28 Day Prescribing

Our practice policy is that we prescribe 28-day prescriptions to all patients. In some exceptional circumstances we may consider prescribing 7-day prescriptions, as outlined by Coventry Warwickshire Integrated Care Board (CWICB):

Coventry & Warwickshire ICB recommends that most repeat prescriptions be written for 28-days’ supply. This is to avoid medication waste and ensure stability of the medication supply chain. However, there are situations where differing intervals are more suitable:

Fewer than 28 days:

On rare occasions, prescriptions for 7-days may be more suitable where risks are perceived, or medication is frequently changing. This should be an agreement with the patient/representative, pharmacy and the GP.

The following considerations will be taken into account if prescriber agrees to 7-day prescribing:

· Drugs liable to abuse.

· Vulnerable patients who are likely to get confused and/or over-dose.

· Terminally ill patients receiving palliative care support.

· Dressings for short-term use or where likely to change.

· When required / PRN medication.

· Medications that are recommended for short term use only, e.g., hypnotics, benzodiazepines.

· Newly prescribed medication when a shorter period is appropriate to assess response / titrating dosages etc.

· An assessment of suicide risk in patients with a past medical history of overdosing should be undertaken and medication prescribed in a suitable quantity and with appropriate support.

Greater than 28 days:

· Oral contraceptives and HRT (supplied in 3-month packs)

· Medication that is supplied in special containers.

Monitored Dosage Systems (MDS):

Where the pharmacy is supplying medication in monitored dosage systems (MDS), a 28-day prescription should be issued and 4 weeks of MDS will be supplied at a time.

The community pharmacist should carry out a Disability Discrimination Act (DDA) assessment with a patient who is requesting an MDS or dosette box. If the assessment identifies that it is appropriate for the patient to receive an MDS, the pharmacy is required to do this at no additional charge. If the patient does not meet the criteria for requiring an MDS but would still like one, the pharmacy is able to charge the patient for this service.

https://www.covwarkformulary.nhs.uk/docs/chapter18/CG017-Monitored%20Dose%20System%20guidance.pdf

Our Local Pharmaceutical Committee (Ardens LPC) has issued the following advice as well with regards to MDS/7-day prescriptions:

It is at the pharmacy’s discretion as to whether they supply MDS – this is ONLY where they meet Equality Act and useful for the patient – which is a very small number of cases and do not qualify if they have a carer either formal or informal.

7 days prescriptions are applicable (MDS or not) if patient cannot safely have more than 7 days at a time – otherwise the pharmacy should provide 28 days at a time, whether that is original pack or other format. Sometimes patients do get confused if given multiple packs and so if concern they may on occasion need 7-days prescription and collected weekly.

Note pharmacies are not funded to provide MDS nor deliveries. If the patient ‘needs’ MDS but do not meet Equality Act then the pharmacy can charge the patient.

When going on holiday:

The maximum prescription duration allowed by the NHS for supplies for an extended holiday is THREE months.

Patients should check UK government advice on travelling with medicines and specific rules for the country that they are travelling to. There is a useful factsheet available here: https://travelhealthpro.org.uk/factsheet/43/medicines-and-travel.

Chaperone Policy

Chaperone policy

Dordon & Polesworth Group Practice 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.

There are occasions where there is the potential for abuse of a person placed in a vulnerable position, and conversely false allegations to be made. This can have serious, long-term consequences for all those involved and may not come to light for many years.

This policy is designed to protect both patients and staff from abuse or allegations of abuse and to assist patients to make an informed choice about their examination or consultations.

Guidelines

Clinicians (male and female) should consider whether an intimate or personal examination of the patient( either male or female) is justified, or whether the nature of the consultation poses a risk of misunderstanding. There may be a rae occasion when an independent witness to a consultation might be prudent.

Ensure that a suitable sign is clearly on display in each consulting or treatment room offering the chaperone service if required.
The patient must be offered the choice to have a chaperone present in the room during an examination – It may be embarrasing to the patient if a staff member is known to them, so a choice of an alternative staff member may be necessary – the patient can refuse a chaperone, this must be recorded in the patient’s medical record.
The clincian should give the patient a clear explanation of what the examination will involve while the chaperone is present.
Always adopt a professional and considerate manner – be careful with humour as a way of relaxing a nervous situation as it can easily be misinterpreted.
Always ensure that the patient is provided with adequate privacy to undress and dress.

This should remove the potential for misunderstanding. However, there will still be times when either the clinician, or the patient, feels uncomfortable, and it would be appropriate to consider using a chaperone. Patients who request a chaperone should never be examined without a chaperone being present. If necessary, where a chaperone is not available, the consultation/examination must be rearranged for a mutually convenient time when a chaperone can be present.

Complaints and claims have not been limited to male doctors with female patients – there are many examples of alleged homosexual assault by female and male doctors. Consideration should also be given to the possibility of a malicious accusation by a patient.

There may be rare occasions when a chaperone is needed for a home visit. The following procedure should be followed.

Who can act as chaperone?

Where the practice determine that non-clinical staff will act in this capacity the patient must agree to the presence of a non-clinician in the examination, and be at ease with this. The staff member should be trained in the procedural aspects of personal examinations, comfortable in acting in the role of chaperone, and be confident in the scope and extent of their role.

Confidentiality

The chaperone should only be present for the examination itself, and most discussion with the patient should take place while the chaperone is not present.
Patients should be reassured that all practice staff understand their responsibility not to divulge confidential information.

The latest GMC guidelines for intimate examinations can be found by viewing: http://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/intimate-examinations-and-chaperones

Procedure

The Clinician will contact reception to request a chaperone.
The Clinician will record in the notes that the chaperone is present, and identify the chaperone (full name must be documented)
Where no chaperone is available the examination will not take place.
The patient should not normally be permitted to dispense with the chaperone once a desire to have one present has been expressed.
The chaperone will enter the room discreetly and remain in the room until the Clinician has finished the examination.
The chaperone will normally attend inside the curtain at the head of the couch and watch the procedure.
To prevent embarrassment, the chaperone should not enter into conversation with the patient or GP unless requested to do so, or make any mention of the consultation afterwards.
The chaperone will make a record in the patient’s notes after examination. The documented notes must give the date, time and state that there were no problems, or give details of any concerns or incidents that occurred.
The patient can refuse a chaperone, and if so this must be recorded in the patients medical record.
If the Clinician wishes to conduct an examination with a chaperone present but the patient does not agree to this, the Clinician must clearly explain why they want a chaperone to be present. The clincian ma choose to consider referring the patient to a colleague who would be willing to examine them without a chaperone, as long as the delay would not have an adverse effect on the patients health.

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Interpretation & Translation Services

Named GP for patients aged 75 years and above

Named GP for all patients aged 75 years and over

The practice is required by the Government under the terms of the GP contract to allocate all patients aged 75 years and over a named GP.

Individual patients are informed of their named GP at the first appropriate interaction with the practice or via letter. If you wish to know the name of your named GP, please ask the receptionist when you are next in the surgery.

Please do not telephone the practice for this information!

Having a named GP does not prevent you from seeing any other doctor within the group practice. Your named GP will not be available at all times and if your needs are urgent, you should discuss them with an alternative doctor.

Your named GP will have overall responsibility for the care and support that our surgery provides to you. They will work with other relevant health and care professionals, who are involved in your care, to ensure that the care you receive from our practice meets your individual needs.

Please note the surgery is a group practice, this means you are registered with the practice and can see any GP at the surgery, do not expect to see the named GP at every visit.

NHS Hospital Contract

A new NHS Hospital Contract came into force on 1st April 2017 which all NHS Organisations have signed.

What this means to you:

MEDICATION – The hospital attended is to supply medication with an adequate supply for the patients immediate clinical need until the GP receives the relevant clinic letter and can prescribe. We appreciate this change is frustrating but in line with this contractual obligation the GP surgery will not be able to issue you with consultant recommended medication even if you have a hospital prescription. You would need to obtain from the hospital attended or contact the consultant or a member of their team. Upon notification from the consultant the GP surgery may automatically add the medication change to your repeat list on the computer system. You will then be able to order your repeat medicaiton without an appointment.

SICK NOTES – Under Section 11, the contract sets out new requirements to reduce inappropriate bureaucratic workload shift onto GP Practices. NHS Trust Hospitals are now contracted to supply patients with the appropriate certification following discharge from an inpatient stay, day cases or following an outpatient appointment. The length of the note given to a patient should be provided for as long as required to anticipate the patients date of recovery or follow up.

RESULTS AND MEDICAL RELATED PROBLEMS – Results of investigations requested by hospital clinicians are to be communicated by hospital directly to patients.

Your consultant and their team are responsible for answering any concerns or queries you may have relating to your care under the hospital service, not the GP. By this change of contractual responsibilities it is hoped nationally that this will reduce millions of GP appointments wasted nationally, responding to patients queries relating to hospital care and/or test results directly arranged by their hospital consultant.

For medically related problems, the hospital is to refer onto other necessary departments i.e. if seen in the Pain Management Clinic for knee pain they can then refer you to the Orthopaedic Department if necessary regarding that knee. GPs will only have to provide a referral when the reason is not medically related to the original referral.

NON ATTENDANCE – If a patient does not attend a hospital appointment it is the hospital, not the GP, will liaise directly with the patient therefore the GP does not have to produce another referral (re-refer).

CLINIC LETTERS – Hospital clinic letters should be sent to the GP within 10 days.

Paediatric ADHD Medication

Our surgery has opted out of prescribing ADHD medications under Shared Care Agreements (SCA) for paediatric patients due to unfamiliarity and uncertainty of this medication in this patient population which may then result in poor patient outcomes and care. Patients have been lost to follow up to adult care in the past, so once the patient turns 18 years old then we may consider a Shared Care Agreement (SCA).

We believe it is too specialised for our care and would prefer the initiating specialist to continue prescribing and continue responsibility and care for the patient due to our patient safety concerns.

Therefore, we are unable to agree future prescribing of paediatric ADHD medication at this current moment.

Our local Integrated Care Board (ICB) has been informed of our decision.

Patient Charter

We endeavour to provide all our patients with the best standard of care within the resources available to us. Patients will be treated in a confidential and respectful manner at all times. All new patients will receive a practice booklet and be invited to a registration health check.

As a patient of this practice we aim to offer you:

A clear explanation of any treatment proposed to you

Privacy and confidentiality

Courtesy from all staff

We offer pre-bookable appointments with a GP of your choice but you may have to wait to see a particular GP

Referral to a consultant when your GP agrees is necessary

Expect your medication to be reviewed regularly and receive repeat prescriptions.

As patient of this practice we hope that you:

Give as much notice as possible if unable to attend an appointment, this allows us to offer your appointment to another patient.

If more than one family member wishes to be seen, please book an appointment slot for each person wishing to be seen. If more than one person is seen in one appointment slot, this can lead to a Clinician running late for the rest of the session which inevitably inconveniences other patients at the practice.
If you have more than one medical condition, please make a double appointment so that the Clinician has enough time to deal with each problem without running late for the next patient.
Treat the Practice staff courteously.
Alongside the rest of the NHS, we have a zero tolerance policy to abuse or violence to any of our staff members.

Patient Complaint Information

DORDON & POLESWORTH GROUP PRACTICE

PATIENT COMPLAINTS INFORMATION LEAFLET

Practice Complaints Procedure

If you have a complaint or concern about the service you have received from the doctors or any of the staff members working in this practice, please let us know. We operate a practice complaints procedure as part of an NHS system for dealing with complaints. Our complaints system meets 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 complaint, we would like you to let us know as soon as possible – ideally, within a matter of days or at most a few weeks – because this will enable us to establish what happened more easily. If it is not possible to do that, please let us have details of your complaint:

within 6 months of the incident that caused the problem; or
within 6 months of discovering that you have a problem, provided this is within 12 months of the incident

All complaints should be addressed to the Practice Manager. Complaints may be made in person ask to speak to the Practice Manager; you may be offered an appointment to see her if she is not available at the time, or in writing addressed to the Practice Manager. The 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.

Action Upon Receipt Of A Complaint

Verbal complaints will be acknowledged by the Practice Manager at the time of discussion. Written complaints will be acknowledged in writing within three working days, where that is not possible, as soon as reasonably practicable.

The practice aims to have looked into your complaint within ten working days of the date when you raised it with us. We shall then be in a position to offer you an explanation, or a meeting with the person/persons involved. When we look into your complaint, we shall aim to:

find out what happened and what went wrong;

make it possible for you to discuss the problem with those concerned, if you would like this;

make sure you receive an apology, where this is appropriate;

identify what we can do to make sure the problem doesn’t happen again

Review of Practice Complaints

A full review of all complaints is carried out annually to identify any trends or additional actions/learning points.

Complaining On Behalf Of Someone Else

Please note that we keep strictly to the rules of medical confidentiality. If you are complaining on behalf of someone else, we have to know that you have 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.

Where the patient is a child the practice may receive the complaint from:

Either parent , in the absence of both parents, the guardian who has care of the child

person authorised by a local authority whose care the child has been committed under the provisions of the Children Act 1989

Complaining To Ombudsman

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. But this does not affect your right to approach the parliamentary and Health Ombudsman, if you feel you cannot raise your complaint with us or you are dissatisfied with the result of our investigation. The contact details are:

The Parliamentary and Health Service Ombudsman

Millbank Tower

Millbank

London

SW1P 4QP

Tel: 0345 015 4033

Website: www.ombudsman.org.uk

You may also approach Patient Advice and Liaison Service (PALS) who provide confidential advice and support, helping you to sort out any concerns you may have about the care we provide, guiding you through the different services available from the NHS. PALS contact details are:

Patient Advice and Liaison Service

Warwickshire Primary Care Trust

Westgate House

Market Street

Warwick

CV34 4DG

Tel: 01926 493 491

Patient Home Visit Protocol

DORDON & POLESWORTH GROUP PRACTICE

Home Visit Protocol for Patients

The practice home visit policy is based on the General Medical Service (GMS) contract, the Local Medical Committee (LMC) guidance and the British Medical Association (BMA) guidance.

Home visits are time consuming; several patients could be seen in the practice in the time it would take to carry out one home visit. Please help the practice to help our other patients by visiting the surgery whenever possible.

The practice will carry out home visits for:

Terminally ill patients
Housebound – a patient who is defined as being an individual who is unable to leave their home environment due to a physical or psychological illness
Patients who are severely ill in bed

Patients are asked to request home visits before 11am. This allows the practice to access the request for necessity and urgency so that it can be appropriately managed. The practice may arrange for another member of the community team to carry out the home visit.

The following ARE NOT valid reasons to request a home visit:

Transport issues for patient

It is not the practice’s responsibility to arrange transport or to perform home visits because the patient has difficulty arranging transport. In these circumstances patients should seek transport help from relatives, friends or taxi firms.

Childcare issues for a patient

If a patient has difficulty arranging for someone to care for their children whilst attending appointments, the patients are welcome to bring their children to the surgery.

Poor mobility

Whilst it is understood that having poor mobility is in convenient and unpleasant, GP surgeries re designed to cater for patients with restricted mobility, if patients are able to attend appointments at other healthcare settings, then they should also be expected to attend appointments in the surgery.

Unwell Child

It is in the best interest of the child to attend the surgery where they can be properly assessed and treated. The Clinician can make a more informed clinical judgement when seeing the child in surgery.

If a parent believes that the child is too unwell to travel to surgery, and is a medical emergency then it would be advisable for them to seek help from the emergency services by calling 999.

Residents of care home

Care home residents are no different to patients in their own homes. The need to visit should be based upon clinical need, not the availability of transport or staff to attend the surgery. It is the responsibility of care facilities to make transport available for residents so that they can get to medical and non-medical appointments. Routine visit requests for care homes can be requested however will be deferred until appropriate clinical resource available.

Practice Telephone Calls

Calls to and from the surgery are recorded and processed in accordance with the General Data Protection Regulation 2016 and the Data Protection Act 2018, calls are recorded for monitoring, training and dispute resolution purposes. The purpose of call recording is to provide an exact record of the call which will:

Protect the interests of both parties;
Help improve Practice performance and best practice;
Help protect Practice staff from abusive or nuisance calls;
Establish the facts in the event of a complaint either by a patient or a member of staff and so assist in resolving it;
Establish the facts and assist in the resolution of any medico-legal claims made against the practice or its clinicians;
A call recording may also be used as evidence in the event that an employee’s telephone conduct is deemed unacceptable. In this situation the recording will be made available to the employee’s manager, to be investigated as per the Practice Disciplinary Policy.

For further information please contact the surgery

Privacy notice for sharing your data outside the practice

As a result of improvements in information technology and appropriate information governance standards, it is becoming possible to share your GP records across Coventry & Warwickshire Health & Social Care electronically using the practice clinical system. We will only share this information with your explicit consent, when seeing a health worker so that you are able to allow doctors, nurses and other health and social care services in other health organisations to view the information held on your GP records. Therefore, enabling health organisations to provide an appropriate health service required to meet the patients’ needs.

The following are examples of the types of organisations that we are likely to share information with:

NHS and specialist hospitals, Trusts
Independent Contractors such as dentists, opticians, pharmacists
Private and Voluntary Sector Providers
Ambulance Trusts
Clinical Commissioning Groups and Primary Care Networks
Social Care Services and Local Authorities

Any patient can choose to withdraw their consent to their data being used in this way. When the Surgery is about to participate in any new data-sharing scheme we will make patients aware by displaying prominent notices in the Surgery and on our website. These schemes are only for direct care so you (or your carer) will be present when the information is accessed and will be asked for consent again, before your records are opened.

A patient can object to their personal information being shared with other health care providers and can withhold consent but if this limits the treatment that you can receive then the doctor will explain this to you at the time.

Removal of patients from Practice List

REMOVAL OF PATIENTS FROM PRACTICE LIST

The Practice aims to provide the best possible health care for its patients. However there may be circumstances when it would be considered reasonable, or in the best interests of the patient, to remove patients from the list.

This protocol defines the practice guidelines for when it is reasonable to remove a patient from the practice list.

Reasons for removal from Practice List:

When a patient is physically violent or threatening towards a doctor, a member of the practice staff or other patients on the practice premises.

Causes physical damage to practice premises or other patient’s property.

Gives verbal abuse or makes threats towards the doctor, practice staff or other patients
· Gives racial abuse, orally or physically.
· Is violent or uses or condones threatening behaviour to doctors (or some other members of the primary health care team) while visiting the patient’s home. Such behaviour may involve the patient, a relative, a household member, or pets (such as unchained dogs)
· Where a patient fraudulently obtains drugs for non-medical reasons.
· Deliberately lies to the doctor or other members of the primary health care team e.g. by giving a false name or false medical history) in order to obtain a service or benefit by deception.
· Attempts to use the doctor to conceal or aid any criminal activity
· Steals from practice premises.
· Where a patient has moved out of the designated practice area and failed to register with another GP.
· Embarkation.
· Where a patient has moved abroad for a period of 3 months or more.
· Failure to attend pre-booked appointments.
· Where a patient fails to attend pre-booked appointments on a number of occasions during a given period.
· Irretrievable breakdown of Doctor-Patient relationship
· Where a patient’s behaviour falls outside of that which is normally considered reasonable and leads to an irretrievable breakdown of the doctor-patient relationship.

Shared Care Agreements with Private Providers

Shared Care Agreements are written agreements between specialist services and general practitioners and allow care, specifically prescribing, to be safely shared between them.

BMA guidance, Advice & Support, “shared care” with private providers:

Sometimes the care of a patient is shared between two doctors, usually a GP and a specialist, and there is a formalised written ‘shared care agreement’ setting out the position of each, to which both parties have willingly agreed. Where these arrangements are in place, GP providers can arrange the prescriptions and appropriate investigations, and the results are fully dealt with by clinicians with the necessary competence under the shared care arrangement. There is NHS guidance available about this.

Share Care is not recommended with private providers due to the NHS constitution principle of keeping a clear separation between private and NHS care. Shared Care is currently set up as an NHS service, and entering into a shared care arrangement may have implications around governance and quality assurance as well as promoting health inequalities. Shared care may be appropriate where contracted private providers are providing commissioned NHS services and where appropriate shared care arrangements are in place.

All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds. The responsibility for the patients care and ongoing prescribing then remains the responsibility of the private provider.

As a practice we are following the BMA guidance, around private ADHD shared care agreements. Presently we are not commissioned for most private ADHD services and therefore, not required to sign up for all private shared care agreements offering ADHD care.

We understand that this is frustrating, but until we are authorised by the Integrated Care Board Contracting Team, Coventry & Warwickshire who have reviewed the providers NHS contract there are limited prescribing ADHD providers we can refer to.

Statement of intent – Online Patient Services

Practice contact details

Practice name: Dordon & Polesworth Group Practice

Address: 162 Long Street, Dordon, Tamworth, Staffordshire, B78 1SY

Telephone: 01827 892893

Email address: admin.enquiries@dordonsurgery.nhs.uk

Website: www.dordonsurgery.nhs.uk

Current online patient services

GP system supplier – EMIS

GP system version – EMIS Web

This practice plans to offer the facility for patients to view online, export or print detailed coded information held in their own records from 31^st March 2016.

These dates are subject to the necessary NHS GP systems and software being available to the practice.

This practice currently offers the facility for patients:

to book, view, cancel and print appointments online
to order online, view and print a list of their repeat prescriptions for drugs, medicines or appliances
to view online, export or print summary information from their record, relating to medications, allergies and adverse reactions.

We will publicise and promote our online services to our practice’s patients through the practice website, practice waiting room leaflets, posters and the Patient Participation Group.

Veterans Policy