Confidentiality

Everyone working for the NHS has a responsibility and a legal duty to protect your information, so that information is not disclosed to unauthorised bodies or people.  You have a right of access to your own health records, subject to certain conditions. If you want to see the information that is kept about you, then make a written request to the person who holds your health records.

If at any time you would like to know more about how we use your information you can speak ­to the person in charge of your care, or to the Caldicott Guardian for the organisation, or visit the NHS web site on http://www.nhs.uk

Patient information regarding consent within the NHS can be found on the NHS Choices website

Consent Policy

Where possible, a clinician must be satisfied that a patient understands and consents to a proposed treatment, immunisation or investigation. This will include the nature, purpose, and risks of the procedure, if necessary by the use of drawings, interpreters, videos or other means to ensure that the patient understands, and has enough information to give 'Informed Consent'. The practice will allow sufficient time for the patient to consider whether to give consent and if required consult others, or ask for a second opinion.

Implied Consent

Implied consent will be assumed for many routine physical contacts with patients. Where implied consent is to be assumed by the clinician, in all cases, the following will apply:

• An explanation will be given to the patient what he / she is about to do, and why.
• The explanation will be sufficient for the patient to understand the procedure.
• In all cases where the patient is under 18 years of age a verbal confirmation of consent will be obtained and briefly entered into the medical record.
• Where there is a significant risk to the patient an "Expressed Consent" will be obtained in all cases (see below).

Expressed Consent

Expressed consent (written or verbal) will be obtained for any procedure which carries a risk that the patient is likely to consider as being substantial. A note will be made in the medical record detailing the discussion about the consent and the risks. A Consent Form may be used for the patient to express consent (see below).

Obtaining Consent

• The clinician will ensure that the patient is competent to provide a consent (16 years or over) or has "Fraser Competence" if under 16 years. Consent will include the provision of all information relevant to the treatment.
• Questions posed by the patient will be answered honestly, and information necessary for the informed decision will not be withheld unless there is a specific reason to withhold. In all cases where information is withheld then the decision will be recorded in the clinical record.
• The person who obtains the consent will be the person who carries out the procedure (i.e. a nurse carrying out a procedure will not rely on a consent obtained by a doctor unless the nurse was present at the time of the consent).
• The person obtaining consent will be fully qualified and will be knowledgeable about the procedure and the associated risks.
• The practice acknowledges the right of the patient to refuse consent, delay the consent, seek further information, limit the consent, withdraw consent or ask for a chaperone.
• The practice will review consent in the light of changing patient circumstances and where appropriate re-visit the consent with the patient.
• Clinicians will use a Consent Form where procedures carry a degree of risk or where, for other reasons, they consider it appropriate to do so.
• No alterations will be made to a Consent Form once it has been signed by a patient.
• Clinicians will ensure that consents are freely given and not under duress (e.g. under pressure from other present family members etc).
• If a patient is mentally competent to give consent but is physically unable to sign the Consent Form, the clinician should complete the Form as usual, and ask an independent witness to confirm that the patient has given consent orally or non-verbally.

Other aspects which may be explained by the clinician include:

• Details of the diagnosis, prognosis, and implications if the condition is left untreated.
• Options for treatment, including the option not to treat.
• Details of any subsidiary treatments (e.g. pain relief).
• Patient experiences during and after the treatment, including common or potential side effects and the recovery process.
• Probability of success and the possibility of further treatments.
• The option of a second opinion.

Immunisations

Informed consent must be obtained prior to giving an immunisation. There is no legal requirement for consent to immunisation to be in writing and a signature on a consent form is not conclusive proof that consent has been given, but serves to record the decision and discussions that have taken place with the patient, or the person giving consent on a child’s behalf.

People with Parental Responsibility for Consent

There are only certain persons who are legally permitted to give consent for a child (for example for vaccination) This consent can be written or verbal.
These people are:

• The child’s birth mother.
• Both the child’s parents IF they were married to each other at the time of conception or birth AND are still married to each other at time of consultation.
• An unmarried genetic father who is present at the child’s registration and who’s name is on the birth certificate (from 1st December 2003 only, before that date this does not apply).
• An unmarried genetic father who has acquired parental responsibility via a court order or a parental responsibility order.
• A genetic father who has married the mother after the birth of the child and is still married to her.
• The child’s legally appointed guardian.
• A person who has been given a residence order by a court regarding the child.
• A local authority designated to have a care order for the child by a court.
• A local authority or anyone having an emergency protection order in respect of a child.
• Grandparents, foster parents and child minders cannot give consent unless they hold a legally binding court order as above.

NB A child’s father who is not married to the mother at the time of birth or conception and who has not married her subsequently cannot in law give legally binding consent for the child unless he has obtained a parental responsibility order via the court system (or unless his name is on the birth certificate from 1/12/2003).
If a person who can give legally binding consent is unable to accompany a child to an appointment they may write a letter giving consent for the named procedure/immunisation for the child and send this, signed, with the child and carer to the appointment.

Chaperone Policy

It is our policy to offer a chaperone to all patients, both male and female, when an intimate examination is required.  Whenever possible the chaperone will be a health professional but there may be occasions when it is necessary to use other staff members.  Where a chaperone is required the clinician will discuss this with the patient prior to examination.

Our chaperone policy adheres to current General Medical Council (GMC) guidelines and is designed to protect both patients and staff.  This enables patients in making an informed choice about their consultation and examination.

A patient may request a chaperone at any time during a consultation and also at the time of booking the appointment.

Patients wishing to see a copy of our chaperone policy are asked to contact our Deputy Practice Manager.

Information Sharing

As the data controller of patient's personal confidential data, GP practices have a duty to protect the data they hold.  We take this responsibility very seriously.  We will normally only release patient information if we have prior written consent from the patient.

However, some patient data is disclosed – this is summarised below:

Personal Demographics Service - The Personal Demographics Service (PDS) is the national electronic database of NHS patient demographic details such as name, address, date of birth and NHS Number.  The PDS enables a patient to be readily identified by the NHS quickly and accurately.  The PDS does not hold any clinical or sensitive data.  You may request your data to be ‘stop-noted’ (your details are hidden) only in special circumstances, e.g. if you are a victim of domestic violence or in a witness protection program.  Having your details hidden will have an impact on your GP being able to make referrals for you to hospital consultants or to other NHS services.

Summary Care Record - The Summary Care Record (SCR) aims to help emergency doctors and nurses help you when you contact them when the surgery is closed. The SCR currently contains information on your current medication, your allergies and any adverse reactions that we know of.  For further information on the SCR, please click here.

The Cheshire Care Record - The Cheshire Care Record is a project involving all GP, hospital, community, mental health and social care services provided in Cheshire.  The service streamlines summary health and social care information into one digital record so you don’t have to keep repeating your medical or social care history.  Your shared record includes information such as test results, medications, allergies and social or mental health information relevant to your care.  All information is held securely and will not be shared with any other organisations.  It is important to note that your information will only be accessed if you have given your consent.  The Cheshire Care Record is a multi-agency initiative, with organisations involved including Cheshire’s four CCGs, Cheshire East Council, East Cheshire NHS Trust – which runs the hospitals in Macclesfield, Congleton and Knutsford – and other providers of social care, mental health and cancer services across Cheshire.  For further information on the Cheshire Care Record, please click here.

NHS England Care.Data - NHS England's Care.Data initiative is aiming to provide NHS England with a more consolidated view of the nation’s health by obtaining greater information from NHS Hospitals and GP Practices.  Further information can be found here.
A patient information leaflet can be found here and here.
An opt-out form can be found here.

Please note that each of the above have separate opt-out processes, i.e. opting out for one does not opt you out for all others.

View the Holmes Chapel Health Centre's Information Sharing Commitment.

Comments & Complaints

We welcome comments or suggestions regarding the services we provide.

We follow the standard NHS procedure for dealing with complaints from registered patients and their family.

If you have a complaint about any aspect of the service provided by the Health centre, please speak or write to the Practice Manager or one of the doctors.

A copy of our Patient Complaints Procedure Leaflet can be downloaded from here.

The Health Centre takes it very seriously if a member of staff or one of the doctors or nursing team is treated in an abusive or violent way.

The staff understand that ill patients do not always act in a reasonable manner and will take this into consideration when trying to deal with a misunderstanding or complaint.

On the other hand, aggressive behaviour, be it violent or abusive, will not be tolerated and may result in you being removed from the practice list and in extreme cases the Police being contacted.

Once a complaint has been submitted to us, if after any discussion or communication that take place we reach a point where we cannot provide you with any further information, we will advise you of this.  At that point, should you remain unhappy, you have the right to take your complaint forward to the Health Service Ombudsman.

The role of the Health Service Ombudsman is to investigate complaints that individuals have been treated unfairly or have received poor service from the NHS in England.  The Health Service Ombudsman will work to put things right where they can and to share lessons learned to improve public services.  The Health Service Ombudsman is a free service open to everyone.

Contact details for the Health Service Ombudsman can be found on the Internet at www.ombudsman.org.uk or by calling 0345 015 4033.

Accessible Information Standard

Making healthcare information accessible

The aim of the accessible information standard is to make sure that people with a medical condition which affects their ability to communicate, get information that they can access and understand, and have any communication support they might need.

The standard tells organisations how to make information accessible to people in the format they need, as well as support people’s communication needs, for example by offering support from a British Sign Language (BSL) interpreter, deafblind manual interpreter or an advocate.

Further information from NHS England can be found here.

At the Holmes Chapel Health Centre we want to make sure that we are communicating with you in a way that is easy for you and that you can understand:

• We want to know if you need information in a specific format e.g. large print, easy read, audio;
• We want to know if you need to receive information in a particular way e.g. electronically, via email, for use with a screen reader;
• We want to know if you need someone to support you at appointments e.g. a sign language interpreter or an advocate;
• We want to know if you lip-read or use a hearing aid or communication tool.