Access to Medical Records
The practice is registered and complies with the General Data Protection Regulation. Any request for access to notes by a patient, patient’s representative or outside body will be dealt with in accordance with the Regulation. Please contact the Practice Manager for further information. Download the Subject Access Request Policy Your health records contain a type of data called confidential patient information. This data can be used to help with research and planning. You can choose to stop your confidential patient information being used for research and planning. You can also make a choice for someone else like your children under the age of 13. Your choice will only apply to the health and care system in England. This does not apply to health or care services accessed in Scotland, Wales or Northern Ireland. Find out how this data is used and how to opt out on the following link:Subject Access Request Policy (GDPR Right of Access Policy)
Your data matters to the NHS
Chaperones
Introduction
This Policy sets out guidance for the use of chaperones, and procedures that should be in place for consultations, examinations and investigations.
This is also aimed at providing practical advice to healthcare professionals working in a variety of locations, where availability of a chaperone may not always be possible.
Purpose of A chaperone
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”. Also, consultations involving dimmed lights, the need for patients to undress, or for intensive periods, of being touched, may 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 protect the healthcare professional against allegations of improper behaviour during such consultations, and sometimes to provide practical support.
Scope of Guidance
This Policy applies to all healthcare professionals working within the Organisation, including medical staff, nurses, health care assistants, allied health professionals, medical students, and complementary therapists working with individual patients in surgeries, clinic situations and in the patient’s home. This guidance also covers any non-medical personnel who may be involved in providing care.
When, and how, should a chaperone be offered?
Information concerning the availability of chaperones is made to patients by:
- Signs in each consulting and treatment room
- Chaperoning information on practice website, patient information leaflet and registration pack
It will only be apparent that a chaperone will be necessary once the consultation is started. The triggers that make the offer of a chaperone necessary include:
- When an intimate examination is deemed necessary. This offer should be accompanied by an explanation as to why the examination is required
- When an examination, which is not intimate, but involves close proximity, physical contact or dim lighting, is necessary and the clinician is concerned that a chaperone is necessary; this may be to protect him/herself, or if the patient is particularly vulnerable or at risk
- Whether the patient and clinician are the same sex or not, is not relevant; an offer of a chaperone should be made regardless. However, if the sex of both parties is the same, it is likely that the clinician will less frequently consider themselves to need a chaperone present to proceed, as the risk of allegation is reduced, though they must be aware it is by no means absent
During the consultation in which a chaperone is required
It is important to provide an environment in which the patient feels relaxed, and is given privacy to undress in preparation for the examination.
Prior to examination, the patient must be given a full explanation of the reason for the examination, and what will be done and, if possible, how it will feel.
There should be no undue delay prior to examination once the patient has removed any clothing.
During an intimate examination:
- Offer reassurance
- Be courteous
- Keep discussion relevant
- Avoid unnecessary personal comments
- Encourage questions and discussion
- Remain alert to verbal and non-verbal indications of distress from the patient
Intimate examinations should take place in a closed room, or well-screened bay, that cannot be entered whilst the examination is in progress.
Where appropriate, a choice of position for the examination should be offered, for example left lateral, dorsal, recumbent and semi-recumbent positions for speculum and bimanual examinations. This may reduce the sense of vulnerability and powerlessness complained of by some patients.
Once the patient is dressed following an examination or investigation the findings must be communicated to the patient.
Any requests that the examination be discontinued should be respected.
Who can be a chaperone?
A friend, or relative, of the patient is an inadequate chaperone – they are neither trained nor independent; however in reality the clinician may well appropriately feel that their presence will reduce the risk of allegations, and may, therefore .allow an examination to proceed even if a chaperone is offered and declined; but a chaperone should still be ‘offered.
An appropriate chaperone is otherwise any member of the health care team; any non-clinical staff who are trained appropriately and have a Standard DBS check – both are requirements for them to be a chaperone.
The patient should be offered a chaperone and the patient should choose whether they wish the chaperone to be male or female.
THE Role of a Chaperone
The role can be considered in any of the following areas:
- Providing emotional comfort and reassurance to patients
- To act as an observer of the examination to protect the clinician from false allegation
- Empowered to alert their line manager should they feel any improper behaviour has occurred
If the clinician requires practice assistance during the examination, for example during a coil insertion, they should request an HCA, or nurse, to support them, and that person would then provide both practical and physical support, as well as implicitly acting as a chaperone. In this case, they may be a differing sex from the patient, but as they are providing a clinical function this is acceptable – a full explanation needs to be given to the patient, and their agreement obtained.
The chaperone should introduce herself/himself to the patient, giving their name. and explaining that they are a member of the Practice. who has received training to act as a chaperone. The two parties should have a short conversation between themselves to ensure there is clear understanding of the role and expectations.
Recording of chaperone offers
Whenever the clinician feels a chaperone may be necessary, it should be offered.
Whenever the offer is made, that fact should be recorded on SystmOne, together with, either the fact that it was declined, or the name of the person performing the role of chaperone, entered in the associated free text box.
If the offer is declined, but the clinician feels they are at risk without a chaperone being present, it is appropriate and correct for them to:
- Further explain why a chaperone is necessary and re-offer one
- Refuse to proceed with the examination and ask the patient to rebook with a clinician of the same sex. This is the best possible scenario for the examination to be safely performed, but even then, it may be that a same sex clinician will also feel a chaperone is necessary, and again, decline to proceed. These cases must be dealt with individually, but the clinician has no obligation to proceed with an action which they are uncomfortable in doing. The patient insisting it is done, is not a sufficient justification to put clinicians at risk.
All these decision processes, and explanations, must be recorded on SystmOne. The only exception to this is if there is an urgent medical need for the examination to proceed – in this scenario patient safety may, and should, override clinician’s assessment of their own risk.
Where a Chaperone is Needed, but not Available
If the patient requests a chaperone, but an appropriate one is not available, the appointment should be re-booked at a time when one is available. The only exception is when there is an urgent clinical need – this should be explained to the patient and alternate actions taken (for example referral to AEU).
If the doctor wants, for whatever reason, a chaperone to be present, but one is not available, then again the appointment should be re-scheduled, unless there is overriding medical need, when each case should be taken individually (again referral to AEU could be considered), or the clinician may consider the clinical need overrides his own risk to exposure.
Careful recording of all decision making processes must be made.
Issues of Consent
Consent may be implicit in attending a consultation, for example, a patient attending with a breast lump may reasonably be assumed to expect a breast examination. However, it is always prudent to obtain consent, after explanation, before all intimate examinations. Verbal consent is sufficient.
The clinician may assume that the patient is seeking treatment, and therefore, consenting to necessary examinations. However, before proceeding with an examination, healthcare professionals should always seek to obtain, by word or gesture, some explicit indication that the patient understands the need for examination and agrees to it being carried out. Consent should always be appropriate to the treatment or investigation being carried out.
The clinician must however be aware that:
- An assessment of capacity may occasionally be necessary to ensure consent is valid
- That if consent is given, either actual or implied, this is nothing to do with the offer of a chaperone. A patient may consent to an intimate examination, but still request, assume or prefer a chaperone to be present, so a chaperone offer should still, always, be made
Special circumstances
If there are medico-legal reasons for the examination, for example after alleged assault, or perhaps because of abuse, the clinician should be aware that written consent may be necessary for the examination to be valid. The clinician should make appropriate enquiries first.
This will be an unusual and rare occurrence.
Issues Specific to Children
In the case of children, a chaperone would normally be a parent or carer, or alternatively someone known and trusted, or chosen by, the child. Patients may be accompanied by another minor of the same age. For competent young adults the guidance relating to adults is applicable.
The age of consent is 16 years, but young people have the right to confidential advice on contraception, pregnancy and abortion, and it has been made clear that the law is not intended to prosecute mutually agreed sexual activity between young people of a similar age, unless it involves abuse or exploitation. However, the younger the person, the greater the concern about abuse or exploitation. Children under 13 years old are considered of insufficient age to consent to sexual activity, and the Sexual Offences Act 2003 makes clear that sexual activity with a child under 13 is always an offence.
In situations where abuse is suspected great care and sensitivity must be used to allay fears of repeat abuse.
Healthcare professionals should refer to their local child protection policies for any specific issues.
Children and their parents, or guardians, must receive an appropriate explanation of the procedure in order to obtain their co-operation and understanding.
If a minor presents in the absence of a parent or guardian, the healthcare professional must ascertain if they are capable of understanding the need for examination. In these cases it would be advisable for consent to be secured and a formal chaperone to be present for any intimate examinations.
Issues Specific to Religion, Ethnicity or Culture
The ethnic, religious and cultural background of some women can make intimate examinations particularly difficult, for example, some patients may have strong cultural or religious beliefs that restrict being touched by others. Patients undergoing examinations should be allowed the opportunity to limit the degree of nudity by, for example, uncovering only that part of the anatomy that requires investigation or imaging. Wherever possible, particularly in these circumstances, a female healthcare practitioner should perform the procedure.
It would be unwise to proceed with any examination, if the healthcare professional is unsure that the patient understands due to a language barrier. If an interpreter is available, they may be able to double as an informal chaperone. In life saving situations, every effort should be made to communicate with the patient, by whatever means available, before proceeding with the examination.
Issues Specific to Learning Difficulties/Mental Health Problems
For patients with learning difficulties, or mental health problems, that affect capacity, a familiar individual, such as a family member or carer, may be the best chaperone. A careful, simple and sensitive explanation of the technique is vital. This patient group is a vulnerable one, and issues may arise in initial physical examination, “touch” as part of therapy, verbal and other “boundary-breaking” in one to one “confidential” settings and, indeed, home visits.
Adult patients with learning difficulties, or mental health problems, who resist any intimate examination or procedure, must be interpreted as refusing to give consent, and the procedure must be abandoned, unless the patient has been sectioned. In life-saving situations the healthcare professional should use professional judgement, and where possible, discuss with a member of the mental health care team.
The series Books Beyond Words (Gaskell Publications), especially “Looking After My Breasts” and “Keeping Healthy Down Below” may be a helpful reference.
Lone Working
Where a health care professional is working in a situation away from other colleagues, e.g. a home visit, the same principles for offering, and use of, chaperones should apply.
In reality it is more likely here that a relative or friend will be available – this person may well be acceptable as a chaperone to both patient and clinician.
Where it is not appropriate, or available, or the clinician feels unable to proceed with a formal chaperone, the clinician may need to rebook the visit and return accompanied by, for example, a district nurse or HCA, to provide a chaperone role, or request the patient attend the surgery at a later date.
If there is an overriding medical need, and urgency, then this should take priority, or may cause the clinician to consider an alternative route of disposal such as referral to AEU.
Health care professionals should note, that they are at a significantly increased risk of their actions being misconstrued or misrepresented, if they conduct intimate examinations where no other person is present, especially in a patient’s home. The clinician has every right, except in cases of dire emergency, to protect themselves from such risk.
Communication & Record Keeping
Details of the examination, including presence/absence of chaperone and information given, must be documented in the patient’s medical records. Both the clinician and the chaperone should make documentation in the patients’ medical notes.
If the patient expresses any doubts, or reservations, about the procedure and the healthcare professional feels the need to reassure them before continuing, then it would be good practice to record this in the patient’s notes. The records should make clear from the history that an examination was necessary.
Complaints and Compliments
A. Confidentiality Notice This document and the information contained therein is the property of Papworth Surgery. This document contains information that is privileged, confidential or otherwise protected from disclosure. It must not be used by, or its contents reproduced or otherwise copied or disclosed without the prior consent in writing from Papworth Surgery. COMPLAINTS PROCEDURE – ENGLAND Introduction The purpose of the policy is to ensure that all patients (or their representatives) who have the cause to complain about their care or treatment can have freely available access to the process and can expect a truthful, full and complete response and an apology where appropriate. Complainants have the right not to be discriminated against as the result of making a complaint and to have the outcome fully explained to them. The process adopted in the practice is fully compliant with the relevant NHS Regulations (2009) and guidance available from defence organisations, doctors` representative bodies and the Care Quality Commission. Everyone in the practice is expected to be aware of the process and to remember that everything they do and say may present a poor impression of the practice and may prompt a complaint or even legal action. The general principle of the practice in respect of all complaints will be to regard it first and foremost as a learning process, however in appropriate cases and after full and proper investigation the issue may form the basis of a separate disciplinary action. In the case of any complaint with implications for professional negligence or legal action, the appropriate defence organisation must be informed immediately. Procedure Availability of information The practice will ensure that there are notices advising on the complaints process conspicuously displayed in all reception/waiting areas and that leaflets containing sufficient details for anyone to make a complaint are available without the need to ask. The practice website and any other public material (Practice Leaflet etc.) will similarly provide this information and also signpost the complainant to the help available through the NHS Complaints Advisory Service. Who can a formal complaint be made to? ONLY TO – either the practice – OR PCN – OR ICB In the event of anyone not wishing to complain to the practice they should be directed to make their complaint to ICB at: By telephone: 03003 11 22 33 By email: [email protected] In those cases where the complaint is made to the ICB, the practice will comply with all appropriate requests for information and co-operate fully in assisting them to investigate and respond to the complaint. Who can make a complaint? A complaint can be made by or, with consent, on behalf of a patient (i.e. as a representative); a former patient, who is receiving or has received treatment at the Practice; or someone who may be affected by any decision, act or omission of the practice. A Representative may also be In all cases where a representative makes a complaint in the absence of patient consent, the practice will consider whether they are acting in the best interests of the patient and, in the case of a child, whether there are reasonable grounds for the child not making the complaint on their own behalf. In the event a complaint from a representative is not accepted, the grounds upon which this decision was based must be advised to them in writing. Who is responsible at the practice for dealing with complaints? The practice “Responsible Person” is Dr Greenwood. They are charged with ensuring complaints are handled in accordance with the regulations, that lessons learned are fully implemented, and that no Complainant is discriminated against for making a complaint. The practice “Complaints Manager” is Alexandra Mackenzie – Practice Manager and they have been delegated responsibility for managing complaints and ensuring adequate investigations are carried out If you wish to make a complaint about the Community Matron or Social Prescribing services, which are provided by Huntingdon PCN, please click to view their dedicated complaints procedure Time limits for making complaints The period for making a complaint is normally: (b) 12 months from the date on which the event which is the subject of the complaint comes to the complainant’s notice. The practice has discretion to extend these limits if there is good reason to do so and it is still possible to carry out a proper investigation. The collection or recollection of evidence, clinical guidelines or other resources relating to the time when the complaint event arose may also be difficult to establish or obtain. These factors may be considered as suitable reasons for declining a time limit extension, however that decision should be able to stand up to scrutiny. Action upon receipt of a complaint A verbal complaint need not be responded to in writing for the purposes of the Regulations if it is dealt with to the satisfaction of the complainant by the end of the next working day, neither does it need to be included in the annual Complaints Return. The practice will however record them for the purposes of monitoring trends or for Clinical Governance and that record will be kept and monitored by Alexandra Mackenzie . Verbal complaints not formally recorded will be discussed when trends or issues need to be addressed and at least annually, with minutes of those discussions kept. If resolution is not possible, the Complaints Manager will set down the details of the verbal complaint in writing and provide a copy to the complainant within three working days. This ensures that each side is well aware of the issues for resolution. The process followed will be the same as for written complaints. It may be that other bodies (e.g. secondary care/ Community Services) will need to be contacted to provide evidence. If that is the case, then a patient consent form will need to be obtained at the start of the process and a pro-forma consent form included with the initial acknowledgement for return. If it is not possible to conclude any investigations within the advised timescale, then the complainant must be updated with progress and revised time scales on a regular basis. In most cases these should be completed within six months unless all parties agree to an extension. The Investigation The practice will ensure that the complaint is investigated in a manner that is appropriate to resolve it speedily and effectively and proportionate to the degree of seriousness that is involved. The investigations will be recorded in a complaints file created specifically for each incident and where appropriate should include evidence collected as individual explanations or accounts taken in writing. Final Response This will be provided to the complainant in writing (or email by mutual consent) and the letter will be signed by the Responsible Person or Complaints manager or by the GP personally involved in the complaint under delegated authority. The letter will be on headed notepaper and include: The final letter should not include: Logging Complaints as Significant Events Annual Review of Complaints The practice will produce an annual complaints report to be sent to the local Commissioning Body (NHSE) and will form part of the Freedom of Information Act Publication Scheme. The report will include: Care must be taken to ensure that the report does not inadvertently disclose any confidential data or lead to the identity of any person becoming known. Confidentiality The practice must keep a record of all complaints and copies of all correspondence relating to complaints, but such records must be kept separate from patients’ medical records and no reference which might disclose the fact a complaint has been made should be included on the computerised clinical record system. Unreasonable or Vexatious Complaints Where a complainant becomes unreasonable or excessively rude or aggressive in their promotion of the complaint, some or all of the following formal provisions will apply and must be communicated to the patient by the Responsible Person in writing: Complaints involving Locums It is important that all complaints made to the practice regarding or involving a locum (Doctor, Nurse or any other temporary staff) are dealt with by the practice and not passed off to a Locum Agency or the individual locum to investigate and respond. The responsibility for handling and investigating all complaints rests with the Practice. Locum staff should however be involved at an early stage and be advised of the complaint in order that they can provide any explanations, preferably in writing. It would not be usually appropriate for any opinions to be expressed by the Practice on Locum staff. Providing their factual account along with any factual account from the practice is the best way to proceed. The practice will ensure that on engaging any Locum, the Locum Agreement will include an assurance that they will participate in any complaint investigation where they are involved or can provide any material evidence. The practice will ensure that there is no discrepancy in the way it investigates or handles complaints between any Locum staff and either practice Partners, salaried staff, students or trainees or any other employees. References Local Authority Social Services & National Health Service Complaints (England) Regulations 2009 – S.I. 209, No.309 NHS Complaints Procedure (England only): Guidance for Primary Care, BMA August 2015 NHS Choices http://www.nhs.uk/chq/pages/1084.aspx?categoryid=68 Medico-legal guide to the NHS Complaints Procedure, M.D.U. https://www.themdu.com/guidance-and-advice/topics/complaints A Guide to effective complaints Resolution, M.P.S 2016 http://www.cddlmc.org.uk/wp-content/uploads/2011/09/MPS-NHS-Complaints-Guidance.pdf NHS England Complaints policy; https://www.england.nhs.uk/contact-us/complaint/ BMA guidance for Primary Care – https://www.bma.org.uk/advice/employment/raising-concerns/compaints-in-primary-care DATE OF POLICY: 1st OCTOBER 2020 REVIEWED BY ALEXANDRA MACKENZIE REVIEWED: OCT 23 NEXT REVIEW DUE: OCTOBER 24
(a) 12 months from the date on which the event which is the subject of the complaint occurred; or
All complaints must be treated in the strictest confidence and the practice must ensure that the patient etc. is made aware of any confidential information to be disclosed to a third party (e.g. NHSE).
Disabled Access
The surgery has a ramp and the front doors of the surgery, pharmacy and those to the waiting room open automatically.
The consulting rooms are entirely on ground floor level and there is a toilet for the disabled. Aids are available for hard of hearing.
GP Net Earnings
NHS England require that the net earnings of doctors engaged in the practice is publicised, and the required disclosure is shown below. However, it should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors spend working in the practice, and should not be used to form any judgement about GP earnings, nor to make any comparison with any other practice.
All GP Practices are required to declare the mean earnings (e.g. average pay) for GPs working to deliver NHS services to patients at each practice.
The average pay for GPs working in the Papworth Surgery in the the last financial year was £40,308 before Tax and National Insurance. This is for 6 part time GPs who worked in the practice for more than six months.
Medical Education
The practice is actively involved in teaching both qualified doctors and senior medical students gaining experience in general practice.
We may have a GP Registrar who spends between 6 and 12 months in our practice.
If you would prefer to consult your doctor alone, please let us know and we will be happy to respect your wishes.
Mission statement
To improve the health and wellbeing of our patients through the provision of high quality, accessible, professional healthcare services that inspire confidence in our patients and our community.Our vision
Our core values
Named GP
As part of a national programme, from April 2015 all Practices are required to provide their patients with a named GP who will have overall responsibility for the care and support that the Surgery provides them. At Papworth Surgery patients have been registered to a named GP and they will be the GP with this responsibility. If you do not know who your registered GP is, please feel free to contact the Surgery and a Receptionist will be happy to inform you. You may continue to request to see any GP for your appointments.
Patient Confidentiality
We respect your right to privacy and keep all your health information confidential and secure. It is important that the NHS keeps accurate and up-to-date records about your health and treatment so that those treating you can give you the best possible care.
This information may be used for management and audit purposes. However, it is usually only available to, and used by, those involved in your care. You have the right to know what information we hold about you. If you would like to see your records please contact the Practice Manager.
Patient Rights and Responsibilities
We aim to treat our patients courteously at all times and expect our patients to treat our staff in a similarly respectful way. It is your responsibility to keep your appointments, inform us of your past illnesses, medication, hospital admissions and any other relevant details.
Privacy Notice
As data controllers, GPs have fair processing responsibilities under the Data Protection Act and GDPR law 2018. This means ensuring that your personal confidential data (PCD) is handled in ways that are safe, transparent and what you would reasonably expect. Please find documents and links below.
Please click the link below to read our full Privacy Notice.
Summary Care Record
There is a new Central NHS Computer System called the Summary Care Record (SCR). It is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had. Storing information in one place makes it easier for healthcare staff to treat you in an emergency, or when your GP practice is closed. This information could make a difference to how a doctor decides to care for you, for example which medicines they choose to prescribe for you. Only healthcare staff involved in your care can see your Summary Care Record. Over half of the population of England now have a Summary Care Record. Ask your GP if you are in the scheme No, it is not compulsory. If you choose to opt out of the scheme, then you will need to complete a form and bring it along to the surgery. You can use the form at the foot of this page. Please visit this link to find out more information and how to opt out of the Summary Care RecordWhy do I need a Summary Care Record?
Who can see it?
How do I know if I have one?
Do I have to have one?
More information and opting out of the summary care record
Updating your details
If you change name, address or telephone number, please let our receptionists know by calling or writing to us.
If you move outside the practice area you may need to find a doctor in your new areaThere are instructions on what to do when you move to a new area on the back of your NHS medical card.
Using this website
The medical information on this website, and on any sites linked to from this website, gives general advice only and SHOULD NOT be used as a substitute for the personal advice patients receive when consulting a GP.
Violent or abusive behaviour
We take seriously any threatening, abusive or violent behaviour against any of our staff or patients. If a patient is violent or abusive, they will be warned to stop their behaviour. If they persist, we may exercise our right to take action to have them removed, immediately if necessary, from our list of patients.