Practice Policies & Patient Information
A Short History
Although it is recorded that in 1851 there were six doctors and surgeons resident in Pocklington, for most of the last century there were five in two practices. In 1965 Dr Fairweather and Dr Moll had a surgery on West Green and Drs Isherwood, Jones and Laing in Regent Street. In 1970 the Health Centre opened and the following year the two practices joined forces to become the Pocklington Group Practice. By 1987 the growth in population and services offered necessitated the move to the previous premises larger premises which were wholly owned by the partners. Fund holding saw the purchase of further premises, the Bungalow Annex, which housed two further consulting rooms and was used for additional services such as Outreach clinics from York District Hospital, midwife clinics and as an out of hours, Primary Care Centre. Since 2015 the practice has been here at the Beckside Centre, a purpose built Practice wholly owned by the Partners. The number of doctors has grown to 12, with 2 nurse practitioners,4 practice nurses, 3 HCAs, a pharmacist plus a number of ARRS personnel including pharmacists, FCP Physio, FCP MH Nurse, social prescriber, Nurse Associate trainee and care coordinators. The team supports our circa 18500 patient population which continues to grow.
Complaints Procedure
Comments, complaints and suggestions are welcome on any aspect of the Practice and the services it provides. Please be assured that all information will be treated confidentially at all times.
If you wish to discuss any matter with us, please initially direct any communication to hnyicb-voy.complaints.pgp@nhs.net.
Pocklington Group Practice follows the NHS Guidelines on dealing with comments, complaints or suggestions about the way that the Practice provides services to its patients.
View our complaints policy here
Complaint Third Party Consent Form
Background Information
If patients are not happy with the NHS care or treatment they have received or they have been refused treatment for a condition, they have always had the following rights:
- have a complaint dealt with efficiently and have it properly investigated,
- know the outcome of any investigation into the complaint,
- have their complaint investigated by a higher authority if they were not satisfied with the way in which the NHS had dealt with their complaint,
- make a claim for judicial review if they felt they had been directly affected by an unlawful act or decision of an NHS body
All the above still stands today and it is the Parliamentary and Health Service Ombudsman who will undertake independent reviews of complaints where complainants are not satisfied with the way the NHS has dealt with their complaint. This change has been brought about by new legislation which, on 1 April 2009, saw the creation of the Care Quality Commission, bringing together the responsibilities of the Commission for Social Care Inspection, the Mental Health Act Commission and the Healthcare Commission. The new legislation has brought about key changes to the way in which NHS complaints are to be handled which means that there will be only two stages to resolving complaints; local resolution at practice/NHS England level or referral to the Ombudsman.
Within this Practice, the people involved in the complaints process are the Complaints Manager (the Deputy Practice Manager)who is responsible for handling and considering complaints in line with the new legislation along with our Business PA and the Responsible Person (one of our GP Partners) who will ensure that compliance with the complaints procedure is achieved.
When should a complaint be made?
Complaints should be made as soon as possible, normally within 12 months of the date of the event being complained about or as soon as the matter first came to the complainant’s attention.
The time limit can be extended sometimes (so long as it is still possible to investigate the complaint). An extension might be possible, for example, in situations where it would have been difficult for the patient to complain earlier, such as if they were grieving or undergoing trauma.
Who can complain?
A complaint can be made by a patient, or anyone else who has been affected by the action, omission or decision of the practice that led to the complaint.
There are a number of cases when a complaint may be made by a third party acting on behalf of someone else; when the individual has died, when the individual is a child, or when the individual is physical or mentally incapable of making a complaint. An individual is also permitted to request that a third party makes the complaint on their behalf.
When a complaint is made by a third party on behalf of a child or individual lacking mental capacity, the practice must be satisfied that there are reasonable grounds for this method of representation and that the third party is genuinely acting in the best interests of the individual. If the practice is not satisfied that this is the case, they must inform the representative in writing, stating the reasons for this decision.
Who does a patient complain to?
Where a patient wishes to make a complaint about a GP Practice, the most appropriate step is normally to raise the matter with the Complaints Manager within the practice, either orally or in writing. This is referred to as local resolution and most cases are resolved at this stage. However, patients can choose to complain to NHS England instead if they wish – note the paragraph about complaints to NHS England on page 3 of this document.
Procedure for Oral Complaints which can be resolved by the end of the next working day
Where patients wish to make an oral complaint which can be resolved by the end of the next working day, such complaints should be brought to the attention of the Complaints Manager (Deputy Practice Manager) or the Business PA. Such complaints do not have to be dealt with under the following procedure.
Procedure for Written/Oral Complaints which cannot be resolved by the end of the next working day
For written complaints or oral complaints which cannot be resolved to the patient’s satisfaction by the end of the next working day, these should be brought to the attention of the Complaints Manager (Deputy Practice Manager) or the Business PA who will ensure the following:
- agree which responsible body will co-ordinate the handling of the complaint and any communications with the complainant
- acknowledge receipt of any complaint either orally or in writing within three working days and offer to discuss the matter further
- include in the discussion with the patient how the complaint will be handled and the likely period for completion of the investigation and responding to the complainant. (If the complainant does not accept the offer of a discussion, the responsible body must determine a specified response period and notify the complainant in writing of that period.)
- accept a request from NHS England to handle a complaint received by them and send an acknowledgement to the complainant within three working days (as long as NHS England receive consent from the complainant that they wish the practice to have details of the complaint and for the practice to handle their complaint.) – see separate note below.
- record all oral complaints in writing and provide a copy of the written record for the complainant
- investigate complaints appropriately and deal speedily, but efficiently with all complaints (there is no allotted timescale for resolution, as it is accepted that the requirements will differ from case to case.)
- keep the complainant informed as far as reasonably practicable of the progress of the investigation
- send the complainant a written response as soon as reasonably practicable after completing the investigation. (This response may be electronic if the complainant has consented in writing or electronically and has not withdrawn that consent.)
This response must be signed off by the “Responsible Person” (unless they are absent for a prolonged period of time) and include a report containing the following details:
- an explanation of how the complaint has been considered
- the conclusions reached, including any matters for which the complaint specifies, or the responsible body considers, that remedial action is needed
- confirmation that the responsible body is satisfied that action needed in consequence of the complaint has been, or is proposed, to be taken
- details of the complainant’s right to take their complaint to the independent Parliamentary and Health Service Ombudsman (PHSO)
- monitor and record
- each complaint;
- the subject matter and outcome of each complaint
- the fact that the complainant was notified of the response period specified, any amendment of that period and whether a report was sent to the complainant within that period
- produce an annual report for NHS England as soon as practicable after 31 March for the preceding 12 months including:
-
- the number of complaints received
- the number of complaints that were shown to be well founded
- the number of complaints that the practice has been informed have been passed to the PHSO
- a summary of the subject matter of complaints
- any matters of general importance arising
- the way in which complaints were handled
- the issues they raise and any matters where action has been taken or is to be taken to improve services as a consequence of those complaints
Complaints made directly to NHS England
If a complaint about a Practice is made directly to NHS England, they will seek permission from the complainant to share the details of the complaint with the practice otherwise it cannot pursue the complaint. Once permission has been granted, NHS England may decide that it is still appropriate that they handle the complaint. However, it is the intention set out in this guidance that complaints should be managed as near to the complainant as possible and therefore NHS England may wish to pass the complaint to the practice to be handled. In such cases, the complainant would be informed and their consent obtained before this was undertaken. In such cases, the complaint would then be deemed as having been made to the practice rather than to NHS England.
NHS Commissioning Board, PO Box 16738, REDDITCH, B97 9PT
Telephone: 0300 311 2233
Email: nhscommissioningboard@hscic.gov.uk
Dissatisfied Complainants
Where a complainant is still dissatisfied with the outcome of the investigation of their complaint, they can refer the matter to the Parliamentary and Health Service Ombudsman who is completely independent of the NHS and government:
The Parliamentary and Health Service Ombudsman
Citygate, 47-51 Mosley Street, Manchester M2 3HQ
Helpline: 0345 015 4033
E-mail: phso.enquiries@ombudsman.org.uk
Who can help?
Making a complaint can feel like a daunting process, but there is help available.
The Independent Complaints Advocacy Service (ICAS) is a free, confidential and independent service which can help you make a formal complaint about NHS services. You can contact your local ICAS directly. Find it in the phone book or through the hospital manager.
Your local Citizens Advice Bureau can advise on NHS complaints.
Citizens Advice Bureau, The Youth Centre, New Street, Pocklington
East Yorkshire YO42 2QA
Telephone: 0300 330 0888
Pocklington Group Practice
Acknowledgements
This policy has been created using information from the following sources:
Northern Lincolnshire and East Yorkshire Local Medical Committees
Department of Health
Dignity and Respect
INTRODUCTION
This policy sets out the Practice provision to ensure that patients are afforded privacy and dignity, and are treated respectfully, in all appropriate circumstances where there is the potential for embarrassment or for the patient to feel “ill at ease”.
The requirement to respect patients is the responsibility of all staff, not just those in direct clinical contact with the patient.
Vulnerable patients in this respect may include:
- Elderly
- Infirm
- Disabled
- Those with racial or cultural beliefs
- Illiterate
- Homeless / no fixed abode
- Those with specific conditions
- Patients with communication difficulties
- Those patients with gender requirements
- Those known to staff / known by staff
- Family members
PROVISIONS
Reception
- The Practice will not stereotype patients based on perceived characteristics
- Patients will be referred to with respect even in private discussions in the surgery
- Patients will be addressed by their preferred method and titles (Mr, Mrs etc) will be used as a first preference by staff
- A sign will be available in reception to offer the facility of a private discussion with a receptionist if required
- Guide dogs will be permitted in all parts of the building. See Guide Dogs Policy [*]
- Under no circumstances will staff enter through a closed consultation room / treatment room door without first knocking, and waiting for permission to enter (if occupied), or pausing to determine that the room is empty
Consultations
- Patients will be allowed free choice of gender of doctor and nurse, where available, and will be able to wait or delay an appointment to see their choice of clinician Where clinically urgent patients will be encouraged to see a clinician appropriate for their “best care” however undue pressure is not appropriate
- Consultations will not be interrupted unless there is an emergency, in which case the room will be telephoned as a first step, before knocking at the door and awaiting specific permission from the clinician to enter
- A chaperone will be offered where an examination is to take place.
- Clinical staff will be sensitive to the needs of the individual and will ensure that they are comfortable in complying with any requests with the potential to cause embarrassment
- Patients will be afforded as much time and privacy as is required to recover from the delivery of “bad news”, and the clinical staff will, where possible, anticipate this need and arrange their appointments accordingly
- Patients will be able to dress and undress privately in a treatment room, or, where a separate treatment room is not available, a screen will be provided for that purpose. Patients using this facility will be requested to advise the clinician when they are ready to be seen, and they will be afforded sufficient time to do this bearing in mind infirmity etc.
- A clean sheet will be available in each examination / treatment room, changed after each patient, and the patient will be advised of its availability
- Clinicians and staff will allow “personal space” where possible and respect this
- Patients will be given adequate opportunity, time and privacy for the provision of samples on the premises without feeling under duress or time limitation
- The area used for dressing / undressing will be equipped with coat / clothes hangers, pegs, or similar for clothes, and will have a chair with arms at a suitable height and design available and suitable for the patient to use
- Patients with difficulty in understanding due to language may have a family member or friend available to interpret or assist
- Communication by staff to patients will be individual according to the needs of the individual patient (e.g. those with speech difficulties, hearing, or learning difficulties may need an individual approach)
- Where an intimate examination is considered necessary to be performed on a patient with difficulty in understanding due to language or other issues (e.g. consent or cultural issues) it is recommended that a Chaperone or family member / carer should always be present
- Areas used by patients for dressing / undressing will be secure from interruption or ingress (i.e. there will be no unlocked door to either a corridor or to any room not occupied by the consulter who is attending that patient
- Patients who may have difficulty in undressing may be offered the services of a second (same gender) clinician or trained Chaperone to assist
- Patients will be requested only to remove a minimum of clothing necessary for the examination
- Consultations in the patient’s home will be sensitive to the location and any other persons who may be present or may overhear
Post – Consultation
- Clinicians and staff will respect the dignity of patients and will not discuss issues arising from the above procedures unless in a confidential clinical setting appropriate to the care of the patient (respectful of the patient even when not there)
GDPR
GP Earnings
GP net earnings for the 2022/23
Income after removal of excluded items per guidance notes | £2126,919 |
Expenditure after removal of excluded items per guidance notes | £849,021 |
Net earnings for reporting purposes | £1117,239 |
Total number of GPs party to contract for at least six months in 2022/23 * | 12 |
Reportable net earnings per GP | £93,103 |
GP earnings 2021/22
NHS England requires that the net earnings of doctors engaged in the practice is publicised, and the required disclosure is shown below.
However, it should be noted that the prescribed method for calculating earning is potentially misleading because it takes no account of how much time doctors spend working in the practice, and should not be used to form any judgment about GP earnings, nor to make any comparison with any other practice.
All GP practices are required to declare the mean earnings (e.g. average pay) for GPs working to deliver NHS services to patients at each practice, the required disclosure is shown below.
The average pay for GPs working in Pocklington Group Practice in the last financial year was £73,826 before tax and National Insurance. This is for 5 full time GP’s and 7 part time GP’s who worked in the practice for more than six months.
GP earnings 2020/21
All GP practices are required to declare the mean earnings (e.g. average pay) for GPs working to deliver NHS services to patients at each practice, the required disclosure is shown below.
The average pay for GPs working in Pocklington Group Practice in the last financial year was £83,202 before tax and National Insurance. This is for 6 full time GP’s and 5 part time GP’s who worked in the practice for more than six months.
However, it should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors spend working in the practice, and should not be used to form any judgment about GP earnings, nor to make any comparison with any other practice.
National Diabetes Audit
Pocklington Group Practice is taking part in an important national project about people at risk of diabetes and diabetes care and treatment in the NHS. The project is called the National Diabetes Audit (NDA).
If you have diabetes, non-diabetic hyperglycaemia, impaired glucose tolerance or pre-diabetes, your GP practice will share information about your diabetes care and treatment with the NDA. The type of information and how it is shared, is controlled by law and enforced by strict rules of confidentiality and security. For more details about how your information is used, please see the links below.
Taking part in the NDA shows that Pocklington Group Practice is committed to reducing diabetes and improving care for people with diabetes.
If you do not want your information to be used, please inform one of our receptionists, your GP or nurse. This will not affect your care.
Please click here for further information for those patients with an increased risk of type 2 diabetes.
NO WALK IN POLICY
PATIENTS REQUESTING URGENT, ON THE DAY SERVICE MUST TELEPHONE THE SURGERY ON 01759 302500.
Please note we do not offer a walk-in service. If you feel you need to be seen by the Duty Team, please telephone the surgery on 01759 302500. The reception team will answer your call and the Duty Doctor will either speak to you immediately or call you back. This will ensure you are assessed safely and seen by the most appropriate person, in a timely manner.
If you are offered an appointment it is important you arrive on time, as the appointment slots fill up quickly. The Doctor/Nurse is unlikely to have the capacity to see you if you are late.
Please note that when you are accessing the above service, the GP triaging you will look at the most appropriate appointment time to help ensure the successful management of the daily demand; this is the only appointment you will be offered. We experience a volume of between 100-150 requests to be seen the same day.
We have had an increasing number of people walking in and requesting to be seen by a GP immediately. If you do not telephone in, we cannot safely triage you and it can lead to long waits for you and other patients.
Our Surgery Charter
OUR SURGERY CHARTER: HELP US TO HELP YOU
Your doctor and their staff will always do their best for you but they need your help to provide the best care for all patients. Please support us by following these simple guidelines:
- Please treat your doctor and their staff as you would expect to be treated by them – with politeness and respect.
- Please cancel appointments you cannot attend or no longer need – somebody else is always waiting.
- Please think twice before calling a doctor to your home – is a visit really necessary?
- Please do not expect a prescription every time you visit the GP – good advice is often the best medicine.
- A second opinion is not always right but you can discuss it with your GP, who knows when to seek extra help.
- You can obtain basic health information elsewhere, for example from your pharmacist or NHS Direct.
- Please request your repeat prescriptions in good time as this will help avoid delays.
- Please remember that doctors are only human – they cannot cure all your problems and illnesses.
- If you do have a genuine complaint, please contact the Practice’s Business Manager in the first instance.
Privacy Notices
If you need to speak to a member of staff in private, please inform one of our receptionists who will arrange this for you in one of our side rooms.
Medicines Management
Your GP Practice supports a medicines management review service of medications prescribed to its patients. This service involves a review of prescribed medications to ensure patients receive the most appropriate, up to date and cost-effective treatments. This service is provided by qualified and registered healthcare professionals from within the GP practice, our NHS Primary Care Network, NHS Vale of York Clinical Commissioning Group or by external partners approved by the GP practice. Patient identifiable information does not leave the practice system but is accessed to ensure only appropriate clinical recommendations or decisions are made for each patient. Each patient can opt out of (or back into) the practice using their data for anything other than specified purposes or where there is a lawful requirement to do so.
Practice GDPR policies
Telephones
Please be aware that ALL calls both inbound and outbound are, by default, recorded for training and monitoring purposes. If you do not wish for your call to be recorded, you can ask the member of our team to pause the recording for you.
Proxy Access Policy
Discrimination
Gender | This policy will be applied equally regardless of the gender of the patient |
Race | This policy will be applied equally regardless of the Race of the patient |
Disability | This policy will be applied equally regardless of whether or not the patient has a disability or not |
Sexual Orientation | This policy will be applied equally regardless of the sexual orientation of the patient |
Age | This policy will be applied equally regardless of the age of the patient |
Religion/Belief | This policy will be applied equally regardless of the religion/belief of the patient |
Human Rights | This policy will not impact on anyone’s human rights |
Introduction
The law states that NHS organisations must, when requested by an individual, give that person access to their personal health information, and occasionally, certain relevant information pertaining to others. In order to do this, they must have procedures in-place that allow for easy retrieval and assimilation of this information.
There are three main areas of legislation that allow the right of the individual to request such personal information, and they are:
- The Data Protection Act 2018 (formerly DPA 1998) (DPA)
- The UK General Data Protection Regulation 2016 (UK GDPR)
- The Access to Health Records Act 1990
- The Medical Reports Act 1988
Where the request for information by an individual falls under the legislation of any of these areas, access must be granted. Patients requesting information about their own personal medical records would usually have their request dealt with under the provisions of the Data Protection Act 2018 and UK UK GDPR 2016.
See section 20 for new requirements regarding Cost and Timeframes for responding to requests
The GMS contract and PMS agreement contract 20202/21 (GP Contract commitment 5.10 (ii)) require practices to promote and offer their registered patients’ online access to all coded data in their GP records, referred to as their Detailed Coded Record.
The introduction of online patient access to services does not change the right that patients already have to request access to their medical records provided by the provisions of the Data Protection Act (DPA) and UK GDPR. The DPA principles and confidentiality requirements apply in the same way for online access as they do for paper copies of the record.
1. What Constitutes a Health Record?
A health record could include, and not exhaustively, hand-written clinical notes, letters between clinicians, lab reports, radiographs and imaging, videos, tape-recordings, photographs and monitoring printouts. Records can be held in either manual or computerised forms.
- What Constitutes the Detailed Coded Record
The minimum specification described by NHS England in the patient online support and resources guide is:
- Demographic data
- Investigation results including numerical values and normal ranges
- Problems/diagnoses
- Procedure codes (medical and surgical) and codes in consultations (symptoms and signs)
- Biological values (e.g. BP and PEFR)
- Immunisations
- Medication
- Allergies and adverse reactions
- Codes showing referrals made or letters received
- Other codes (ethnicity, QOF)
The Detailed Coded Record can also include consultation free text and access to letters, but this is optional. At this stage the practice has decided not to include this level of access.
3. Medical Records Access – Staff Responsibility
Practice Manager and Clinical Leads
For the purposes of reviewing requests, the Practice Manager and a named Clinical Lead will ensure current data protection requirements are followed. The main (but not exhaustive) duties of these roles are explained below:
Practice Manager
- To process and co-ordinate the application.
- Verification of identity (See Section 6)
- Reviewing the medical records for third party information and redacting information where consent has not been given.
- Contacting the patient to explain the process and inform of the outcome.
- The Locality Manager for each surgery will be the named Administrative Lead.
- Each Locality Manager will consult the Practice Manager or Clinical Lead for further advice where needed.
Clinical Lead
- Responsibility for reviewing the medical record and limiting or redacting sensitive and/or harmful information.
- Overall responsibility for decision to allow access.
- Requests under the Data Protection Legislation
The scope of the Data Protection law includes the right of patients to request information on their own medical records. Requests for information under this legislation must:
Should be made to the surgery. E-mail requests are allowed. Verbal requests can be accepted where the individual is unable to put the request in writing, or chooses not to – however a record of what is requested should be recorded and a letter for approval by the patient sent out (this must be noted on the patient record);
See SECTION 20 For updated access advice
Be accompanied with appropriate proof of identity (please see Section 6.).
Where requests are made on behalf of another evidence of correct and adequate consent must be provided (please see Section 6.).
Where an information request has been previously fulfilled, the practice does not have to honour the same request again unless a reasonable time-period has elapsed. It is up to the administrative/clinical leads to ascertain what constitutes a reasonable time-period.
Suitably trained and authorised reception staff should ensure the application form has been completed correctly and verify identify via the stipulated methods. The application form must be completed and signed by the patient.
The administrative lead will check whether all the individual’s health record information is required or just certain aspects. They will then check the records for third party information and ensure that this is not given to the patient. (Please see Section 7) If it is not possible to remove such information the clinical lead should be consulted.
The Clinical lead will review the content of the medical record and ensure that sensitive or harmful data are not made available to the patient.
The Clinical Lead can refuse the request for the reasons set out in section 8.
The clinical lead will also check the record for quality, clarity of presentation, completeness, and accuracy.
- Detailed Coded Records Access – Application
Patients will also be given a leaflet on the benefits and risks to Detailed Coded Access to Records.
On completion of an application form the administrative lead will review the application form and invite the patient into the practice to complete the following:
Identity Verification (See Section 6)
Inform the patient of the benefits and potential risks to detailed coded access to records.
Advice Leaflet will be given to the patient and application process and timescales will be discussed.
(this is not applicable to DCRA but to requests under DPA)
The administrative lead will then check the records for third party information and redact information where appropriate. (Please see Section 7) If it is not possible to remove information the clinical lead should be consulted.
The Clinical Lead will review the content of the medical record and ensure that sensitive or harmful data are not made available to the patient. The clinical lead may redact sensitive or harmful data if they consider it to be in the patients’ best interest.
The Clinical Lead can refuse the request for the reasons set out in section 8.
The Clinical Lead will also check the record for quality, clarity of presentation, completeness, and accuracy.
If approved the administrative lead will place an alert on the system to notify other members of staff that the patient has Detailed Coded Record access.
The completed application form should be scanned and attached to the patient’s record. The administrative lead will contact the patient to inform them of the outcome of the application, explain the next steps and provide any further information.
- Identity Verification
Before access to health records is granted, the patient’s identity must be verified. There are three ways of confirming patient identity:
- Documentation (Forms of Identification)
- Vouching
- Vouching with confirmation of information held in the applicant’s records
All applications for access to health records will require formal identification through 2 forms of ID one of which must contain a photo. Acceptable documents include passports, photo driving licences and bank statements, but not bills.
Where a patient may not have suitable photographic identification – Vouching with confirmation of information held in the medical record can be considered by the Administrative Lead. This should take place discreetly and ideally in the context of a planned appointment. It is extremely important that the questions posed do not incidentally disclose confidential information to the applicant before their identity is verified.
Adult proxy access verification – Before the practice provides proxy access to an individual or individuals on behalf of a patient further checks must be taken:
- There must be either the explicit informed consent of the patient, including their preference for the level of access to be given to the proxy, or there has been a Mental Capacity Assessment undertaken and it was deemed to be in the patient’s best interest for proxy access to be granted.
- The identity of the individual who is asking for proxy access must be verified as outlined above.
- The identity of the person giving consent for proxy access must also be verified as outlined above. This will normally be the patient but may be someone else acting under a power of attorney or as a Court Appointed Deputy.
- When someone is applying for proxy access on the basis of an enduring power of attorney, a lasting power of attorney, or as a Court Appointed Deputy, their status should be verified by making an online check of the registers held by the Office of the Public Guardian.
Child proxy access verification – Before the practice provides parental proxy access to a child’s medical records the following checks must be made:
- The identity of the individual(s) requesting access via the method outlined above.
- That the identified person is named on the birth certificate of the child.
- In the case of a child judged to have capacity to consent, there must be the explicit informed consent of the child, including their preference for the level of access to be given to their parent.
- Third Party Information
Patients’ records may contain confidential information that relates to a third person. This may be information from or about another person. It may be entered in the record intentionally or by accident.
It does not include information about or provided by a third party that the patient would normally have access to, such as hospital letters.
All confidential third-party information must be removed or redacted. This will be reviewed and completed by the Administrative Lead. If this is not possible then access to the health records will be refused.
8. Denial or Limitation of Information
Access to any health records can be denied or limited in scope of information. This decision will be made by the Practice Manager for the practice.
Access will be denied or limited where in the reasonable opinion of the clinical lead access to such information would not be in the patient’s best interests because it is likely to cause serious harm to:
- The patient’s physical or mental health, or
- The physical or mental health of any other person
- The information includes a reference to any third party who has not consented to its disclosure
A reason for denial of information must be recorded in the medical records and where possible and appropriate an appointment will be made with the patient to explain the decision.
- Proxy Access to Medical Records
Proxy access is when an individual other than the patient has access to an individual’s medical record on their behalf to assist in their care. Proxy access arises in both adults and children and is dealt with differently according to whether the patient has capacity or not.
The patient’s proxy should have their own login details to the patient’s record. If a patient wants to have more than one proxy, they should all have their own personal login details. In the current version of our electronic records system (EMIS) login details will be shared between the patient and the individual with proxy access.
Proxy access should not be granted where:
- The practice suspects Coercive behavior. (See Section 14)
- There is a risk to the security of the patient’s record by the person being considered for proxy access.
- The patient has previously expressed the wish not to grant proxy access to specific individuals should they lose capacity, either permanently or temporarily; this should be recorded in the patient’s record.
- The clinical lead assesses that it is not in the best interests of the patient and/or that there are reasons as detailed in Denial or Limitation of Information. (Please see 8)
- Proxy Access in Adults (including those over 13 years of age) with capacity
Patients over the age 13 (under UK DPA 2018) are assumed to have mental capacity to consent to proxy access. Where a patient with capacity gives their consent, the application should be dealt with on the same basis as the patient.
In terms of online access, it may be possible to give the proxy different levels of access depending on the wishes of the patient and/or the views of the clinical lead. For example, some patients may want to allow a family member to have access only to book appointments and order repeat prescriptions without accessing the detailed care record.
- Proxy Access in Adults (including those over 13 years of age) without capacity
Nursing/ Residential homes will not be granted proxy access for patients under their care.
Proxy Access without the consent of the patient may be granted in the following circumstances:
The patient has been assessed as lacking capacity to make a decision on granting proxy access and has registered the applicant as a lasting power of attorney for health and welfare with the Office of the Public Guardian.
The patient has been assessed as lacking capacity to make a decision on granting proxy access, and the applicant is acting as a Court Appointed Deputy on behalf of the patient
The patient has been assessed as lacking capacity to make a decision on granting proxy access, and in accordance with the Mental Capacity Act 2005 code of practice, the Clinical Lead considers it in the patient’s best interests to grant access to the applicant.
When an adult patient has been assessed as lacking capacity and access is to be granted to a proxy acting in their best interests, it is the responsibility of the Clinical Lead to ensure that the level of access enabled or information provided is necessary for the performance of the applicant’s duties.
- Proxy Access in Children under the age of 11
All children under the age of 11 are assumed to lack capacity to consent to proxy access. Those with parental responsibility for the child can apply for proxy access to their children’s medical records.
Parents will apply for access through the same process outlined in Sections 4 and 5. Additional identification of Parental / Guardian evidence will be required. (See Section 6)
- Proxy Access in Children above the age of 11 and under 13 years of age
Access to medical records will need to be assessed on a case by case basis. Some children aged 11 to 13 have the capacity and understanding required for decision-making with regards to access to their medical records and should therefore be consulted and have their confidence respected.
Online proxy access will automatically be turned off when a child reaches the age of 11. Online proxy access to the Detailed Coded Record of children aged 11 to 13 will not normally be approved unless it is in the best interests of the child or is the express wishes of a competent child.
The Clinical Lead will invite the child for a confidential consultation to discuss the request for proxy access whether this is for requests under the Data Protection Law or for online access.
The clinical lead should use their professional judgement in deciding whether to grant parental access and/or whether to withhold information.
If the practice suspects coercive behaviour access will be refused and documented in the medical notes. The clinical lead will liaise with Child Safeguarding teams if appropriate
Online proxy access will also be turned off when a child turns 13. Access can be turned back on by following the processes set out above governing access to adults.
- Coercion
Coercion is the act of governing the actions of another by force or by threat, in order to overwhelm and compel that individual to act against their will.
Online access to records and transactional services provides new opportunities for coercive behaviour.
If the practice suspects coercive behaviour for either an individual or proxy access application, then access will be refused and documented in the medical notes. The clinical lead will liaise with CCG Safeguarding Team if appropriate.
15. Staff Training and Education
All staff at the practice will be required to read the policy and confirm their understanding.
All staff will be encouraged to undertake the E-learning programmes provided by. For the Practice Manager and Clinical Leads this will be mandatory.
Presentations of Detailed Coded Access will be given at Organisational Education Meetings.
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The practice endeavour to continue to improve the patient experience. Detailed Coded Records Access may improve the level of communication between patient and clinician and encourage patients to self-manage their health and wellbeing.
The practice will make patients aware via the following medias:
- Surgery Websites
- Practice Notice Boards
- Display Screens in surgery
17. Former NHS Patients Living Outside the UK
Patients no longer resident in the UK still have the same rights to access their information as those who still reside here and must make their request for information in the same manner.
Original health records should not be given to an individual to take abroad with them, however, the Practice may be prepared to provide a summary of the treatment given whilst resident in the UK.
- Subject Access Requests- Following Implementation of UK GDPR (from 25 May 2018)
On 25 May 2018 the current UK Data Protection Act 1998 (DPA 1998) will be fully replaced by the UK General Data Protection Regulation (2016/679)
As with the DPA 1998, these new regulations give living individuals the right to request access to personal data held on them by the Practice. This is known as a Subject Access Request (SAR), the person who will hold data about is known as the Data Subject, in many cases this will be the patient, but could be a staff member, a contractor or contact.
Requests must not always be writing, this includes, letter, e-mail, however verbal requests should be documented, and a clarification letter sent to the patient for approval. There could also an electronic form for requesters to complete if they prefer. SARs can also be submitted via social media, such as the practice Facebook page or Twitter.
Requesters must be either, the data subject OR have the written permission of the data subject OR have legal responsibility for managing the subject’s affairs to access personal information about that person. It is the requester’s responsibility to satisfy the Practice of their legal authority to act on behalf of the data subject.
The practice must be satisfied of the identity of the requester before we can provide any personal information.
- New Requirements for Subject Access
From 25 May 2018 some new requirements were introduced affecting the handling of subject access requests.
These are listed below:
What do we need to provide to a requester?
As well as providing confirmation that their personal is being processed and providing a copy of this personal data that the data subject has asked for; (subject to any exemptions). Individuals will have the right to be provided with additional information which largely corresponds to the information to be provided in a privacy notice:
- Source of the data.
- Recipient, including details international transfers.
- Retention period for the data.
- How to amend inaccurate data.
- How to complain to the Information Commissioner’s Office (internal review will usually need to be satisfied first).
- Timeframe for responding to requests
The Statutory timeframe has now been reduced to at least one month of receipt of the request, and in any event without delay. In Accordance with Article 12 of the UK GDPR 2016.
The period of compliance can be extended by a further two months where requests are determined to be ‘complex’ or ‘numerous’.
Research
Pocklington Group Practice is an active Research Practice
Pocklington Group Practice takes part in effective medical research through the Primary Care Research Network within the NHS National Institute for Health Research. NHS medical research helps to improve the health and well-being of the nation.
The Practice is currently involved in the following research trials
ACTIVE BRAINS TRIAL https://www.activebrains.online/ – Trial team have made a new website called ‘Active Brains’ which aims to help older adults to look after their brain and body health. The aim is to help prevent problems with things like remembering, concentrating or reasoning (known as cognitive decline). The website will help older adults to make simple changes such as getting more active, playing brain training games and finding ways to eat more healthily. This research will test how well the website works.
CANAssess https://ctru.leeds.ac.uk/canassess/– Cancer Needs Assessment in Primary Care. A cluster randomised feasibility trial (cRCT) to test the routine use of the NAT:PD-C in primary care to reduce unmet cancer patient and caregiver need and determine the feasibility of a definitive trial
ATTACK https://www.nctu.ac.uk/our-research/randomised-trials/current-studies/attack.aspx – Does low-dose aspirin reduce the chance of a first heart attack or stroke in patients with chronic kidney disease (CKD)?
This is a large-scale academic study, being led by the University of Southampton, to see whether or not patients with chronic kidney disease should take aspirin daily to prevent a first heart attack or stroke. It is recruiting patients from GP practices across the UK, and looks to invite 198,000 patients.
DaRe2THINK https://www.birmingham.ac.uk/research/cardiovascular-sciences/research/dare2think – DaRe2THINK is a transformational project that will test a new way of running clinical trials at General Practices in the NHS.
The trial will use health information already collected in the NHS to reduce the time taken for research, both for patients and NHS staff. This will allow the NHS to reach new and larger groups of patients that could benefit from new treatments.
The first trial will target an important health concern, aiming to improve the health outcomes of patients with atrial fibrillation (AF), by reducing the risk of stroke, blood clots and potentially cognitive decline and vascular dementia.
Discover ME https://www.discovermestudy.com/– Discover Me is a research study that aims to analyse health and genetic information on thousands of people. The aim is to increase our understanding of many different diseases, and help improve patient care.
RELIEF https://www.nctu.ac.uk/our-research/randomised-trials/current-studies/relief.aspx – The trial is looking at whether an inhaler which contains drugs to both relieve symptoms and to prevent attacks, in a single combination inhaler, is better for treating mild asthma symptoms in adults than two separate inhalers — one for symptoms (attacks) and one for prevention (before attacks happen).
ASYMPTOMATIC https://asymptomatic-trial.org.uk/– A randomised controlled trial assessing symptom-driven versus maintenance preventer therapy for the outpatient management of asthma in children
From time to time, we may also invite patients to take part in other trials by acting as a Participant Identification Centre. Examples of this include the recent ‘Smell Test Direct’ which is a study from The Michael J. Fox Foundation exploring the link between smell loss and brain disease, specifically, if smell loss is a precursor to Parkinson’s Disease.
The Research Team for Pocklington Group Practice are:
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Dr Lewis Pearce
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Lisa Schofield
Speak to your GP for more information on how to volunteer for a research trial. Patients often find our research trials to be an interesting and enjoyable experience.
Statement of Purpose
Summary Care Record
SUMMARY CARE RECORD – YOUR EMERGENCY CARE SUMMARY
The NHS in England is introducing the Summary Care Record, which will be used in emergency care.
The record will contain information about any medicines you are taking, allergies you suffer from and any bad reactions to medicines you have had to ensure those caring for you have enough information to treat you safely.
Your Summary Care Record will be available to authorised healthcare staff providing your care anywhere in England, but they will ask your permission before they look at it. This means that if you have an accident or become ill, healthcare staff treating you will have immediate access to important information about your health.
Your GP practice is supporting Summary Care Records and as a patient you have a choice:
• Yes I would like a Summary Care Record – you do not need to do anything and a Summary Care Record will be created for you.
• No I do not want a Summary Care Record. Please complete an opt-out form click here or paper copies are available from the Practice and hand it to a member of the GP practice staff.
If you need more time to make your choice you should let your GP Practice know.
For more information please visit www.nhscarerecords.nhs.uk or telephone the dedicated NHS Summary Care Record Information Line on 0300 123 3020.
Additional copies of the opt out form can be collected from the GP practice or from the website www.nhscarerecords.nhs.uk or requested from the dedicated NHS Summary Care Record Information Line on 0300 123 3020.
You can choose not to have a Summary Care Record and you can change your mind at any time by informing your GP practice.
If you do nothing we will assume that you are happy with these changes and create a Summary Care Record for you. Children under 16 will automatically have a Summary Care Record created for them unless their parent or guardian chooses to opt them out. If you are the parent or guardian of a child under 16 and feel that they are old enough to understand, then you should make this information available to them.