Introduction and Overview

The National Carers Strategy identified the National Health Service as being the first and most important point of contact for the majority of carers (The National Carers Strategy, 1999). It is therefore vital that GPs play a pivotal role in identifying increased numbers of the ‘hidden carers’ who continue to fall through the system.

There are currently an estimated 60,000 carers in Manchester (Manchester Carers Strategy 2008 – 2011), of which the majority are unknown to Social Services or their local GP with an estimated 1 in 10 patients in a practice undertaking caring responsibilities, which may have an adverse affect on their health and well-being (Best Practice, Better Practices – A New Deal for Carers In Primary Care 2006).

Guidance

The practice should have a procedure for how carers are identified and a referral protocol to social services for assessment of carers support needs or to other local support such as carers centres.

A carer is identified as, someone who, without payment, provides help and support to a relative, friend or neighbour, who could not manage to stay at home without their help due to age, sickness, addiction or disability.

The practice should remember to include any young carers who are particularly vulnerable.

Further Information:

• NHS Carers Information Strategies guidance – HDL22 (2006) (sections 3.3 and 3.10)

Methodology For Identifying Carers

Identifying a Carer will enable them to receive information, advice, support and training which may include financial assistance.

Carers are identified by:

• All new patients are asked about caring responsibilities on New Patient Questionnaire – this information is then entered into the patient’s clinical record by Debbie Mohammed
• There is a notice in the waiting room inviting patients to identify themselves as carers
• Patients are asked opportunistically during consultations about caring responsibilities
• Occasionally, members of the reception team may learn of a patient’s Carer status and are aware that the Practice Manage or a doctorr should be informed

Mechanism For Referral

Patients who identify themselves as carers can be referred to Manchester City Council by faxing the attached referral form. (refer to Items 2, 3 and 6 of MCC Toolkit).

To refer a patient for Carers Assessment, please contact Manchester City Council’s Contact Centre on 0161 255 8250. Please note that this is for residents of the Manchester City Council area only – external residents will need to be referred to their local authority. It may therefore be necessary to contact local services outside the Manchester area, especially for practices residing near boundaries, as a change in practice process may have an effect on their workload i.e. increased number of referrals/queries.

As the role of a Carer is most likely to change with time, it has been recommended by Social Services for a Carer to be re-assessed at least once every 12 months.

Practice Carer Lead

The Practice Manager/Nominated Other Member will be the Carer Lead and will:

• undertake the role of maintaining and monitoring the Carer Protocol within the practice
• promote an awareness of caring services and available literature amongst the practice team

Acknowledging A Carers Status

Once a Carer has been identified, it is then necessary to document this information accordingly and create a dedicated dynamic Carers Register.  This would enable GPs to identify who a Carer is and take into account their unique and individual needs.  This information may then be passed over (consent must be provided by patient/carer) to other agencies and professionals i.e. hospitals etc.

• Once a Carer has been identified their Carer status will be entered into their clinical record using the appropriate Read Codes illustrated on page 7 of this document.
• A Carer Register will be created by the Practice Manager conducting a search of these codes on the practice’s clinical system on a 3-monthly basis
• New Carer’s will be asked if they wish to complete a Carer’s Self-Referral Form for submission to the Carer’s Strategy Team at Manchester City Council

Supporting A Carer

• Carer’s can either be offered or request longer appointments with the doctor or nurse
• The practice will endeavour to provide any relevant literature, website addresses, contact numbers for Carer’s upon request
• Practice staff are aware that Carer’s have special needs and will respond to these, where possible and appropriate

Under Age Carers

Carer’s under the age of 18 are identified when they come in with the patient or when a clinician has been to the residence for a visit.

Monitoring Effectiveness

i.e. annual reviews, carer surveys, feedback to staff and carers etc.

Appropriate/suggestive Read Codes

• 918A Carer
• 918G Is a carer
• 918F Has a carer
• 918H Primary Carer
• 918V Does not have a carer
• 918f Is no longer a carer
• 918c Carer of a person with chronic disease
• 918m Carer of a person with a terminal illness
• 918W Carer of a person with learning disability
• 918X Carer of a person with physical disability
• 918d Carer of a person with mental health problems
• 918y Carer of a person with sensory impairment
• 918a Carer of a person with substance misuse
• 918b Carer of a person with alcohol misuse
• 918g Parent is informal carer
• 918h Child is informal carer
• 918i Relative is informal carer
• 918j Partner is informal carer
• 918k Friend is informal carer
• 918l No longer has a carer
• 3892 Assessment of needs of carer completed
• 671E Discussed with Carer
• 807 Carer Support
• 9180 Carer Details
• 918E Is A Carer

All patients have the opportunity of being examined in the presence of a chaperone when an intimate examination is carried out.

The chaperone could be someone you bring to the surgery, a member of staff or an interpreter.

If you know in advance that you would like someone with you please inform reception at the time of booking the appointment.

Everyone who works for the NHS has a legal duty to keep information about you confidential. We will only provide information to those who are authorised to receive it and who will keep it confidential. Whenever possible any information passed on will be anonymised.

In line with the new GDPR (General Data Protection Regulation Act) which comes into force on 25th May 2018 you will be asked by a member of staff/clinician for your consent before sending any referral/information to other medical professionals in looking after your clinical needs.

We hold your patient records in the strictest confidence, regardless of whether they are electronic or on paper. We take all reasonable precautions to prevent unauthorised access to your records, however they are stored. Any information that may identify you is only shared with the practice team, or, if you are referred to hospital, to the clinician who will be treating you. We will only share information about you with anyone else if you give your permission in writing.

Use of your contact details

We may try to contact you using the mailing address, land line telephone number, mobile telephone number (including text messaging) or email address that you provide. This may be for, amongst other things, appointment reminders, information about special clinics or to request information from you. If you prefer not to be contacted by one or more of these means then please let us know so that we can record your preferences.

It is your responsibility to ensure that the practice has your current contact details to ensure that there is no possible delay to your treatment.

Data Protection Notice

We ask you for information about yourself so that you can receive proper care and treatment. All personal information (updated as appropriate), together with details of your care, is stored in your medical record which is held on paper and computer. All members of the practice are contractually and ethically obliged to maintain the confidentiality of your medical record at all times, even after leaving the practice. Just because we hold the data does not give every member of staff the right to look at it. Anyone viewing your medical record must have a valid reason to do so in the course of performing their job. All computer held records have an audit trail of activity by all users.

Officially, your medical record is the property of the Secretary of State for Health. However, we are considered to be the Data Controller and therefore responsible for the confidentiality of your medical record whilst you are registered as a patient with us.

We are required to share certain identifiable data about you with other parts of the NHS in relation to financial claims. This will ordinarily just be your NHS number. We also share demographic and relevant clinical details within the NHS for the purpose of operating recall systems, eg childhood immunisations, cancer screening and diabetic retinopathy programmes.

If you require care from another healthcare provider, eg a referral to see a specialist, then we will need to share relevant information about you and your care. We will obtain consent to this sharing if you are in agreement with the need for the referral.

The information we hold about you may be used for secondary purposes. This includes planning health services, clinical audit, monitoring the spread of disease (epidemiology) etc. Your personal details are never disclosed for secondary purposes, only relevant clinical data is provided, for example the total number of people registered with us who have diabetes.

We will never disclose any information about you to a third party without your consent, unless required to do so by law.

• How is your personal information kept safe and secure in the Greater Manchester Care Record?

Access to Records

If you wish to request access to your medical records under the terms of the Data Protection Act 1998 to be updated by the GDPR Act which comes into force 25th May 2018, then you should apply in writing to the Data Controller. You should include your name, date of birth and the address that we will have on your file. Such requests must be accompanied by a signature and you are therefore advised to write or come in person to issue your request. Please note that as of the 25th May 2018, you will no longer be required to pay a fee although depending on the request e.g. a written medical report a fee will be applied. If you request copies of your medical records on more than one occasion we are able to provide apply an administration fee. As we are no longer able to charge for our time and consumables for providing copies of your records you may be required to attend the practice to collect them for onward transmission as the postage can be quite costly dependent on the size of your records. Further information about your rights under this Act are available from the Information Commissioner’s website.

www.ico.org

The Information Commissioner recognises the unprecedented challenges the NHS and other health professionals are facing during COVID-19.

The ICO (Information Commissioners Office) also recognise that ‘Public bodies may require additional collection and sharing of personal data to protect against serious threats to public health.’

On 20th March 2020 the Secretary of State for Health and Social Care issued a Notice under Regulation 3(4) of The Health Service (Control of Patient Information) Regulations 2002 requiring organisations such as GP Practices to use your information to help GP Practices and other healthcare organisations to respond to and deal with the COVID-19 pandemic.

In order to look after your healthcare needs during this difficult time, we may urgently need to share your personal information, including medical records, with clinical and non-clinical staff who belong to organisations that are permitted to use your information and need to use it to help deal with the COVID-19 pandemic. This could (amongst other measures) consist of treating you; and enable us and other healthcare organisations to monitor the disease, assess risk and manage the spread of the disease.

Please be assured that we will only share information and health data that is necessary to meet yours and public healthcare needs.

The Secretary of State for Health and Social Care has also stated that these measures are temporary and will expire on 30th September 2020 unless a further extension is required.

Please also note that the data protection and electronic communication laws do not stop us from sending public health messages to you, either by phone, text or email as these messages are not direct marketing.

It may also be necessary to use your information and health data to facilitate digital consultations and diagnoses and we will always do this with your security in mind.

If you are concerned about how your information is being used, please contact our DPO using mhcc.ig@nhs.net.

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 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 Data Protection Act.

For more information see these websites:

• Legislation GOV.UK
• Information Commissioners Office

The average pay for GPs working in Dickenson Road Medical Practice in the 2020/21 financial year was £140,453 before tax and National Insurance.

This is for 4 part time GPs who worked in the practice for more than 6 months.

We aim to keep our surgery clean and tidy and offer a safe environment to our patients and staff. We are proud of our 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. Ankita Shah is our lead on infection control implementation in the practice.

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

• Privacy Notice
• GDPR Leaflet
• Privacy Information Leaflet
• Fair Processing Notice for Patients

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.

If you have a comment, concern or complaint about any staff member or aspect of service then please let us know.

How to complain

We handle complaints in line with the NHS complaints procedures.

We hope that most problems can be resolved at the time between those parties concerned. Please ask to speak to the Practice manager or Operations Manager at the time of the incident. However, if this is not possible then you can phone or write to the practice manager as soon as possible. Prompt contact will enable us to investigate the matter more easily.

There are some time limits for reporting any issues. Complaints should be reported within twelve months of the incident, or within twelve months of becoming aware of the incident.

Please be as precise as possible when documenting your complaint. Vague statements such as “they were rude on the phone” are very difficult to investigate or evidence afterwards. Give examples of things that were said that you considered to be rude.

What we will do

We must acknowledge receipt of your correspondence within three working days of receiving it.

Our acknowledgement will offer you the opportunity to discuss how we will handle your complaint and provide the date by which we will respond in full.
Our investigation will allow for the following points.

• To find out why the incident occurred and how;
• To make it possible for you to discuss the complaint with those concerned if you would like this;
• To provide an apology if and when appropriate;
• To inform you of our plans to prevent similar incidents occurring in the future.

Complaining on behalf of someone else

Please note that we are unable to divulge patient details to any third party without prior written consent of the patient.

Therefore if you are complaining on behalf of someone else, you must provide a letter of authorisation from the person concerned, unless they are incapable of doing this (eg due to illness). If you cannot provide consent then please contact us for advice.

Complaining to someone outside the practice

We hope that you will use our internal complaints procedure and allow us to resolve your complaint. However, under NHS complaints procedures you can raise your concerns with the commissioner of the service. Both NHS England and Greater Manchester Integrated Care Board(GM ICB) commission us to provide services. You can contact them using the details below.

NHS England Contact Centre
NHS Commissioning Board,
PO Box 16738,
Redditch,
B97 9PT

0300 311 2233
www.england.nhs.uk/contact-us/complaint

Complaints
Manchester – NHS GM ICB,
Manchester Feedback and Complaints Service
PO Box 532,
Town Hall,
Manchester,
M60 2LA

Email: nhscomplaints@manchester.gov.uk
Call: 0161 953 8388

https://gmintegratedcare.org.uk/have-your-say/contact-us/

Dickenson Road Medical Centre aims to provide high quality healthcare and we will treat all patients with respect and dignity.

Verbal or physical assaults on staff will be taken very seriously and police assistance sought. This will result in your immediate removal from our list.

Unfortunately, there has been an increase in verbal and physical attacks on staff and this is unacceptable.

Dickenson Road Medical Centre and Manchester Health and Care Commissioning support The NHS Zero Tolerance Policy. This policy recognises the increasing problem of violence against staff working in the NHS and ensures that doctors and healthcare staff have a right to care for others without fear of being attacked or abused.

Patients also have a right to access services without fear of violence at their practice.

In line with this policy, we have a zero tolerance approach to aggression, abuse, violence or anti-social behaviour.

What do we mean by zero tolerance?

We understand that when patients feel ill, they 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 healthcare professionals and practice staff courteously and act reasonably.

Whilst it is not possible to list all types of incidents, some examples of unacceptable behaviour are provided below:

• offensive language, verbal abuse and swearing
• racist and hate comments
• loud and intrusive conversation
• unwanted or abusive remarks
• negative, malicious or stereotypical comments
• carrying weapons or using objects as weapons
• damage, defacing or vandalism of NHS property
• threats or risk of injury to NHS staff
• intimidation
• stalking
• unreasonable behaviour and non-cooperation

This relates to any form of abuse from patients or staff which includes (but is not limited to) sexism, racism homophobia, biphobia, transphobia and ageism, or harassment or abuse on basis of disability, marriage or civil partnership, pregnancy or maternity, religion or belief.

Such behaviour or verbal abuse causing distress and or constituting harassment will not be tolerated and could lead to the person being removed from the practice list. In extreme cases the police will be contacted if the patient is posing a threat to staff or others.

If you wish to provide feedback or make a complaint, please click on the link below:

Feedback & Complaints

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 practice, 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 if there is a 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.

For more information and the latest news, please visit our home page: www.dickensonroadmc.nhs.uk/news_archive