Patient Removal Policy
The Almond Group Practice aims to provide the best possible health care for its patients. However, there may be circumstances when it would be considered reasonable, or in the best interests of the Practice or the patient, to remove patients from our list. The purpose of this policy is therefore to define the practice guidelines for patient removal ensuring that all cases are dealt with fairly.
Below are examples that will trigger the removal process and the resulting action by the practice.
Physical abuse or Violence, or threats of the same, including any damage to practice premises: Will be immediately reported to the Police and the person will be immediately removed from the list and referred to the scheme for Violent Patients.
Crime and deception: Where a patient fraudulently obtains drugs for non-medical reasons, deliberately lies in order to obtain a service or benefit by deception, steals from the practice or attempts to use the doctor to conceal or aid any criminal activity, they will be immediately removed from the list
Verbal Abuse of a member of staff: Normally one written warning will be issued with any further incident resulting in removal from the list but the practice reserves the right to remove someone instantly depending on the severity and nature of the incident.
Persistent Failure to Attend Appointments: Once an appointment is made, patients are expected to keep it, or inform us in good time that they need to cancel or change it. Failure to do so for three appointments within one year at the surgery will trigger a warning letter. Further failure to attend will result in removal from the list.
Persistent, unreasonable demands: Examples might include pressurising clinicians to prescribe a certain medication that they deem inappropriate or demanding urgent appointments for minor problems. Persistent instances will result in the patient being issued with a warning. A further incident will result in removal.
Persistent abuse of services: If the practice is aware that a patient, or relative, persistently ignores requests to follow procedures set down to ensure safe clinical care for them and other patients, two warnings in writing will be given. On a third occasion, the removal of that patient will be made.
Irretrievable breakdown of the doctor-patient relationship: Occasionally a patient’s behaviour falls outside that which is normally considered reasonable and leads to an irretrievable breakdown of the essential doctor-patient relationship. In some cases this can be overcome by changing GP’s within the practice but in others this will not be appropriate and following written explanation the patient will be removed from the practice list. Examples might include sexual advances towards a clinician or falling out with multiple clinicians within the practice and insisting on seeing only one.
Distance: If a patient moves outside of the practice boundary they are automatically deemed to have left the practice and will be removed from the list by the Health Authority.
Benzodiazepine Prescribing Policy
This policy outlines current prescribing practice for benzodiazepines at the group practice. Benzodiazepines include medications such as diazepam, lorazepam, temazepam, zopiclone and zolpidem.
The long-term use of benzodiazepines carry numerous risks and can cause a number of health complications. We recently reviewed, as per national guidance, the way in which we prescribe and monitor these medications.
It is now routine practice that we will not issue these medications on repeat prescription.
If you are currently prescribed these medications, they will be reviewed regularly at an appointment with the GP either at the practice or via telephone. The length of time between reviews will be arranged at these appointments. Regular trial of reduction of these medications is routine practice across West Lothian.
If you register with the practice and are currently prescribing of these medications, you will be asked to arrange an appointment in surgery with GP to look at how these may be reduced over time and to set out arrangements for review.
It may be that these medications are issued for a weekly fortnightly on monthly basis at the discretion of the reviewing GP.
It is the responsibility of the patient to ensure medications are stored safely. If misplaced damaged or stolen a replacement supply will not be provided earlier than the due date of the original prescription.
It will not be possible to have medications issued early with our prior discussion with GP.
If there are ongoing issues or concerns relating to the safety of prescribing these medications the patient may be asked to see review from community addiction services to aid with ongoing management.
Consent for a Friend or Family Member to Access Your Medical Record
Often it is easier for you to have a friend or family member contact their GP and discuss your medical problems on your behalf. Your medical notes are strictly confidential and we cannot do this unless we have your permission which involves written consent. If you would like to grant permission, please download, complete and return the form below.
About the personal information we use
The Almond Group Practice and uses personal information on different groups of individuals including:
- Complainants, enquirers
- Survey respondents
- Professional experts and consultants
- Individuals captured by CCTV
- Members of the public phoning the practice
The personal information we use includes information that identifies you like your name, address, date of birth and postcode. We also use more sensitive types of personal information, including information about racial or ethnic origin; political opinions; religious or philosophical beliefs; trade union membership; genetic data, health; sex life or sexual orientation. The information we use can relate to personal and family details; education, training and employment details; financial details; lifestyle and social circumstances; goods and services; visual images; details held in the patient record; responses to surveys.
Our purposes for using personal information
Under the National Health Service (General Medical Services Contracts)(Scotland) Regulations 2018 the Almond Group Practice is contracted to provide continuing, comprehensive, co-ordinated and person centred healthcare to patients in their communities. We undertake these tasks so that we can help to promote the improvement of the physical and mental health of our patients.
We use personal information to enable us to provide healthcare services for patients, supporting and managing our employees; maintaining our accounts and records, telephone recording for staff training and protection from verbal abuse and the use of CCTV systems for crime prevention.
Our legal basis for using personal information
The Almond Group Practice as a data controller, is required to have a legal basis when using personal information. The Almond Group Practice considers that the performance of our tasks and functions are in the public interest. So when using personal information our legal basis is usually that its use is necessary for the performance of a task carried out in the public interest, or in the exercise of official authority vested in us. In some situations we may rely on a different legal basis; for example, when we are using personal information to pay a supplier, our legal basis is that its use is necessary for the purposes of our legitimate interests as a buyer of goods and services. Another example would be for compliance with a legal obligation to which The Almond Group Practice is subject to, for example under the Public Health etc (Scotland) Act 2008 we are required to notify Health Protection Scotland when someone contracts a specific disease.
When we are using more sensitive types of personal information, including health information, our legal basis is usually that the use is necessary:
- for the provision of health or social care or treatment or the management of health or social care systems and services; or
- for reasons of public interest in the area of public health; or
- for reasons of substantial public interest for aims that are proportionate and respect people’s rights, for example research; or
- in order to protect the vital interests of an individual; or
- for the establishment, exercise or defence of legal claims or in the case of a court order.
On rare occasions we may rely on your explicit consent as our legal basis for using your personal information. When we do this we will explain what it means, and the rights that are available, to you. You should be aware that we will continue to ask for your consent for other things like taking part in a drug trial.
Who provides the personal information
When you do not provide information directly to us, we receive it from other individuals and organisations involved in the delivery of health and care services in Scotland. These include NHS Boards including hospitals and primary care contractors such as GPs, dentists, pharmacists and opticians; other public bodies e.g. Local Authorities and suppliers of goods and services.
Sharing personal information with others
Depending on the situation, where necessary we will share appropriate, relevant and proportionate personal information in compliance with the law, with the following:
- Our patients and their chosen representatives or carers
- Current, past and potential employers
- Healthcare social and welfare organisations
- Suppliers, service providers, legal representatives
- Auditors and audit bodies
- Educators and examining bodies
- Research organisations
- Financial organisations
- Professional bodies
- Police forces, Fire Services, Armed Forces
- Central Government Insurance Companies & Solicitors
Transferring personal information abroad
It is sometimes necessary to transfer personal health information overseas for example if you require urgent medical treatment abroad. When this is needed information may be transferred to countries or territories around the world. Any transfers made will be in full compliance with NHS Scotland Information Security Policy.
Retention periods of the information we hold
Within the Almond Group Practice we keep personal information as set out in the Scottish Government Records Management: NHS Code of Practice (Scotland) Version 2.1 January 2012. The NHS Code of Practice sets out minimum retention periods for information, including personal information, held in different types of records including personal health records and administrative records.
How we protect personal information
We take care to ensure your personal information is only accessible to authorised people. Our staff has a legal and contractual duty to keep personal health information secure, and confidential. The following security measures are in place to protect personal information:
- All staff undertake mandatory training in Data Protection and IT Security
- Compliance with NHS Scotland Information Security Policy
- Organisational policy and procedures on the safe handling of personal information
- Access controls and audits of electronic systems
This section contains a description of your data protection rights within the Almond Group Practice.
The right to be informed
The Almond Group Practice must explain how we use your personal information. We use a number of ways to communicate how personal information is used, including:
- This Data Protection Notice
- Information leaflets
- Discussions with staff providing your care
The right of access
You have the right to access your own personal information.
This right includes making you aware of what information we hold along with the opportunity to satisfy you that we are using your information fairly and legally.
You have the right to obtain:
- Confirmation that your personal information is being held or used by us
- Access to your personal information
- Additional information about how we use your personal information
Although we must provide this information free of charge, if your request is considered unfounded or excessive, or if you request the same information more than once, we may charge a reasonable fee.
If you would like to access your personal information, you can do this by contacting:
Karen Smibert, Practice Manager
Once we have details of your request and you have provided us with enough information for us to locate your personal information, we will respond to your request without delay, within one month (30 days). However If your request is complex we may take longer, by up to two months, to respond. If this is the case we will tell you and explain the reason for the delay.
The right to rectification
If the personal information we hold about you is inaccurate or incomplete you have the right to have this corrected.
If it is agreed that your personal information is inaccurate or incomplete we will aim to amend your records accordingly, normally within one month, or within two months where the request is complex. However, we will contact you as quickly as possible to explain this further if the need to extend our timescales applies to your request. Unless there is a risk to patient safety, we can restrict access to your records to ensure that the inaccurate or incomplete information is not used until amended.
If for any reason we have shared your information with anyone else, perhaps during a referral to another service for example, we will notify them of the changes required so that we can ensure their records are accurate.
If on consideration of your request the Almond Group Practice does not consider the personal information to be inaccurate then we will add a comment to your record stating your concerns about the information. If this is case we will contact you within one month to explain our reasons for this.
If you are unhappy about how we have responded to your request for rectification we will provide you with information on how you can complain to the Information Commissioner’s Office, or how to take legal action.
The right to object
When the Almond Group Practice is processing your personal information for the purpose of the performance of a task carried out in the public interest or in the exercise of official authority you have the right to object to the processing and also seek that further processing of your personal information is restricted. Provided we can demonstrate compelling legitimate grounds for processing your personal information, for instance; patient safety or for evidence to support legal claims, your right will not be upheld.
There are other rights under current Data Protection Law however these rights only apply in certain circumstances.
The right to complain
The Almond Group Practice designates a Data Protection Officer to check that we handle personal information in a way that meets data protection law. If you are unhappy with the way in which we use your personal information please tell our Data Protection Officer using the contact details below.
Data Controller and Protection Officer: Dr Kirsten Marriott
You also have the right to complain about how we use your personal information to the Information Commissioner’s Office (ICO).
Patients Rights and Responsibilities
What you can expect from us:
- We are committed to providing you with the best possible service.
- To treat you with courtesy and respect at all times. Winchburgh Medical Practice has a policy of non-discrimination.
- We will make every effort to see you promptly. Our aim is a maximum delay of 20 minutes from the time of a booked appointment. However, there are occasions on which emergencies mean that the delay can be longer – you will be informed of any delays.
- We will respect your confidentiality.
- We will offer you a health check when you first register at the practice.
- We will offer advice to promote health, for example smoking, exercise, and healthy eating.
- We will have repeat prescriptions ready to collect within two working days.
- We will arrange a home visit with the agreement of the doctor if you are too ill to attend the centre.
What we expect from you:
- That you treat the staff with courtesy and respect at all times.
- That you attend appointments on time and let us know if you need to cancel giving us 24 hours notice if possible.
- That you tell us if you change your name, address or telephone number.
- That you do not abuse the emergency appointment system – these appointments are for genuine emergency conditions only.
- That you only request a home visit if you are too ill to visit the practice.
- That you let us know if you feel that there are things that you want to see improved or changed within the practice.
Access to Medical Records
Please phone the practice or come in to speak to a receptionist if you would like to access your medical records.
Violent or Abusive Patients “Zero Tolerance”
The Practice takes it very seriously if a member of staff or one of the doctors or nursing team is treated in an abusive or violent way.
The Practice supports the government’s ‘Zero Tolerance’ campaign for Health Service Staff. This states that GPs and their staff have a right to care for others without fear of being attacked or abused. To successfully provide these services a mutual respect between all the staff and patients has to be in place. All our staff aim to be polite, helpful, and sensitive to all patients’ individual needs and circumstances. They would respectfully remind patients that very often staff could be confronted with a multitude of varying and sometimes difficult tasks and situations, all at the same time. The staff 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.However, aggressive behaviour, be it violent or abusive, will not be tolerated and may result in you being removed from the Practice list and, in extreme cases, the Police being contacted.In order for the practice to maintain good relations with their patients the practice would like to ask all its patients to read and take note of the occasional types of behaviour that would be found unacceptable:
- Using bad language or swearing at practice staff
- Any physical violence towards any member of the Primary Health Care Team or other patients, such as pushing or shoving
- Verbal abuse towards the staff in any form including verbally insulting the staff
- Racial abuse and sexual harassment will not be tolerated within this practice
- Persistent or unrealistic demands that cause stress to staff will not be accepted. Requests will be met wherever possible and explanations given when they cannot
- Causing damage/stealing from the Practice’s premises, staff or patients
- Obtaining drugs and/or medical services fraudulently
We ask you to treat your GPs and their staff courteously at all times.
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 practice, 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.