Accessing someone else’s information

As a parent, family member or carer, you may be able to access services for someone else. We call this having proxy access. We can set this up for you if you are both registered with us.

To requests proxy access:

• collect a proxy access form from reception from 10am to 6pm

Linked profiles in your NHS account

Once proxy access is set up, you can access the other person’s profile in your NHS account, using the NHS App or website.

The NHS website has information about using linked profiles to access services for someone else.

The Surgery prides itself in maintaining professional standards. For certain examinations during consultations an impartial observer (a “Chaperone”) will be required.

This impartial observer will be a practice Nurse, Health Care Assistant or a member of our reception team who is familiar with the procedure and be available to reassure and raise any concerns on your behalf. If a nurse in unavailable at the time of your consultation then your examination may be re-scheduled for another time.

You are free to decline any examination or chose an alternative examiner or chaperone. You may also request a chaperone for any examination or consultation if one is not offered to you. The GP may not undertake an examination if a chaperone is declined.

The role of a Chaperone:

• Maintains professional boundaries during intimate examinations.

• Acknowledges a patient’s vulnerability.

• Provides emotional comfort and reassurance.

• Assists in the examination.

• Assists with undressing patients, if required.

Please see here for all our policies.

Minuteful Kidney

Access to Medical Reports

Accurx

Complaints, Subject Access Requests and Freedom of  Information Requests

CQC

Direct Care Emergencies

Direct Care routine care and referrals

DVLA

HR, Staffing, Employment, Recruitment & Training

Litigations & Claims

National screening and reporting programs

NHS Digital

Patient Communications

Patient Participation and Engagement Groups

Payments

Public Health

Reporting Gunshot and Knife Wounds

Research

Telephony system

Comissioning, Planning, risk stratification, patient identification

Safeguarding

If you have any special needs please let our staff know so that we can help and ensure you get the same support in the future.

Wheelchair access

Our premises have easy access, wide corridors, no steps, and a toilet for the disabled.

If you have any difficulty in using our facility do please ask a member of staff who will be pleased to assist you.

Disabled Parking – Blue Badge Scheme

The Blue Badge scheme is for people with severe mobility problems. It allows Blue Badge holders to park close to where they need to go.

Loop System

We have a loop induction system please ask reception for more details. For more information on the loop hearing system visit Hearing Link website.

• British Deaf Association

• The Deaf Health Charity – SignHealth

• Action Hearing Loss

• Royal Association for Deaf People

• National Deaf Children’s Society

Blind/Partially Sighted

If you or family members are blind or partially sighted we will try our best to provide them for you. If we cannot provide such leaflets we will be very happy to explain and research information that you require. Just ask at reception and staff will either help directly or pass your request on to the Practice Manager.

For more advice and support for blind people please see the following websites:

• Royal National Institute of Blind People (RIND)

• Action for Blind People

• Blind.org.uk

• British Blind Sport

Guide Dogs

Guide dogs are welcome at the surgery with a bowl of water available upon request.

Other Disability Websites

• BID Services

• Disability Go

• Disabled People, your Rights, Benefits, Carers and the Equality Act

• Disability Rights UK

• Living with a Disability NHS Choice

• Disability Action

• Mencap

The Freedom of Information Act creates a right of access to recorded information and obliges a public authority to:

• Have a publication scheme in place

• Allow public access to information held by public authorities.

The Act covers any recorded organisational information such as reports, policies or strategies, that is held by a public authority in England, Wales and Northern Ireland, and by UK-wide public authorities based in Scotland, however it does not cover personal information such as patient records which are covered by the Data Protection Act.

Public authorities include government departments, local authorities, the NHS, state schools and police forces.

The Act is enforced by the Information Commissioner who regulates both the Freedom of Information Act and the Data Protection Act.

The Surgery publication scheme

A publication scheme requires an authority to make information available to the public as part of its normal business activities. The scheme lists information under seven broad classes, which are:

• who we are and what we do

• what we spend and how we spend it

• what our priorities are and how we are doing it

• how we make decisions

• our policies and procedures

• lists and registers

• the services we offer

You can request our publication scheme leaflet at the surgery.

Who can request information?

Under the Act, any individual, anywhere in the world, is able to make a request to a practice for information. An applicant is entitled to be informed in writing, by the practice, whether the practice holds information of the description specified in the request and if that is the case, have the information communicated to him. An individual can request information, regardless of whether he/she is the subject of the information or affected by its use.

How should requests be made?

Requests must:

• be made in writing (this can be electronically e.g. email/fax)

• state the name of the applicant and an address for correspondence

• describe the information requested.

What cannot be requested?

Personal data about staff and patients covered under Data Protection Act.

For more information see these websites:

• Legislation GOV.UK

• Information Commissioners Office

All GP practices are required to declare the mean earnings (e.g. average pay) for GPs working to deliver NHS services to patients at each practice.

The average pay for GP’s working in Chelsfield Surgery in the last financial year was £76,473 before tax and national insurance. This for 2 full time GPs, 2 part time GPs and 3 locum GPs who worked in the practice for more than 6 months.

To Provide You with Treatment

Doctors need to make notes about any diagnosis, test results, treatments including drugs prescriptions, and other information that you may provide, that seems relevant to the treatment of your condition. We need to keep this information in order to provide proper care for you (for later treatment, or if you should be seen by another doctor) and to allow others to check the treatment that you have received.

Nurses and other health professionals also need access to these records, and will add their own notes, as part of the overall healthcare provision. Secretaries, receptionists, and other clerical staff need access to some of your records in order to do administrative tasks, such as: booking appointments and communicating with you and other parts of the NHS.

Your doctor may also need to provide information under certain Acts of Parliament (e.g. the Communicable Diseases Act 1978, which is necessary to prevent the outbreak of certain highly contagious diseases) to protect you and others.

The Health Service

In order to manage the NHS, some restricted information concerning treatments, drugs prescribed, numbers of patients seen etc. is needed, and hospitals and general practices must provide this information in returns to various central bodies. This information has personal details such as your name and address removed wherever possible. It is necessary from time to time to check these returns to prevent fraud as part of the NHS’s statutory obligations. This may result in your being contacted by an NHS Fraud Office to see if you will consent to your records being checked. Only if you provide your consent will the auditors be allowed to access your records.

Teaching Clinicians

Some medical files are needed to teach student clinicians. Without such materials, new doctors and nurses would be not be properly prepared to treat you.

Planning

We need to be able to plan ahead about treatments, patient numbers, etc., but this uses summary information, not personal information.

Medical Research

Some medical research will require your direct involvement (especially if taking part in clinical trials) in which case the circumstances will be fully explained to you, and your express consent required. If you do not consent, then you will not be included in the trial.

Other researchers only require access to medical statistics, and can greatly improve our understanding of health, and how to treat patients more effectively. Generally, researchers only need information about groups of people, so that no individual information is apparent. In some cases, they need individual records, but wherever we can we will provide these in an anonymous form (so individuals cannot be identified). Sometimes, researchers need access to individual medical files. We will contact you first for your consent (and before this the researchers must present their case before an Ethics Committee to check that their research is appropriate and worthwhile). Rarely, it may not be practicable (or even possible) to contact individuals for their consent, in which case the researchers must make their case before a Confidentiality Committee to show that there is enough benefit to the public at large to justify this.

How do we manage your information?

We need to be able to move electronic information from system to system, extracting the data and modifying it for the next system. Occasionally, tests will need to be made on the data to check that it has been transferred correctly. This will only be done under carefully controlled conditions and all employees and contractors will be under strict contractual obligations to protect your confidentiality.

Practice staff should use the new GP e-form to report all patient safety incidents and near misses whether they result in harm or not.

These reports are used to spot any emerging patterns of similar incidents or anything of particular concern.

This will help protect patients by raising awareness of the risks through shared learning with general practices and other health providers across the country.

We aim to keep our surgery clean and tidy and offer a safe environment to our patients and staff. We are proud of our modern, purpose built Practice and endeavour to keep it clean and well maintained at all times.

If you have any concerns about cleanliness or infection control, please report these to our Reception staff.

Our GPs and nursing staff follow our Infection Control Policy to ensure the care we deliver and the equipment we use is safe.

We take additional measures to ensure we maintain the highest standards:

• Encourage staff and patients to raise any issues or report any incidents relating to cleanliness and infection control.  We can discuss these and identify improvements we can make to avoid any future problems.
• Carry out an annual infection control audit to make sure our infection control procedures are working.
• Provide annual staff updates and training on cleanliness and infection control
• Review our policies and procedures to make sure they are adequate and meet national guidance.
• Maintain the premises and equipment to a high standard within the available financial resources and ensure that all reasonable steps are taken to reduce or remove all infection risk.
• Use washable or disposable materials for items such as couch rolls, modesty curtains, floor coverings, towels etc., and ensure that these are laundered, cleaned or changed frequently to minimise risk of infection.
• Make Alcohol Hand Rub Gel available throughout the building

We have allocated a Named Accountable GP for all of our registered patients. If you do not know who your named GP is, please ask a member of our reception team.

Unfortunately, we are unable to notify patients in writing of any change of GP due to the costs involved.

Where it is clinically appropriate and practical to register, we now accept new registration from patients who work in the local area but reside outside of our registration area. Patients registered this way would not be entitled to home visit from the practice, however they will be able to contact NHS 111 in order to be seen by a practice closer to where they live.

For further information about this type of registration, please contact us on 01689 852204 or feel free to come into the practice.

Effective Date: 28/05/25

Purpose:
To ensure the safety and well-being of all patients, visitors, and staff, the Chelsfield Surgery maintains a strict No Nuts Policy. This policy is implemented due to the potentially severe allergic reactions that nuts can cause.

Scope:
This policy applies to all staff, patients, visitors, contractors, and anyone entering the premises of Chelsfield Surgery.

Policy:

1. Prohibition of Nuts
   • No nuts or nut-containing products (including peanuts, tree nuts, and any foods or snacks containing nuts or nut oils) are allowed anywhere on the premises, including waiting rooms, consultation rooms, staff areas, and kitchens.
2. Staff Responsibilities
   • Staff must avoid bringing any nut or nut-containing products to work or consuming them on-site.
   • Staff should inform patients about this policy when necessary, especially if they bring food items to appointments.
3. Patient and Visitor Responsibilities
   • Patients and visitors are asked not to bring or consume nuts or nut-containing products within the surgery premises.
   • We encourage patients to inform the staff if they have any allergies, including nut allergies.
4. Signage and Communication
   • Clear signage stating “No Nuts Allowed” will be displayed at entrances and key locations within the surgery.
   • The policy will be communicated via appointment reminders and the surgery’s website where applicable.
5. Enforcement
   • Any person found in violation of this policy will be reminded politely of the risks and asked to remove any nut-containing products immediately.
   • Repeated violations may result in restriction of access to the premises for the safety of others.

Reason for Policy:
Nut allergies can cause severe and potentially life-threatening reactions (anaphylaxis). This policy helps create a safe environment for all.

Review:
This policy will be reviewed annually or as needed to ensure ongoing safety and compliance.

What is non-NHS work and why is there a fee?

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 because the service is not covered by the NHS, for example, producing medical reports for insurance companies, to whom it may concern letters. The Government’s contract with GPs covers medical services to NHS patients but not non-NHS work. It is important to understand that many GPs are not employed by the NHS; they are self-employed and they have to cover their costs – staff, buildings, heating, lightning, etc. – in the same way as any small business.

In recent years, however, 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 ensure that information provided to them is true and accurate.

Examples of non-NHS services for which GPs can charge their own NHS patients are:

• accident/sickness certificates for insurance purposes
• school fee and holiday insurance certificates
• reports for health clubs to certify that patients are fit to exercise
• private prescriptions for travel purposes

Examples of non-NHS services for which GPs can charge other institutions are:

• life assurance and income protection reports for insurance companies
• reports for the Department for Work and Pensions (DWP) in connection with
• disability living allowance and attendance allowance
• medical reports for local authorities in connection with adoption and fostering
• copies of records for solicitors

Do GPs have to do non-NHS work for their patients?

With certain limited exceptions, for example a GP confirming that one of their patients is not fit for jury service, GPs do not have to carry out non-NHS work on behalf of their patients. Whilst GPs will always attempt to assist their patients with the completion of forms, they are not required to do such non-NHS work.

Is it true that the BMA sets fees for non-NHS work?

The British Medical Association (BMA) suggest fees that GPs may charge their patients for non-NHS work (i.e. work not covered under their contract with the NHS) in order to help GPs set their own professional fees. However, the fees suggested by them are intended for guidance only; they are not recommendations and a doctor is not obliged to charge the rates they suggest.

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 or her patients. Most GPs have a very heavy workload and paperwork takes up an increasing amount of their time. Our GPs do non-NHS work out of NHS time at evenings or weekends so that NHS patient care does not suffer.

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. In order to complete even the simplest of forms, therefore, the doctor might have to check the patient’s ENTIRE medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the Police.

If you are a new patient we may not have your medical records so the doctor must wait for these before completing the form.

What will I be charged?

It is recommended that GPs tell patients in advance if they will be charged, and what the fee will be. It is up to individual doctors to decide how much they will charge. The surgery has a list of fees based on these suggested fees which is available on request.

What can I do to help?

• Not all documents need a signature by a doctor, for example passport applications. You can ask another person in a position of trust to sign such documents free of charge. Read the information that comes with these types of forms carefully before requesting your GP to complete them.
• If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them at the same time to speed up the process.
• Do not expect your GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this may cost more. Usually non-NHS work will take 2 weeks.

View our full Privacy Notice

What do we record?

Information about you, your medical treatment, and family background may be recorded, either on paper or in computer files, as part of providing you with health services. This information is vital to the proper operation of the NHS, and is needed to give you and others the best possible healthcare.

What you can do?

Please read the rest of this notice in order to better understand how we use medical information about you. For further details please see information leaflet entitled “Your Information” displayed in the Practice or ask receptionist for details.

Other Agencies

The NHS is not the only government service to provide you with care, and it will be necessary for us to provide other agencies with appropriate information, but only with your consent (or that of your relatives if you are too ill).

How do we protect your information?

The sensitivity of patient information is well understood within the NHS. All staff and contractors are trained to respect their duty of confidentiality to you. We keep paper and electronic records securely to prevent unauthorised access or misuse. Wherever practicable, we also remove references to personal details such as your name and address, and often restrict it further to reduce the chances of anyone identifying a record as relating to you.

Other questions?

You can have a say in how the NHS uses information about you. If you want to find out more or have any concerns you can phone NHS Direct on 0845 4647 and request a booklet giving more details; go online at www.nhs.uk\confidentiality; or you can contact the Patient Liaison Team at the following address: Bromley PCT, Bassetts House, Broadwater Gardens, Orpington, Kent BR6 7UA. Tel. No. 01689 853339

Freedom of Information

The ICO has published a new Model Publication Scheme that all public authorities are required to adopt by 1st January 2009.

Model Publication Scheme – further information

How information about you helps us to provide better care.

Confidential information from your medical records can be used by the NHS to improve the services offered so we can provide the best possible care for everyone. This information along with your postcode and NHS number  but not your name, are sent to a secure system where it can be linked with other health information. This allows those planning NHS services or carrying out medical research to use information from different parts of the NHS in a way which does not identify you. You have a choice. If you are happy for your information to be used in this way you do not have to do anything. If you have any concerns or wish to prevent this from happening, please see the leaflet “How information about you helps us to provide better care” in the waiting Room.

Useful Websites

• Confidentiality NHS Code of Practice
  • Confidentiality and Mental Health
  • Confidentiality Guidance

Chelsfield Surgery

Policy: Private Consultant Prescriptions and transfer To NHS prescriptions

1. Introduction

This policy outlines the approach to managing requests for NHS primary care prescribers to convert or continue private prescriptions initiated by private consultants. It provides guidance on medico-legal considerations, clinical appropriateness, and responsibilities when patients request private consultant recommendations to be prescribed on the NHS.

The policy aims to:

• Ensure patient safety and high-quality care
• Clarify professional responsibilities
• Manage resources effectively and equitably
• Provide a consistent approach to handling private-to-NHS prescription requests

2. Legal and Professional Context

2.1 Clinical Responsibility

When an NHS GP issues a prescription, they assume full clinical responsibility for that prescription, regardless of who recommended it. This includes responsibility for:

• The clinical appropriateness of the medication
• Ongoing monitoring requirements
• Potential side effects and interactions
• Long-term management of the patient’s condition

GPs must only prescribe when they have adequate knowledge of the patient’s health and are satisfied that the medication serves the patient’s needs, in accordance with GMC Good Medical Practice guidance.

2.2 Legal Framework

The prescriber is legally responsible for:

• Ensuring prescriptions comply with legal requirements under the Medicines Act
• Adhering to NHS regulations regarding which medications can be prescribed on FP10 forms
• Following local formulary and prescribing guidelines
• Complying with NHS contractual obligations

3. General Principles

3.1 Patient-Centered Approach

All decisions should be made with the patient’s best interests as the primary consideration, while maintaining equitable access to NHS resources for all patients.

3.2 Primary Care Prescribing Discretion

The decision to prescribe a medication recommended by a private consultant on the NHS lies solely at the discretion of the GP. There is no obligation for NHS GPs to prescribe medications recommended by private providers.

3.3 Equity of Care

Medications or treatments that would not be available to an NHS patient should not automatically be provided on an NHS prescription simply because they were initially recommended through a private consultation.

4. Red, Amber, Green Classification System

Many NHS regions use a traffic light system to classify medications:

4.1 RED Medications (Specialist Only)

• Must only be prescribed by specialists
• Generally should not be prescribed in primary care
• Examples include:
  • Biologics (e.g., adalimumab, etanercept, infliximab)
  • Certain cancer treatments
  • Novel anticoagulants in specific indications
  • Medications requiring complex monitoring
  • Experimental or newly licensed medications

4.2 AMBER Medications (Shared Care)

• Initially prescribed by specialists but may be continued in primary care under shared care arrangements
• Requires formal shared care agreement between specialist and GP
• May require ongoing specialist monitoring
• Examples include:
  • Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, sulfasalazine
  • Certain antipsychotics (e.g., clozapine)
  • ADHD medications (e.g., methylphenidate, atomoxetine)
  • Medications for Parkinson’s disease
  • Certain immunosuppressants

4.3 GREEN Medications

• Can be initiated and continued in primary care
• Standard monitoring requirements
• Part of routine primary care prescribing
• Examples include most common medications for chronic conditions

5. Circumstances Where NHS Prescribing Following Private Consultation May Be Appropriate

The GP may consider prescribing on the NHS when ALL of the following conditions are met:

1. The medication is within the GP’s competence to prescribe
2. The medication would be available on the NHS for a patient with the same condition
3. The medication is included in local formularies and prescribing guidelines
4. The GP has received adequate clinical information from the private consultant
5. The medication is classified as suitable for primary care prescribing (GREEN or AMBER with appropriate shared care arrangements)
6. The GP is satisfied that the prescription is clinically appropriate and in the patient’s best interest

6. Circumstances Where NHS Prescribing Following Private Consultation May Not Be Appropriate

The GP may decline to prescribe on the NHS when ANY of the following apply:

1. The medication is classified as RED in the local formulary
2. The medication is on the “blacklist” (Schedule 1 of the NHS General Medical Services Contracts Regulations)
3. There is insufficient clinical information to safely prescribe
4. The medication requires specialist monitoring that cannot be provided in primary care
5. The treatment would not normally be funded by the NHS for patients with the same condition
6. The medication is outside the GP’s expertise or competence
7. The medication is experimental or being used outside its licensed indication without appropriate guidance
8. The private consultation was for a procedure or treatment package where medication forms part of the private care pathway
9. The drug requires specialized or regular hospital-based monitoring
10. The medication is new or experimental with limited evidence base
11. The medication is high cost and not approved by local NHS prescribing committees
12. The prescribing of the medication would create inequitable access to treatment compared to NHS patients
13. There is no established NHS referral pathway should the patient experience complications
14. The private consultant has not provided a first prescription allowing time for stabilization
15. There are more cost-effective alternatives available through the NHS for the same condition
16. The medication requires a formal shared care protocol which does not exist with the private provider

7. Process for Managing Requests

7.1 Information Requirements

Before considering prescribing, the GP requires:

• A detailed letter from the private consultant containing:
  • Full patient details
  • Diagnosis and clinical findings
  • Medication details (name, dose, duration, monitoring requirements)
  • Rationale for treatment
  • Follow-up arrangements
  • The consultant’s GMC registration details
• Confirmation that the patient has received the first prescription from the private consultant

7.2 Decision-Making Process

1. The practice will allow at least 7 working days for the consultant letter to arrive
2. The GP will review the request against the criteria in sections 5 and 6
3. The GP may consult with colleagues or the local medicines management team if necessary
4. The patient should make a routine appointment with their GP to discuss the request
5. The decision will be communicated to the patient with a clear explanation

7.3 Communication and Documentation

All decisions regarding private prescription requests should be:

• Clearly communicated to the patient
• Documented in the patient’s record
• Communicated to the private consultant if necessary

8. Shared Care Arrangements

8.1 NHS to NHS Shared Care

Formal shared care agreements between NHS specialists and NHS GPs are well-established for certain medications. These include clear definitions of:

• Responsibilities of each party
• Monitoring requirements
• Criteria for referral back to the specialist
• How to access specialist advice

8.2 Private to NHS Shared Care

Shared care arrangements between private specialists and NHS GPs present additional challenges:

• No formal commissioning arrangements for specialist support
• Potential discontinuity if private care ceases
• Unclear pathways for urgent specialist review if needed
• Potential inequity in access to treatments

As per BMA guidance, shared care with private providers is generally not recommended due to the NHS constitution principle of maintaining clear separation between private and NHS care.

9. Examples of Specific Drug Categories

9.1 Medications Commonly Subject to Private-to-NHS Requests

9.1.1 ADHD Medications

• Methylphenidate, atomoxetine, lisdexamfetamine
• Often initiated privately due to long NHS waiting lists
• Require specialist initiation and titration
• Regular monitoring requirements
• May be continued in primary care only under formal shared care arrangements

9.1.2 Hormone Treatments

• Testosterone, growth hormone, certain HRT regimens
• Specialist initiation and monitoring required
• Potential for misuse and side effects
• May require additional tests not routinely available in primary care

9.1.3 Weight Management Medications

• GLP-1 agonists (e.g., semaglutide/Wegovy, liraglutide/Saxenda)
• Strict NHS eligibility criteria vs broader private availability
• Significant cost implications
• May require monitoring and specialist input

9.1.4 Dermatological Treatments

• Isotretinoin (Roaccutane)
• Biological treatments for psoriasis
• High monitoring requirements
• Significant safety concerns (e.g., teratogenicity, mental health monitoring)

9.1.5 Fertility Treatments

• Ovulation induction agents
• Specialist monitoring essential
• Potential for multiple pregnancies and complications
• Often part of a comprehensive treatment plan

9.1.6 Ophthalmic Medications

• Ciclosporin eye drops (Ikervis) for severe keratitis
• Preservative-free glaucoma medications when not meeting NHS criteria
• Certain eye lubricants only available privately
• Specialized anti-VEGF treatments for macular degeneration outside NICE guidance
• Compounded ophthalmic preparations (e.g., fortified antibiotics)
• Ophthalmic preparations requiring specialist administration or monitoring

10. Patient Education and Communication

10.1 Recommended Practice Approaches

• Clear information on the practice website about the policy on private prescriptions
• Patient leaflets explaining the interface between private and NHS care
• Training for reception and administrative staff on how to handle requests
• Template letters for common scenarios

10.2 Explaining Decisions to Patients

When declining to convert a private prescription to an NHS prescription, explain:

• The clinical reasoning for the decision
• The focus on patient safety and equitable care
• Options available to the patient, including:
  • Continuing with private prescriptions
  • Referral to an NHS specialist for assessment
  • Alternative NHS-approved treatments if appropriate

10.3 Sample Explanation for Declining Prescriptions

“The practice has carefully considered your request to prescribe [medication] on the NHS following your private consultation. After reviewing the information provided and considering our clinical responsibilities, we are unable to issue an NHS prescription for this medication because:

[SELECT APPROPRIATE REASONS]

• This medication requires specialist oversight and monitoring that cannot be provided in primary care
• The medication is classified as a ‘specialist only’ (RED) drug in our local formulary
• We do not have sufficient clinical information to safely prescribe this medication
• This medication would not normally be funded by the NHS for patients with your condition
• There is no formal shared care agreement in place for this medication between private providers and NHS GP practices
• The medication is outside the GP’s expertise and competence to prescribe
• Prescribing this medication on the NHS would create inequity of access compared to other NHS patients
• There are more cost-effective alternatives available on the NHS for your condition

We understand this may be disappointing. We would be happy to discuss alternative treatments that are available on the NHS, or to refer you to an NHS specialist for assessment. If you wish to continue with this specific treatment, you will need to obtain ongoing prescriptions from your private consultant.”

11. Review and Governance

This policy should be:

• Reviewed annually
• Updated in line with national guidance
• Discussed with all clinical team members
• Applied consistently across the practice

12. References

1. General Medical Council. Good Medical Practice.
2. British Medical Association. General practice responsibility in responding to private healthcare.
3. NHS England. Responsibility for prescribing between primary and secondary care.
4. Local Medicines Management Guidelines.

SG May 2025

At Chelsfield Surgery, we are committed to providing high-quality care to all of our patients. However, there are important reasons why we do not accept shared care agreements from private healthcare providers. These reasons are based on national guidance from the British Medical Association (BMA) and reflect our responsibility to ensure patient safety, maintain quality care, and manage our workload effectively.

What is a Shared Care Agreement?

A shared care agreement is an arrangement where a patient’s care is divided between a private healthcare provider and a General Practitioner (GP) in the NHS. Typically, the private provider will initiate treatment or prescribe medication, and the GP will then be asked to take over part of the treatment or ongoing monitoring of the patient, as outlined in the shared care agreement.

1. NHS and Private Care Work in Different Systems

The NHS and private healthcare systems operate independently, with different frameworks, funding, and expectations. The NHS is publicly funded, and GP practices like ours are required to prioritise NHS-funded work. Accepting shared care agreements from private healthcare providers introduces a complex administrative burden, as we must align private treatments with our NHS responsibilities, often without sufficient funding or resources to do so.

2. Workload and Capacity Management

The BMA’s guidance highlights the pressures on GP practices to manage growing patient demand within an already stretched healthcare system. GP practices are responsible for the ongoing care of all registered patients, which includes monitoring long-term conditions, providing preventive care, and responding to urgent medical needs.

3. Responsibility for Clinical Care and Accountability

As GPs, we are responsible for ensuring the safety and well-being of our patients. This includes making clinical decisions based on the best available evidence and guidelines.
Shared care agreements can create complications in clinical accountability. When a patient is treated privately, the GP may not have access to the full details of their treatment plan, test results, or ongoing management, which can make it difficult to provide safe and effective care. The BMA’s guidance advises that GPs should not take on responsibility for the clinical care provided by a private healthcare provider, as we cannot oversee or control these treatments in the same way we would for NHS treatments. This could potentially lead to clinical risks if adverse reactions or complications arise that the GP is unaware of due to a lack of information or direct involvement.

4. Financial and Resource Implications

Providing care for patients who have been treated privately often requires additional time, effort, and administrative work. GPs may be asked to monitor a patient’s condition, adjust prescriptions, or perform follow-up tests, all of which take valuable time and resources.
Under NHS funding, GP practices are not reimbursed for the time spent managing private care. This could unfairly divert resources away from NHS patients, further exacerbating pressures on the practice and the healthcare system as a whole.

Our Commitment to NHS Care

At Chelsfield Surgery, our priority is providing safe, effective, and comprehensive care to our NHS patients. By not accepting shared care agreements from private healthcare providers, we ensure that our resources are focused on meeting the needs of our NHS patients, without compromise.
We understand that navigating between private and NHS care can sometimes be challenging. If you are receiving private healthcare and have concerns or need support, we encourage you to speak directly with your private healthcare provider to discuss how best to manage your care moving forward.
We appreciate your understanding and cooperation as we continue to deliver the best care possible within the resources available to us.

New contractual requirements came into force from 1 April 2014 requiring that GP Practices should make available a statement of intent in relation to the following IT developments:

• Summary Care Record (SCR)
• GP to GP Record Transfers
• Patient Online Access to Their GP Record
• Data for commissioning and other secondary care purposes

The same contractual obligations require that we have a statement of intent regarding these developments in place and publicised by 30 September 2014.

Please find below details of the practices stance with regards to these points.

Summary Care Record (SCR)

NHS England require practices to enable successful automated uploads of any changes to patient’s summary information, at least on a daily basis, to the summary care record (SCR) or have published plans in place to achieve this by 31st of March 2015.

Having your Summary Care Record (SCR) available will help anyone treating you without your full medical record. They will have access to information about any medication you may be taking and any drugs that you have a recorded allergy or sensitivity to.

Of course, if you do not want your medical records to be available in this way then you will need to let us know so that we can update your record. You can do this via the opt out form.

The practice confirms that your SCR is automatically updated on at least a daily basis to ensure that your information is as up to date as it can possibly be.

GP to GP Record Transfers

NHS England require practices to utilise the GP2GP facility for the transfer of patient records between practices, when a patient registers or de-registers (not for temporary registration).
It is very important that you are registered with a doctor at all times. If you leave your GP and register with a new GP, your medical records will be removed from your previous doctor and forwarded on to your new GP via NHS England. It can take your paper records up to two weeks to reach your new surgery.

With GP to GP record transfers your electronic record is transferred to your new practice much sooner.

The practice confirms that GP to GP transfers are already active and we send and receive patient records via this system.

Patient Online Access to Their GP Record

NHS England require practices to promote and offer the facility to enable patients online access to appointments, prescriptions, allergies and adverse reactions or have published plans in place to achieve this by 31st of March 2015.

We currently offer the facility for booking and cancelling appointments and also for ordering your repeat prescriptions and viewing a summary of your medical records on-line. If you do not already have a user name and password for this system – please register your interest with our reception staff.

Data for commissioning and other secondary care purposes

It is already a requirement of the Health and Social Care Act that practices must meet the reasonable data requirements of commissioners and other health and social care organisations through appropriate and safe data sharing for secondary uses, as specified in the technical specification for care data.

At our practice we have specific arrangements in place to allow patients to “opt out” of care.data which allows for the removal of data from the practice. Please see the page about care data on our website

The Practice confirm these arrangements are in place and that we undertake annual training and audits to ensure that all our data is handled correctly and safely via the Information Governance Toolkit.

We make every effort to give the best service possible to everyone who attends our practice.

In the majority of cases the best way to resolve your concerns as quickly as possible is with the front line staff or the service or organisation that you are complaining about.

However, we are aware that things can go wrong resulting in a patient feeling that 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.

Simply contact the Practice Manager preferably in writing via our  Contact Us page or by completing a complaints form available in surgery, and she/he will set all the necessary wheels in motion. Alternatively please visit our feedback form if you have any suggestions.

We are continually striving to improve our service. Any helpful suggestions would be much appreciated and a suggestion box is located in the waiting area.

About your Summary Care Record

Your Summary Care Record contains important information about any medicines you are taking, any allergies you suffer from and any bad reactions to medicines that you have previously experienced.

Allowing authorised healthcare staff to have access to this information will improve decision making by doctors and other healthcare professionals and has prevented mistakes being made when patients are being cared for in an emergency or when their GP practice is closed.

Your Summary Care Record also includes your name, address, date of birth and your unique NHS Number to help identify you correctly.

You may want to add other details about your care to your Summary Care Record. This will only happen if both you and your GP agree to do this. You should discuss your wishes with your GP practice.

Healthcare staff will have access to this information, so that they can provide safer care, whenever or wherever you need it, anywhere in England.

FAQs

Who can see my Summary Care Record?

Healthcare staff who have access to your Summary Care Record:

• need to be directly involved in caring for you
• need to have an NHS Smartcard with a chip and passcode
• will only see the information they need to do their job and
• will have their details recorded every time they look at your record

Healthcare staff will ask for your permission every time they need to look at your Summary Care Record. If they cannot ask you (for example if you are unconscious or otherwise unable to communicate), healthcare staff may look at your record without asking you, because they consider that this is in your best interest.

If they have to do this, this decision will be recorded and checked to ensure that the access was appropriate.

What are my choices?

You can choose to have a Summary Care Record or you can choose to opt out.

If you choose to have a Summary Care Record and are registered with a GP practice, you do not need to do anything as a Summary Care Record is created for you.

If you choose to opt out of having a Summary Care Record and do not want a SCR, you need to let your GP practice know by filling in and returning an opt-out form which can be optained from your GP practice.

If you are unsure if you have already opted out, you should talk to the staff at your GP practice.

You can change your mind at any time by simply informing your GP and they can create a Summary Care Record for you.

Children and the Summary Care Record

If you are the parent or guardian of a child under 16, you should make this information available to them and support the child to come to a decision as to whether to have a Summary Care Record or not.

If you believe that your child should opt-out of having a Summary Care Record, we strongly recommend that you discuss this with your child’s GP. This will allow your child’s GP to highlight the consequences of opting-out, prior to you finalising your decision.

Where can I get more information?

For more information about Summary Care Records you can:

• talk to the staff at your GP practice
• phone the Health and Social Care Information Centre on 0300 303 5678
• Read the Summary Care Record patient information

The Surgery is an approved training practice for the training of General Practice Registrars (GPRs). Being an approved training practice means that:

• patients can directly contribute to the training of future GPs
• patients who consult with the GPR will have longer consultations
• it keeps all doctors and nurses keep in touch with new medical developments and skills
• It improves all doctors and nurse’s consultation and training skills
• It ensures that clinical standards and standards of medical record keeping are maintained
• It helps with recruitment of high quality doctors to the practice for job vacancies

GPRs are doctors in training who are qualified doctors and have already worked in hospitals as junior doctors for at least 3 years and have now decided that they would like to specialise in General Practice.

In order to qualify as a GP all doctors have to complete Postgraduate Specialist Training which includes at least 18 months training in General Practice.

The practice will be regularly assessed for its suitability for postgraduate training in general practice. This process includes an inspection of medical records for quality, NOT content. If you object to your record being seen for this process then you must let us know in writing so these notes can be withdrawn.

An essential component of training in all medical practice is the use of video and consultations with the both the GPR and the trainer present. We hope that all our patients will be willing to take part in these educational consultations to help us all in improving and maintaining our medical and consultation skills. All video recordings are strictly confidential and are used for teaching only. We will not video your consultation without your consent. Please inform Reception if you would prefer not to participate.

Patient’s Rights

We are committed to giving you the best possible service. This will be achieved by working together. Help us to help you. You have a right to, and the practice will try to ensure that:

• You will be treated with courtesy and respect
• You will be treated as a partner in the care and attention that you receive
• All aspects of your visit will be dealt with in privacy and confidence
• You will be seen by a doctor of your choice subject to availability
• In an emergency, out of normal opening hours, if you telephone the practice you will be given the number to receive assistance, which will require no more than one further call
• You can bring someone with you, however you may be asked to be seen on your own during the consultation
• Repeat prescriptions will normally be available for collection within two working days of your request
• Information about our services on offer will be made available to you by way of posters, notice boards and newsletters
• You have the right to see your medical records or have a copy subject to certain laws.

Patient’s Responsibilities

With these rights come responsibilities and for patients we would respectfully request that you:

• Treat practice staff and doctors with the same consideration and courtesy that you would like yourself. Remember that they are trying to help you
• Please ensure that you order your repeat medication in plenty of time allowing 48 working hours.
• Please ensure that you have a basic first aid kit at home and initiate minor illness and self-care for you and your family.
• Please attend any specialist appointments that have been arranged for you or cancel them if your condition has resolved or you no longer wish to attend
• Please follow up any test or investigations done for you with the person who has requested the investigation
• Attend appointments on time and check in with Reception
• Patients who are more than 20 minutes late for their appointment may not be seen.
• If you are unable to make your appointment or no longer need it, please give the practice adequate notice that you wish to cancel. Appointments are heavily in demand and missed appointments waste time and delay more urgent patients receiving the treatment they need
• An appointment is for one person only. Where another family member needs to be seen or discussed, another appointment should be made
• Patients should make every effort to be present at the surgery to ensure the best use of nursing and medical time. Home visits should be medically justifiable and not requested for social convenience
• Please inform us when you move home, change your name or telephone number, so that we can keep our records correct and up to date
• Read the practice leaflets and other information that we give you. They are there to help you use our services. If you do not understand their content please tell us
• Let us have your views. Your ideas and suggestions, whether complimentary or critical, are important in helping us to provide a first class, safe, friendly service in pleasant surroundings.

NHS Constitution

The NHS Constitution establishes the principles and values of the NHS in England. For more information see these websites:

• GOV.UK – The NHS Constitution for England
• NHS Choices – NHS Constitution 

The practice fully supports the NHS Zero Tolerance Policy. The aim of this policy is to tackle the increasing problem of violence against staff working in the NHS and ensures that doctors and their staff have a right to care for others without fear of being attacked or abused.

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. We ask you to treat your doctors and their staff courteously and act reasonably.

All incidents will be followed up and you will be sent a formal warning after a second incident or removed from the practice list after a third incident if your behaviour has been unreasonable.

However, aggressive behaviour, be it violent or verbal abusive, will not be tolerated and may result in you being removed from the Practice list and, in extreme cases, the Police will be contacted if an incident is taking place and the patient is posing a threat to staff or other patients.

Removal from the Practice List

A good patient-doctor relationship, based on mutual respect and trust, is the cornerstone of good patient care. The removal of patients from our list is an exceptional and rare event and is a last resort in an impaired patient-practice relationship. When trust has irretrievably broken down, it is in the patient’s interest, just as much as that of The Surgery, that they should find a new practice. An exception to this is on immediate removal on the grounds of violence e.g. when the Police are involved.

Removing other members of the household

In rare cases, however, 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. The prospect of visiting patients where a relative who is no longer a patient of the practice by virtue of their unacceptable behaviour resides, or being regularly confronted by the removed patient, may make it too difficult for the practice to continue to look after the whole family. This is particularly likely where the patient has been removed because of violence or threatening behaviour and keeping the other family members could put doctors or their staff at risk.