Medication for ADHD can include amphetamines and stimulants. These medications have a higher risk of severe side effects and long term risks and some are controlled drugs by law. For this reason they are usually initiated and prescribed by specialists.

In some cases GPs can take over prescribing under a Shared Care Agreement (SCA) which is convenient for the patient. Unfortunately in Lothian this SCA is not funded or resourced by the Healthboard or Scottish Government and GPs are not given any additional training in prescribing these medications. As per the GMC (General Medical Council), the responsibility for errors or adverse consequences with medication lies with the prescriber, irrespective of any SCA. Due to the of lack of resourcing and expertise, our practice has decided not to sign up to the SCAs for ADHD and prescriptions and monitoring will have to continue to be provided by the specialist. We understand this will be frustrating for some patients however we feel that prescribing safety and core GP services must be prioritised over convenience.

If you feel strongly that GPs are in an ideal position to provide these services then please contact your MSP and ask that primary care is adequately funded and trained to relieve pressure from hospital clinics.

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.

Grief is a natural response people have when they experience a death (a bereavement). Symptoms can include stress, low mood and anxiety. This is normal and will lessen with time.

If you have suffered a bereavement and you feel as though you cannot work, you should ask your employer for compassionate leave. Compassionate leave is not the same as sick leave and should not be treated as such. Similarly you should not be asked to get a ‘sicknote’ from your GP. These requests are not appropriate as bereavement is a normal process and not an illness. These requests take appointments away from people who are ill and in need of seeing a GP in a time of unprecedented pressures on the NHS. Please see the ACAS guidance below for further information.

Leave and pay when someone dies – Time off work for bereavement – Acas

If you feel you need to speak to someone for bereavement support ask your employer or have a look at bereavement counselling organisations here.

If your employer insists on treating bereavement as an illness and requests a sicknote please ask them to write to the practice outlining this.

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.

CONSENT FORM

Otherwise known as ‘get your hospital tests done at your local practice’.

We understand that it is more convenient for you to get all of your tests done at the GP practice rather than in your hospital clinic. However, GP Practices are not contractually responsible for carrying out tests or other monitoring for hospital outwith the ‘GP Enhanced Services Programme: Disease modifying drugs’ service agreement which covers only a few medications. GP phlebotomy services are for exclusive use for essential GP services.

During the COVID pandemic GP Practices willingly but temporarily carried out a variety of hospital monitoring services to prevent patients from having to travel to hospitals and potentially catch or spread COVID infection. Both the ‘GP Enhanced Services Programme: Disease modifying drugs’ service agreement and GP Practice activity during the pandemic have understandably led to the misunderstanding that GP Practices are responsible for carrying out hospital services.

GP Practices are only contractually responsible for the work that their GPs generate and taking on extra services without the adequate competencies or resources only lessens the GP services that they are responsible for providing. Over the past few years our practice has experienced an unsustainably high workload leading to long waiting times for our own tests irrespective of hospital tests. The more hospital testing our practice carries out, the longer you have to wait to get your GP tests for cancer, thyroid, anaemia, bowel, liver kidney.

For these reasons the Almond Group Practice will not be carrying out services or monitoring on the behalf of hospital clinics until such a time that adequate training, resources and funding are provide by the Healthboard and Scottish Government. This position is supported by the Local Medical Committee (LMC)

Once medication has been prescribed by the Practice it is the patient’s property and the patient’s responsibility for its safekeeping.

The Almond Group Practice reserves the right to refuse to replace lost medication and it is at the issuing doctor’s complete discretion as to whether to issue another prescription to replace it.

Controlled Medication including all opiate and benzodiazepine medication will not be replaced apart from in exceptional circumstances.

Non-NHS “Private” Work Examples

• Medicals for pre-employment, sports and driving requirements (HGV, PSV etc.)
• Insurance claim forms
• Prescriptions for taking medication abroad
• Certain travel vaccinations
• Private sick notes for work, college or university
• Vaccination certificates
• Power of Attorney / Guardianship forms
• Access to medical records

Please note, Almond Group Practice does not countersign driving licence applications, passport applications, complete BUPA & PPP forms, or provide health club fitness to exercise certificates.

Non-NHS “Private” Services Information

Why do GPs sometimes charge fees – surely the doctor is being paid anyway?

It is important to understand that GPs are not employed by the NHS. GP partners are self-employed and have to cover costs in the same way as any other small business i.e. staff, building, heating, lighting, stationary etc. These costs are covered partly by the NHS for NHS work, but private fees also contribute towards these expenses.

What costs do the NHS cover and what is not?

The Government’s contract with GPs covers medical services to NHS patients, including the provision of ongoing medical treatment. However, in recent years, more and more organisations have been involving doctors in a range of non-medical work. Sometimes the only reason that GPs are asked is because they are in a position of trust in the community, or because an insurance company or employer wants to ensure that information provided to them is true and accurate.

Do GPs have to do non-NHS work for their patients?

Whilst GPs will always attempt to assist patients with the completion of forms i.e. for insurance purposes, GPs are not contractually required to do non-NHS work.

Who sets the fees for non-NHS work?

Prices are set following guidance from The British Medical Association (who are the professional association and registered trade union for British doctors’) combined with the time required to complete the form.

Why does it sometimes take my GP a long time to complete my form?

GP time is always prioritised to patient care. Due to the current heavy workload of GPs there is very little time to complete forms and it is usually done in the evening outside of working hours. It can take a minimum of two weeks to complete these forms.

I only need the doctor’s signature – what is the problem?

To remain on the Medical Register, the doctor must only sign or complete a certificate or report that they know to be true. In order to complete even the simplest of forms the doctor will check the patient’s entire medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the Police.

For our Non-NHS “Private” Services Fees – please contact the surgery.

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 include sexual advances towards a clinician, making an unfounded allegation against a GP or the practice, or falling out with several 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.

Almond Group Practice – Privacy Policy

About the personal information we use

The Almond Group Practice and uses personal information on different groups of individuals including:

• Patients
• Staff
• Contractors
• Suppliers
• 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
• Staff
• 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

Your rights

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.

Other rights

There are other rights under current Data Protection Law however these rights only apply in certain circumstances.

View further information about your rights on the Information Commissioner’s Office website

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).

View details on the Information Commissioner’s Office website

Patients can access NHS bariatric surgery services via the Lothian Weight Management Service, and must complete the necessary assessment and management processes to meet the criteria for surgery.

Some patients are opting to have their surgery done privately, often overseas and return to the UK expecting to have their aftercare provided by the NHS.

The NHS is not responsible for providing routine aftercare for private procedures and this has been discussed at, and confirmed by the Lothian Medical Committee and Bariatric Surgery Service.

Routine aftercare includes blood monitoring, blood pressure and weight checks and prescription medication. These services will therefore NOT be undertaken by our practice and will need carried out by a private healthcare provider. Long-term bariatric medications such as vitamins can be prescribed by the practice after post-operative monitoring has finished (2 years) and the patient has been discharged by the specialist.

Emergency care following bariatric surgery such as infections and other complications will be provided by the NHS via GP practices or Accident and Emergency.

Test Requests. Private medical providers will try to reduce costs by requesting that NHS GPs carry out tests on their behalf. NHS GPs are not responsible or contractually required to carry out tests on behalf of private providers. If a private provider thinks certain tests are required then the responsibility lies with the provider to carry out the tests.

Test Interpretation. Private providers will also try to reduce costs by doing tests and then asking NHS GPs to interpret them. GPs are not responsible or contractually required to interpret these tests either and the GMC (General Medical Council) is clear that the clinician requesting a test is responsible for arranging the test and following up the results. If the private provider thinks the there are problems that would be best investigated or treated by the NHS then they should write a letter of referral or email to the practice outlining the problem, tests done to date and their concerns. Private providers that find ‘abnormal results’ and then simply ask the patient to ‘go to see their GP’ are not only failing in their duty of care but are  creating extra unnecessary work for the NHS and increasing patient health anxiety. The vast majority of private ‘abnormal results’ are subsequently found to be normal in the NHS accredited labs or of no clinical significance and requiring no further investigation.

This policy is supported by the NHS Lothian Local Medical Committee (LMC) and by the GMC (see below).

“GMC Good Medical Practice

Continuity and coordination of care:

44. You must contribute to the safe transfer of patients between
healthcare providers and between health and social care providers.
This means you must:
a share all relevant information with colleagues involved in your
patients’ care within and outside the team, and when you delegate care or
refer patients to other health or social care providers.”

An SCA is an agreement between a hospital clinic and a GP practice to transfer some responsibility for a complex condition to the GP Practice. The condition usually involves treatment with drugs with a higher risk of dangerous side effects and the requirement of close blood or other biometric monitoring. These conditions and treatment are agreed upon between hospital clinics, health boards and GP Practices every year in the ‘GP Enhanced Services Programme: Disease modifying drugs’ service agreement. The current drugs that are resourced and funded are as follows:

Azathioprine

Ciclosporin

Hydroxychloroquine

Leflunomide

Methotrexate

Penicillamine

Sulfasalazine

Erythropoiesis stimulating drugs in chronic renal failure

Mercaptopurine in inflammatory bowel disease

Mycophenolate

Many SCAs for other conditions and medications exist despite not being included under the ‘GP Enhanced Services Programme: Disease modifying drugs’ service agreement. Unfortunately this leads to confusion and hospital clinics often understandably think that the existence of an SCA means that a GP practice is obligated to enter into it. The Almond Group Practice understands that it is more convenient for patients to receive their prescriptions and monitoring of conditions from their local GP practice and therefore we will continue our services for the above agreed drugs. However, we will not be entering into any SCAs outwith the above list. This policy is in line with our contract and has been agreed with the Local Medical Committee (LMC) and the GP Prescribing Committee (GPPC).

There has been a large increase in requests for testosterone therapy for the treatment of menopause.

Testosterone is not licensed for use in menopause meaning that it has not met standards of efficacy, safety, and quality in accordance with the MHRA. Testosterone has known long-term harmful effects.

Some specialist clinics or GPs with a specialist interest in menopause in the UK will prescribe testosterone however this is a specialist area and out with the scope of a standard GP’s competencies. The RCGP’s curriculum does not cover testosterone supplementation, nor is there funding provided by the Healthboard to GP practices to set up and run specialist menopause clinics.

Thus, the Almond Group Practice has decided not to prescribe testosterone for the treatment of menopause. We are happy to refer you to the NHS specialist menopause clinic for further advice but unfortunately as of this time (2023) they do not have the resources to fund testosterone prescriptions and is therefore also unavailable for prescription through this route. If you feel strongly that GPs are in an ideal position to provide these services then please contact your MSP and ask that primary care is adequately funded and trained to relieve pressure from secondary care clinics.