Some of our clinicians at Arcadian Gardens Surgery are currently utilising a dictation AI software called Tandem to summarise their consultations when you visit them:

Tandem ISMS Certificate

Tandem Data Processing Overview

Tandem Health NHS DPIA

Arcadian Gardens Surgery operates a ‘zero-tolerance’ policy towards aggressive or abusive behaviour. This includes any personal, abusive or threatening comments, bad language, physical contact and aggressive gestures. In keeping with the rest of the National Health Service, this means that no abuse of our staff is acceptable, whether verbal or physical.  Any patient behaving in this manner will be removed from the practice list with immediate effect. In some cases, the police will be called.

Introduction

The Practice takes it very seriously if a member of staff is treated in an abusive or violent way.

The Practice supports the government’s ‘Zero Tolerance’ campaign for Health Service Staff. This states that GP practices and their staff have a right to care for others without fear of being attacked or abused. To successfully provide these services a mutual respect between all the staff and patients has to be in place.

The team at Arcadian Gardens Surgery aims to be polite, helpful, and sensitive to all patients’ individual needs and circumstances. We respectfully remind patients that very often staff could be confronted with a multitude of varying and sometimes difficult tasks and situations, all at the same time. We 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.

However, 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.

In order for the practice to maintain good relations with our patients, we would like to ask them all to read and take note of the occasional types of behaviour that would be found unacceptable:

• Using bad language or swearing at practice staff
• Any physical violence towards any member of the Primary Health Care Team or other patients, such as pushing or shoving
• Verbal abuse towards the staff in any form including verbally insulting the staff
• Racial abuse and sexual harassment will not be tolerated within this practice
• Persistent or unrealistic demands that cause stress to staff will not be accepted. Requests will be met wherever possible and explanations given when they cannot
• Causing damage/stealing from the Practice’s premises, staff or patients
• Obtaining drugs and/or medical services fraudulently

We ask you to treat your GPs and their staff courteously at all times.

The Legal Position

As a responsible employer, the Practice has a duty as a provider of NHS healthcare to protect the health, safety and welfare of staff under the Health & Safety at Work Act. This includes a risk assessment of violence towards staff and taking steps to mitigate this under the Management of Health and Safety at Work Regulations 1999.

Staff members who are victims of violent conduct or assault have the right to sue their employers for compensation if the risk of violence could have been reduced or removed completely, but the employers did not act upon this information.

Examples of security issues:

• Security of grounds and car parking
• Security of premises – incl. storage, “out of hours”
• CCTV
• Cash and staff – storing, handling and transferring
• Security Systems
• Security of equipment – medical devices, computers
• Communication of national security alerts
• Information records
• Contingency planning.
• Security of employees
• Staff working on their own
• (Staff can be lone workers when making domiciliary visits or within a hospital department e.g. out of hours)

This list is not exhaustive.

For example, a lone working risk assessment must provide the lone worker full knowledge of the hazards and risks to which he or she is being exposed and what they must need to do will something go wrong. Other responsible persons must know the whereabouts of lone workers and what they are doing.

Violence At Work

The practice acknowledges that there may be instances where violence and / or aggression forms part of a patient’s illness.  In these circumstances, the issue will be discussed with the patient and form part of their care planning.

This information will be recorded in the patient’s medical record and flagged to ensure that members of staff are aware. In addition, where deemed necessary, appropriate support will be put in place, e.g. staff members do not see the patient alone.

Definition Of Physical And Verbal Abuse And Violence

Physical and verbal abuse includes:

• Unreasonable and / or offensive remarks or behaviour / rude gestures / innuendoes
• Sexual and racial harassment
• Threatening behaviour (with or without a weapon)
• Actual physical assault (whether or not it results in actual injury) includes being pushed or shoved as well as being hit, punched or attacked with a weapon, or being intentionally struck with bodily fluids or excrement.
• Attacks on members of staff or the public
• Discrimination of any kind
• Damage to an employee’s or employer’s property

Zero Tolerance Stance Adopted By The NHS

The Practice supports the Zero Tolerance stance adopted by the NHS.

The HSE (Health and Safety Executive) defines work-related violence as:

“Any incident, in which a person is abused, threatened or assaulted in circumstances relating to their work”.

Violence and aggression towards a person may also be defined as:

“A physical contact with another person which may or may not result in pain or injury. The contact is uninvited and is an attempt to cause harm, injury or to intimidate. Non-physical aggression includes the use of language which causes offence or threatens the safety of a member of staff”.

The Health And Safety at Work Act 1974

Under the Health and Safety at Work Act 1974, the practice will also undertake the following measures to ensure a safe work environment:

• Carry our risk assessments to assess and review the duties of employees, identifying any “at risk” situations and taking appropriate steps to reduce or remove the risk to employees, particularly if they are working alone.
• Assess and review the layout of the premises to reduce the risk to employees where physically possible.
• Assess and review the provision of personal safety equipment, such as alarms.
• Develop surgery policies, procedures and guidelines for dealing with physical and verbal abuse.
• Provide support and counselling for victims, or refer to suitably qualified health professionals.
• Make employees aware of risks and ensure employee involvement in suitable training courses.
• Record any incidents on a Significant Event form and take any remedial action to ensure similar incidents are prevented in future.

Removal From The Practice List

The removal of patients from our list is an exceptional and rare event and is a last resort in an impaired patient-practice relationship. We value and respect good patient-doctor relationships based on mutual respect and trust. When trust has irretrievably broken down, the practice will consider all factors before removing a patient from their list, and communicate to them that it is in the patient’s best interest that they should find a new practice. An exception to this is in the case of immediate removal on the grounds of violence e.g. when the Police are involved.

Removing Other Members Of The Household

Because of the possible need to visit patients at home, it may be necessary to terminate responsibility for other members of the family or the entire household to ensure the safety of practice staff.

The prospect of visiting patients that is the residence of a relative who is no longer a patient of the practice, or the risk of being regularly confronted by the removed patient, may make it difficult for the practice to continue to look after the whole family. This is more likely where the removed patient has been violent or displayed threatening behaviour, and keeping the other family members could put doctors or their staff at risk.

An exception to this is in the case of immediate removal on the grounds of violence (e.g., when the Police are involved), or in cases of sexual harassment. Any form of sexual harassment, whether verbal, physical, or otherwise, will result in the immediate removal of the patient from our list, as this behaviour is unacceptable and breaches the fundamental principles of respect and trust in the patient-practice relationship.

To view our full Infection Prevention and Control Audit Report and Action Plan, click here.

Under NHS legislation, the NHS ceases to have responsibility for people when they leave the UK to live abroad on a permanent basis. This is because the NHS is a Residency Based System.

People traveling within Europe should be advised to carry either a UK Global Health Insurance Card (UK GHIC) (for most people) or a UK European Health Insurance Card (UK EHIC) if you have rights under the Withdrawal Agreement which entitles them to medically necessary state-provided healthcare whilst in a European Union (EU) country or Switzerland.. Not all state healthcare is free within the EU and Switzerland and so you may have to pay for services that you would get for free on the NHS. For most people, the UK Global Health Insurance Card (UK GHIC) replaces the existing European Health Insurance Card (EHIC) for new applications.

Requests for extra supplies of medications for patients who wish to travel abroad

The BMA guidance on prescribing in General Practice states that the NHS accepts responsibility for supplying ongoing medication for temporary periods abroad of up to three months. This applies for both holidays and working abroad. If a person is going to be abroad for more than three months, then only a sufficient supply of his/her regular medication should be provided to enable them to get to the destination and find an alternative supply. The patient should be advised to register with a local doctor for continuing medication, which they may need to pay for; the patient should check if the medicines required are available in the country being visited. GP practices however are not responsible for finding a doctor or ensuring medication supplies are available at the holiday destination. The patient is responsible for finding and registering with a local doctor and for confirming a regular supply of their medication. NHS prescriptions must never be obtained by relatives or friends on behalf of patients who are currently abroad, irrespective of such factors as owning a house in the UK or paying UK taxes. Patients are responsible for ensuring that any drugs they take into a country conform to local laws Further information is available on the NHS website and the UK government website.

Controlled drugs and travellers

A personal import/export licence is not required by the Home Office if a person travelling abroad is carrying less than3 months’ supply of a controlled drug (schedules 2, 3, or 4 Part I (CD Benz) and Part II (CD Anab), but is required for longer periods. See the BNF. Advice to prescriber – It is advised that a covering letter from the prescriber is obtained that confirms the name of the patient, travel plans, the name of the prescribed controlled drug, total quantity and dose. Patient responsibilities – The patient should check with the embassies or High Commission for the countries they will be travelling through to ensure that import and export regulations in those countries are complied with Patients should also check any additional requirements that their travel operator/airline company may impose. Patients can obtain further information on carrying controlled drugs abroad from Bringing medicine containing a controlled drug into the UK.

If you’re moving abroad on a permanent basis, you’ll no longer automatically be entitled to medical treatment under normal NHS rules. This is because the NHS is a residence-based healthcare system.
You’ll have to notify your GP practice so you and your family can be removed from the NHS register.

Before leaving for your new destination, it’s important to check what health services are available to you in that country.

Healthcare systems vary from country to country and might not include services you’d expect to get free of charge on the NHS. You may have to pay a patient contribution towards any treatment you get, or it may be necessary to take out health insurance.
The Foreign, Commonwealth and Development Office (FCDO) provides useful information for British nationals living abroad on GOV.UK, including information on entry and residence requirements, health, benefits and finance.

Information:
Find out how UK nationals can access healthcare in the EU, Norway, Iceland, Liechtenstein and Switzerland on GOV.UK
In most countries, you’ll have to register with the relevant authorities.
Once you’re registered as a resident, to work and make social security (national insurance) contributions, you’ll be entitled to state-run healthcare on the same basis as a resident of that country. Even if you’re not working, many countries expect you to make patient contributions or to join a national health insurance scheme.

Moving to Europe
There are circumstances in which you might be entitled to healthcare paid for by the UK.
This will depend on whether you want to live abroad permanently or only work outside the UK for a set period. The assistance available only applies within the European Union (EU) and in Switzerland and can also depend on whether you receive a UK State Pension or some other UK benefits.

You can use a UK-issued European Health Insurance Card (EHIC) or UK Global Health Insurance Card (GHIC) to access healthcare for temporary stays, usually up to 90 days.
Find out how to apply for healthcare cover abroad (GHIC and EHIC)
Once you’re registered to live and work in an EU country or Switzerland, you should not use your EHIC or GHIC to get healthcare in that country. However, you may be able to get an EHIC card from that country for travel. If you live in an EU country or Switzerland, you may also be eligible to apply for an S1 form for entitlement to state healthcare paid for by the UK once you begin to draw a UK State Pension.
You will not be covered for healthcare paid for by the UK if you’re going to live permanently outside the EU and Switzerland.

Posted workers
If you’re a worker temporarily posted by a UK company to an EU country, Norway, Iceland, Liechtenstein or Switzerland, you may be entitled to health cover funded by the UK in the country you’re posted to.
You can find out your National Insurance status from HM Revenue and Customs (HMRC):
Contact HMRC about your National Insurance and health cover abroad (UK residents) on GOV.UK
Contact HMRC about your National Insurance and health cover abroad (non-UK residents) on GOV.UK
If you move to an EU country or Switzerland and you receive a UK State Pension, you may be entitled to state healthcare paid for by the UK.
You’ll need to apply for a certificate of entitlement known as an S1 form. S1 forms show that your state healthcare is paid for by the UK if you live in an EU country or Switzerland.
If you’re applying for an S1 form in Switzerland, you’ll need to satisfy additional nationality criteria to be eligible. You’ll only be issued with an S1 in Switzerland if you’re a UK national, a Swiss national, an EU citizen, a refugee or a stateless person, or if you’re the family member or survivor of someone who has one of these nationalities or statuses.
If you receive both a pension from the country you now live in and your UK State Pension, you cannot get an S1 form. This is because the country you live in will be responsible for your healthcare. If you receive your UK State Pension as well as a pension from an EU member state, but are now living in a different EU state, the country to which you paid contributions toward your pension for the longest period becomes responsible for your healthcare.

Healthcare if you have an exportable benefit
If you’ve been living in an EU country, Norway, Iceland, Liechtenstein or Switzerland since before 1 January 2021, and you receive contribution-based Employment Support Allowance or some other exportable benefits, you may also be entitled to an S1 form.
Read more about claiming benefits if you live, move or travel abroad on GOV.UK

How to get an S1 form
You can apply for an S1 form from the Overseas Healthcare Services.
Telephone: +44 (0)191 218 1999
Email: s1applications@nhsbsa.nhs.uk
Monday to Friday 8am to 6pm (GMT) You can apply for an S1 form up to 90 days before moving to live in an EU country. You can ask for the form to be sent to your UK address if you need it for your visa application.
For the S1 form to be issued, you need to have an address in the EU country you are moving to. This can be a temporary address, but you must contact NHS Business Services Authority (NHSBSA) and the relevant authority in the country you are moving to, to let them know your new address (if it changes). This is to prevent important confidential information being sent to the wrong address.

How to use an S1 form
Once issued, register the S1 form with the relevant authority in your country of residence.
Often you need to do this before you can register for healthcare or obtain a medical card.
If you have registered an S1 in an EU country, you’ll be able to use your UK-issued EHIC or GHIC to access state-funded necessary medical treatment when you visit other EU countries. You’ll not be able to use it in Switzerland.
Changes to who can get an S1 form
The rules have changed around S1 cover for people who claim the following exportable benefits:

• Disability Living Allowance (DLA)
• Personal Independence Payment (PIP)
• Carer’s Allowance (CA)
• Attendance Allowance (AA)

These benefits currently entitle you to an S1 form if you moved to an EU country, Norway, Iceland, Liechtenstein or Switzerland before 1 January 2021, for as long as you receive that benefit.

If you do not yet have an S1 form
You can no longer get an S1 form based on receiving one of the exportable benefits listed above.
However, it may still be possible to receive an S1 if you export your Maternity Allowance or certain qualifying industrial accident or bereavement benefits.
Read more about claiming benefits if you live, move or travel abroad on GOV.UK
You may also be entitled to an S1 form through exporting a UK State Pension or other qualifying benefit if you are in scope of the Withdrawal Agreement.
If you already have an S1 form
You’ll continue to be covered by your S1 form if you already have one for as long as you’re receiving one of the above benefits.
If you have a time-limited S1 form, you can apply to renew it, as long as you’re still receiving one of the benefits listed above.
Further information about accessing NHS services can be found on the visiting or moving to England pages

Missing two or more appointments within a year can lead to you receiving a letter from the practice. You’ll get warnings and a chance to explain the reason why you could not attend, but persistent no-shows will result in removal from the patient list of the surgery and you having to find a new doctor.

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You can also call 020 3198 8738 or email nclicb.digitalhelpdesk@nhs.net