The practice is registered and complies with the Data Protection Act 1998. Any request for access to notes by a patient, patient’s representative or outside body will be dealt with in accordance with the Act. If you wish to request access to the records held by the practice, please put in a written request addressed to the practice manager.

You may be aware that our car park now has ANPR cameras. If you are using our car park please accept this message as a reminder to enter your car registration details should you have an appointment at the surgery. We will not get involved in disputes with Creative Car Park Solutions, please contact them using the details on the PCN notice.

If you feel you would like a chaperone present at your consultation, please inform the doctor or nurse who will be happy to arrange this for you.

On some occasions, your doctor or nurse may ask for a chaperone to be present during an examination.

Market Quarter Medical Practice adheres to local and national guidance, e.g. NCGST guidance on the role and effective use of chaperones in primary and community care settings.

Table of contents

• Introduction
• Scope of policy
• Responsibilities, accountabilities and duties
• Uses
• Justification
• Implied consent
• Being open and honest about how information is used
• Children
• Risks
• Monitoring compliance

1        Introduction

It is recognised that the use of email and text messaging are well-established methods of communication. Market Quarter Medical Practice supports the use of email and text messaging as a means of communication with patients/service users and carers, subject to compliance with this policy.

2       Scope of Policy

This policy sets out the circumstances in which patients, service users and carers can be contacted using email or text message and the procedures that must be followed when using this method of communication.

3       Responsibilities, accountabilities and duties

This guidance applies and must be adhered to by anyone working within Market Quarter Medical Practice including; but not exclusively, employees, seconded staff and contractors who use or who intend to use text messages and email in the course of their communication with patients and service users.

The Senior Partner has overall responsibility for the organisation’s data.

The Senior Information Risk Owner is accountable to the GP Partners for information risks and security of information.

The Caldicott Guardian is responsible for the establishment of procedures governing access to, and the use of, person-identifiable information and, where appropriate, the transfer of that information to other bodies.

Managers are responsible for making sure this guidance is highlighted to relevant staff, that it has been understood, and that it is being followed.

4       Uses

Example uses of text messages:

• Appointment reminders and confirmations
• Communicating negative (clear) test results
• Asking the patient to call the service at a convenient time
• Communicating advice to patient (e.g. bad weather reassurance of a Community Nurse visit)
• Ad-hoc communication between key worker and patient.

Example uses of email:

• Asking the patient to call the service at a convenient time
• Communicating advice to patient (e.g. bad weather reassurance of a Community Nurse visit)
• Ad-hoc communication between key worker and patient
• Copies of letters sent to GP, if requested
• Appointment letters.

The practice will never share this information with third parties.

Health promotional material will only relate to services directly offered by the practice and will not include third party marketing material.

5       Justification

Services must individually agree the need/benefit of using email and text message and formally approve and document the implementation of the service. Individual users must not use email or text messages for health-related purposes without formal documented approval.

Local/departmental procedures for the use of email and text message, which comply with this policy, must be documented and cover the following topics:

• Identification of the service or facility to be provided

• Identification of the need or justification for the use of email/text message

• The agreement to the use of the service by its intended beneficiaries/recipients

• Clear identification of the associated risks and of the means by which these risks are managed

• Storage and retention procedures.

6       Implied consent

It is appropriate to rely on implied consent when contacting individual patients and service users about their individual care or requesting they complete a friends and family test survey.

It is important that any preferences are recorded in their record and respected. Patients and service users should be able to change their preferences about how they are contacted at any time.

7       Being open and honest about how information is used

It is essential that the use of email addresses and mobile telephone numbers is in line with transparency guidance and best practice. This means that the use of personal information held by the organisation must be understood by the individual. Services should explain to the patients and service users:

•  What information they need about them, e.g. mobile number:

•  For what purpose, e.g. to send appointment reminders;

•  Who the information may be shared with, e.g. it will not be shared;

•  What they will do with that information, e.g. it will be stored on your record.

Services should be clear about the rationale for using email and/or text messaging to communicate with their patients/service users and should clearly define the purpose and scope of communication by these means. This includes making patients and service users aware that text messages and emails will not be read during non-working hours and therefore should not be used for urgent queries.

Services should make this information readily available to their patients and service users:

• During the registration process

• When a mobile phone or email address is recorded/updated

• Through online applications, e.g.Patient Online

• During contacts with the patient or service user, either in person or on the phone. This doesn’t need to be with the clinician and could be with reception staff.

• Through information in a waiting area which highlights the benefits to patients and service users and signposts them about how to give their consent.

8       Children

The age at which a child becomes competent to make certain decisions about their health and care and information sharing will vary depending on the child and the particular decision.

A child with competence is able to make choices about how health and care providers use their information. As such they should be given a choice about who receives emails and messages about their care.

9       Risks

A Data Protection Impact Assessment (DPIA) must be completed prior to the implementation of the service. In areas where it is felt that risks are unacceptable, the service must not be implemented.

The following risks must always be taken into account:

• Confidentiality

Risks can be mitigated to a large extent by only sending non-sensitive messages and by never sending sensitive data such as – “your next ante-natal appointment is…”

• Ensuring delivery to the correct recipient

Risks can be mitigated by

• Explaining to the patient or service user that it is their responsibility to keep and provide an up to date email address and/or mobile phone number, and to be clear that the service are not responsible for onwards use or transmission of email or text message once it has been received by the patient/service user:

• Have processes in place to remind patients and service users to update their email address and mobile number when needed

• Contracting out services for sending emails and text messages

If a service wishes to use an external provider, it must seek approval from IG, complete a Data Protection Impact Assessment (DPIA) and ensure all contractual and security measures are in place before any agreement takes place.

10   Monitoring compliance

Audit procedures and audit cycles will be established by the IG Team, in collaboration with Operational Services to ensure that:

• The exchange of text messages with patients and service users has not created any problems or difficulties for the organisation or for the patient/service users.

• Any risks are identified, regularly re-assessed and adequately addressed.

• Confidentiality is not put at risk, and that appropriate records of contact are properly maintained.

• Any incidents that are raised as a result of email or text message communication with patients and service users will be investigated, reviewed and reported to the Practice Manager.
• Any action required to increase the effectiveness of this policy will be undertaken.

• This policy will be regularly reviewed to reflect any changes to national policy, technology or operational practice.

Dissemination

The policy will be disseminated to all staff. The policy will also be available on the practices website.

The purpose of this policy is to set out the practice’s approach to consent and the way in which the principles of consent will be put into practice.

Where possible, a clinician must be satisfied that a patient understands and consents to a proposed treatment or immunisation.

As a result of the Montgomery Judgement in 2015, the clinician must also ensure that other possible treatment options, including the risks and benefits of each, have been explained to the patient before the patient makes their decision to consent.

The doctor is under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in the proposed treatment, and of reasonable alternatives.

Where a patient is accompanied by a carer, advocate or other support person, the clinician will ensure that:

• They understand the care, treatment and support choices available to the patient.
• Involve them appropriately in making decisions about the patient’s care.
• Give opportunities for them to represent the views of the patient.

Whether explaining to a patient, carer, advocate or other support person; information given will include the nature, purpose, and risks of the procedure to ensure that they understand, and have enough information to give informed consent.

The practice will ensure that where consent is necessary, this is recorded on EMIS.

Implied Consent

Implied consent will be assumed for many routine physical contacts with patients. Where implied consent is to be assumed by the clinician, in all cases, the following will apply:

• An explanation will be given to the patient what s/he is about to do, and why.
• The explanation will be sufficient for the patient to understand the procedure.
• In all cases where the patient is under 18 years of age, a verbal confirmation of consent will be obtained and briefly entered into the medical record.
• Where there is a significant risk to the patient an ‘Expressed Consent’ will be obtained in all cases.

Expressed Consent

Expressed consent (written or verbal) will be obtained for any procedure which carries a risk that the patient is likely to consider as being substantial.

A note will be made in the medical record detailing the discussion about the consent and the risks. A consent form may be used for the patient to express consent.

Obtaining Consent

• Consent (Implied or Expressed) will be obtained prior to the procedure.
• The clinician will ensure that the patient is competent to provide a consent (16 years or over) or has Gillick Competence if under 16 years.
• Questions posed by the patient will be answered honestly, and information necessary for the informed decision will not be withheld unless there is a specific reason to withhold. In all cases where information is withheld, then the decision will be recorded in the clinical record.
• The clinician will explain the proposed treatment and any alternatives available to the patient, the risks and benefits of each option, and support the patient choice about which treatment best meets their needs.
• The person who obtains the consent will be the person who carries out the procedure (i.e. a nurse carrying out a procedure will not rely on a consent obtained by a doctor unless the nurse was present at the time of the consent).
• The person obtaining consent will be fully qualified and will be knowledgeable about the procedure and the associated risks.
• The scope of the authority provided by the patient will not be exceeded unless in an emergency.
• The practice acknowledges the right of the patient to refuse consent, delay the consent, seek further information, limit the consent, or ask for a chaperone.
• Clinicians will use a consent form where procedures carry a degree of risk or where, for other reasons, they consider it appropriate to do so (e.g. malicious patients).
• No alterations will be made to a consent form once it has been signed by a patient.
• Clinicians will ensure that consents are freely given and not under duress (e.g. under pressure from other present family members etc.).
• If a patient is mentally competent to give consent but is physically unable to sign the consent form, the clinician should complete the Form as usual, and ask an independent witness to confirm that the patient has given consent orally or non-verbally.

Other aspects which may be explained by the clinician include:

• Details of the diagnosis, prognosis, and implications if the condition is left untreated.
• Options for treatment, including the option not to treat.
• Details of any subsidiary treatments (e.g. pain relief).
• Patient experiences during and after the treatment, including common or potential side effects and the recovery process.
• Probability of success and the possibility of further treatments.
• The option of a second opinion.

Immunisations

Informed consent must be obtained prior to giving an immunisation.

Consent for Children under 16 (Gillick Competence)

Everyone aged 16 or more is presumed to be competent to give consent for themselves unless the opposite is demonstrated.

If a child under the age of 16 has sufficient understanding and intelligence to enable him/her to understand fully what is proposed (known as Gillick Competence), then she/he will be competent to give consent for him/herself.

Young people aged 16 and 17, and legally ‘competent’ younger children, may, therefore, sign a consent form for themselves, but may like a parent to countersign as well.

For children under 16 (except for those who have Gillick Competence as noted above), someone with parental responsibility should give consent on the child’s behalf by signing accordingly on the consent form.

Withdrawal of Patient Consent

• The practice acknowledges the right of the patient to refuse consent, delay consent, seek further information, limit the scope of consent, or ask for a chaperone.
• The patient or parent/guardian has the right to withdraw consent at any time.
• Questions posed by the patient will be answered honestly, and information necessary for them to make an informed decision will not be withheld unless there is a specific reason to withhold it. In all cases where information is withheld, the reasons for this will be recorded in the patient’s clinical record.
• The person who would have been carrying out the procedure will make sure that all issues around the withdrawal of consent have been fully explained to the patient or parent/guardian to enable them to fully understand what may happen if the treatment/operation is not carried out. (The person discussing this must be fully qualified and knowledgeable about the procedure itself and the associated risks).
• The scope of the authority provided by the patient will not be exceeded unless in a medical emergency.
• No alterations will be made to the withdrawal of consent form once it has been signed by a patient.

Coming soon

Information about the GPs and the practice required for disclosure under the Freedom of Information Act 2000 can be made available to the public. All requests for such information should be made to the practice manager.

coming soon

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

Information about your health and care helps the NHS to improve your individual care, speed up diagnosis, plan your local services and research new treatments.

It can also help research organisations to explore new treatments or make discoveries.

You can decide that you do not want your information to be used in this way.

Choose if data from your health records is shared for research and planning

The practice reserves the right to reject any request from a private Specialist to prescribe medications on an ongoing basis. If the specialist wishes for a medication to be added to the patient’s repeat prescriptions, the same approach as per standard NHS guidance should be followed. i.e.

• Specialist writes to GP outlining the reason for the medication being initiated and requests it to be placed on repeat prescription AND
  Specialist issues a private prescription for 1 month (this allows a reasonable amount of time for a clinic letter to reach the GP practice and be processed).
• Patients who are issued a medication by a private specialist will need to pay the private prescription fee for that item. Requests to transfer private prescriptions to an NHS prescription before a clinic letter has been received will always be rejected.

Requests to take on prescribing of the below classes of medications will NOT be accepted by the practice.

SC – Shared care
SI – Specialist initiated
SO – Specialist only
BL – Black listed medicines
NR – Not recommended
DM – Discontinued medicines

The Practice may consider adding medications that are on the Coventry and Warwickshire approved prescribing committee formulary if they are not in the above classes. The formulary can be found here: www.covwarksformulary.nhs.uk

If a patient feels a medication in the above classes requires a prescription on repeat basis the following options are available:

The private specialist continues to prescribe the medication for their patient
The private specialist arranges for care to be transferred to an NHS specialist and an NHS shared care agreement can be completed (please note this does not guarantee the GP practice will take on the responsibility of prescribing shared care medications purely that it will be considered).

Market Quarter Medical Practice follows the following guidance regarding requests for blood tests to be done by a private provider:

If a patient has chosen to pay for private healthcare because

1. a) their treatment is not available on the NHS or
2. b) they do not wish to be treated on the NHS

they are responsible for paying for all costs, including tests, and the private provider is responsible for managing every aspect of their healthcare (unless the patient chooses to transfer back to the NHS at a later date to continue treatment).

For that reason, private providers should not be asking GPs to arrange any tests that they deem necessary, and intend to use, to make a diagnosis and recommend a course of treatment with.

It is the private provider’s responsibility to arrange tests for patients whose care they are managing, and the patient’s responsibility to pay for them.

The practice supports the national guidance which can be found here Screening (rcgp.org.uk)

If you choose to have private screening tests or investigations that are not available or recommended by the NHS, you should ensure that you have the funds or insurance in place to cover the costs of any additional treatment or investigation that is incurred as the NHS may not cover these.

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Market Quarter Medical Practice is an approved training practice for the training of general practice Registrars (GPRs). Being an approved training practice means that:

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

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

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

The practice will be regularly assessed for its suitability for postgraduate training in general practice. This process includes an inspection of medical records for quality, not content. If you object to your record being seen for this process then you must let us know in writing so these notes can be withdrawn.

An essential component of training in all medical practice is the use of video and consultations with both the GPR and the trainer present. We hope that all our patients will be willing to take part in these educational consultations to help us all in improving and maintaining our medical and consultation skills. All video recordings are strictly confidential and are used for teaching only. We will not video your consultation without your consent. Please contact the practice if you would prefer not to participate.

We aim to treat our patients courteously at all times and expect our patients to treat staff in a similarly respectful way. We take seriously any threatening, abusive or violent behaviour against any of our staff or patients. If a patient is violent or abusive, they will be warned to stop their behaviour. If they persist, we may exercise our right to take action to have them removed, immediately if necessary, from our list of patients.