHS England / North West London Area Team: 020 7322 3700
See more advice on what to do if you think someone is at risk of abuse on the People First website.
Child Safeguarding
Child Safeguarding is the responsibility of all everybody and is highly regarded at the Surgery. We make every effort to recognise issues and address as they occur in the practice. By raising safeguarding children issues within the practice all staff will be aware of how they may access advice, understand their role in protection, and understand the importance of effective Inter-agency communication.
It is very important that all Practice staff understand the need for early identification, assessment and intervention when they have concerns about a child. Case discussion and reflective practice is encouraged. Child protection issues in general practice require a robust system of note-keeping and recording, message handling and communication of any concerns.
Key Factors to be aware of in safeguarding children
- The welfare of the child is paramount
- Be prepared to consult with colleagues
- Be prepared to take advice from local experts
- Keep comprehensive, clear, contemporaneous records
- Be aware of GMC guidance about sharing confidential information
Risk Factors and Identification – Child Sexual Exploitation
A child in need is defined as a child whose vulnerability is such that they are unlikely to reach or maintain a satisfactory level of health or development without the provision of services (section 17, Children’s Act 1989). This includes disabled children. The Children’s Acts 1984 and 2004 define a child as someone who has not reached their 18th birthday. The fact that a child has reached their 16th birthday and may be living independently, working, or be members of the armed forces does not remove their childhood status under the Acts.
Local authority social services departments working with other local authority departments and health services have a duty to safeguard and promote the welfare of children in their area who are in need. If you are considering making a referral to Social Services as a child in need, it is essential to discuss the referral with the child’s parents or carers and to obtain consent for the sharing of information. Social Services will then follow local procedures to undertake an assessment of the child and their family.
Child Protection Plan
Children judged to be at continuing risk have a child protection plan in place, this list is maintained by children’s social care (CSC).
CSC, police and health professionals have 24 hour access to this. A child on the register has a “key worker” to whom reference can be made.
Recognising Child Abuse
(for full details please ref to Working Together to Safeguard Children 2013)
There are 4 main categories of child abuse:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Neglect/failure to thrive
These are not however exclusive, and a number of abuse types can often coexist.
Physical abuse may include:
Injuries in children under 1 years of age or non-mobile children should be treated with a high degree of care
- Hitting, shaking, throwing, poisoning, burning or scalding, or other forms of physical harm
- Where a parent or carer deliberately causes ill-health of a child
- Single traumatic events or repeated incidents
- FGM
Sexual abuse may include:
- Forcing or enticing a child under 18 to take part in sexual activities where the child is unaware of what is happening
- May include both physical contact acts and non—contact acts
Emotional abuse may include:
- Persistent ill-treatment which has an effect on emotional development
- Conveyance of a message of being un-loved, worthlessness or inadequacy
- May instill a feeling of danger, being afraid
- May involve child exploitation or corruption
- Living in families where domestic violence is taking place
Neglect may include:
- Failure to meet the child’s physical or psychological needs
- Failure to provide adequate food or shelter
- Failure to protect from physical harm
- Neglect of a child’s emotional needs
Common presentations and situations in which child abuse may be suspected include:
- Disclosure by a child or young person
- Physical signs and symptoms giving rise to suspicion of any category of abuse
- The history is inconsistent or changes
- A delay in seeking medical help
- Extreme or worrying behaviour of a child, taking account of the developmental age of the child
- Accumulation of minor incidents giving rise to a level of concern, including frequent A&E attendances
Some other situations which need careful consideration are:
- Disclosure by an adult of abusive activities
- Girls under 16 presenting with pregnancy or sexually transmitted disease, especially those with learning difficulties
- Very young girls requesting contraception, especially emergency contraception
- Situations where parental mental health problems may impact on children
- Parental/ carer alcohol, drug or substance misuse which may impact on children
- Parents with learning difficulties
- Violence or domestic abuse in the family (please see separate document in safeguarding folder on domestic violence)
- Acuminous separation of parents with alleged allegation
Statement of Intent
New contractual requirements came into force from 1 April 2014 requiring that GP Practices should make available a statement of intent in relation to the following IT developments:
- Summary Care Record (SCR)
- GP to GP Record Transfers
- Patient Online Access to Their GP Record
- Data for commissioning and other secondary care purposes
The same contractual obligations require that we have a statement of intent regarding these developments in place and publicised by 30 September 2014.
Please find below details of the practices stance with regards to these points.
Summary Care Record (SCR)
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) or have published plans in place to achieve this by 31st of March 2015.
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.
GP to GP Record Transfers
NHS England require practices to utilise the GP2GP facility for the transfer of patient records between practices, when a patient registers or de-registers (not for temporary registration).
It is very important that you are registered with a doctor at all times. If you leave your GP and register with a new GP, your medical records will be removed from your previous doctor and forwarded on to your new GP via NHS England. It can take your paper records up to two weeks to reach your new surgery.
With GP to GP record transfers your electronic record is transferred to your new practice much sooner.
The practice confirms that GP to GP transfers are already active and we send and receive patient records via this system.
Patient Online Access to Their GP Record
NHS England require practices to promote and offer the facility to enable patients online access to appointments, prescriptions, allergies and adverse reactions or have published plans in place to achieve this by 31st of March 2015.
We currently offer the facility for booking and cancelling appointments and also for ordering your repeat prescriptions and viewing a summary of your medical records on-line. If you do not already have a user name and password for this system – please register your interest with our reception staff.
Data for commissioning and other secondary care purposes
It is already a requirement of the Health and Social Care Act that practices must meet the reasonable data requirements of commissioners and other health and social care organisations through appropriate and safe data sharing for secondary uses, as specified in the technical specification for care data.
At our practice we have specific arrangements in place to allow patients to “opt out” of care data which allows for the removal of data from the practice. Please see the page about care data on our website
The Practice confirm these arrangements are in place and that we undertake annual training and audits to ensure that all our data is handled correctly and safely via the Information Governance Toolkit.
Suggestions, Comments and Complaints
We welcome all comments on the services provided by the Practice.
We are continually looking to turn out patients’ feedback into real improvements in the services we provide. We use it to focus on the things that matter most to our patients, carers and their families.
We would like to hear from you if you have a suggestion on how we can do things better to improve our patients’ experiences. We’d also like to hear from you if you are pleased with the service you’ve received.
We’ll let the staff involved know and share the good practice across our teams.
You may write to us or contact us by phone or fax, our details can be found on our Contact Us page.
Your Rights and Responsibilities
Patient’s 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 doctor 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
- Information about our services on offer will be made available to you by way of posters, notice boards and newsletters
- You have the right to see your medical records or have a copy subject to certain laws.
Patient’s Responsibilities
With these rights come responsibilities and for patients we would respectfully request that you:
- Treat practice staff and doctors with the same consideration and courtesy that you would like yourself. Remember that they are trying to help you
- Please ensure that you order your repeat medication in plenty of time allowing 48 working 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.
- 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
- Please follow up any test or investigations done for you with the person who has requested the investigation
- Attend appointments on time and check in with Reception
- 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. Appointments are heavily in demand and missed appointments waste time and delay more urgent patients receiving the treatment they need
- 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 be present at the surgery 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 leaflets 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 in pleasant surroundings.
NHS Constitution
The NHS Constitution establishes the principles and values of the NHS in England. For more information see these websites:
- GOV.UK – The NHS Constitution for England
- NHS Choices – NHS Constitution
Zero Tolerance
The practice fully supports the NHS Zero Tolerance Policy. The aim of this policy is to tackle the increasing problem of violence against staff working in the NHS and ensures that doctors and their staff have a right to care for others without fear of being attacked or abused.
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.
