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Practice Policies

Accessible Information Standard
The standard aims to make sure our patients, or their carers, with a disability, sensory loss or impairment are provided with information they can easily read or understand with support, for example large print, so they can communicate effectively with health and social care services
If you have any information or communication support needs relating to a disability, impairment or sensory loss please let us know.   
Getting to our Surgeries

Hamworthy Surgery

Situated on Blandford Road we have good access to bus routes to and from Poole Town Centre and local residential areas. Check More Buses for route numbers and times.

There is a car parking available with marked disabled bays at the top by the main entrance and also by the lower ground floor entrance

Cycling to the surgery? Feel free to secure your bike to the cycle hoops at the front entrance. Please ensure these are secured. We also have puncture repair kits in our secure shelters should your bike need a quick repair! CCTV covers the cycle parking area. Beryl Bikes also has a location on the surgery premises.

UPDATE JULY 2023 We have recently moved the waste bins away from the front entrance to enable better access to the cycle hoops and more space to park mobility scooters.

Cycling maps are available from BCP council website and we do have some on Hamworthy site to hand out. Cycle routes and maps (bcpcouncil.gov.uk)

Poole Surgery

Situated on Longfleet Road we have good access to bus routes to and from Poole Town Centre and local residential areas. Check More Buses for route numbers and times.

There is a car parking available with marked disabled/emergency bays along the right side of the surgery as you enter the car park.

Cycling to the surgery? Feel free to secure your bike to the cycle hoops at the front entrance. Please ensure these are secured. We also have puncture repair kits in our secure shelters should your bike need a quick repair! Beryl Bikes has a location on Longfleet Road outside the hospital, a few yards from the surgery.

Upton Surgery

This is situated within Upton Health Centre which is signposted from Poole Road.  There is a small car park with marked disabled bays. Bus routes are also good along Poole & Blandford Road.

We are working to bring cycling facilities to this surgery.

Heath Cottage surgery

Is situation just above Tesco on the High Street within easy walking distance. A small car park is available with 2 marked disabled bays close to the level entrance of the surgery. There is also car park opposite beside the playing field.

We are working to bring cycling facilities to this surgery.

THINK CYCLING / THINK WALKING TO OUR SURGERIES

REDUCE CAR USE & KEEP FIT

Baby Friendly

We are a baby-friendly Practice. You are welcome to breastfeed your baby; please ask a Receptionist if you would like to sit somewhere private.

Chaperones

Our Practice is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times; the safety of everyone is of paramount importance.

All medical consultations, examinations and investigations are potentially distressing. Patients can find examinations, investigations or photography involving the breasts, genitalia or rectum particularly intrusive (these examinations are collectively referred to as ‘intimate examinations’). Consultations involving dimmed lights, the need for patients to undress or intensive periods of being touched may also make a patient feel vulnerable.

Chaperoning is the process of having a third person present during such consultations to provide support, both emotional and sometimes physical, to the patient, to provide practical support to the Doctor as required, and also to protect the Doctor against allegations of improper behaviour during such consultations.

Please refer to our Chaperone Policy shown below for further information

Chaperone Policy

Introduction

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
  • A suitable sign will be clearly on display in each Consulting or Treatment Room offering the Chaperone Service.

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.

Where the Practice determines that non-clinical staff will act in this capacity, the patient will be asked to agree to the presence of a non-Clinician in the examination, and for confirmation that they are at ease with this. The staff member will be trained in the procedural aspects of personal examinations, be comfortable acting in the role of Chaperone, and be confident in the scope and extent of their role. They will also have received instruction on where to sit/stand and what to watch and listen for. A Chaperone will document in the patient notes that they were present, and detail any issues arising.

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 reception 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, as long as 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, as long as 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 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 Chaperone will make a record in the patient’s notes after examination. The record will either state that there were no problems, or give details of any concerns or incidents that occurred. The Chaperone must be aware of the procedure to follow if any concerns require to be raised
  • The patient can refuse a Chaperone, and if so this must be recorded in the patient’s medical record.
Clinical Governance

Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish.

Clinical governance encompasses quality assurance, quality improvement and risk & incident management.

Clinical Research

Clinical Trials help Doctors understand how to treat a particular disease or condition. It may benefit you, or others like you, in the future.

If you take part in a Clinical Trial, you may be one of the first people to benefit from a new treatment.

However, if you do take part you should also be aware that there is a chance that the new treatment turns out to be no better, or worse, than the existing standard treatment.

Consent Protocol

Consent to treatment is the principle that a person must give permission before they receive any type of medical treatment, test or examination and is generally requested on the basis that an explanation of the required treatment, test or procedure has been received from a Clinician.

Consent from a patient is needed regardless of the procedure, whether it’s a physical examination, organ donation or something else.

The principle of consent is an important part of medical ethics and international human rights law.

Defining consent

For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

These terms are explained below:

  • voluntary– the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family
  • informed– the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn’t go ahead
  • capacity– the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.This is still the case even if refusing treatment would result in their death, or the death of their unborn child.

If a person doesn’t have the capacity to make a decision about their treatment, the Healthcare Professionals treating them can go ahead and give treatment if they believe it’s in the person’s best interests.

Clinicians must however take reasonable steps to seek advice from the patient’s friends or relatives before making these decisions.

Read more about assessing the capacity to consent.

How consent is given

Consent can be given:

  • verbally– for example, by saying you are happy to have an X-ray
  • in writing– for example, by signing a Consent Form for surgery to be performed

Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place – for example, holding out an arm for a blood test.

Consent should be given to the Healthcare Professional directly responsible for the person’s current treatment, such as:

  • a Nurse arranging a blood test
  • a GP prescribing new medication
  • a Surgeon planning an operation

If someone is going to have a major medical procedure such as an operation, their consent should ideally be secured plenty of time in advance, so that they have time to obtain information about the procedure and ask questions.

If a patient changes their mind at any point before the procedure, they are entitled to withdraw their previous consent.

Consent from children and young people

If they’re able to, consent is usually given by patients themselves. However, someone with parental responsibility may need to give consent for a child up to the age of 16 to have treatment.

Read more about the rules of consent applying to children and young people.

When consent isn’t needed

There are a few exceptions when treatment may be able to go ahead without the person’s consent, even if they’re capable of giving their permission.

It may not be necessary to obtain consent if a person:

  • requires emergency treatment to save their life, but they’re incapacitated (for example, they’re unconscious) – the reasons why treatment was necessary should be fully explained once they’ve recovered
  • immediately requires an additional emergency procedure during an operation – there has to be a clear medical reason why it would be unsafe to wait to obtain consent, and it can’t be simply for convenience
  • with a severe mental health condition such as schizophrenia, bipolar disorder or dementia, lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act 1983) – in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental illness
  • requires Hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act 1983) – the person’s nearest relative or an approved Social Worker must make an application for the person to be forcibly kept in Hospital, and two Doctors must assess the person’s condition
  • is a risk to public health as a result of rabies, cholera or tuberculosis (TB)
  • is severely ill and living in unhygienic conditions (under the National Assistance Act 1948) – a person who is severely ill or infirm and is living in unsanitary conditions can be taken to a place of care without their consent

You can always talk to the clinician providing you with care if you have any concerns in relation to consent.

Consent and life-sustaining treatments

A person may be being kept alive with supportive treatments – such as lung ventilation – without having made an advance decision based on information which outlined the care that they may have refused to receive.

In these cases, a decision about continuing or stopping treatment needs to be made based on what that person’s best interests are believed to be.

To help reach a decision, the Healthcare Professionals responsible for the person’s care should discuss the issue with the relatives and friends of the person receiving the treatment.

They should consider, among other things:

  • what the person’s quality of life will be if treatment is continued
  • how long the person may live if treatment is continued
  • whether there’s any chance of the person recovering

Treatment can be withdrawn if there’s an agreement that continuing treatment isn’t in the person’s best interests.

The case will be referred to the Courts before further action is taken if:

  • an agreement can’t be reached
  • a decision has to be made on whether to withdraw treatment from someone who has been in a state of impaired consciousness for a long time (usually at least 12 months)

It’s important to note the difference between withdrawing a person’s life support and taking a deliberate action to make them die. For example, injecting a lethal drug would illegal.

Complaints

If you believe you’ve received treatment you didn’t consent to, you can make an official complaint, please write to the Practice Manager, who will assist you with this process.

Disability Access

We are committed to ensuring patients have equal access to our surgeries. We assess the needs of its disabled patients, or those with mobility or other requirements annually to ensure that their access to services is, as far as practicable, maximised.

Accessible Entrances & Toilets

All our surgeries have accessible entrances and toilets. Hamworthy, Poole & Upton surgeries have automatic entrance doors. Heath Cottage surgery has a wider entrance adjacent to the car park.

Disabled Parking bays

We provide clearly marked clearly marked, wider parking bays at all our surgeries. These are located as follows:

  • Hamworthy – at the front of the premises and one at the bottom of the car park
  • Poole – use the yellow hatched area as you come into the car park
  • Heath Cottage – parking bay close to accessible entrance
  • Upton – marked bays close to the entrance

Disabled parking – Blue badge scheme

The Blue Badge Scheme is for people with severe mobility problems. It allows Blue Badge holders to park close to where they need to go. For more information and an Application Form visit your local council office.

Hearing Impairments 

We have a loop induction system at all our receptions to assist the hearing impaired. Please ask for this to be turned on if you wish to use it. For more information on the loop hearing system visit Hearing Link website.

Some of our staff are trained in Makaton sign language. Please ask if you would like to communicate using this method.

Blind/partially sighted

If you or your family members are blind or partially sighted we can give you a large print of our Practice leaflet upon request. Please ask our staff for further information.

For more advice and support for blind people please visit the following websites:

Guide Dogs

Guide dogs are welcome at the Practice but we ask that you be aware of other patients and staff who may have an allergy or fear of dogs. Please visit the guide dog website for further information. Owners of assistance dogs will be given the opportunity to tour the practice and the grounds with their assistance dog. This will enable the dog to become familiar with routes throughout the building.

Private room 

We offer private room facilities for patients who may have communication, reading, or writing difficulties. Please ask at reception or telephone ahead of your visit.

Seating

The practice provides high-backed and high seat base to assist elderly or disabled patients in standing or sitting. These are located in our waiting rooms.

If you encounter any accessibility problems when you visit our surgeries, please let us know. We are always keen to improve our facilities and welcome suggestions patients have. Please send an

Duty of Candour

We share a common purpose with our partners in health and social care – and that is to provide high quality care and ensure the best possible outcomes for the people who use our services. Promoting improvement is at the heart of what we do.

We endeavour to provide a first class service at all times but sometimes things go wrong and our service may fall below our expected levels.
In order to comply with Regulation 20 of the Health and Social Care Act 2008 (Regulations 2014) we pledge to:
  • Have a culture of openness and honesty at all levels
  • Inform patients in a timely manner when safety incidents have occurred which may affect them
  • Provide a written and truthful account of the incident, explaining any investigations and enquiries made
  • Provide a written apology
  • Provide support if you are affected directly by an incident.
Equality and Diversity

Our Policy is designed to ensure and promote equality and inclusion, supporting the ethos and requirements of the Equality Act 2010 for all visitors to our Practice.

We are committed to:

  • ensuring that all visitors are treated with dignity and respect
  • promoting equality of opportunity between men and women
  • not tolerating any discrimination or perceived discrimination against, or harassment of, any visitor for reason of age, sex, gender, marital status, pregnancy, race, ethnicity, disability, sexual orientation, religion or belief
  • providing the same treatment and services (including the ability to register with the Practice) to any visitor irrespective of age, sex, marital status, pregnancy, race, ethnicity, disability, sexual orientation, medical condition, religion or belief
  • This Policy applies to the general public, including all patients and their families, visitors and contractors

Procedure

Discrimination by the Practice or Visitors / patients against you

If you feel discriminated against:

  • You should bring the matter to the attention of the Practice Manager
  • The Practice Manager will investigate the matter thoroughly and confidentially within 14 working days
  • The Practice Manager will establish the facts and decide whether or not discrimination has taken place, and advise you of the outcome of the investigation within 14 working days
  • If you are not satisfied with the outcome, you should raise a formal complaint through our Complaints Procedure

Discrimination against our Practice staff

The Practice will not tolerate any form of discrimination or harassment of our staff by any visitor. Any visitor who expresses any form of discrimination against or harassment of any member of

Facilities

Parking

Please ensure that you use the surgery car park only when being seen in the surgery and ensure you park within marked bays. Disabled spaces are provided at all surgeries close to entrances. At our Poole Surgery patients are required to provide their registration number at reception on every visit as we operate a permit scheme. This is to ensure all our patients and staff can park easily whilst at the surgery.

Security

Please ensure that you lock your car, leaving valuables out of sight. Please take care not to leave anything in the waiting room when you leave.
The practice cannot accept any responsibility for patients’ property whilst on surgery premises.

Mobile Phones

Please switch off while visiting practice premises.

Infection Control Statement

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.
Named GP Policy

As part of the NHS commitment to providing more personalised care, from June 2015 all practices are required to provide all their Patients with a named GP who will have overall responsibility for the care and support that our surgery provides.  

  •  This will not impact your experience at the practice, the provision of appointments, your treatment, or which GP you can see
  •  You may wonder why your allocated GP is not necessarily the one you see most regularly.  Please be assured that you can still access all of our medical team in exactly the same way as before
  •  Having a named GP does not guarantee you will always be seen by that GP
  •  Please note that the GP responsible for your care may be subject to change and reallocation in the future

You do not need to take any further action, but if you have any questions or wish to know your named GP, please speak to a member of the reception team.

What does ‘accountable’ mean?

This is largely a role of oversight, with the requirements being introduced to reassure patients that they have one GP within the practice who is responsible for ensuring that this work is carried out on their behalf.   

What are the named GP’s responsibilities to 75s and over?

This is unchanged from 2014-2015; for patients aged 75 and over the named accountable GP is responsible for:  

  •  working with relevant associated health and social care professionals to deliver a multi-disciplinary care package that meets the needs of the patient
  •  ensuring that these patients have access to a health check as set out in section 7.9 of the GMS Contract Regulations.

Does the requirement mean 24-hour responsibility for patients? No. The named GP will not:  

  •  take on vicarious responsibility for the work of other doctors or health professional
  •  take on 24-hour responsibility for the patient, or have to change their working hours. The requirement does not imply personal availability for GPs throughout the working week
  •  be the only GP or clinician who will provide care to that patient

Can patients choose their own named GP

In the first instance, patients should simply be allocated a named GP. However, if a patient requests a particular GP, reasonable efforts should be made to accommodate their preference, recognising that there are occasions when the practice may not feel the patient’s preference is suitable. 

Do patients have to see the named GP when they book an appointment with the practice?

No. Patients can and should feel free to choose to see any GP or nurse in the practice in line with current arrangements. However, some practices

Non-Smoking Premises

Smoking is not permitted either within the Practice premises or in the Practice car park.

Quality Assurance

Our Practice aims to provide quality, consistent primary care for all patients. We strive to meet the high standards expected in any clinical setting and we expect all members of our Team to work to these standards to help us achieve our aim.

The policies, systems and processes in place in our Practice reflect our professional and legal responsibilities and follow recognised standards of good practice. We evaluate our Practice on a regular basis, through audit, peer review and patient feedback and monitor the effectiveness of our quality assurance procedures.

Quality standards and procedures

To assist our Team in providing our patients with care of a consistent quality we will:

  • Provide a safe and welcoming environment
  • Ensure all members of our Team are appropriately trained
  • Provide patients with information about the Practice and the care available, and ensure the patient understands the terms under which care is offered
  • Explain all treatment options and agree clinical decisions with the patient(s), explaining the possible risks involved with each option
  • Obtain valid consent for all treatment
  • Refer to Specialists for investigation or treatment as appropriate and without undue delay
  • Maintain contemporaneous clinical records with an up-to-date medical history for all patients
  • Provide secure storage of patients records to maintain confidentiality
  • Explain the procedure to follow for raising a complaint about the service, identifying the Practice contact

To provide our patients with a Team that provides care of a consistent quality we will:

  • Provide a safe working environment through hazard identification and risk assessment
  • Provide relevant training for all new Team members
  • Provide Job Descriptions and Contracts of Employment
  • Agree terms for all non-employed contractors working at the Practice
  • Maintain staff records, ensuring they are kept as up-to-date as possible
  • Ensure staff are notified where all Practice policies and procedures are stored and accessed
Safeguarding Children

Our Primary Care Team is committed to safeguarding children. The safety and welfare of children who come into contact with our services either directly or indirectly is paramount, and all staff have a responsibility to ensure that Best Practice is followed, including compliance with statutory requirements.

We are committed to a Best Practice which safeguards children and young people irrespective of their background, and which recognises that a child may be abused regardless of their age, gender, religious beliefs, racial origin or ethnic identity, culture, class, disability or sexual orientation.

The Primary Care Team are committed to working within agreed policies and procedures and in partnership with other agencies, to ensure that the risks of harm to a child or young person are minimised. This work may include direct and indirect contact with children, access to patient’s details and communication via email or text message/telephone.

Our Surgery is supported by the CCG who have designated Nurses and Doctors in post who offer professional expertise and advice regarding safeguarding children.

Further information about Safeguarding
Shared Decision Making

Making decisions about your care with your doctor or nurse (shared decision making)

When you visit your doctor’s surgery you will often find that there are decisions to be made about your health and the treatments that might be available to you.  This includes when you are choosing between different types of treatment or different ways of managing any condition(s) you have.  When these decisions are made it is important that you are part of that process, so that you are able to come to the best decisions based on what is important to you.

Shared Decision Making

Your doctor/nurse is an expert about health and health care. You are an expert in knowing about yourself, the impact that any conditions have on you, and what is important to you in treating your condition and in your wider life.  When you and your doctor/nurse work together to share what you both know, and then use all of that information to come to a decision together, this is called ‘Shared Decision Making’.

How to get involved

In order for you to be involved in decisions about your care there are three key things you need to know;

  1. What are my options?
  2. What are the possible risks, benefits and consequences of each option?
  3. How can we make a decision together that is right for me?

With shared decision making your doctor/nurse is there to support you by providing good quality information, helping you understand this information, and giving you support and guidance as you think about what is most important to you.  This will help you to understand what choices are available to you, the pros and cons of each option, and then use that information to come to a decision together about the best option for you.

If you would like to know more about Shared Decision Making the following video provides further information.

Where to find more information

Here are some links to information which may help you make any decisions about your healthcare

Patient Decision Aids

Patient Decision Aids (PDAs) are designed to help you decide which treatments and care options are best for you.

PDAs are useful because they allow you to pick out the things that are most important to you (your values) and make comparisons about how different treatments might affect these values.  Patient decision aids have been developed for a number of common health care decisions and your doctor/nurse may use one or refer you on to one when you talk with them, or you might find it useful to look at one by yourself.  If you would like to know more about patient decision aids and look at some of the patient decision aids that are publicly available, the following websites :

Decision aids developed in the UK

An international inventory of decision aids 

If you are looking for information about the risk of cardio vascular disease or Type 2 diabetes and ways in which those risks can be reduced these sites contains some useful information:

The Absolute CVD Risk/Benefit Calculator

Q Intervention

Unacceptable Actions 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 individuals 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 requesting further supplies of stolen medication, without the required Police Incident number
  • Repeatedly ordering prescriptions outwith 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
  • Not ensuring that a review appointment is in place, prior to ongoing medication finishing
  • 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 life-span 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 Senior 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 have to take action 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, taking into account 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 a given 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 take into account 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
  • With the exception of 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 Senior 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 Senior 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 computer records. Each quarter a report on all restrictions will be presented to our Senior Management Team so that they can ensure the policy is being applied appropriately. 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 of time has passed. Each case is different.

This policy is subject to review

Zero Tolerance

NHS staff should be able to come to work without fear of violence, abuse or harassment from patients or their relatives.

The NHS operate a Zero Tolerance Policy with regard to violence and abuse and the Practice has the right to remove violent patients from their list with immediate effect, in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.

Where patients are disruptive and display aggressive and/or intimidating behaviour and refuse to leave the premises, staff are instructed to dial 999 for Police assistance, and charges may then be brought against these individuals.

Removal of Patients from our List

It is our policy not to remove patients without serious consideration. If a patient has a serious continuing medical condition, removal will be postponed until the patient’s condition stabilises.

Possible grounds for consideration of removal include:

  1. Physical violence to staff, Doctors or other patients
  2. Threat of violence to staff, Doctors or other patients
  3. Abusive or disruptive behaviour including when under the influence of alcohol or drugs
  4. Theft from the Surgery, staff, Doctors or other patients
  5. Criminal damage to the Surgery
  6. Dangerous dogs posing a real or potential hazard on home visits
  7. Altering documents e.g. prescriptions, insurance certificates
  8. Defamation of Doctors or staff
  9. Misuse of appointments
  10. Misuse of home visits
  11. Moving outwith the area
  12. Any other breakdown of the bond of trust between Doctor and patient

It should be noted that if a patient does not attend for their appointment they will not be given another one for 48 hours. In the event of a patient not attending on three occasions they will receive a letter advising them that if they miss another appointment, they will be removed from our Practice list.

In some cases we reserve the right to remove other members of the household. We will continue to be responsible for the patient’s medical care for a period of up to 8 days from the date of notification to our local health authority or until the patient registers with another Doctor, whichever is the sooner.

Social Media

Patients are reminded that if they are found posting any derogatory, defamotory, or offensive comments on social media directed to the Practice or members of staff on social networking sites, this may result in them being removed from the Practice List. We ask if you have a complaint to please contact the Practice Manager in the first instance. We would be grate

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