IPC Statement 28.12.23 to 8.1.2025

As an employer, the practice has a duty of care for the health, safety and wellbeing of its staff. The practice also has a legal responsibility to provide a safe and secure working environment for staff. Staff mental health is as important as their physical health.

All patients and staff are expected to behave in an acceptable, respectful manner.

The practice follows the NHS guidance concerning Zero Tolerance.

Any incident in which an employee is abused, threatened or assaulted in circumstances relating to their work is unacceptable and not tolerated.

This includes the serious or persistent use of verbal abuse, aggressive tone and/or language and swearing/foul language.

Staff should not be left upset and distressed following an interaction with a patient.

All instances of actual physical abuse or threatening behaviour on any doctor or member of staff, by a patient or their relatives will be reported to the police as an assault.

We expect all patients to be responsible and avoid attending the surgery under the influence of alcohol or illegal drugs. Any alteration of prescriptions is illegal and will not be tolerated.

The General Medical Council states In Good Medical Practice that: “In rare circumstances, the trust between you (the Practice) and a patient may break down, and you may find it necessary to end the professional relationship. For example, this may occur if a patient has been violent to you or a colleague, has stolen from the premises, or has persistently acted inconsiderately or unreasonably.”

This includes unnecessarily persistent or unrealistic service demands that cause disruption. Examples of this include, but are not limited to :

• Demanding to only speak to a specific team member
• Refusing appointments with an appropriate clinician for the presenting care need i.e. insisting on a GP appointment when seeing a pharmacist or nurse prescriber is most appropriate or refusing to see an available GP for your presenting care need when your preferred GP is unavailable
• Refusing to access the service in the appropriate manner i.e. sending emails/texts instead of using the NHS Digital approved digital consultation service
• Demanding a same day appointment for a routine clinical need – this deprives access to urgent care services for those who genuinely need it
• Contacting individuals directly via social media or personal email instead of through the practice contact channels
• Entering clinical or non-clinical space without being invited to do so

The practice has a finite number of available appointments and you may be directed to a clinician who is not a GP, or your preferred GP, but who is appropriately qualified to manage the presenting care need. We provide a named GP service but we cannot always accommodate requests to speak to the same GP due to high patient demand for appointments.

If you are seriously unhappy with the quality of service you have the right to register with another practice without notifying us. Similarly, on the very rare occasions when a patient breaches this policy, we have the right to remove the patient from our Practice list.

Examples of Unacceptable Standards of Behaviour

In exceptional circumstances, a breakdown may occur between a doctor and their patient. If the breakdown is of a serious nature e.g. serious physical or verbal abuse to any member of the practice team, the doctors may feel that the doctor/patient relationship has been compromised. Steps may be taken to have the patient removed immediately from the practice list. Where possible, conciliation would always be the preferred route. Reasons for removal will be given in writing.

Where we deem an incident is not serious enough to warrant immediate removal, we will issue a first and final warning.

You will be removed from our patient list immediately when we have needed police assistance or have made a report to the police.

The following are examples of when you may be issued with a first and final warning or removed from our patient list dependent on the severity of the incident.

• Violence.
• Excessive noise eg recurrent loud or intrusive conversation or shouting.
• Threatening or abusive language involving swearing or offensive remarks.
• Racial or sexual remarks.
• Aggressive, forceful tone and/or language that upsets staff.
• Malicious allegations relating to members of staff, other patients or visitors.
• Offensive gestures or behaviours.
• Abusing alcohol or drugs on practice premises.
• Drug dealing on practice premises.
• Wilful damage to practice property.
• Threats or threatening behaviour which can include entering private areas without prior consent of the staff member
• Theft.
• Persistent and/or unrealistic demands on the service
• Repeated derogatory comments about the practice or individuals either verbally, in writing/digitally or on social media platforms – this applies to factual and false information as we have a process to feed back dissatisfaction.

This list is not exhaustive and there may be other occasions where we have cause to issue a warning or remove you from our patient list.  If you are unhappy with the practice we have a complaints procedure to assist you or you have the choice to register with another practice – there really is no need for unpleasant behaviour with these options available to support you.

We trust this policy is clear and supports a mutually respectful environment for patients and staff.

Our Policy & Why do GPs charge fees? Your questions answered

The National Health Service provides most health care to most people free of charge, but there are exceptions.

Prescription charges have existed since 1951, and there are a number of other services for which fees are charged. Sometimes the charge is made to cover some of the cost of treatment, for example dental fees. In other cases. In other cases it is because the service isn’t covered by the NHS, for example, medical reports for insurance companies, claims on private health insurance and other letters and forms which require the doctor to review the patient’s medical records.

It is important to understand that GPs are not employed by the NHS, they are self employed, and they have to cover their costs- staff, buildings, heating, lighting etc- in the same way as any small business.

The NHS pays the doctor for specific NHS work, but for non-NHS work the fee has to cover the doctor’s costs.

What is covered by the NHS and what is not?

What is covered by the NHS and what is not?
The government’s contract with GPs covers medical services to NHS patients. In recent years, more and more organisations have been involving doctors in a whole 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 be sure that information provided is true and accurate.

Examples of non-NHS services for which GPs can charge their patients

• Certain travel vaccinations
• Private medical insurance reports
• Holiday cancellation forms
• Referral for private care forms / letters
• Letters requested by or on behalf of, the patient
• In certain instances fitness to work forms

Examples of non-NHS services for which GPs can charge other institutions

• Medical reports for an insurance company
• Some reports for the DSS/Benefits agency
• Examinations of local authority employees

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

Time spent completing forms and preparing reports takes the GP away from the medical care of his/her patients. Most GPs have a very heavy workload- the majority of our GPs work up to 60 hours a week and paperwork takes up an increasing amount of their time. In addition non-NHS work must be undertaken outside of NHS contracted time.

We aim to complete private requests within 14 calendar days, but this is dependent on NHS requirements which take priority.

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

When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. Therefore in order to complete even the simplest of forms, the doctor needs to check the patient’s entire record. Carelessness or an inaccurate report can have serious consequences for the doctor, with the General Medical Council or even the Police.

Why do some letters cost £25 and others £50 or more?

Each request is very different and some requests can be completed very quickly as the medical history of the patient is very small and known to the GP. However, where a GP has to review a large medical history to ensure accuracy of any comment they make in a letter; or the content of the letter is extensive we must consider how much time it has taken to complete this work. Your cost includes the time the GP takes to review the request, review your medical record, to dictate a letter and the time for the admin team to type up the letter where necessary and printing/postage costs where necessary.

Why am I being charged for a private referral letter when I am saving the NHS money in going private?

Where a private referral request is treated in the same timescales as an NHS referral we do not charge a fee i.e. 7-14 working days. Where a patient requires the letter quicker than this timescale we apply a charge for providing the letter more quickly than would be available if it was an NHS referral.  This is because the request is requiring additional medical secretary time to provide it without detriment to the existing NHS referral workload. Please note we may not always be able to provide a private letter in the timescale that you require where we have pressures on staffing capacity.

Why won’t you refund me if I don’t need a private letter any more?

We require payment in advance of any private work commencing. Clinicians and medical admin have to take time away from NHS work to complete private work. If you change your mind after the work has been completed, we still have to fund the time that was taken to do it. Therefore, we will not refund any monies where the work has already been commenced.

I have had a request for a letter declined – why is that?

All private requests are at the absolute discretion of the GP and they reserve the right to decline a request.

There are also several letter types we do not provide as they are not effective use of GP time and/or they are not necessary.

These include but are not limited to:

• Letters to schools and colleges regarding absence
• Letters regarding sickness absence during the period of self certification
• Letters to schools/nurseries regarding non prescribed medications.
• Please note that where a medication has been prescribed, a copy of the prescription and the medication with the administering instructions is sufficient for a school/nursery and they should not require an additional letter.
• We may not be able to help where a specialist opinion is necessary e.g. fitness to undertake extreme sports etc
• We may also decline you where we do not have sufficient staffing capacity to complete the private fee paying work in addition to our NHS work – this can occur when we have absence in the team. Private work cannot be undertaken to the detriment of NHS work
• We will not accept requests for ‘the doctor must write these exact words’. The GP will write what they know, supported by your medical record. Both the letter and the opinion they produce is final and you cannot request changes to be made. The GP has the right to refuse your request or provide alternative wording if they feel it is necessary.
• If you insist on the GP changing your letter to suit what you think it should say, or if you want to dictate the contents, we may withdraw our offer to write the letter or allocate a further charge. Please remember, the doctor is not obliged to write a letter for you at all, as this is not an NHS requirement

We do hope you understand that with so much pressure on NHS financial resources that we cannot provide private work without charge.

All GP practices are required to declare the mean net earnings (eg. Average pay) for GPs working to deliver NHS services to patients at each practice.  This is required in the interests of the greater public accountability recognising GP pay is ultimately funded from tax paid by the public.

The average pay for GPs working in  Birchwood Medical Centre in the last financial year was £45837 before tax and national insurance.

This is for 0 full time GP,8 part time GPs and 0 locum GPs who worked in the practice for more than six months.)

SUBJECT ACCESS REQUESTS (SAR)

ALSO KNOWN AS REQUESTS FOR
COPIES OF MEDICAL RECORDS

What is the right of access?

The right of access, commonly referred to as subject access, gives individuals the right to obtain a copy of their personal data as well as other supplementary information. It helps individuals to understand how and why we are using their data, and check we are doing it lawfully. Our privacy notice provides further information about this.

PLEASE NOTE WE CAN ONLY PROVIDE A SAR FOR REGISTERED, LIVING PATIENTS. IF YOU ARE NO LONGER REGISTERED WITH A GP SURGERY OR YOUR REQUEST RELATES TO A DECEASED PATIENT PLEASE CLICK THIS LINK

What is an individual entitled to?

Individuals have the right to obtain the following from us:

• Confirmation we are processing their personal data;
• A copy of their personal data; and
• Other supplementary information – this largely corresponds to the information that you should provide in a privacy notice detailed above.

Personal data of the individual

An individual is only entitled to their own personal data, and not to information relating to other people (unless the information is also about them or they are acting on behalf of someone).

How do I make a request for my records (SAR)?

You can make a request in several ways to enable access to all:

In Person -Simply come to the practice in person with ID and ask for a Subject Access Request (SAR) form.

Over the Phone – Call us and we can arrange for a form to be emailed or posted to you.

Digitally – You can also make a request using our online enquiry form.

For us to progress your request we will need to have evidence that you are who you say you are! Your medical information is exceptionally personal and sensitive and we have a duty of care to protect it for you.

You will be asked to provide 2 x forms of ID – one must be photographic e.g. passport / driving licence /work ID card.

If we know you we will vouch for you without ID.

Then once you have been identified formally, completed the form and advised us what information you need, we do the following:

• Make copies of the part(s) of your record you have requested.
• Upload them to our software that automatically redacts identifiable 3rd party information and some sensitive data.
• A trained Patient Co-ordinator reviews the record for any missed redactions including any reference to 3rd parties not involved in your care.
• The record is passed to the GP to check what has been redacted and make any further redactions where necessary – a redaction is only made when it relates to a 3rd party not involved in your care or where it has been assessed the information being shared would cause harm or distress to you.
• The copy of your record is then ready for you and we will contact you to let you know. This may be digitally or by phone/letter.
• We will do this within one calendar month of having received the completed SAR and having identified you – unless there is an issue which we will notify you about in advance. The calendar month commences once we have identified you as the person making the request.
• Once you have taken receipt of your copy record, the practice accepts no responsibility or liability for it or how a patient chooses to use the information contained within it. The patient is responsible for secure storage or onward carriage of the information provided in an intact form where that is necessary.
• The ICO has advised us that as our patients live within a close distance to the practice it is reasonable for the patient to collect the record when a paper copy has been insisted upon by a patient or their representative. We would be happy to post the record where the requestor/3rd party provides payment in advance for the cost of signed for delivery. Where a patient is housebound and within our catchment area, we may also deliver the record and request signed receipt.

Consent to email your completed request 

We are able to complete your request via secure email. This is also the fastest way to make a request for access to medical records.

Please note: by submitting your SAR request online, you are consenting to receive any communication/records via secure email. For guidance on how to access these emails, please click here.

Can someone else make the request on my behalf?

You may ask someone to make the request on your behalf e.g. friend, solicitor, relative.

In these instances we still have a duty of care to ensure that we identify you as the subject and confirm your consent –  we need to ensure that we provide you with what you actually want.

The Information Commissioner’s Office (ICO) states:

“If you think an individual may not understand what information would be disclosed to a third party who has made a subject access request on their behalf, you may send the response directly to the individual rather than to the third party. The individual may then choose to share the information with the third party after having had a chance to review it.”

Due to the complex, sensitive nature of medical records, we check that you have provided signed consent for the sharing of your personal data. We attempt to notify you of requests, however, it is important that you are aware that your signed consent is sufficient for the practice to process the SAR and make the disclosure. It is reasonable to expect patients or their representatives to have fully understood what they have consented to share when the patient is working with a 3rd party requestor on their behalf. You may also ask to view what is being shared before it has been sent. Please ensure that this is documented on any signed consent request. We cannot action this if we have not been advised in advance.

Birchwood Medical Practice accepts no liability for the record(s) once the patient has confirmed receipt and whether they remain intact for onward carriage to the 3rd party who may need to process information held within them.

What happens if I need another copy of my records?

The first copy of your records is provided for free. Any further requests for the same information whether for yourself or a third party would be deemed manifestly excessive and would incur a fee.

The fee is dependent on the amount of work required and relates to the size of the record and also any complexity involved in its review for redaction prior to final copy readiness.

Recent examples have been in the range of £20 to £183 of work undertaken for copy records.

So, please don’t lose your free copy!