Surgery policies and procedures

East Practice, Springfield Medical Centre, 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. The reasons for this include:

1. Diazepam is a sedative, which means it makes you sleepy and more relaxed. If there is an emergency during the flight it may impair your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences or you and those around you.
2. Sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at increased risk of developing a blood clot (DVT) in the leg or even the lung. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than four hours.
3. Whilst most people find benzodiazepines like diazepam sedating, a small number of people experience agitation and even aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.
4. According to the prescribing guidelines doctors are required to follow (BNF), Benzodiazepines are contraindicated (not allowed) for phobia (fear). Your doctor is taking a significant legal risk by prescribing against these guidelines.
5. Diazepam and similar drugs are illegal in a number of countries. They may be confiscated, or you may find yourself in trouble with the police.
6. Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing, you may fail this having taken diazepam

We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines and we have listed a number of these below.

Easy Jet www.fearlessflyer.easyjet.com Tel 0203 8131644

British Airways www.flyingwithconfidence.com Tel 01252 793250

Virgin www.flyingwithoutfear.co.uk Tel 01423 714900

Patients are reminded that if they are found posting any derogatory, defamotory, or offensive comments on social media directed to the Practice or members of staff on social networking sites, this may result in them being removed from the Practice List. We ask if you have a complaint to please contact the Practice Manager in the first instance. We would be grateful if patients could be pro-active in reporting any incidents of this nature to the Practice Manager.

We understand how frustrating and disappointing this may be for many individuals. NHS Scotland are currently considering this as a matter of importance.

With regard to both ADHD and Transgender care, it is therefore understandable that patients who wish to pursue this may choose to access Private Clinics for timely assessment and treatment where indicated. 

Private ADHD and Transgender clinics may recommend medication. Individuals who are started on medication are advised that ongoing prescription on the NHS is not guaranteed. Private clinic monitoring must take place at regular intervals and is essential to enable ongoing treatment whilst ensuring patient safety. 

Requests for shared care between Private Clinics and General Practice are discussed individually on a case to case basis. Correspondence from the referring clinic, the expertise of the practitioner making the assessment, duration and compliance with medication and monitoring protocols are taken into consideration. 

Failure to engage in drug monitoring and follow up with the specialist clinic will result in termination of the shared care agreement and cessation of NHS prescriptions. 

This, alongside the financial implications of private care should be taken into consideration. 

We kindly request patients bring a letter to their initial appointment with the GP if you suspect you may have ADHD. The letter should outline your concerns and relevant information about your symptoms and when your first suspected that you had ADHD.

Alternatively, you may choose to email the practice with the same details, and the information will be securely stored in your file. This proactive step will assist the GP in understanding your situation better and facilitate a more comprehensive discussion during your appointment.

Thank you for your understanding.

Unacceptable Actions Policy Explained

We believe that patients have a right to be heard, understood and respected. We work hard to be open and accessible to everyone. Occasionally, the behaviour or actions of individuals using our Practice makes it very difficult for us to deal with their issue or complaint. In a small number of cases the actions of individuals become unacceptable because they involve abuse of our staff or our process. When this happens we have to take action to protect our staff, and must also consider the impact of the individuals behaviour on our ability to do our work and provide a service to others. This Policy explains how we will approach these situations.

Section 1 – What actions does the Practice consider to be unacceptable?

People may act out of character in times of trouble or distress. There may have been upsetting or distressing circumstances leading up to us being made aware of an issue or complaint. We do not view behaviour as unacceptable just because a patient is forceful or determined. In fact, we accept that being persistent may sometimes be a positive advantage when pursuing an issue or complaint. However, we do consider actions that result in unreasonable demands on our Practice or unreasonable behaviour towards Practice staff to be unacceptable. It is these actions that we aim to manage under this Policy.

Section 2 – Aggressive or abusive behaviour

We understand that patients may be angry about the issues they have raised with the Practice. If that anger escalates into aggression towards Practice staff, we consider that unacceptable. Any violence or abuse towards staff will not be accepted. Violence is not restricted to acts of aggression that may result in physical harm. It also includes behaviour or language (whether verbal or written) that may cause staff to feel offended, afraid, threatened or abused. We will judge each situation individually, and appreciate individuals who come to us may be upset.

Language which is designed to insult or degrade, is derogatory, racist, sexist, transphobic, or homophobic or which makes serious allegations that individuals have committed criminal, corrupt, perverse or unprofessional conduct of any kind, without any evidence, is unacceptable.

We may decide that comments aimed not at us, but at third parties, are unacceptable because of the effect that listening or reading them may have on our staff.

Section 3 – Unreasonable demands

A demand becomes unacceptable when it starts to (or when complying with the demand would) impact substantially on the work of the Practice. Examples of actions grouped under this heading include:

• Repeatedly demanding responses within an unreasonable timescale
• Repeatedly requesting early supplies of medication
• Repeatedly requesting further supplies of stolen medication, without the required Police Incident number
• Repeatedly ordering prescriptions outwith the set timeframe
• Insisting on seeing or speaking to a particular member of staff when that is not possible
• Repeatedly changing the substance of an issue or complaint or raising unrelated concerns
• Repeatedly insisting on a course of medical treatment for which there is no clinical evidence
• Not ensuring that a review appointment is in place, prior to ongoing medication finishing
• An example of such impact would be that the demand takes up an excessive amount of staff time and in so doing disadvantages other patients

Section 4 – Unreasonable levels of contact

Sometimes the volume and duration of contact made to our Practice by an individual causes problems. This can occur over a short period, for example, a number of calls in one day or one hour. It may occur over the life-span of an issue when a patient repeatedly makes long telephone calls to us, or inundates us with letters or copies of information that have been sent already or that are irrelevant to the issue. We consider that the level of contact has become unacceptable when the amount of time spent talking to a patient on the telephone, or responding to, reviewing and filing emails or written correspondence impacts on our ability to deal with that issue, or with other Patients’ needs.

Section 5 – Unreasonable refusal to co-operate

When we are looking at an issue or complaint, we will ask the patient to work with us. This can include agreeing with us the issues or complaint we will look at; providing us with further information, evidence or comments on request; or helping us by summarising their concerns or completing a form for us.

Sometimes, a patient repeatedly refuses to cooperate and this makes it difficult for us to proceed. We will always seek to assist someone if they have a specific, genuine difficulty complying with a request. However, we consider it is unreasonable to bring an issue to us and then not respond to reasonable requests.

Section 6 – Unreasonable use of the complaints process

Individuals with complaints about the Practice have the right to pursue their concerns through a range of means. They also have the right to complain more than once about the Practice, if subsequent incidents occur. This contact becomes unreasonable when the effect of the repeated complaints is to harass, or to prevent us from pursuing a legitimate aim or implementing a legitimate decision. We consider access to a complaints system to be important and it will only be in exceptional circumstances that we would consider such repeated use is unacceptable – but we reserve the right to do so in such cases.

Section 7 – Examples of how we manage aggressive or abusive behaviour

• The threat or use of physical violence, verbal abuse or harassment towards the  Practice staff is likely to result in a warning from the Senior Management Team. We may report incidents to the Police – this will always be the case if physical violence is used or threatened.
• Practice staff will end telephone calls if they consider the caller aggressive, abusive or offensive.  Practice staff have the right to make this decision, to tell the caller that their behaviour is unacceptable and end the call if the behaviour persists.
• We will not respond to correspondence (in any format) that contains statements that are abusive to staff or contain allegations that lack substantive evidence. Where we can, we will return the correspondence. We will explain why and say that we consider the language used to be offensive, unnecessary and unhelpful and ask the sender to stop using such language. We will state that we will not respond to their correspondence if the action or behaviour continues and may consider issuing a warning to the Patient.

Section 8 – Examples of how we deal with other categories of unreasonable behaviour

We have to take action when unreasonable behaviour impairs the functioning of our Practice. We aim to do this in a way that allows a Patient to progress through our process. We will try to ensure that any action we take is the minimum required to solve the problem, taking into account relevant personal circumstances including the seriousness of the issue(s) or complaint and the needs of the individual.

Section 9 – Other actions we may take

Where a patient repeatedly phones, visits the Practice, raises repeated issues, or sends large numbers of documents where their relevance isn’t clear, we may decide to:

• limit contact to telephone calls from the patient at set times on set days, about the issues raised
• restrict contact to a nominated member of the  Practice staff who will deal with future calls or correspondence from the patient about their issues
• see the patient by appointment only
• restrict contact from the patient to writing only regarding the issues raised
• return any documents to the patient or, in extreme cases, advise the patient that further irrelevant documents will be destroyed
• take any other action that we consider appropriate

Where we consider continued correspondence on a wide range of issues to be excessive, we may tell the patient that only a certain number of issues will be considered in a given period and ask them to limit or focus their requests accordingly. In exceptional cases, we reserve the right to refuse to consider an issue, or future issues or complaints from an individual. We will take into account the impact on the individual and also whether there would be a broader public interest in considering the issue or complaint further. We will always tell the patient what action we are taking and why.

Section 10 – The process we follow to make decisions about unreasonable behaviour

• Any member of  the Practice staff who directly experiences aggressive or abusive behaviour from a Patient has the authority to deal immediately with that behaviour in a manner they consider appropriate to the situation and in line with this Policy
• With the exception of such immediate decisions taken at the time of an incident, decisions to issue a warning or remove patients from our Practice List are only taken after careful consideration of the situation by the Senior Management
• Wherever possible, we will give a patient the opportunity to change their behaviour or actions before a decision is taken

Section 11 – How we let people know we have made this decision

When a Practice employee makes an immediate decision in response to offensive, aggressive or abusive behaviour, the patient is advised at the time of the incident. When a decision has been made by Senior Management, a patient will always be given the reason in writing as to why a decision has been made to issue a warning (including the
duration and terms of the warning) or remove them from the Practice list. This ensures that the patient has a record of the decision.

Section 12 – How we record and review a decision to issue a warning

We record all incidents of unacceptable actions by patients. Where it is decided to issue a warning to a patient, an entry noting this is made in the relevant file and on appropriate computer records. Each quarter a report on all restrictions will be presented to our Senior Management Team so that they can ensure the policy is being applied appropriately. A decision to issue a warning to a patient as described above may be reconsidered either on request or on review.

Section 13 – The process for appealing a decision

It is important that a decision can be reconsidered. A patient can appeal a decision about the issuance of a warning or removal from the Practice list. If they do this, we will only consider arguments that relate to the warning or removal, and not to either the issue or complaint made to us, or to our decision to close a complaint.

An appeal could include, for example, a patient saying that: their actions were wrongly identified as unacceptable; the warning was disproportionate; or that it will adversely impact on the individual because of personal circumstances.

The Practice Manager or a GP Partner who was not involved in the original decision will consider the appeal. They have discretion to quash or vary the warning as they think best. They will make their decision based on the evidence available to them. They must advise the patient in writing that either the warning or removal still applies or a different course of action has been agreed. We may review the warning periodically or on further request after a period of time has passed. Each case is different.

This policy is subject to review

It is our policy not to remove patients without serious consideration. If a patient has a serious continuing medical condition, removal will be postponed until the patient’s condition stabilises.

Possible grounds for consideration of removal include:

1. Physical violence to staff, Doctors or other patients
2. Threat of violence to staff, Doctors or other patients
3. Abusive or disruptive behaviour including when under the influence of alcohol or drugs
4. Theft from the Surgery, staff, Doctors or other patients
5. Criminal damage to the Surgery
6. Dangerous dogs posing a real or potential hazard on home visits
7. Altering documents e.g. prescriptions, insurance certificates
8. Defamation of Doctors or staff
9. Misuse of appointments
10. Misuse of home visits
11. Moving outwith the area
12. Any other breakdown of the bond of trust between Doctor and patient

It should be noted that if a patient does not attend for their appointment they will not be given another one for 48 hours. In the event of a patient not attending on three occasions they will receive a letter advising them that if they miss another appointment, they will be removed from our Practice list.

In some cases we reserve the right to remove other members of the household. We will continue to be responsible for the patient’s medical care for a period of up to 8 days from the date of notification to our local health board or until the patient registers with another Doctor, whichever is the sooner.

Our Policy is designed to ensure and promote equality and inclusion, supporting the ethos and requirements of the Equality Act 2010 for all visitors to our Practice.

We are committed to:

• ensuring that all visitors are treated with dignity and respect
• promoting equality of opportunity between men and women
• not tolerating any discrimination or perceived discrimination against, or harassment of, any visitor for reason of age, sex, gender, marital status, pregnancy, race, ethnicity, disability, sexual orientation, religion or belief
• providing the same treatment and services (including the ability to register with the Practice) to any visitor irrespective of age, sex, marital status, pregnancy, race, ethnicity, disability, sexual orientation, medical condition, religion or belief
• This Policy applies to the general public, including all patients and their families, visitors and contractors

Procedure

Discrimination by the Practice or Visitors / patients against you

If you feel discriminated against:

• You should bring the matter to the attention of the Practice Manager
• The Practice Manager will investigate the matter thoroughly and confidentially within 14 working days
• The Practice Manager will establish the facts and decide whether or not discrimination has taken place, and advise you of the outcome of the investigation within 14 working days
• If you are not satisfied with the outcome, you should raise a formal complaint through our Complaints Procedure

Discrimination against our Practice staff

The Practice will not tolerate any form of discrimination or harassment of our staff by any visitor. Any visitor who expresses any form of discrimination against or harassment of any member of our staff will be required to leave the Practice premises immediately. If the visitor is a patient they may also, at the discretion of the Practice Management, be removed from the Practice list if any such behaviour occurs.