Practice Policies

This Policy is designed to protect both patients and staff from abuse or allegations of abuse, and to assist patients in making an informed choice about their examinations and consultations.

Guidelines

Clinicians (male and female) will consider whether an intimate or personal examination of the patient (either male or female) is justified, or whether the nature of the consultation poses a risk of misunderstanding.

• The Clinician will give the patient a clear explanation of what the examination will involve.
• They will always adopt a professional and considerate manner and be careful with humour as a way of relaxing a nervous situation, as it can easily be misinterpreted.
• The patient will always be provided with adequate privacy to undress and dress.

The above guidelines are to remove the potential for misunderstanding. However, there will still be times when either the Clinician, or the patient, feels uncomfortable, and it would then be appropriate to consider using a Chaperone.

Patients who request a Chaperone will never be examined without a Chaperone being present. If necessary, where a Chaperone is not available, the consultation/examination will be rearranged for a mutually convenient time when a Chaperone can be present.

Complaints and claims have not been limited to doctors treating/examining patients of the opposite gender – there are many examples of alleged assault by female and male doctors on people of the same gender.

Consideration will always be given by staff to the possibility of a malicious accusation by a patient, and a Chaperone organised if there is any potential for this.

There may be occasions when a Chaperone is needed for a home visit in which case the following procedure will be followed.

Who can act as a Chaperone?

A variety of people can act as a Chaperone in the practice, but staff undertaking a formal Chaperone role will have been trained in the competencies required. Where possible, Chaperones will be clinical staff familiar with procedural aspects of personal examination.

Confidentiality

• The Chaperone will only be present for the examination itself, with most of the discussion with the patient taking place while the Chaperone is not present.
• Patients are reassured that all Practice staff understand their responsibility not to divulge confidential information.

Procedure

• The Clinician will contact the team to request a Chaperone.
• Where no Chaperone is available, a Clinician may offer to delay the examination to a date when one will be available, if the delay would not have an adverse effect on the patient’s health.
• If a Clinician wishes to conduct an examination with a Chaperone present but the patient does not agree to this, the Clinician will explain clearly why they want a Chaperone to be present. The Clinician may choose to consider referring the patient to a colleague who would be willing to examine them without a Chaperone, if the delay would not have an adverse effect on the patient’s health.
• The Clinician will record in the notes that the Chaperone is present and identify the Chaperone.
• The Chaperone will enter the room discreetly and remain in the room until the Clinician has finished the examination.
• A clinical Chaperone will attend inside the curtain/screened-off area at the head of the examination couch and observe the procedure.
• To prevent embarrassment, the Chaperone will not enter into conversation with the patient or GP unless requested to do so or make any mention of the consultation afterwards.
• The patient can refuse a Chaperone, and if so, this must be recorded in the patient’s medical record.

Click HERE to download a copy of this policy.

Please be aware that our staff are bound to the NHS code of confidentiality; they are therefore not permitted to discuss any of our patient’s medical history, including registration status, without their written consent to do so.

Once written consent has been received and verified with the patient, we can provide you with information as required; this includes communicating with you on behalf of the patient with regards to any complaints but excludes patients who are unable to act on their own behalf and already have a designated person or carer responsible for their medical care.

We therefore respectfully ask parents, relatives, and guardians not to request information regarding their relatives/friends or to complain on their behalf unless we have their written consent that you may do so. If consent is required, we advise that the person concerned attends the Practice to complete the required form.

Policy for Children

Please note in Scotland if you are 12 or over, the law assumes you can make your own decisions about your healthcare information unless there is evidence to suggest you can’t, and our Practice Staff are unable to provide confidential information to your parents or guardian unless you have given written permission for them to do so. If you are under 12, you may still be able to make decisions about your healthcare information, but your doctor must believe that you understand enough to do this. When you are young, your parents are usually involved in your healthcare. They may make decisions for you and speak to health workers on your behalf. However, as you get older you have more rights, and you can decide if you want your parents to be involved or not.

Interpreter

If you want to talk about your health in private and you need an interpreter, please ask a team member to arrange this for you.

For further information concerning Confidentiality and your rights please visit NHS Inform.

Privacy and confidentiality when using the NHS – Health rights | NHS inform

Click HERE to download a copy of this policy.

What is the Freedom of Information Act?

The Freedom of Information (Scotland) Act 2002 introduced important new laws about our obligation to make information publicly available. The Act gave people new rights to access information, most of which came into effect in January 2005. The Act opens with a general statement that ‘A person who requests information from a Scottish public authority which holds it, is entitled to be given it by the authority’; section 1 (1) Freedom of Information (Scotland) Act 2002.

Who can request Information?

Any person or organisation can make a request for information which is not already detailed in our Publication Scheme. They do not have to work or live in the area.

The Process

• Practices must reply within 20 working days to any credible written request for information from anywhere in the world
• The request can be by email or on paper, and be made to any member of staff
• It does not have to refer to the Freedom of Information Act
• Practices cannot ask the reason for the request, or question its reasonableness, but can work with the person(s) requesting the information to help them clarify what it is they are after so that the practice can best meet the request
• Every practice must maintain a publication scheme
• Failure to comply with the Act can result in contempt of court

If you are unhappy with the information provided by the Practice, please contact the Scottish Information Commissioner who has the power to enforce individuals with rights under the act.

Contact can be made at:

Scottish Information Commissioner
Kinburn Castle
Doubledykes Road
St Andrews
Fife
KY16 9DS

Telephone: 01334 464610

Fax: 01334 464611

Email: enquiries@itspublicknowledge.info

Click HERE to download a copy of this policy.

Clarkston Medical have the facility to send SMS Text messages to your mobile phone to contact you.

These may be used to notify you of for example:

• Changes to your booked appointment
• National issues such as Flu pandemics
• Practice being closed due to unforeseen circumstances
• Cancelled clinics including GP, Nurse and Health care assistant
• Other notifications the practice deem necessary to your health care provision

If you would like the GP practice to contact you by this means please make sure we have your up to date mobile number. By providing your mobile phone number whether on registration documents, verbally or by any other means, you will then automatically be opted in to receive SMS messages from the Practice.

It is important that you let the practice know if you wish to OPT OUT of this service otherwise you will be automatically sent text messages to the mobile number we have on file for you. Patient can opt in and out of this service at any time.

If you agree to the GP practice contacting you via your mobile phone number, the GP practice agrees to adhere to the following:

• The mobile phone number will only be used by the GP practice and will not be passed to any other parties.
• If at any time you would like to opt out of above service, please make a personal request to the GP practice and you will be opted out of the service within 48 hours. You may also like to include your reason for opting out, to help us review and improve the service in the future.
• Your mobile phone number will solely be used by the GP practice in relation to the healthcare services offered by the GP practice. You will not be contacted in relation to any other types of products or services.
• Whilst the GP practice will regularly check your telephone numbers with you, please be aware that the onus of keeping your contact details current with the practice rests with you.

Click HERE to download a copy of this policy.

We believe that patients have a right to be heard, understood and respected. We work hard to be open and accessible to everyone. Occasionally, the behaviour or actions of individuals using our Practice makes it very difficult for us to deal with their issue or complaint. In a small number of cases the actions of individuals become unacceptable because they involve abuse of our staff or our process. When this happens, we have to take action to protect our staff, and must also consider the impact of the individual’s behaviour on our ability to do our work and provide a service to others.

This Policy explains how we will approach these situations.

Section 1 – What actions does the Practice consider to be unacceptable?

People may act out of character in times of trouble or distress. There may have been upsetting or distressing circumstances leading up to us being made aware of an issue or complaint. We do not view behaviour as unacceptable just because a patient is forceful or determined. In fact, we accept that being persistent may sometimes be a positive advantage when pursuing an issue or complaint. However, we do consider actions that result in unreasonable demands on our Practice or unreasonable behaviour towards Practice staff to be unacceptable. It is these actions that we aim to manage under this Policy.

Section 2 – Aggressive or abusive behaviour

We understand that patients may be angry about the issues they have raised with the Practice. If that anger escalates into aggression towards Practice staff, we consider that unacceptable. Any violence or abuse towards staff will not be accepted. Violence is not restricted to acts of aggression that may result in physical harm. It also includes behaviour or language (whether verbal or written) that may cause staff to feel offended, afraid, threatened or abused. We will judge each situation individually and appreciate individuals who come to us may be upset.

Language which is designed to insult or degrade, is derogatory, racist, sexist, transphobic, or homophobic or which makes serious allegations that individuals have committed criminal, corrupt, perverse or unprofessional conduct of any kind, without any evidence, is unacceptable.

We may decide that comments aimed not at us, but at third parties, are unacceptable because of the effect that listening or reading them may have on our staff.

Section 3 – Unreasonable demands

A demand becomes unacceptable when it starts to (or when complying with the demand would) impact substantially on the work of the Practice. Examples of actions grouped under this heading include:

• Repeatedly demanding responses within an unreasonable timescale
• Repeatedly requesting early supplies of medication
• Repeatedly ordering prescriptions out with the set timeframe
• Insisting on seeing or speaking to a particular member of staff when that is not possible
• Repeatedly changing the substance of an issue or complaint or raising unrelated concerns
• Repeatedly insisting on a course of medical treatment for which there is no clinical evidence
• An example of such impact would be that the demand takes up an excessive amount of staff time and in so doing disadvantages other patients

Section 4 – Unreasonable levels of contact

Sometimes the volume and duration of contact made to our Practice by an individual causes problems. This can occur over a short period, for example, a number of calls in one day or one hour. It may occur over the lifespan of an issue when a patient repeatedly makes long telephone calls to us, or inundates us with letters or copies of information that have been sent already or that are irrelevant to the issue. We consider that the level of contact has become unacceptable when the amount of time spent talking to a patient on the telephone, or responding to, reviewing and filing emails or written correspondence impacts on our ability to deal with that issue, or with other Patients’ needs.

Section 5 – Unreasonable refusal to co-operate

When we are looking at an issue or complaint, we will ask the patient to work with us. This can include agreeing with us the issues or complaint we will look at; providing us with further information, evidence or comments on request; or helping us by summarising their concerns or completing a form for us.

Sometimes, a patient repeatedly refuses to cooperate, and this makes it difficult for us to proceed. We will always seek to assist someone if they have a specific, genuine difficulty complying with a request. However, we consider it is unreasonable to bring an issue to us and then not respond to reasonable requests.

Section 6 – Unreasonable use of the complaints process

Individuals with complaints about the Practice have the right to pursue their concerns through a range of means. They also have the right to complain more than once about the Practice, if subsequent incidents occur. This contact becomes unreasonable when the effect of the repeated complaints is to harass, or to prevent us from pursuing a legitimate aim or implementing a legitimate decision. We consider access to a complaints system to be important and it will only be in exceptional circumstances that we would consider such repeated use is unacceptable – but we reserve the right to do so in such cases.

Section 7 – Examples of how we manage aggressive or abusive behaviour

• The threat or use of physical violence, verbal abuse or harassment towards the Practice staff is likely to result in a warning from the Management Team. We may report incidents to the Police – this will always be the case if physical violence is used or threatened.
• Practice staff will end telephone calls if they consider the caller aggressive, abusive or offensive.  Practice staff have the right to make this decision, to tell the caller that their behaviour is unacceptable and end the call if the behaviour persists.

• We will not respond to correspondence (in any format) that contains statements that are abusive to staff or contain allegations that lack substantive evidence. Where we can, we will return the correspondence. We will explain why and say that we consider the language used to be offensive, unnecessary and unhelpful and ask the sender to stop using such language. We will state that we will not respond to their correspondence if the action or behaviour continues and may consider issuing a warning to the Patient.

Section 8 – Examples of how we deal with other categories of unreasonable behaviour

We must act when unreasonable behaviour impairs the functioning of our Practice. We aim to do this in a way that allows a Patient to progress through our process. We will try to ensure that any action we take is the minimum required to solve the problem, considering relevant personal circumstances including the seriousness of the issue(s) or complaint and the needs of the individual.

Section 9 – Other actions we may take

Where a patient repeatedly phones, visits the Practice, raises repeated issues, or sends large numbers of documents where their relevance isn’t clear, we may decide to:

• limit contact to telephone calls from the patient at set times on set days, about the issues raised
• restrict contact to a nominated member of the Practice staff who will deal with future calls or correspondence from the patient about their issues
• see the patient by appointment only
• restrict contact from the patient to writing only regarding the issues raised
• return any documents to the patient or, in extreme cases, advise the patient that further irrelevant documents will be destroyed
• take any other action that we consider appropriate

Where we consider continued correspondence on a wide range of issues to be excessive, we may tell the patient that only a certain number of issues will be considered in each period and ask them to limit or focus their requests accordingly. In exceptional cases, we reserve the right to refuse to consider an issue, or future issues or complaints from an individual. We will consider the impact on the individual and also whether there would be a broader public interest in considering the issue or complaint further. We will always tell the patient what action we are taking and why.

Section 10 – The process we follow to make decisions about unreasonable behaviour

• Any member of the Practice staff who directly experiences aggressive or abusive behaviour from a Patient has the authority to deal immediately with that behaviour in a manner they consider appropriate to the situation and in line with this Policy
• Except for such immediate decisions taken at the time of an incident, decisions to issue a warning or remove patients from our Practice List are only taken after careful consideration of the situation by the Management
• Wherever possible, we will give a patient the opportunity to change their behaviour or actions before a decision is taken

Section 11 – How we let people know we have made this decision

When a Practice employee makes an immediate decision in response to offensive, aggressive or abusive behaviour, the patient is advised at the time of the incident. When a decision has been made by Management, a patient will always be given the reason in writing as to why a decision has been made to issue a warning (including the
duration and terms of the warning) or remove them from the Practice list. This ensures that the patient has a record of the decision.

Section 12 – How we record and review a decision to issue a warning

We record all incidents of unacceptable actions by patients. Where it is decided to issue a warning to a patient, an entry noting this is made in the relevant file and on appropriate records. A decision to issue a warning to a patient as described above may be reconsidered either on request or on review.

Section 13 – The process for appealing a decision

It is important that a decision can be reconsidered. A patient can appeal a decision about the issuance of a warning or removal from the Practice list. If they do this, we will only consider arguments that relate to the warning or removal, and not to either the issue or complaint made to us, or to our decision to close a complaint.

An appeal could include, for example, a patient saying that: their actions were wrongly identified as unacceptable; the warning was disproportionate; or that it will adversely impact on the individual because of personal circumstances.

The Practice Manager or a GP Partner who was not involved in the original decision will consider the appeal. They have discretion to quash or vary the warning as they think best. They will make their decision based on the evidence available to them. They must advise the patient in writing that either the warning or removal still applies, or a different course of action has been agreed. We may review the warning periodically or on further request after a period has passed. Each case is different.

Click HERE to download a copy of this policy.