Policies and Procedures

You are entitled to have a chaperone present for any consultation, examination or procedure and this would be a specially trained member of staff. If you would like the practice to provide a chaperone, please try to request this in advance so that arrangements can be made and avoid the need for the appointment to be rescheduled. Your healthcare professional may also require a chaperone to be present for certain consultations. 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. You are free to decline any examination or chose an alternative examiner or chaperone.

Clinical governance describes the structures, processes and culture needed to ensure that
healthcare organisations – and all individuals within them – can assure the quality of the care they provide and are continuously seeking to improve it. The main components of clinical governance include: risk management, clinical audit, education training and CPD, evidence- based care, patient and carer involvement and staffing and management. If you would like further details on our clinical governance policy, please contact the practice manager.

All information from every contact you have with the practice is covered under the Data
Protection Act 1998 and includes both electronic and paper records and face to face and
telephone conversations. All staff within the practice will have access to your records to do their job and all are bound by the same rules of confidentiality. Anyone with access to your record is properly trained in confidentiality issues and is governed by both a legal and contractual duty to keep your details private.

Under 16

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.

Useful Websites

The purpose of this protocol is to set out the practice’s approach to consent and the way in
which the principles of consent will be put into practice. Where possible, a clinician must be satisfied that a patient understands and consents to a proposed treatment, immunisations or investigation.

Implied Consent:

Implied consent will be assumed for many routine physical contacts with
patients. Where implied consent is to be assumed by the clinician, in all cases, the following will apply: an explanation will be given to the patient about what he/she is about to do and why. In all cases where the patient is under 18 years of age, a verbal confirmation of consent will be obtained and briefly entered into the medical record. Where there is a significant risk to the patient an ‘Expressed Consent’ will be obtained in all cases (see below).

Expressed Consent :

Expressed consent (written or verbal) will be obtained for any procedure that carries a risk that the patient is likely to consider a substantial risk. A note will be made in the medical record detailing the discussion about the consent and the risks. A consent form may be used for the patient to express consent (see below).

Obtaining Consent:

Consent (implied or expressed) will be obtained prior to the procedure. The clinician will ensure that the patient is competent to provide a consent (16 years or over) or has ‘Gillick Competence’ if under 16 years (has ‘sufficient understanding and maturity to enable
them to understand fully what is proposed’). For children under 16 years, someone with parental responsibility should give consent on the child’s behalf by signing accordingly on the consent form.

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.

Wheelchair access

Our Harptree surgery is fully wheelchair accessible and the building is entirely on one level. The two doors leading to the waiting room are not power-assisted but a member of staff will be very happy to open them for you.

The Cameley surgery is a Grade II listed building and it has not been possible to provide suitable access to the upstairs consultation room nor the treatment room, where the nurses normally see patients. However, on request we can arrange for you to be seen by a doctor or nurse in the downstairs consultation room. Please mention if you have restricted mobility when booking your appointment. The main entrance is wheelchair accessible but not power assisted.

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.

Loop System

At both surgeries we have a loop induction system at the reception desk to assist the hearing impaired.

Blind/Partially Sighted

If you or family members are blind or partially sighted we can give you a CD or 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

Our practice is committed to providing equality of opportunity and anti-oppressive practice. The organisation will not tolerate any kind of discrimination, harassment or oppressive practices and is committed to stopping it.

The organisation wishes to secure genuine equality of opportunity whether required by
legislation or not, in all aspects of its activities.

It applies to the provision of services, all aspects of employment from recruitment, selection and training of staff and volunteers, to conditions of service and reasons of termination of employment.

The individual responsibility of everyone connected to and acting on behalf of the organisation.

We aim to ensure that:

  • No person is treated less favourably than another on grounds of:
    • age
    • gender
    • marital status
    • physical or mental disability
    • race
    • responsibility for dependants
    • sexual orientation
    • caring responsibilities
    • political affiliation
    • religious belief
    • offending background
    • or any other improper ground
  • All employees and job applications are treated fairly and consistently and are not subject
    to unjustifiable requirements or conditions.
  • Services provided to the public do not disadvantage patients on any of the grounds
    detailed above.

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:

All GP practices are required to declare the mean earnings (eg average pay) for GPs working to deliver NHS services to patients at each practice.

The average pay for GPs working at Harptree & Cameley Surgery in the last financial year was £38,268 before tax and national insurance. This is for 3 full-time GPs and 4 part-time GPs who worked in the practice for more than six months.

We aim to keep our surgery clean and tidy and offer a safe environment to our patients and staff 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

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.

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 British Medical Association (BMA) sets fees for non-NHS work?

The 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 suffer.

The practice will endeavour to deal with your request as quickly as possible.  We will always prioritise urgent NHS work, therefore this information (your request) may take up to 28 days to be available to you from the date of your written request.  This period may have to be extended to three months in some circumstances.

I only need the doctor’s signature – what is the problem?

When a GP 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 GP 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.

In most instances we will request payment in advance.

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 28 days.

The impact of patients failing to attend appointment can be significant and may result in you not being able to see a particular GP on the day that you wish to.

In an attempt to try and resolve this, the practice has developed the following policy:

  • If you fail to attend two consecutive appointments without informing us, we will write to you asking whether there are specific problems preventing you from letting us know.
  • If you fail to attend a further appointment, you may be removed from the practice list and have to find an alternative.

View our Privacy Policy (with Subject Access Requests) here

The NHS Constitution states that research is a core function of the NHS. Clinical research is a major driver of innovation and central to NHS practice for maintaining and developing high standards of patient care.

Ultimately, clinical research means patients get access to new treatments, interventions and medicines. Investment in research means better, more cost-effective care for patients.

How can I get involved?

There are different ways that patients can become involved in studies our practice is
participating in.

  • A GP or nurse may talk to you about the study and ask whether you would consider
    taking part,
  • You may be sent information through the post if we feel that you might be a suitable
    participant, or
  • You may read information on the website about a current study you wish to take part in.

For further information, please contact reception. The notice board in the main waiting room also holds information on some of these studies.

Everyone has the human right to live a life that is free from abuse and neglect. Safeguarding means protecting vulnerable adults and children who are at risk and need support, and is fundamental to ensuring high-quality health and social care. If you are concerned that someone is at risk of abuse, don’t hesitate to report your concern with the Virgin Care ASIST team on 01225 396000. You can find more support and advice about services in B&NES, including how to report concerns, here.

People who may be particularly vulnerable to abuse include:

  • disabled people who have physical or sensory impairments
  • people who have learning difficulties
  • people who experience mental ill health
  • older people
  • children
  • people who live in care homes
  • people with acquired brain damage
  • People who misuse substances.

Identifiable information about you may be shared with others with your prior written consent. This includes friends and family, other healthcare providers and social services if you require any further treatment or services. This is also true if we are asked to provide information about you, for example, a medical report for insurance or mortgage purposes. In all circumstances we will only share appropriate and necessary information.

Sometimes the law requires us to pass on information e.g. to notify a birth or when we encounter infectious diseases that may endanger the safety of others. Anonymised patient information will also be used at local and national level to help the Health Board and Government plan services e.g. for diabetic care. If you do not wish anonymous information about you to be used in such away, please let us know.

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

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 requires 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 GP2GP 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.

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 email or phone. Our details can be found on our Contact Us page.

We request that complaints are submitted in writing.

If your complaint has been investigated by the practice and you are not happy with how
the practice has handled this then you may consider contacting the following advice
agencies:

NHS Bath and North East Somerset Clinical Commissioning Group Patient Advice and
Liaison Service (PALS)

PALS is impartial and will work with you to try to resolve a difficulty or problem and can act on your behalf if you wish.  We will discuss with you the best ways to resolve your concerns or problems and will agree with you what action to take for your individual circumstances, contact us on:

Freephone: 0300 013 4762
Email: BSCCG.Feedback@nhs.net
Address: PALS and Complaints Manager, NHS Bath and North East Somerset Clinical
Commissioning Group, 1 st Floor, Kempthorne House, St Martin’s Hospital, Clara Cross Lane, Bath BA2 5RP.

NHS England

By post to: NHS England
PO Box 16738
Redditch
B97 9PT
By email to: england.contactus@nhs.net

If you are making a complaint please state: ‘For the attention of the complaints team’ in the subject line.

By telephone: 0300 311 22 33

Our opening hours are: 8am to 6pm Monday to Friday, except Wednesdays when we open at the later time of 9.30am.

Health Services Ombudsmen

Telephone: 0345 015 4033
Textphone: 0300 061 4298
(open 8.30am – 5.30pm, Monday to Friday)
Email: phso.enquiries@ombudsman.org.uk
Website: www.ombudsman.org.uk

Your Summary Care Record contains important information about any medicines you are taking, any allergies you suffer from and any bad reactions to medicines that you have previously experienced.

Allowing authorised healthcare staff to have access to this information will improve decision making by doctors and other healthcare professionals and has prevented mistakes being made when patients are being cared for in an emergency or when their GP practice is closed.

Your Summary Care Record also includes your name, address, date of birth and your unique NHS Number to help identify you correctly.

You may want to add other details about your care to your Summary Care Record. This will only happen if both you and your GP agree to do this. You should discuss your wishes with your GP practice.

Healthcare staff will have access to this information, so that they can provide safer care,
whenever or wherever you need it, anywhere in England.

FAQs

Who can see my Summary Care Record?

Healthcare staff who have access to your Summary Care Record:

  • need to be directly involved in caring for you
  • need to have an NHS Smartcard with a chip and passcode
  • will only see the information they need to do their job and
  • will have their details recorded every time they look at your record

Healthcare staff will ask for your permission every time they need to look at your Summary Care Record. If they cannot ask you (for example if you are unconscious or otherwise unable to communicate), healthcare staff may look at your record without asking you, because they consider that this is in your best interest.

If they have to do this, this decision will be recorded and checked to ensure that the access was appropriate.

What are my choices?

You can choose to have a Summary Care Record or you can choose to opt out.

If you choose to have a Summary Care Record and are registered with a GP practice, you do
not need to do anything as a Summary Care Record is created for you.

If you choose to opt out of having a Summary Care Record and do not want a SCR, you need to let your GP practice know by filling in and returning an opt-out form. Opt-out forms can be downloaded from the website or from your GP practice.

If you are unsure if you have already opted out, you should talk to the staff at your GP practice. You can change your mind at any time by simply informing your GP practice and either filling in an opt-out form or asking your GP practice to create a Summary Care Record for you.

To learn more see: https://bsw.icb.nhs.uk/your-health/your-care-record/

Children and the Summary Care Record

If you are the parent or guardian of a child under 16, you should make this information available to them and support the child to come to a decision as to whether to have a Summary Care Record or not.

If you believe that your child should opt-out of having a Summary Care Record, we strongly
recommend that you discuss this with your child’s GP. This will allow your child’s GP to highlight the consequences of opting-out, prior to you finalising your decision.

Where can I get more information?

For more information about Summary Care Records you can:

The Surgery is an approved training practice for the training of General Practice Registrars
(GPRs). Being an approved training practice means that:

  • patients can directly contribute to the training of future GPs
  • patients who consult with the GPR will have longer consultations
  • it keeps all doctors and nurses in touch with new medical developments and skills
  • it improves all doctors and nurse’s consultation and training skills
  • it ensures that clinical standards and standards of medical record keeping are maintained
  • it helps with recruitment of high quality doctors to the practice for job vacancies

GPRs are qualified doctors in training who have already worked in hospitals as junior doctors for at least 3 years and have now decided that they would like to specialise in General Practice.

In order to qualify as a GP all doctors have to complete Postgraduate Specialist Training which includes at least 18 months training in General Practice.

Very occasionally, as part of an essential component of training in all medical practice, your consultation may be filmed and reviewed later by the trainer and GPR. We hope that all our patients will be willing to take part in these educational consultations to help us all in improving and maintaining our medical and consultation skills. All video recordings are strictly confidential and are used for teaching only. We will not video your consultation without your consent.

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 72 hours 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 72 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 20 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 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:

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.