The Surgery prides itself in maintaining professional standards. For certain examinations during consultations an impartial observer (a “Chaperone”) can be requested.

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. If a nurse is unavailable at the time of your consultation then your examination may be re-scheduled for another time.

You are free to decline any examination or choose an alternative examiner or chaperone. You may also request a chaperone for any examination or consultation if one is not offered to you. The GP may not undertake an examination if a chaperone is declined.

The role of a Chaperone:

• Maintains professional boundaries during intimate examinations.

• Acknowledges a patient’s vulnerability.

• Provides emotional comfort and reassurance.

• Assists in the examination.

• Assists with undressing patients, if required.

Under the new GDPR regulation which comes in effect on 25th May 2018 we may need to ask your permission to provide you with information about health care services which are not related to your direct care. You will also be asked to express a preference in choosing services such as your designated pharmacy for prescriptions. You can find out more about the information we hold on you and your choices about how you share through:

How We Use Your Information:

All GP practices are required to declare the mean earnings (average pay) for their GPs working to deliver NHS services.

The average pay for GPs working in H&F Partnership in the last financial year was £63,753 before tax and national insurance.

This is for 14 full time GP’s and 52 part time GPs who worked in the partnership at our five surgeries for more than six months.

We aim to keep our surgery clean and tidy and offer a safe environment to our patients and staff. We are proud of our modern, purpose built Practice and endeavour to keep it clean and well maintained at all times.

If you have any concerns about cleanliness or infection control, please report these to our Reception staff.

Our GPs and nursing staff follow our Infection Control Policy to ensure the care we deliver and the equipment we use is safe.

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.  The accountable GP will be one of the five partners.  This is a contractual obligation and does not reflect who you see.

You can see any GP in the practice.  We encourage patients to ask to see the GP they know and have formed a relationship with.  We work as a team and when we get information about you we think is important we will share this with the GP who last saw you.

If you do not know who your named accountable 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.

We are happy to look after patients who don’t live locally subject to a few considerations laid out below.

If you live or move outside our catchment area (shown in Catchment Area on this page) and want to register as an “out-of-area” patient, please take note of the following conditions:

If your medical concern requires attention, you must be able to visit the surgery during our opening hours. Phone consultations may not be appropriate for certain issues.

Your own health should not pose any personal factors or concerns that could prevent you from attending the surgery.

At present, you should not require access to any community health or social care services, as these are organized geographically.

It is your responsibility to visit the surgery to collect items like prescriptions and make suitable arrangements.

Home visits cannot be provided under any circumstances.

In the event that you need a GP but are too unwell to come to the surgery, please contact us initially. If we determine that you require services in your local area, we will direct you to the appropriate local service established by NHS England. This service could be a GP practice near your home, a local walk-in or urgent care centre, or a minor injuries unit.

You must reside within North West London.

Please understand that if your health needs change and you require access to other services, such as home visiting doctors, we may review your registration and ask you to register with a GP closer to your home.

Registration with our practice is subject to our discretion. If we find that your care needs become more complex after registration, we reserve the right to review your registration and ask you to register with a GP closer to your home.

In the event that we become aware of your out-of-area residence, we will notify you and ask for your agreement to the above conditions. If we don’t receive a response, we will send reminders. Failure to comply may result in deregistration. However, please note that we will still provide care on an “immediate and necessary” basis if an urgent need arises.

OUR NEW TELEPHONE SYSTEM

We have switched to a new and better phone system at the surgery.

Please note that all calls are now recorded to help us review and improve services, monitor and review the quality of care, and train, develop and manage staff and medical trainees

Call recording also helps us to prevent, detect, investigate, and prosecute allegations, complaints, claims and / or fraud relating to patients, other organisations, or our staff

It will also help to protect staff and patients from abuse.

We do this in the interests of offering a good service to our service users, patient safety, being a good employer and to protect public funds.

How will call recordings be used?

Quality monitoring: Written records only provide partial information. A call recording provides a more rounded view and allows us to better understand patient and staff experience and assess the processes applied. This can help us identify any improvement areas.

Training and development: Listening to a sample number of calls allows managers to identify training needs. Call recordings may also be used as part of training for medical students, GP registrars and other clinical staff in training at the practice. This is part of their clinical skills development.

Gaining a better understanding of our patients: Many calls are verbally resolved without the need to complete records. Listening to sample calls will help us better understand our patient and staff needs and gain a more informed view of organisations we signpost to.

Complaints and disputes: Some calls are verbally resolved. Where information is entered onto an electronic system this becomes the established record. In the event of a complaint or dispute, a call recording (if possible), may provide additional information to help us investigate and resolve

Employee safety and wellbeing: A recording may become a vital piece of evidence in the event of any threats being made to the organisation or an individual or in dealing with employment-related matters.

How your information is shared

Generally, call recordings are not shared. In certain circumstances, for example to comply with a court order or carry out a legislative requirement, we may share call recordings.

How long we keep your call recording?

General call recordings will be retained for up to 36 months from the date of creation. The retention period is in line with the Records Management Code of Practice for Health and Social Care 2016.

Can I request a copy of my call record?

If the recording is still available, you can request a copy of your conversation by contacting the surgery. This information will be provided to you in accordance with the terms of the Data Protection Act 1998.

PRIVACY NOTICE FOR RECORDING OF TELEPHONE CONVERSATIONS

1. We may record telephone calls to:

• Review and improve services
• Monitor and review quality of care
• Train, develop and manage staff and medical trainees
• Prevent, detect, investigate and prosecute allegations, complaints, claims and / or fraud relating to patients, other organisations or Holderness Health staff
• Protect staff and patients

We do this in the interests of offering a good service to our service users, patient safety, being a good employer and to protect public funds.

2. How will call recordings be used:

• Quality monitoring: Written records only provide partial information. A call recording provides a more rounded view and allows us to better understand patient and staff experience and assess the processes applied. This can help us identify any improvement areas.
• Training and development: Listening to a sample number of calls allows managers to identify training needs. Call recordings may also be used as part of training for medical students, GP registrars and other clinical staff in training at the practice. This is part of their clinical skills development.
• Gaining a better understanding of our patients: Many calls are verbally resolved without the need to complete records. Listening to sample calls will help us better understand our patient and staff needs and gain a more informed view of organisations we signpost to.
• Complaints and disputes: Some calls are verbally resolved. Where information is entered onto an electronic system this becomes the established record. In the event of a complaint or dispute, a call recording (if possible), may provide additional information to help us investigate and resolve
• Employee safety and wellbeing: A recording may become a vital piece of evidence in the event of any threats being made to the organisation or an individual or in dealing with employment-related matters.

3. How your information is shared

Generally, call recordings are not shared. In certain circumstances, for example to comply with a court order or carry out a legislative requirement, we may share call recordings.

4. How long we keep your call recording

General call recordings will be retained for 1 month from the date of creation.

5. Can I request a copy of my call record?

If the recording is still available, you can request a copy of your conversation by contacting the surgery. This information will be provided to you in accordance with the terms of the Data Protection Act 1998.

6. What we use your data for (including call recordings). Your data is processed to:

• Review and improve services
• Check and review quality of care
• Train, develop and manage staff and medical trainees
• Prevent, detect, investigate, and prosecute allegations, complaints, claims and / or fraud relating to patients, other organisations, or our staff
• Protect staff and patients

Vulnerable Adults

Introduction

The purpose of this document is to set out the policy of the Practice in relation to the protection of vulnerable adults. Further guidance may be available on local inter-agency procedures via the Primary Care Organisation and / or Social Services.

What is a vulnerable adult?

The definition is wide, however this may be regarded as anyone over the age of 18 years who may be unable to protect themselves from abuse, harm or exploitation, which may be by reason of illness, age, mental illness, disability or other types of physical or mental impairment.

Those at risk may live alone, be dependent on others (care homes etc.), elderly, or socially isolated.

Forms of Abuse

• Neglect – ignoring mental or physical needs, care, education, or basic life necessities or rights
• Bullying – family, carers, friends
• Financial – theft or use of money or possessions
• Sexual – assault, rape, non-consensual acts (including acts where unable to give consent), touching, indecent exposure
• Physical – hitting, assault, man-handling, restraint, pain or forcing medication
• Psychological – threats, fear, being controlled, taunts, isolation
• Discrimination – abuse based on perceived differences and vulnerabilities
• Institutional abuse – in hospitals, care homes, support services or individuals within them, including inappropriate behaviours, discrimination, prejudice, and lack of essential safeguards

Abuse may be deliberate or as a result of lack of attention or thought, and may involve combinations of all or any of the above forms. It may be regular or on an occasional or single event basis, however it will result in some degree of suffering to the individual concerned.

Abuse may also take place between one vulnerable adult and another, for example between residents of care homes or other institutions.

Indications

• Bruising
• Burns
• Falls
• Apparent lack of personal care
• Nervousness or withdrawn
• Avoidance of topics of discussion
• Inadequate living conditions or confinement to one room in their own home
• Inappropriate controlling by carers or family members
• Obstacles preventing personal visitors or one-to-one personal discussion
• Sudden changes in personality
• Lack of freedom to move outside the home, or to be on their own
• Refusal by carers to allow the patient into further care or to change environs
• Lack of access to own money
• Lack of mobility aids when needed

Action Required

Where abuse of a vulnerable adult is suspected the welfare of the patient takes priority. In deciding whether to disclose concerns to a third party or other agency the GP will assess the risk to the patient.

• Ideally the matter should be discussed with the patient involved first, and attempt made to obtain consent to refer the matter to the appropriate agency. Where this is not possible, or in the case of emergency where serious harm is to be prevented, the patient’s doctor will balance the need to protect the patient with the duty of confidentiality before deciding whether to refer.
• The patient should usually be informed that the doctor intends to disclose information, and advice and support should be offered.
• Where time permits, the medical defence organisation will be telephoned before any action is taken.

Due regard will be taken of the patient’s capacity to provide a valid consent.

In assessing the risk to the individual, the following factors will be considered:

• Nature of abuse, and severity
• Chance of recurrence, and when
• Frequency
• Vulnerability of the adult (frailty, age, physical condition etc.)
• Those involved – family, carers, strangers, visitors etc.
• Whether other third parties are also at risk (other members of the same household may being abused at the same time)

Subject to the local procedures in force, consideration will be given to;

• Report to Social Services Mental Health team
• Report to Police
• Report to CCG lead

Contact List:

– Police – Emergency: 999 / Non-Emergency: 101

– Adult Support Services / Safeguarding Adult: 020 8753 4198 – Option 3

– Adult Support Services (out of hours) / Adult Protection Officer: 020 8748 8588

– Community Mental Health – Claybrook Centre: 020 7386 1348 / Glenthorne Road: 020 8483 1979 / 24-hour Crisis Helpline: 0300 1234 244

– Age Concern: 020 7386 9085

– Social Services: 0845 313 3935

– MIND Hammersmith and Fulham: 020 7471 0580

– Hammersmith and Fulham Child and Adult Mental Health Services (CAMHS): 020 8483 1979

– Drug Misuse: 020 3315 6111

– Medical Defence Organisation: MDU – Via doctor/nurse or management membership details

– Hammersmith and Fulham Clinical Commissioning Group (CCG) 87-91 Newman Street, London, W1T 5EY: 020 3350 4000

– NHS England / North West London Area Team: 020 7322 3700

See more advice on what to do if you think someone is at risk of abuse on the People First website.

Child Safeguarding

Child Safeguarding is the responsibility of all everybody and is highly regarded at the Surgery. We make every effort to recognise issues and address as they occur in the practice. By raising safeguarding children issues within the practice all staff will be aware of how they may access advice, understand their role in protection, and understand the importance of effective Inter-agency communication.

It is very important that all Practice staff understand the need for early identification, assessment and intervention when they have concerns about a child.  Case discussion and reflective practice is encouraged.  Child protection issues in general practice require a robust system of note-keeping and recording, message handling and communication of any concerns.

Key Factors to be aware of in safeguarding children

• The welfare of the child is paramount
• Be prepared to consult with colleagues
• Be prepared to take advice from local experts
• Keep comprehensive, clear, contemporaneous records
• Be aware of GMC guidance about sharing confidential information

Risk Factors and Identification – Child Sexual Exploitation

A child in need is defined as a child whose vulnerability is such that they are unlikely to reach or maintain a satisfactory level of health or development without the provision of services (section 17, Children’s Act 1989). This includes disabled children. The Children’s Acts 1984 and 2004 define a child as someone who has not reached their 18th birthday. The fact that a child has reached their 16th birthday and may be living independently, working, or be members of the armed forces does not remove their childhood status under the Acts.

Local authority social services departments working with other local authority departments and health services have a duty to safeguard and promote the welfare of children in their area who are in need. If you are considering making a referral to Social Services as a child in need, it is essential to discuss the referral with the child’s parents or carers and to obtain consent for the sharing of information. Social Services will then follow local procedures to undertake an assessment of the child and their family.

Child Protection Plan

Children judged to be at continuing risk have a child protection plan in place, this list is maintained by children’s social care (CSC).

CSC, police and health professionals have 24 hour access to this. A child on the register has a “key worker” to whom reference can be made.

Recognising Child Abuse

(for full details please ref to Working Together to Safeguard Children 2013)

There are 4 main categories of child abuse:

• Physical abuse
• Sexual abuse
• Emotional abuse
• Neglect/failure to thrive

These are not however exclusive, and a number of abuse types can often coexist.

Physical abuse may include:

Injuries in children under 1 years of age or non-mobile children should be treated with a high degree of care

• Hitting, shaking, throwing, poisoning, burning or scalding, or other forms of physical harm
• Where a parent or carer deliberately causes ill-health of a child
• Single traumatic events or repeated incidents
• FGM

Sexual abuse may include:

• Forcing or enticing a child under 18 to take part in sexual activities where the child is unaware of what is happening
• May include both physical contact acts and non—contact acts

Emotional abuse may include:

• Persistent ill-treatment which has an effect on emotional development
• Conveyance of a message of being un-loved, worthlessness or inadequacy
• May instill a feeling of danger, being afraid
• May involve child exploitation or corruption
• Living in families where domestic violence is taking place

Neglect may include:

• Failure to meet the child’s physical or psychological needs
• Failure to provide adequate food or shelter
• Failure to protect from physical harm
• Neglect of a child’s emotional needs

Common presentations and situations in which child abuse may be suspected include:

• Disclosure by a child or young person
• Physical signs and symptoms giving rise to suspicion of any category of abuse
• The history is inconsistent or changes
• A delay in seeking medical help
• Extreme or worrying behaviour of a child, taking account of the developmental age of the child
• Accumulation of minor incidents giving rise to a level of concern, including frequent A&E attendances

Some other situations which need careful consideration are:

• Disclosure by an adult of abusive activities
• Girls under 16 presenting with pregnancy or sexually transmitted disease, especially those with learning difficulties
• Very young girls requesting contraception, especially emergency contraception
• Situations where parental mental health problems may impact on children
• Parental/ carer alcohol, drug or substance misuse which may impact on children
• Parents with learning difficulties
• Violence or domestic abuse in the family (please see separate document in safeguarding folder on domestic violence)
• Acuminous separation of parents with alleged allegation

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. Please email comments, suggestions, and compliments to: [email protected]

We’ll let the staff involved know and share the good practice across our teams.

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 two working days 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 48 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 10 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 be 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:

• GOV.UK – The NHS Constitution for England
• NHS Choices – NHS Constitution

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 may be sent a formal warning letter, or be asked to sign a “good behaviour agreement” if there are ongoing difficulties.

If the bullying or offensive behaviour persists we may remove you from the practice list and transfer you to the local GP service that is for aggressive patients. 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.