MENCAP

Learning disability charity Mencap, in partnership with NHS England, has launched a new animation and online guides called Don’t Miss Out to raise awareness of the importance for people with a learning disability to be on their GP’s learning disability register.

If people with a learning disability tell their GP’s they have a learning disability they are entitled to extra help. This can include:

• Extra time for appointments.
• Easy Read information that is accessible.
• Annual health checks that help to maintain health, detect conditions and illnesses and help GPs to understand how to provide better care to patients with a learning disability.

For more information visit the MENCAP website.

Easy Read Health Leaflets and Films

Visit the website for over 390 easy read resources on about 120 health conditions or topics.

www.easyhealth.org.uk – Easy Read Health Leaflets and Films

Policy for accessible information standard

Patient information

Introduction

The accessible information standard aims to ensure that disabled people have access to information they can understand and the communication support they may need. The Standard applies to service providers across the NHS and adult social care system. As organisations that provide NHS services, GP practices are required by law to follow the Standard under Section 250 of the Health and Social Care Act.

Key requirements

There are five key requirements of the standard:

• Ask patients and carers if they have any information or communication needs, and find out how to meet their needs.
• Record those needs in a set way.
• Highlight a patient’s file, so it is clear that they have information or communication needs, and clearly explain how those needs should be met.
• Share information about a person’s needs with other NHS and adult social care providers, when they have consent or permission to do so.
• Make sure that people get information in an accessible way and communication support if they need it.

What we will do to meet the standard

Ask patients and carers if they have any information or communication needs, and find out how to meet their needs.

We will ask patients and their carers to tell us if they have any communication or information needs relating to a disability, impairment or sensory loss, and if so, what they are.

New patients will be asked at the point of registration if they have any communication or information needs relating to a disability, impairment or sensory loss, and if so, what they are (there is a section on the New Patient Questionnaire that covers this question).

Existing patients can be asked opportunistically (e.g. when making an appointment, with repeat prescriptions, newsletters, posters, email, text message, information screens, website).

Patients should be asked to self-define their communication/information needs and it is these needs (and not the disability) which should be recorded.

Record those needs in a set way

Once a patient has informed the practice that they have communication or information needs relating to a disability, impairment or sensory loss they will be asked or assisted in completing the communication or information needs template.

This is designed to enable us to have as much accurate information as possible to assist the patient.  Once completed and returned this information will be added to the patient’s medical record using the approved template to create a protocol to provide information to all users that access the record.

Highlight a patient’s file, so it is clear that they have information or communication needs, and clearly explain how these needs should be met.

In order to inform all users and provide the opportunity to keep information up to date the protocol will launch each time the patient’s record is entered informing the user of the patients access needs and giving the opportunity for these to be updated if required.

Share information about a person’s needs with other NHS and adult social providers, when they have consent or permission to do so.

As the information is being recorded in a standardised way via Read Code and users are being informed of any needs every time they enter the record the information recorded will be shared subject to patient’s choice regarding the sharing of information.

Make sure that people get information in an accessible way and communication support if they need it.

The practice provides one or more contact methods which are accessible to the patients. Methods include email, text message, telephone and text.

Where information/communication needs are identified, information (e.g. correspondence) will be provided in one or more accessible formats (e.g. non standard print). Alternative formats can be provided if available either through auto generated systems, or through prompting staff to make alternative arrangements.  The adjustments made should be reasonable – but this does not mean that the patient must always receive information in their preferred format. What is important is that they can access and understand the information.

Where needed, appropriate professional communication support is arranged by the practice to enable patients and carers to effectively receive NHS care i.e. text talk, interpreters.

A patient’s family member, friend or carer may also provide necessary support in certain circumstances and where this is the patent’s explicit preference (which should be recorded);

Patients or carers themselves must not be asked to meet the costs of any information or communication needs.

We recommend that you carry an anticoagulation card with you at all times, in case of emergency. If you do not already have the card, please ask your pharmacist for one.

General safety information

Please let other healthcare professionals treating you know that you are taking an anticoagulant. This includes anyone who prescribes you medication or carries out a procedure, for example a dentist.

If you have any questions or concerns about your anticoagulant medication or you are starting any new medications or stopping existing ones, please talk to your doctor, nurse or pharmacist.

Dosing

We advise taking your anticoagulant at the same time each day.

Please be aware if you occasionally or frequently forget to take your anticoagulant medication you may be at increased risk of blood clots/stroke/heart attack. If you require support with medications please contact your pharmacist for advice.

Late or missed doses

Apixaban or dabigatran

If you’re taking apixaban or dabigatran twice a day and you miss one of your doses, you should take it as soon as you remember if it’s still more than 6 hours until your next scheduled dose. If it’s less than 6 hours until your next dose, skip the dose you missed and take the next scheduled dose as normal.

If you accidentally take a double dose, skip your next scheduled dose and take the following dose the next day as scheduled.

Rivaroxaban or edoxaban

If you’re taking rivaroxaban or edoxaban once a day and you miss one of your doses, you should take it as soon as you remember if it’s still more than 12 hours until your next scheduled dose. If it’s less than 12 hours until your next dose, skip the dose you missed and take the next scheduled dose as normal.

If you accidentally take a double dose, take your next dose the next day as scheduled.

Warfarin

If you’re taking warfarin and you miss one of your doses, you should skip the dose you missed and wait to take your next scheduled dose as normal. Don’t take a double dose to make up for the one you missed.

Inform the clinician at your next INR appointment.

Overdose

In the event of an overdose of your anticoagulant medication seek immediate medical advice.

Adverse effects

The most common adverse effect of anticoagulants is bleeding.

You should seek immediate medical advice if:

• spontaneous bleeding occurs and does not stop or reoccurs. This includes bruising, bleeding gums, nosebleeds, prolonged bleeding from cuts, blood in the urine, stools, sputum, vomit, or eyes, and vaginal bleeding in postmenopausal woman.
• you have chest pain and nose bleeds lasting longer than 10 minutes
• sudden severe back pain (which may indicate internal bleeding) or in the event of a head injury
• stroke symptoms – For symptoms, please visit the NHS website at www.nhs.uk/conditions/stroke/symptoms/
• shortness of breath/chest pain

There are occasions when patients need to be examined by a clinician which may involve intimate examinations. A chaperone provides a safeguard for patients during such an examination or consultation and protects against verbal, physical, sexual or other abuse for both patient and clinician. A clinician has the right to request a chaperone if they feel it necessary.

Sheringham Medical Practice is committed to  putting patients at ease wherever possible. If you wish a chaperone to be present during an examination please do not hesitate to ask a clinician or one of our receptionists. It may not be possible for such a person to be provided immediately and you may have to return for the examination to be carried out at a mutually convenient time.

Trust is important in the relationship between clinician and patient and we would at all times, wish you to feel able to ask for a chaperone. It is the policy of Sheringham Medical Practice to respect the privacy, dignity, cultural and religious beliefs of our patients.

If you have a complaint or concern about the service you have received from the doctors or any of the staff working in this GP surgery, please let us know. This includes Primary Care Network staff working as part of our GP surgery. We operate a complaints procedure as part of an NHS system for dealing with complaints. Our complaints system meets national criteria.

How to complain

We hope that most problems can be sorted out easily and quickly when they arise and with the person concerned. For example, by requesting a face-to-face meeting to discuss your concerns.

If your problem cannot be sorted out this way and you wish to make a complaint, we would like you to let us know as soon as possible. By making your complaint quickly, it is easier for us to establish what happened. If it is not possible to do that, please let us have details of your complaint:

• Within 6 months of the incident that caused the problem; or
• Within 6 months of discovering that you have a problem, provided this is within 12 months of the incident.

Complaints should be addressed to the GP surgery team verbally or in writing to the Practice Manager. Alternatively, you may ask for an appointment with the GP surgery to discuss your concerns. They will explain the complaints procedure to you and make sure your concerns are dealt with promptly. Please be as specific as possible about your complaint.

What we will do

We will acknowledge your complaint within three working days. We will aim to have investigated your complaint within ten working days of the date you raised it with us. We will then offer you an explanation or a meeting with the people involved, if you would like this. When we investigate your complaint, we will aim to:

• Find out what happened and what went wrong.
• Make it possible for you to discuss what happened with those concerned, if you would like this.
• Make sure you receive an apology, where this is appropriate.
• Identify what we can do to make sure the problem does not happen again.

Complaining on behalf of someone else

We take medical confidentiality seriously. If you are complaining on behalf of someone else, we must know that you have their permission to do so. A note signed by the person concerned will be needed unless they are incapable (because of illness) of providing this.

Complaining to NHS England

We hope that you will use our Practice Complaints Procedure if you are unhappy. We believe this will give us the best chance of putting right whatever has gone wrong and an opportunity to improve our GP surgery.

However, if you feel you cannot raise the complaint with us directly, please contact NHS England. You can find more information on how to make a complaint at https://www.england.nhs.uk/contact-us/complaint/complaining-to-nhse/.

Unhappy with the outcome of your complaint?

If you are not happy with the way your complaint has been dealt with by the GP surgery and NHS England and would like to take the matter further, you can contact the Parliamentary and Health Service Ombudsman (PHSO). The PHSO makes final decisions on unresolved complaints about the NHS in England. It is an independent service which is free for everyone to use.

To take your complaint to the Ombudsman, visit the Parliamentary and Health Service Ombudsman website or call 0345 015 4033

Need help making a complaint?

If you want help making a complaint, Healthwatch Norfolk can help you find independent NHS complaints advocacy services in your area.

What We Do With Your Information

How We Keep Your Information Safe

Your Information Rights

Your Information

Sheringham Medical Practice takes privacy seriously and we want to provide you with information about your rights, who we share your information with and how we keep it secure.

Please use the links below to find more information about the practice and data protection.

• Transparency
• CCTV
• Telephone Recording
• Case Finding (ECLIPSE)
• Information Sharing Norfolk and Waveney
• Sheringham Medical Practice Processor List
• Sheringham Medical Practice Processing Activities Log

NHS Norfolk and Waveney Integrated Care Board (ICB) plans and buys healthcare services for our local population. We are accountable for the performance and finances of the NHS across Norfolk and Waveney – a total budget of £2 billion a year. Known as NHS Norfolk and Waveney, the organisation works with local people, health and care professionals, and partner organisations to improve the health and wellbeing of our population.

The organisation is part of the Norfolk and Waveney Integrated Care System. A system dedicated to working with partners in local government, the voluntary sector and others and helping the NHS to support broader social and economic development and to tackle inequalities in health outcomes.

For more information about what they do you can visit the https://improvinglivesnw.org.uk/about-us/our-nhs-integrated-care-board-icb/

The practice is required by the Government under the terms of the latest GP contract to allocate all patients a named accountable GP.

Individual patients will be informed of their named accountable GP at the first appropriate interaction with the practice.

For convenience if you have a medical card your accountable GP is likely to be the named doctor you are registered with. Patients registering over the last 2-3 years will not have received a medical card as these are no longer routinely sent when registering with GP the practice.

However, the practice does keep a record of your usual or registered (accountable) GP. If you wish to be told the name of your accountable GP, please ask the receptionists when you are next in the surgery.

Please note that there is no need to telephone the practice for this information.

Where a patient expresses a preference as to which GP they have been assigned, the practice will make reasonable efforts to accommodate this request.

Having a named GP does not prevent you seeing any other doctor in the practice. Your named GP will not be available at all times and if your needs are urgent, you may need to discuss them with an alternative doctor.

Your named GP will have overall responsibility for the care and support that our surgery provides to you. They will also work with other relevant health and care professionals, who are involved in your care, to ensure that your care package meets your individual needs.

• Please click here for more information

Sheringham Medical Practice is part of the primary care research network, therefore takes part in various clinical trials and studies. Any research project which is undertaken at Sheringham Medical Practice has to be approved by a research ethics committee. The committee ensures that any research undertaken is of a high standard, necessary and is ethical. They also ensure that people undertaking research are properly trained and have a duty of confidentiality.

When a research project has been approved you may be contacted to be invited to take part. For certain studies we provide your name and address to the research team so that they can contact you, however when your record is used for research we would only release identifiable information about you with your written permission.

The research team work as part of the practice team and have a strict duty of confidentiality. We follow national guidance, regulations and the law when sharing information in your medical records and we may release anonymised information for research purposes.

Good Clinical Practice (GCP)

This is a key requirement for anyone involved in the conduct of clinical research as it forms the standard and guidelines to which all research is conducted. A number of clinical practice team have undertaken training (GCP) to ensure that they are qualified to deliver research within our primary care setting.

What is the Primary Care Research Network?

The primary care research network is part of the national institute for health research, clinical research network and is funded by the department of health.

What does the Primary Care Research Network do?

The primary care research network are dedicated to providing a world class infrastructure to conduct clinical research in primary care settings, where the majority of patient/practitioner contacts take place. They work with a wide range of primary care practitioners, including GPs, nurse practitioners, dentists, pharmacists and health visitors. As well as supporting high quality research in areas for which primary care has particular responsibility. These include disease prevention, health promotion, screening and early diagnosis, as well as the management of long-term conditions, such as arthritis and heart disease.

Why they do it

Clinical research is, and has always been, fundamental to the work of the NHS. Only by carrying out research into ‘what works’ can they continually improve treatments for patients, and understand how to focus NHS resources where they will be most effective. All the research that they support is driven by the priorities of the NHS and the department of health, and informed by the views of patients and their carers.

How they do it

They provide researchers with the practical support they need to make clinical studies happen in a primary care setting in the NHS, so that more research takes place, and more patients can take part.

The Primary Care Research Network’s vision

To provide improved treatment and services for NHS patients by conducting important and relevant research to the highest standards working in partnership with patients, researchers and primary care practitioners in efficient and effective ways.

Sheringham Medical Practice is a level one ‘research active’ practice and regularly takes part in clinical trial studies in conjunction with the East of England Primary Care Research Network based in Norwich. You may be invited to participate in some research projects if you fit the relevant criteria.

The practice research staff are:

Dr Ian Smith
Nurse Practitioner Julie Sterry
Pauline Craske
Kayleigh Dorey

Increasingly patients, carers and members of the public are contributing their perspectives to the way clinical research is designed, commissioned, managed and supported. Active involvement in clinical research is very different from being a participant in a study.

For a number of years, work has been ongoing to improve the way that medical records are made available to treating clinicians. Our main computer system is called SystmOne, which has the advantage of enabling information to be shared between certain health professionals.

Enhanced Data Sharing Model (EDSM) enables us, with your consent, to share your medical records with those in the NHS who are involved in your care. NHS staff can only access shared information if they are involved in your care and being an electronic service an audit log is maintained showing when and who has accessed medical records.

EDSM only allows those treating you to access medical records. It does not enable your records to be used for research or other purposes.

We already share records of children for child protection reasons and patients who are under the care of the District Nursing Team. This helps clinicians to make decisions based upon a wider knowledge of you and also helps to reduce the number of times that you or your family members are asked the same question. In short it assists clinicians to provide more ‘joined up care’.

If I agreed, who could see my records?

EDSM will allow clinicians treating you, who have access to SystmOne to view and in some cases update your medical records. Locally this includes the Walk-In-Centre, many departments at local hospitals (including A&E) and community services, such as the District Nursing Team. It is anticipated that over time more health services will be able to benefit from EDSM.

Clinicians outside of the surgery who wish to access your medical records will ask for your permission to do so and will need to have been issued with a NHS Smartcard. The is a chip and pin card – similar to a bank card.

Can I ‘opt out’ pick and choose who sees my record?

Yes, you can. Under EDSM there are two levels of consent. The first is to agree to sharing your medical records OUT of the practice. This is your agreement that records maintained by your GP can be seen, subject to your authority at the time, by clinicians working outside of the surgery. The second is agreeing to share your records in. This means that your GP can see records made by other health professionals who have access to EDSM.

However, as the treating clinician needs to ask your permission to see the records at the beginning of each period of care you are in control of who can see your medical information.

I can see the benefits of the other people treating me seeing my notes, but what if there is a matter that I want to stay between me and my doctor? You can ask for any consultation to be marked as private, this means that viewing is restricted to the surgery, but allows the rest of the record to be viewed by whoever else is treating you. It is your responsibility to ask for a consultation to be marked as private.

Haven’t I agreed/disagreed to do this before?

EDSM may seem very similar to patients as the Summary Care Record which went live some years ago. The Summary Care Record contains a very small part of your record that is available to be seen by clinicians who might be treating you in A&E departments, Walk-In-Centres or if you register temporarily somewhere else within the UK.

The Summary Care Record allows other NHS Services to see your current medications and the drugs that you are allergic or sensitive to. Your Summary Care Record can be enriched by your GP to include information that is important to pass on in the case of an emergency.

Can I change my mind?

Yes, you can always change your mind and amend who you consent to see your records. For instance you can decline to share your records out from the surgery, but if you build up a relationship with the Physiotherapist who was treating you and they asked you if they could look at an x-ray report, you could give your consent at that point form them to view your records. You will be referred back to us to change your preference, so the physio treating won't be able to see your records instantly, but should be able to by, the next time of your next appointment.

If I decline – what happens in an emergency?

In the event of a medical emergency, for instance if you were taken unconscious to A&E, and the clinician treating you feels it is important to be able to see your medical records he is able to override any consents set. However, the doctor has to give a written reason for doing so. Where this happens an audit is undertaken by the local Caldicott Guardian (the person with overall responsibility for Data Protection compliance).

Can anyone else see my medical records?

On a daily basis, we get requests from Insurance Companies to either have copies of medical records or excerpts from patients medical records. This requires your signed consent as it has not been requested to treat/care for you. Occasionally we are asked for information from the medical records for legal reasons, again this has to be done with your written consent, or in very exceptional circumstances, by court order.

Any questions?

If you have any questions, please speak to reception. If necessary the receptionist will arrange for someone to give you a call.

The summary care record will initially consist of basic information from the patient record such as your date of birth and address, details of allergies, current prescriptions and bad reactions to medicines. Then, each time a patient uses an NHS service, more information may be added to it.

In Norfolk, many patients have had summary care records created. These can be accessed, with patient consent, by hospitals, A&E departments, the out of hours services, 111 and the ambulance service.

Red more about enhanced summary care records on the North Norfolk CCG website.

Medical Students

Sheringham Medical Practice is proud to be a training practice for 4^th year medical students from the University of East Anglia and we are looking to recruit patients to volunteer to come and speak with our medical students on one of the following three modules (this is not a group participation with other patients)

• Women’s Health, Obstetrics & Gynaecology
  • (for example: benign breast lumps, breast cancer, mastectomy, vaginal prolapse, ectopic pregnancy, menopause, HRT, endometriosis, polycystic ovary syndrome, miscarriage, bladder problems, hysterectomy, infertility, IVF, patients currently pregnant)
• Babies/Children’s Health & General Development
  • (age range from new born to 16-17years of age – this Module covers any medical condition and/or general development).
• Mental Health
  • (for example: anxiety, depression, seasonal affective disorder, panic attacks, bipolar, eating disorder, obsessive compulsive disorder, post-traumatic stress syndrome, phobias, post-natal depression).

Please contact us for further information if you currently have/have previously had any of the medical conditions above, or have any other condition not listed under the three modules that would be appropriate and you would be happy to come and speak to two or three medical students on a Monday for 1 hour (appointment times are usually 11:00 and 14:00).

All appointments with the students will be confidential

Please call 01263 820509 for further information

You could win yourself a £20 worth of shopping vouchers by way of ‘thank you’ from the surgery for taking part, if your name is drawn from the list of participants at the end of each module.

Feedback from patients who have come to speak to medical students in the past have been very positive and many patients come back year on year to speak with the new intake of 4^th year medical students.

This is a great opportunity for you to share your health experiences with the next generation of doctors.

Video Recording

As a training practice video recordings are sometimes made of consultations. These are made for teaching purposes only. Video recordings are only done with your consent and you do have the right to refuse. However, we would stress that all aspects of general practice, including training, are governed by rules of strict confidentiality.

No examinations are filmed.

Our staff come to work to care for others, and it is important for all members of the public and our staff to be treated with respect.

In line with the rest of the NHS and to ensure this is fully observed, we have instigated a dignity at work and zero tolerance policy, whereby aggressive or violent behaviour towards our staff will not be tolerated under any circumstances.

Anyone giving verbal abuse towards members of staff, will be sent a letter from the practice manager to advise that this behaviour will not be tolerated. Any future violation of this policy may result in removal from the practice patient list. There will be no appeal process.

The practice feels sure you will understand that proper behaviour is absolutely necessary for our staff and patients and that non observance will not be accepted.