ADHD Assessment and Support Policy – ADULTS & CHILDREN – WITH EFFECT FROM THE 1ST APRIL 2025

We understand that many adults are curious about whether they might have ADHD. We are pleased to advise, there is a clear pathway in Bristol for assessing ADHD. You can find all the necessary information about the Bristol Adult ADHD pathway here.

Commissioned Services in Bristol, North Somerset & South Gloucestershire (BNSSG)

There are currently only 2 fully commissioned services in BNSSG :

• Avon & Wiltshire Partnership (AWP)
• Clinical Partners

Birchwood will provide shared care and ongoing prescribing for the above 2 providers following initial diagnosis and stabilised prescribing. Wait times vary and we recommend you contact the providers or use their websites via the links above for further information.

Private ADHD Assessments and Shared Care with Right To Choose Providers

Patients have the right to go privately or to select a provider on the Right to Choose Pathway. Many people make this decision as they can receive an assessment and diagnosis more quickly.

We are aware that more providers are offering ADHD assessments and then asking GP practices to prescribe the medication. At Birchwood, we do not provide ‘shared care’ or ‘shared prescribing’ with private or Right to Choose providers. 

If you choose to go privately or use a Right to Choose provider for an ADHD assessment, you are entitled to do so. However, we do not take on the prescribing of ADHD medication due to the significant amount of variance in referral quality, monitoring processes and the volume that we simply do not have the capacity to manage.

Some of the providers will prescribe for you directly, but it is important that you contact these providers and get their responses in writing. If any of these providers state the GP practice will take on the prescribing this is false. The practice will only do shared care prescribing for AWP and Clinical Partners.

Bristol Children’s ADHD Pathway

Click here for information on the ADHD pathway for children in Bristol. As with Adult ADHD services, Birchwood only prescribes for BNSSG ICB directly commissioned services and not for Right to Choose or Private providers.

School Referral (Preferred Route)

If your child is suspected of having ADHD and is aged 5 or older, the school SENCO can usually assess and refer them. We recommend parents raise concerns through this route first, as the school is best placed to observe your child daily, whereas a GP only gets a brief snapshot in a 15-minute appointment.

GP Referral

If a school referral is not possible, a GP or other healthcare professional can refer your child to community paediatrics. For children with more complex mental health issues, a referral to CAMHS can be made. Please note that a cardiovascular examination is required.

Children Under 5

While children can show ADHD symptoms from an early age, local community paediatric services do not prescribe medication for children under 5 and restrict assessments until they are older. However, families with children under 5 showing ADHD symptoms can receive support through local behavioural interventions, such as the Incredible Years course, which focuses on managing attention difficulties and challenging behaviour. These courses can be accessed without a formal ADHD diagnosis – Link for courses available for Bristol

We appreciate that it can be disappointing to wait longer for a service the practice can prescribe for, but we trust you understand that it is simply not feasible for the practice to deal with multiple different providers with differing policies and procedures.

Transition Period

We recognise some patients will already be on the pathway for an ADHD referral and we will have discussed various referral pathways and awaiting assessments. Therefore, we have put in place a transitional period where we will facilitate shared care prescribing for Right To Choose provider referrals already in progress. Where your referral has already been completed  and submitted before the 1st April 2025 to a Right to Choose provider, we will undertake shared care prescribing.

Where you have had your initial consultations and taken forms away for completion from the 1st March  to the 31st March 2025- as long as the forms are completed and returned by the 30th April we will undertake shared care prescribing. Forms taken away before the 1st March and not returned will not be honoured as we they should have been completed and returned for a prompt referral before the 31st March 2025.

Patients we are already undertaking shared care prescribing for are not impacted by this change in policy – only new referrals.

New to Birchwood Patients

We do not accept continuing prescribing (except BNSSG Commissioned providers) where a patient registers with us from the 1st April having been prescribed at a different GP surgery. We do not accept the ongoing prescribing for prescribing commenced by other surgeries as we become the responsible prescriber when you register with us. Patients can contact their provider and arrange prescribing directly or transfer to a provider commissioned by the BNSSG ICB; or ask their previous practice to retain them as an out of area patient if their policy permits.

Patient Information

Introduction
At Birchwood Medical Practice we make every effort to give the best service possible to everyone who attends our practice.  However, we are aware that things can go wrong resulting in a patient feeling they have a genuine cause for complaint.  If this is so we would wish for the matter to be settled as quickly, and as amicably, as possible.

We are continually striving to improve our service. We appreciate that people often do not like to complain, but assure you we do want to know if you are not satisfied. If you have a comment, complaint or suggestion, please tell any member of staff who will assist you. We have a campaign that we believe in called “You Said, We Listened, We Took Action” which is committed to ongoing service improvement.

Receiving of complaints
Who can complain? The Practice may receive a complaint made by, or (with his/her consent) on behalf of a patient, or former patient, who is receiving or has received treatment at the Practice, or:

(a) Where the patient is a child:

• by either parent, or in the absence of both parents, the guardian or other adult who has care of the child;
• by a person duly authorised by a local authority to whose care the child has been committed under the provisions of the Children Act 1989;

(b) Where the patient is incapable of making a complaint; by a relative or other adult who has an interest in his/her welfare.

We must observe the rules of medical confidentiality. This means that we can only accept a complaint on behalf of someone else if we have written authority of the person concerned, that is, unless the person is incapable, through illness, of providing this as indicated in (b) above.

Should you wish for someone to complain on your behalf, please complete our consent form and in section 3 indicate how you wish the access to your sensitive medical and non-medical information to be limited e.g. for the purposes of responding to a complaint about my medical record care.

Your complaint does not have to be in writing. Access to being able to make a complaint is important and ensures that we are receiving feedback as easily as possible.

Please ask our staff member to take the details of your complaint if you are making it verbally.

What is the time limit for making a complaint?
The period for making a complaint is normally:

(a) 12 months from the date on which the event which is the subject of the complaint occurred; or

(b) 12 months from the date on which the event which is the subject of the complaint comes to the complainant’s notice.

To whom should I complain initially?
If you are unhappy with our services please tell a member of our staff.  Often the problem can be sorted out straight away.  We aim to resolve informal complaints within 48 hours.

If you prefer not to talk to the member of staff involved in your care, you can contact the management team. You can make a complaint digitally through our website – Please click here to ensure our Management Team receives your complaint.

Our Procedure

We aim to acknowledge your verbal or written complaint within three working days. In most cases, we will offer you the opportunity to meet face-to-face to discuss your concern.

We will also ask you what you would like to happen as a result of your complaint, such as an apology, a new appointment, or an explanation. Whenever possible, we try to speak to you directly about your concerns and may arrange to meet with you to hear your experience firsthand.

We will then agree on a plan of action and assess and agree on the timescales in which we will respond to your complaint. We will communicate this to you in our acknowledgement of the complaint.

Your complaint will be fully investigated. This involves finding out what has happened by talking to the staff involved, reviewing medical records, available video and telephone call recordings, and taking any necessary action and learning to prevent it from happening again.

If it is not possible to deal with your complaint within the agreed period, we will write to you explaining the reason for the delay. The sooner you make a complaint, the easier it is to investigate and the more likely it is that the complaint can be resolved.

Alternatively, if you’d rather not raise the issue directly with the practice, you can direct your concerns to:

Bristol, North Somerset and South Gloucestershire Integrated Care Board (ICB)
Tel: 0300 311 22 33
Email: bnssg.customerservice@nhs.net
BNSSG ICB Floor 2, North Wing, 100 Temple Street, Bristol BS1 6AG

If you are not satisfied with our response
If you remain unhappy following the response, you can complain to the Health Service Ombudsman. The Ombudsman is completely independent of the NHS and Government. You can:

• Visit their ‘Making a complaint page’ to complain online or download a paper form: Making a complaint | Parliamentary and Health Service Ombudsman (PHSO)
• Call their Customer Helpline on 0345 015 4033

Email: phso.enquiries@ombudsman.org.uk
Write: City Gate, 51 Mosley St, Manchester M2 3HQ

Keeping your complaint confidential
Any personal data and information collected in relation to your concern or complaint is treated as strictly confidential and only made available to people who are involved in the investigation.

Information about the nature of the complaint is used to monitor the quality of care and may be followed up with the professionals concerned where problems are identified.

The fact that you have complained will not be recorded on your medical records.

ADVOCACY

Some patient’s may find it difficult to make a complaint directly to the Practice or to the NHS.  They can seek advice or get support from the following:

Healthwatch

Healthwatch is the local champion for patients and the public. They are there to listen to your feedback, and to make sure that local services know what people expect from them. They also want to hear about times when you have experienced excellent care.

Telephone : 0117 2690400
www.healthwatchbristol.co.uk
Or you can text them (use ‘Bris’ followed by your message) to: 07860021603

POhWER Bristol

Email: pohwer@pohwer.net

Website : Bristol | Home | POhWER

Telephone: 0300 456 2370 (charged at your standard network rate)

They welcome calls via Relay UK (the national speech to text telephone relay service for people who are deaf, have hearing loss or speech impairment.)

Text: send the word ’pohwer’ with your name and number to 81025

Post: PO Box 17943, Birmingham, B9 9PB

Thank you for your patience and support during the pandemic.

Guidance on the wearing of face coverings changes regularly and when there is a change in local health issues, this may vary from National guidance as healthcare settings undertake risk assessments and determine differing local policies.

Our current guidance is as follows :

Patients

• Patients with respiratory symptoms who are required to attend for emergency treatment should wear a facemask/covering, if tolerated, or offered one on arrival.
• All other patients are not required to wear a facemask unless this is a personal preference

For the consideration of other more vulnerable users of the health centre, patients may choose to wear a facemask to support them.

Health & Care Staff:
• Health and care staff should continue to wear facemasks as part of personal protective equipment required for transmission-based precautions when working in COVID-19/respiratory care pathways, and when clinically caring for suspected/confirmed COVID-19 patients. This is likely to include settings where untriaged patients may present such as emergency departments or primary care, depending on local risk assessment. In all other clinical care areas, universal masking should be applied when there is known or suspected cluster transmission of SARS-CoV-2, eg during an outbreak, and/or if new SARS-CoV-2 VOC emerge.

• Health and care staff are in general not required to wear facemasks in nonclinical areas eg offices, social settings, unless this is their personal preference or there are specific issues raised by a risk assessment. This should also be considered in community settings.

Please refer to C1657_next-steps-on-infection-prevention-and-control-letter_010622.pdf (england.nhs.uk) for further detail as needed.

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.)

At Birchwood we recognise the impact of all areas of our work on the health of our planet, as well as on our patients. We are pleased to announce we will be signing up to up to the Green Impact For Health Toolkit when it is relaunched in early 2023, which will help us move our practice into being more environmentally friendly, reducing our carbon emissions and plastic waste, helping us to care better for both people and the planet at the same time.

The toolkit aims to help General Practices make better decisions in this climate and ecological emergency. The NHS is responsible for 4-5% of the UK’s carbon footprint.

The majority of General Practice’s carbon footprint comes from prescribing. The clinical actions that reduce our carbon footprint are aligned with our existing health priorities and evidence-based, person-centred practice. This BMJ article outlines Six steps to both greener and better primary care. We can significantly reduce our carbon footprint by supporting health and wellbeing (e.g. nature-based interventions, social prescribing, de-prescribing where appropriate and low-carbon prescribing). Person-centred medicine, which works in collaboration with patients on what matters to them, is likely to lead to improved patient empowerment and self-care. Greener practice can deliver win-win solutions for patients and the planet. To learn more, visit the BMJ’s page here.

What We’re Doing to Help

What you can do to Help

We’ve put together a list of a few things you can do to help the planet and our Greener Practice project. A lot of the information here, and more, can be found at Greener Practice – For Patients.

To Help our Project you can:

• Discuss which inhaler you’re using with your GP, nurse or Pharmacist to see if a more environmentally friendly inhaler is suitable.
• Recycle any used inhalers at your local pharmacy.
• Make sure your chronic disease-control is as good as it can be- your GP can help you with this.
• Talk to your GP about any medication you’re not using.
• Keep yourself fit, active and healthy! There are excellent local resources here

To Help the Planet Some More, you can:

• Switch your search engines to Ecosia (Ecosia – the search engine that plants trees) which plant trees when you use their search engine.
• Try to reduce your meat intake- This helps your health and the planet’s health!
• Use public transport, walk, or cycle to work whenever you can.
• Work out your carbon footprint: WWF- Your Footprint

It is vital we make our practice accessible, so that people who are deaf or have hearing loss can contact us, communicate well during appointments – and fully understand the information we give them.

We have worked with the Royal National Institute for Deaf People (RNID) to ensure we are enabling our patients to access services effectively when they need them and to understand what is available to them.

People with hearing loss may find it difficult or impossible to use the telephone to book an appointment, order repeat prescriptions or receive test results.

Communication Methods we support:

• online booking requests via our eConsultation service for non-urgent appointments
• SMS text replies to patients
• Textphone
• Relay UK (which has replaced Text Relay) – typed messages are relayed to the other caller via an operator
• video relay – conversation is relayed through a British Sign Language (BSL) interpreter using video.
• You can ask any of our team to write something down for you or read something you have brought in – we are here to help

We do not offer email communication as this is not a secure or safe method of communication and can prevent delay in receipt of urgent care. Our eConsultations service provides a digital means of contacting the practice safely and confidentially.

Check in and Patient call systems are in place to support you:

• Highly visible check in screen
• Working hearing loop at our reception desk
• Our patient call system has been changed from audible only to a large screen in reception with the patient name and room number visible
• Our clinicians will also come to reception to check if they know a patient has impaired hearing

When you register, we ask about how you prefer to communicate, but if you need to change this you can do so at any time and we will record this on your record to help us help you better when you access our services. We can provide double appointments on request if this would help you for improved, effective communication.

You may also wish to contact Adult Services at Bristol City Council for support with any equipment that you may need to access the specialist services noted above including textphones / Relay UK.

Please note that where a patient decides not to communicate with the practice using one of the RNID recommended services above to enable safe, timely, effective treatment and care from our clinicians, the practice will have no choice but to ask the patient to register with a new GP practice as patient safety is our priority.

We are providing training for receptionists and other staff members on the different ways people with hearing loss may wish to make contact and be contacted. We welcome feedback on any other ways we could help.

IPC Statement 28.12.23 to 8.1.2025

There may be occasions where you would like our staff to speak to a member of your family or an advocate regarding your health care.

Your medical records are confidential so for us to do this we would require your signed consent.

Please click here for a consent form that you can download, print, sign and return to the practice should you need to do this.

The practice has procedures in place for appropriate prescribing for patient safety. Please refer to the relevant sections below.

Fear of Flying

People sometimes ask the doctor or nurse to prescribe diazepam, or similar drugs like lorazepam, temazepam or clonazepam, for fear of flying or to help sleep during flights. In the past, this type of prescribing was permitted, but guidance has changed and the practice has updated its protocols to reflect National, safe guidance on prescribing policy in this area.

Birchwood Medical Practice does NOT prescribe sedatives for fear of flying. This policy decision has been made by the GP Partners and is adhered to by all prescribers working in the practice.

Prescribing these drugs is not recommended any more for these reasons:

1. Although plane emergencies are rare, taking Diazepam reduces awareness and reaction times for patients so you risk not being able to react to save your life if you have to escape quickly. You may also put other people in danger by getting in their way or making them help you.
2. The use of these drugs can make you sleep in an unnaturally deep sleep. This means you won’t move around as much as during natural sleep so you have a bigger risk of getting a blood clot (Deep Vein Thrombosis – DVT) in the leg or lungs. Blood clots are very dangerous and can kill. This risk is bigger if your flight is longer than 4 hours.
3. They have short term bad effects on memory, co-ordination, concentration and reaction times, and are addictive if used for a long time, with withdrawal leading to fits, hallucinations, agitation and confusion. They have also become widely used drugs of abuse since they first came on the market. Diazepam in the UK is a controlled drug. The prescribing guidelines doctors have to follow say that that use to treat short-term ‘mild’ anxiety is inappropriate. They are only to be used short term for a ‘crisis in generalised anxiety’. But if you are having such a crisis you are not likely to be fit to fly. Fear of flying in isolation is not a generalised anxiety disorder.
4. Some people get agitated and aggressive after taking diazepam and similar drugs, and behave in a way that they would not normally, which can pose a risk on the plane. This affects everyone’s safety and could get you into trouble with the law. A similar effect can be seen with alcohol, which has led to people being removed from flights.
5. There is evidence use of these drugs stops the normal adjustment response that would gradually lessen anxiety over time, and may increase anxiety in the long term, especially if used repeatedly.
6. Diazepam and similar controlled drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the police.
7. Diazepam stays in your system for some time. If your job or sport needs you to have random drug testing you may fail this having taken diazepam.
8. It is important to tell your travel insurer about your medical conditions and medications you take. If not, there is a risk of your insurer not paying if you try to make a claim.

So we no longer provide Diazepam or similar drugs for flight anxiety. Instead you may wish to consider one of these aviation industry recommended flight anxiety courses.

Fly And Be Calm™

Fly And Be Calm™ is an instant download and comes with a money back guarantee (Guarantee does not apply to app versions).6 MP3 tracks which include instructions, the fear removal tool and two hypnotic tracks. Visit the website: https://flyandbecalm.co.uk/

Easy Jet
www.fearlessflyer.easyjet.com

British Airways
https://www.britishairways.com/en-gb/information/travelassistance/flying-with-confidence

Virgin Atlantic
https://www.flyingwithoutfear.co.uk/

General Phobia Prescribing

Many people with a phobia don’t need treatment and avoiding the object of their fear is enough to control the problem. Medication isn’t usually recommended for treating phobias, because talking therapies are usually effective and don’t have any side effects. However, medication may sometimes be prescribed to treat the effects of phobias, such as anxiety once other treatment options have been explored. For more information of phobia treatment pathways, please review the NHS Website and book an appointment if you wish to discuss your phobia and talking therapies further.

Prescribing for Medical Procedures

• Where the practice has made the test request (e.g. lower GI endoscopy/MRI etc)
  • We do not prescribe benzodiazepines for sedation due to the associated risks
  • A patient can request a consultation to discuss available options as relaxants

• Where secondary care/3^rd party has made the request – the practice does NOT undertake the prescribing. This is the responsibility of the requesting, responsible clinician/team for patient safety and clinical responsibility reasons.

This policy outlines the procedure for patients travelling abroad for short and long periods of time.

NHS Policy

By law, the NHS ceases to have responsibility for the medical care of patients when they leave the UK.  In addition GPs are not required by their terms of service to provide prescriptions for the treatment of a condition that is not present and may arise while the patient is abroad.

The NHS does accept responsibility for supplying ongoing medication for temporary periods abroad of up to 3 months. However, if a person is going to be abroad for more than 3 months, then they are only entitled (at NHS expense) to a sufficient supply of regular medication in order to get to their destination, where they should the find an alternative supply of that medication.

Patients residing abroad for a period of more than 3 months should be removed from the registered patient list.

Birchwood Medical Practice Policy

Travelling out of the country for LESS than 3 months
For patients who inform us they will be out of the country for less than 3 months, we will provide sufficient medicines for an existing condition (e.g. asthma, diabetes…) for the period while the patient is away where it is safe to do so.  Drugs that require frequent monitoring may not be prescribed where there are safety concerns.  1 months supply only will be issued for drugs normally available over the counter, such as paracetamol.

Travelling out of the country for MORE than 3 months
Patients who inform the NHS they will be leaving the country for more than 3 months will be prescribed sufficient medication to enable them to make alternative arrangements at their destination (up to 3 months supply where safe to do so).

They will also be removed from our patient list. We will be pleased to re-register patients on their return to residence in the UK and can reassure patient that their electronic notes are kept on file for reference on your return.

Patients and relatives should not seek medication for themselves while they are abroad as this constitutes NHS fraud.

Prescriptions for medicines in case of illness while abroad

GPs may provide private prescriptions if it is clinically appropriate and they can be self-administered safely without medical assessment while abroad. These prescriptions are not free and it is at the discretion of the doctor as to whether they undertake this private work.

Patients should be aware that some drugs commonly prescribed in the UK may be illegal in certain countries and you should check with that countries embassy before you travel.

See NHS facts of travel abroad

http://www.nhs.uk/chq/Pages/1755.aspx?CategoryID=73&SubCategoryID=105

https://www.wessexlmcs.com/patientstravellingabroadprescriptionsadvice

https://www.gov.uk/travelling-controlled-drugs

Birchwood Medical Practice (the Surgery)

We understand how important it is to keep your personal information safe and secure and we take this very seriously. We have taken steps to make sure your personal information is looked after in the best possible way and we review this regularly.

Please read this privacy notice (‘Privacy Notice’) carefully, as it contains important information about how we use the personal and healthcare information we collect on your behalf.

202505 Children’s Privacy Notice

We regularly review and update our Privacy Notice. This Privacy Notice was last updated on 29/06/2023

The practice undertakes work that is classed as not NHS e.g. private letters/private medical reports/insurance claims at the absolute discretion of the practice.

We do not undertake private clinical procedures.

The practice reserves the right to decline private fee paying work requests and examples of this can be found on our fees page.

Where a patient has chosen to go private for a clinical pathway the patient has the choice to remain on that pathway or transfer to the NHS pathway at any point. The patient cannot mix and match their care. For example if a patient is seeing a non NHS private provider for a pathway such as fertility or weight loss, the patient must either stay with that provider for all associated tests and advice or end the treatment with the private provider and restart from the beginning with the NHS provider. The patient is not permitted to request the GP practice undertakes diagnostic tests (inc blood tests) for the use by their private care provider. The responsibility remains with the consulting, responsible clinician.

Naturally, should a patient end treatment with their private provider, the NHS doctor will recommence the care and request the appropriate tests on the NHS.

The NHS Guidlines are very explicit and state:

• Private and NHS care should be kept as clearly separate as possible.
• Private care should be carried out at a different time to the NHS care that a patient is
  receiving.

Birchwood Medical Practice does not accept responsibility for continuing to offer a private service, even if a previous GP surgery has provided it for you. We understand this may be disappointing to some patients. You may wish to enquire at other GP surgeries as to whether they would provide it.

This does not affect your access to NHS care as a result of other health issues not related to your private treatment.

The practice acts in line with NHS Policy which can be found here.

Understanding Our Practice’s Policy

Our practice has been receiving requests from private providers to review patient notes to ensure it is safe for them to prescribe weight loss medications including, but not limited to Wegovy, Saxenda or Mounjaro. Here’s what you need to know:

Responsibility for Prescribing

• The clinical responsibility for prescribing is with the private 3rd party provider
• When a private provider asks us to review your notes, it implies that our practice would take responsibility for prescriptions initiated by other organisations.
• General Practice is under extreme pressure and cannot take on unfunded, non-contractual work for Non-NHS providers.

Regulations and Safety

• According to GMC regulations, it is the responsibility of the prescribing clinician to ensure their prescribing is safe. This includes:
  • Taking an adequate history.
  • Examining the patient.
  • Conducting and acting on any appropriate pre-prescribing investigations.
• NICE guidelines require an examination of the patient, including accurate weight measurement at initial assessment and regular reviews.

Private Providers’ Responsibilities

• Private providers should not expect NHS GPs to perform private work on their behalf.
• They must not assume that a non-response from us means there are no contraindications to prescribing the medication.

Access to Medical Records

• Patients can arrange for private providers to have full access to their NHS records via the NHS app.

Our Policy

• We direct third-party private prescribers back to their patients.
• We direct patients to share their medical record via the NHS App
• We cannot take responsibility or get involved in third-party prescribing, which remains the clinical responsibility of the prescribing clinician.

What You Should Do

Private Providers: Please contact your patient directly to resolve any queries about their medical history.

Patients: Ensure your private provider has access to your NHS records through the NHS app.

Additional Information

Contact Information

If you have any further questions or need assistance with accessing your NHS records, please contact us.

Frequently Asked Questions (FAQs)

Q: How can I give my private provider access to my NHS records?

A: You can do this through the NHS app. Here’s a link to the NHS app guide. If you have limited visibility, please contact the practice either by phone, in person or digitally via the Admin request online.

Q: What should I do if my private provider insists on the practice reviewing my notes?

A: Inform them of our policy and direct them to contact you directly for any necessary information.

Patient Support

Your care and safety are our top priorities. These policies are in place to ensure that all treatments are safe and effective.

Links to Resources

For more information, you can refer to the GMC regulations and NICE guidelines.

We appreciate your understanding and cooperation in this matter. If you have any questions, please do not hesitate to contact us directly.

Privacy Notice

Birchwood Medical Practice (the Surgery)

We understand how important it is to keep your personal information safe and secure and we take this very seriously. We have taken steps to make sure your personal information is looked after in the best possible way and we review this regularly.

Please read this privacy notice (‘Privacy Notice’) carefully, as it contains important information about how we use the personal and healthcare information we collect on your behalf.

202505 Patient Privacy Notice

We regularly review and update our Privacy Notice. This Privacy Notice was last updated on 22/05/2025

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!

Birchwood is dedicated to supporting all patients and understands that to do this we need to adapt how we work with our patients to improve their outcomes.

Autism and Learning Disabilities are not the same and we can help in each area.

What we can do for you :

• We can provide a map of the practice rooms to help you around the building
• You can arrange for a staff member to walk you around the building at a quiet time
• We can book appointments at quieter times for you to improve your waiting room experience
• We can arrange for you to wait outside/in a vehicle and arrange for a phone call to tell you when to come in for your appointment
• Click this link for helpful resources on what to expect when you visit the doctor or nurse
• Click here for autism resources that are family friendly
• We can add a note to your records about your preferences – we will do our best to meet reasonable patient preferences
• You do not need to phone us for a routine appointment – you can use our online service here for medical and admin help
• We offer free flu jabs for patients with a learning disability
• We offer free flu jabs for carers of patients
• We offer support for vital smear appointments
• We have regular training
  • As a result of direct feedback we have liaised with the Bristol branch of the National Autism Society and together we created a training video for staff through the lived experiences of an autistic person. This has been rolled out to all staff and forms part of our induction for new staff.
  • We will be completing the The Oliver McGowan Mandatory Training on Learning Disability and Autism when it is fully available

Hospital passports

We recommend that every person with a learning disability and/or autism complete a hospital passport. Although this is usually for hospitals, the practice can review the content and do our best to support your needs.

Here are blank templates kindly provided by North Bristol Trust:

• LD hospital passport.docx
• NBT003387_Autism Hospital Passport.docx

You can email completed hospital passports to us at birchwoodmedicalpractice@nhs.net. Please encrypt your email to make it secure if you can. We will put it on your GP record with an alert for our staff to read it. This email address is only for hospital passports and not general patient contact for health issues as it is not monitored daily.

Please also bring in any important guidelines, care plans or protocols that you may have (e.g. epilepsy protocols, eating and drinking guidelines, positive behaviour support plans etc).

General Information

Referrals for autism and other related diagnosis take time. Wait times can be more than 12 months depending on symptoms so it is important to be prepared for delays.

Please ask your GP about the wait time for a referral during your appointment.

Concerns about possible Attention Deficit Hyperactivity Disorder (ADHD) or autistic spectrum disorders (ASD) will usually be referred to Community Paediatrics if under 18 years. After that it will mean a referral to adult services.

Hospitals in Bristol have dedicated teams to support you when you attend for appointments or if you want to look around in case you may need an emergency appointment. A lot of autistic patients and those with learning disabilities find this helpful.

Bristol Royal Infirmary (BRI)

Link to their support page

Southmead Hospital and South Bristol Community Hospital

Link to their support page

NHS England introduced the AIS to help clarify what is reasonable under the Equality Act. It aims to make sure people who have a disability, impairment or sensory loss receive information they can easily read or understand, and get support so they can communicate effectively with health and social care services. It covers patients, their parents and carers.

Since 2016, providers of any NHS funded care must, by law:

1. Identify/ask people if they have any information or communication needs
2. Find out how to meet their needs.
3. Record those needs in a clear and consistent way.
4. Flag their file or notes so it is clear that they have information or communication needs. Record how to meet those needs.
5. Share people’s information and communication needs with other providers of NHS and adult social care. This is only when they have consent or permission to do so.
6. Meet needs. Make sure people receive information they can access and understand. They should receive communication support if they need it.

All staff within the Practice will endeavour to ascertain whether patients have specific needs they require meeting in order for them to be fully involved in their care.

This will be done via the New Patient Registration Form and opportunistically during patient contact.

The information will be transferred to the Patient Record to ensure that their specific needs are identified. The patient’s record will be highlighted so it is clear there are information or communication needs and clearly explain what those needs are. This information will be shared with other NHS organisations if the practice has the consent to do so. The practice will make sure patients get information in an accessible way and communication support if they need it. Patients should be aware that this may not be instant and may take some time to organise depending what the request is.

The New Patient Registration Form has a section where patients can alert the practice to any specific needs they may have.

Specific needs include:

• Sensory impairment, i.e. speech, hearing, sight
• Physical disability
• Mental disability
• Religious or cultural needs
• Translation/interpretation
• Allergies and sensitivities
• Has or is a carer
• Access to premises
• Assistance dog
• Advocacy
• Phobias

If you are not a new patient or if your needs have changed please do use our Patient Feedback page to tell us about your information or communication needs – or call the practice – so we can update them for you.

At Birchwood we use the Language Empire Group to provide interpreter services. They also provide British Sign Language (BSL) support for patients who wish to contact them. Please click this link for more information and be aware that BSL support can take longer to arrange.

We experience a large volume of requests for prescriptions every day. In order to safely and efficiently carry this out we have a policy for issuing acute prescriptions. The full policy is detailed below the list of medication.

Medications other than the ones in this list will not be routinely issued on an urgent basis. Requests for routine prescription renewal require 5 working days for the script to be processed for collection. If you request prescriptions through a pharmacy or other 3rd party this may take longer as the service level agreement commences when the practice receives the prescription NOT when you make the request via a 3rd party.

URGENT PRESCRIPTION LIST

PLEASE ALSO NOTE THAT IF YOU ARE REQUESTING A MEDICATION THAT HAS NOT BEEN PRESCRIBED IN THE LAST 3 MONTHS YOU WILL NOT BE PROVIDED WITH AN URGENT PRESCRIPTION AND WILL BE ASKED TO MAKE A GP APPOINTMENT.

URGENT PRESCRIPTIONS REQUEST POLICY

Purpose

We receive a large volume of requests for prescriptions every day. In order to safely and efficiently undertake this function we have made a standard policy framework outlining the process and what drugs constitute and acute and urgent prescriptions. The management of urgent prescriptions support patients safely through less surgery interruptions and enabling the GPs to work uninterrupted.

Protocol

• When urgent medication is requested practices must establish whether it is the fault of the practice and the script was not produced as requested or the patient has left the request too late.

• If the practice establishes that this is not an error on the practices part, check against the provided list of medications classed by the Practice as urgent.

• If the prescription is deemed to be urgent, explain to the patient that it will be ready by 6pm that day, if the request is deemed not to be urgent the patient will be informed the request will be ready within 5 working days and that this will have no detriment to their health.
• There may be occasions where you will be asked to obtain an emergency supply from your preferred pharmacy who know you and will be able to accommodate the request in line with NICE Guidance

• Patients who repeatedly request their prescriptions on an urgent basis will receive a letter warning them that they must comply with the Practice’s Policy or potentially face removal from the Practice.

• Patients should be reminded that requests for routine prescriptions should be made well in advance to avoid medical lapses.

• Patients who do not comply with the policy will on the first occasion receive a confirmation via text or letter reminding them of the process and on any subsequent occasion will receive a letter from the practice clearly stating the process and consequences of ignoring the policy.
• In line with our standard prescription request policy no more than 2 month’s worth of medication will be provided unless it is under repeat dispensing or a contraceptive pill. This also aligns to and NHSE recommendations to reduce medication wastage and ensure patient safety.

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.

Your Confidential Records

Your data matters to us at Birchwood Medical Practice. You can be assured that your medical records are safe with Birchwood Medical Practice. We will only share data that identifies you under the following circumstances:

• With other health care professionals e.g. locum clinicians either in the practice or working remotely, hospital or community staff as part of an agreed plan of treatment
• With your explicit consent, e.g. for participation in research studies
• In circumstances where it is in the interests of your health and you are not able to give consent, e.g. if you are unconscious
• Where we are obliged to divulge information under the Health & Social Care Act 2012, e.g. in the case of a national emergency or pandemic
• Where we are required to do so for health service planning purposes and you have not explicitly opted out of having your data shared
• Please see our privacy notices for detailed information

Our strict rules about confidentiality mean that we will not discuss your medical affairs even with your close family unless you give us permission to do so. This includes details of appointments you have made. If you would like your partner, parent, son/daughter or carer to be able to speak to us on your behalf, you must tell us beforehand. Please ask our Reception Team for a consent form or download one here if you require an ongoing arrangement for sharing consent. You can withdraw your consent at any time.

Information about your health and care helps the NHS to improve your individual care, speed up diagnosis, plan your local services and research new treatments.

Here is a video to show you how your data is shared from NHS Digital

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.