Work Based Learning Business Report – Procedures, Policies and Practice

Jessica Aspinall

11020475

Contents Page

Introduction – Page 3

Confidentiality and Data Protection Policy – Pages 3-6

Chaperone Policy – Pages 6-7

Dress Code Policy – Page 7-8

Mobile Phone Usage Policy – Pages 8-9

Conclusion – Page 9

Introduction

In this report I am going to critically analyse and review 4 policies that are used in my workplace.

For the last two years I have been employed by Irwell Medical Practice as a part time GP Medical Receptionist. This is a large training practice with a patient population of approximately 14,000 patients.
I will review the following;

* Confidentiality and Data Protection – formal * Chaperone – formal * Dress Code – informal * Mobile Phone Usage – informal

The main focus of this report is to discover if these policies enhance or distract the practice from achieving a smooth and efficient working environment for both staff and patients.

Confidentiality and Data Protection Policy

GP Practices hold information about patients which must be kept private and confidential. All patients can expect that their personal information will not be disclosed without their permission (except in the most exceptional circumstances when disclosure is required when someone is at grave risk of serious harm). In some instances patient records can be very sensitive and may contain information concerning third parties. Patients have a right to expect that information about them will be held in confidence by their doctors.

Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to seek medical attention or to give doctors the information they need in order to provide good care. Most patients understand the need for the healthcare team, who provides their care, need to be aware of their personal information.

Although confidentiality is an important duty, it is not absolute because information can be disclosed if:

1. It is required by law

2. The patient consents – either implicitly for the sake of their own care or expressly for other purposes

3. Is justified in the public interest

Seeking a patient’s consent to disclosure shows respect and is part of good communication between doctors and patients.

All practice staff from GPs to Receptionists are bound by the same rules of confidentiality and its consequences if breached, it is a serious disciplinary offence and may lead to dismissal. The practices confidentiality policy must also abide with the Data Protection Act 1998, if this is broken then there will be serious legal consequences for the practice, as shown in the quote taken from the Medical Protection website.

‘As of 6 April 2010, the Information Commissioner can impose a Civil Monetary Penalty of a maximum of £500,000 if there is a serious breach of the Data Protection Act and the data controller acted deliberately, or was reckless, and the breach was of a kind likely to cause substantial distress or damages to an individual.’

http://www.medicalprotection.org/uk/booklets/common-problemsgp/confidentiality

To help support management run a smooth and efficient practice all staff members are trained at induction on the six Caldicott Principles and receives annual updates on confidentiality and data protection, Appendix 1. This ensures that management run a safe and secure workplace for staff and patients.

I have attached a copy of the confidentiality agreement each member of staff signs on commencement of their employment, see Appendix 2.

The Data Protection Act (DPA) 1998 came into force in March 2000 and repealed most of the 1990 Access to Health Records Act. The Access to Medical Reports Act 1988 gave individuals the right of access, subject to certain exceptions, to health information recorded about themselves, and, in certain circumstances, about others, within manual records. In February 2010 the Department of Health (DoH) published amended guidance applicable in England to encompass best practice covering the above legislative process.

Under section seven of the DPA, patients have the right to apply for access to their health records. Provided that the fee has been paid and a written application is made the Practice is obliged to comply with a request for access. However, the Practice also has a duty to maintain the confidentiality of patient information and to satisfy itself that the applicant is entitled to have access before releasing information.

In order to process and ensure the above legislation is not breached management have implemented procedures for staff to follow. A flowchart is a simple and quick tool that is easily accessible and auditable, Appendix 3. This allows management to approach quality with a ‘right first time’ model preventing ‘rework’ which adds extra cost to the business. Errors whether this be human error or carelessness, cost money in staff time and give an impression of an inefficient and badly run practice. By putting correct procedures in place that follow the DPA’s guidelines allows patients and employees to be confident in trusting the practice with their personal information. This enhances the practices reputation and the well being of practice employees.

Appendix 4 shows the procedure staff and patients are required to complete for access to their medical records.

The Confidentiality and Data Protection Policy is accepted and valued by both patients and staff due to the importance of how a false disclosure can affect a person’s life either financially or emotionally. It could have implications on their insurance or employment, be it past or current. Patients can relate to the policy and understand that it is wholly in place to protect them.

Confidentiality and Data Protection is vital at my workplace due to the fact the practice employs local people who may know registered patients. Patients may feel uneasy with the thought that their neighbour for example, may be able to access their personal information. This policy is put in place to ensure patients have full trust and confidence that their medical records will not be disclosed without their permission and that all staff regard patient information as confidential.

Information can not be disclosed without prior consent from the patient to a third party for example; a relative/carer.

When requests are received via the telephone from a third party you are never 100% certain who you are speaking to. Therefore, it is vital that you follow practice policy, Appendix 5.

Waiting rooms can be a source of confidentiality breaches; it is very easy for patients to overhear sensitive information. Solutions to this could be as simple as;

* Conducting conversations in as quiet and discreet manner as possible, preferably somewhere private. * Using telephones always get the patient to confirm their personal details. * Use patient unidentifiable coding e.g. clinical ID numbers when speaking to colleagues. * Awareness that careless talk can lead to breach of confidentiality.

The Confidentiality and Data Protection policy Appendix 6 is widely advertised throughout the practice ensuring that all patients are informed and have up to date information. Posters are displayed on notice boards and on the practice website.

Chaperone Policy

‘Irwell Medical Practice is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times and the safety of everyone is of paramount importance.’

Above is a quote taken from the Practices Chaperone Policy. This is designed to protect both patients and staff from abuse or allegations of abuse and to assist patients to make an informed choice about their examinations and consultations.

There is no common definition of a chaperone. Their role varies considerably depending on the needs of the patient, the healthcare professional and the examination being carried out.

They can assist in any of the following areas:

* Emotional comfort and reassurance to patients * Assist in examination * Assist in undressing * Act as an interpreter * Protection to the healthcare professional against allegations/attack.

A variety of people can act as a chaperone. Best practice recommends that chaperones should be clinical staff familiar with procedural aspects of personal examination. However, non-clinical staff can act in this capacity, as long as they have received accredited training, be comfortable in acting in the role of chaperone and be confident in the role. The patient must agree to the presence of a chaperone. Appendix 7 outlines the chaperone procedure.

The Chaperone Policy is clearly advertised through patient information leaflets, on the website and can be read at the Practice upon request. A poster is also displayed in the Practice Waiting Area, Appendix 8.

The Chaperone Policy is accepted and valued by patients as well as staff, patients are reassured that practice staff have been thoroughly trained and understand their responsibility not to divulge confidential information. Management are reassured that by implementing the policy it reinforces the practices commitment to providing a safe and comfortable environment and that safety is of paramount importance to both patients and staff.

Dress Code Policy

Personal appearance of employees makes an important contribution to the Practice's reputation and image. Therefore, it is important that dress and appearance is professional and reflects the work environment.
I am required to wear a practice uniform at all times during my working hours. The uniform must be clean, in good condition and worn in a presentable fashion and must not be altered without prior approval of management.

This policy is helpful to management as it portrays a professional and corporate image. Dress code policy provides a clear distinction of roles within the business e.g., the uniform of a health care assistant is light blue tunic with black trousers and a practice nurse wears a navy blue tunic with black trousers. The policy enhances workplace harmony and team morale.

The reception team were previously provided with a full dress uniform consisting of, one skirt, one pair of trousers, three blouses and a jacket. However, problems arose with differing sizes and body shapes and younger members of staff adapting the uniform to reflect the ‘on trend styles’. This was not the professional image the management wanted to project. The policy was reviewed and a decision taken that three blouses would be provided to all staff chosen by management to reinforce a professional image. Staff are allowed to wear smart black trousers or a smart knee length black skirt provided by themselves.

Each member of staff is made aware of the Dress Code Policy at their first week’s induction; it is in their contract of employment and also in the staff handbook if they need to refer back to it.

Jessica Aspinall, GP Receptionist. Image taken from practice website.

http://www.irwellmedicalpractice.nhs.uk/staff1.aspx?t=3

Mobile Phone Policy

Employees are not permitted to use mobile phones during working hours. Anyone found doing so may be subject to disciplinary action. All mobile devices must be kept on silent either in staff lockers/bags and not on desks. Phones may be checked during breaks only. The practice will make available a telephone for emergency situations if authorisation is obtained from the line manager.

This policy has been put in place so employees are not distracted from their work duties. It also helps the manager by reducing any situations where an accidental or deliberate breach of confidentiality occurs. All staff are made aware of this policy at their induction; it is contained in their contract of employment and is also in the staff handbook.

This policy was the subject of a recent disciplinary case in which a staff member was reported texting her friends and using social media sites during working hours. The policy allowed management to follow Human Resources guidelines and all staff were issued with a reminder of the policy. See Appendix 9.

Conclusion

Policies whether they be formal or informal are put in place to help and support management run a smooth and efficient business. They bring structure, uniformity and order to the working environment, every member of staff is ‘singing from the same hymn sheet’.

The ultimate aim of the confidentiality and data protection policy is to protect patient’s personal information and to prevent any form of breach. After reviewing the policy I feel it has been implemented to a high standard. I believe it has been communicated and brought to the attention of all relevant parties in a timely and effective manner. However, on reflection I and my colleagues feel that management should provide update training six monthly as opposed to annually. The benefits being legislation is current and correct, and the business is working within the current guidelines. This will incur extra costs to the business, in my opinion this is justified by minimising the risk of the severity of consequences if a breach occurs.

The chaperone and mobile phone policy, in my opinion, have no recommended improvements. They are both widely advertised to staff and patients through many different methods. After discussion with my manager she agrees, the policies as they are, are doing their ‘job’. The chaperone policy is protecting patients and clinicians from any abuse/abuse allegations and it reinstates the practices goal of providing a safe and comfortable environment. All staff are aware of and adhere to the mobile phone policy after management followed disciplinary procedures due to a serious breach of policy.

After deliberating with my colleagues from the reception team we are in agreement that management should provide a full uniform as opposed to just three blouses. This will abolish personal interpretation of style and reinforce the overall equal and professional image management wish to portray. Again this will be an added cost for the practice but personally I feel will enhance a corporate and professional image.

Appendix 1 – 6 Principles of Caldicott

Caldicott Principles
The Caldicott Report set out a number of general principles that health and social care organisations should use when reviewing its use of client information and these are set out below:
Principle 1: Justify the purpose(s)
Every proposed use or transfer of personally identifiable information within or from an organisation should be clearly defined and scrutinised, with continuing uses regularly reviewed by the appropriate guardian.
Principle 2: Do not use personally identifiable information unless it is absolutely necessary.
Personally identifiable information items should not be used unless there is no alternative.
Principle 3: Use the minimum personally identifiable information.
Where the use of personally identifiable information is considered to be essential, each individual item of information should be justified with the aim of reducing identifiably.
Principle 4: Access to personally identifiable information should be on a strict need to know basis.
Only those individuals who need access to personally identifiable information should have access to it.
Principle 5: Everyone should be aware of their responsibilities.
Action should be taken to ensure that those handling personally identifiable information are aware of their responsibilities and obligations to respect patient/client confidentiality.
Principle 6: Understand and comply with the law.
Every use of personally identifiable information must be lawful. Someone in each organisation should be responsible for ensuring that the organisation complies with legal requirements.

Principles of the Data Protection Act 1998
Personal data shall be processed fairly and lawfully, and in particular, shall not be processed unless at least one of the conditions in Schedule 2 is met, and in the case of sensitive personal data, at least one condition in Schedule 3 is also met.
Personal data shall be obtained only for one or more specified and lawful purposes , and shall not be further processed in a manner incompatible with that purpose or those purposes.
Personal data shall be adequate, relevant and not excessive in relation to the purpose or purposes for which they are processed.
Personal data shall be accurate and, where necessary, kept up to date.
Personal data processed for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes.
Personal data shall be processed in accordance with the rights of data subjects under this Act.
Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data.
Personal data shall not be transferred to a country or territory outside the European Economic Area unless that country or territory ensure an adequate level of protection of the rights and freedoms of data subject in relation to the processing of personal data.

Appendix 2 – Staff Confidentiality Agreement

Staff confidentiality agreement
(a copy of this agreement should be signed by every staff member/worker and kept in personal files.

* Declaration * * I understand that all information about patients held by IRWELL MEDICAL PRACTICE is strictly confidential, including the fact of a particular patient having visited the Surgery.

* I will abide by the confidentiality guidelines set out below.

I have read the Staff Confidentiality Policy above and fully understand my obligations and the consequences of any breach of confidentiality. I understand that a breach of these obligations may result in dismissal.

I understand that any breach, or suspected breach, of confidentiality by me after I have left the Practice’s employment will be passed to the Practice’s lawyers for action.

* If I hold a professional qualification and my right to Practice depends on that qualification being registered with a governing body, it is my responsibility to have read and understood their advice on confidentiality.

Name: ____________________________________________

Signature: _________________________________________

Date: _______________________

CONFIDENITILTY IS VITAL WITHIN GENERAL PRACTICE.
FAILURE TO OBSERVE WILL RESULT IN DISCIPLINARY ACTION, WHICH, IF FOUND TO BE GROSS MISCONDUCT WILL LEAD TO INSTANT DISMISSAL.

Appendix 3 – Access to Medical Records Flowchart

Access to Medical Records - Patient Enquiry
Has Patient provided a written request?
Collect £10
Are copies required? Provide Form
COPIES:
Record totally on computer COPIES:
Part
computer and part paper COPIES:
Record
totally paper based VIEW:
Record
totally on computer VIEW:
Part
computer and part paper VIEW: record totally paper based
Collect £10
Collect £10
Collect £50
Collect £50
Collect £10
Has the record been added to in the last 40 days? Check that:
Form is fully completed
You can positively identify the patient
That the information required is specific
That you have a valid consent
That the patient has received a copy of the Fees and Charges leaflet
Advise Patient that:
The request will be actioned as soon as possible, and within a maximum of 21 days
That they will be contacted when the request has been completed.
That requests to view will be by appointment with the Practice Administrator.
Prepare
copies / printouts Pass to
Usual GP to Check
Advise patient copies are ready to collect
Advise patient to make a appointment to view

No
Yes
Yes
No
No
Yes

Appendix 4 – Application for access to Medical Records

25/03/2014 APPLICATION FOR ACCESS TO MEDICAL RECORDS
Data Protection Act 1998 Subject Access Request

Details of the Record to be Accessed: Patient Surname | NHS Number | Forename(s) | Address | Date of Birth | |
Details of the Person who wishes to access the records, if different to above: Surname | | Forename(s) | | Address | | Telephone Number | | Relationship to Patient | |
Declaration: I declare that the information given by me is correct to the best of my knowledge and that I am entitled to apply for access to the health records referred to above under the terms of the Data Protection Act 1998.
Tick which ever of the following statements apply.

* I am the patient.

* I have been asked to act by the patient and attach the patient’s written authorisation.

* I am acting in Loco Parentis and the patient is under age sixteen, and is incapable of understanding the request / has consented to me making this request.
(*delete as appropriate).

* I am the deceased patient’s Personal Representative and attach confirmation of my appointment.

* I have a claim arising from the patient’s death and wish to access information relevant to my claim on the grounds that….(please supply your reasons below).

YOUR SIGNATURE……………………..DATE………………………..
NOTE: There is a fee of £10 for access to records. An additional fee of 35p per page is charged if records are to be photocopied up to a maximum of £50. The fee must accompany this request. Cheques to be payable to Irwell Medical Practice. 21 days prior notice is usually required.
Details of my Application (please tick as appropriate)

Patient to complete

I am applying for access to view my records only | | I am applying for copies of my medical record | | I have instructed someone else to apply on my behalf | | I have attached the appropriate fee | |

Notes:

Under the Data Protection Act 1998 you do not have to give a reason for applying for access to your health records.

Optional - Please use this space below to inform us of certain periods and parts of your health record you may require, or provide more information as requested above.

This may include specific dates, consultant name and location, and parts of the records you require e.g. written diagnosis and reports. Note: defining the specific records you need may result in lower fee charges and a quicker response.

I would like a copy of all records | | I would like a copy of records between specific dates only (please give date range) below | | I would like copy records relating to a specific condition / specific incident only (please detail below) | |

Appendix 5 – Information Governance Factsheet for Staff

Information Sharing Checklist

Information sent by e-mail MUST be sent using the ‘NHS.net’ domain identifier.

See below for a checklist which must be followed when sharing information by telephone or fax.

You must be able to answer YES to ALL of the following questions before proceeding: * Do you understand your responsibilities regarding confidential information? * Can you justify why you are processing this information? * Are you doing it for a specific purpose? * Is it adequate, relevant and not excessive? * Is it accurate and up-to-date? * Is it being processed in accordance with the rights of data subjects? * Is it protected by appropriate security (e.g. Safehaven fax, encrypted data stick)?

The following two pages each contain a protocol – one for sharing confidential information by telephone, one for fax:
Guidance for Sharing Confidential Information by Telephone

This guidance relates to
Data Principle 7:
Personal Data Must be ‘Protected by Appropriate Security’

Caldicott Principle 4
‘Access should be on a Strict Need to Know Basis’

* Confirm the name, job title, department and organisation of the person requesting the information; * Confirm that the reason for the information request is appropriate; * Take a contact telephone number (e.g. main switchboard number (never a direct line or mobile telephone number)); * Stop to consider if this information is required, then check if it is allowed to be provided. If in doubt, tell the enquirer you will call them back. (You may need to contact the Caldicott Guardian who is [ Fiona Ticehurst (IT Administrator) ] to verify if the request is possible); * Provide the information only to the person who has requested it (do not leave messages); * Ensure that you record your name, date and the time of disclosure, the reason for it and who authorised it; * Record the recipient’s name, job title, organisation and telephone number.

IF IN DOUBT, ASK!

Contact ***Fiona Ticehurst*** on ***253386*** if you require any further Information Governance help or advice

Guidance for Sharing Confidential Information by Fax

If you are faxing to a known Safe Haven/Secure Fax you do not need to follow any special instructions. If not, follow the steps below:

This guidance relates to
Data Principle 7:
Personal Data Must be ‘Protected by Appropriate Security’

Caldicott Principle 4
‘Access should be on a Strict Need to Know Basis’

* Do not fax personal or confidential information unless it is absolutely necessary; * Personal details should be faxed separately from clinical details, which must be accompanied by the NHS number; * Telephone the recipient of the fax (or their representative) to let them know you are going to send confidential information; * Ask the recipient to acknowledge receipt of the fax; * Double check the fax number and use pre-programmed numbers wherever possible; * Make sure your fax cover sheet states who the information is for and mark it ‘Private and Confidential’; * If appropriate, request a report to confirm that the transmission was completed.

IF IN DOUBT, ASK!

Contact ***Fiona Ticehurst*** on ***253386*** if you require any further Information Governance help or advice.

Appendix 6 - Data Protection Patient Information Poster
Data Protection Act – Patient Information

We need to hold personal information about you on our Computer system and in paper records to help us to look after your health needs.

Please help to keep your record up to date by informing us of any changes to your circumstances.

Doctors and staff in the practice have access to your medical records to enable them to do their jobs. Your doctor is responsible for their accuracy and safe-keeping.

From time to time, it may be necessary to share information with others involved in your care. Anyone with access to your record is properly trained in confidentiality issues and is governed by both a legal and contractual duty to keep your details private.

All information about you is held securely and appropriate safeguards are in place to prevent accidental loss.

In some circumstances we may be required by law to release your details to statutory or other official bodies, for example if a court order is presented, or in the case of public health issues. In other circumstances you may be required to give written consent before information is released – such as for medical reports for insurance, solicitors etc.

To ensure your privacy, we will not disclose information over the telephone or fax unless we are sure that we are talking to you.

Information will not be disclosed to family, friends, or spouses unless we have prior written consent, and we do not leave messages with others.

You have a right to see your records if you wish. Please ask at reception if you would like further details and our patient information leaflet. An appointment will be required. In some circumstances a fee may be payable.

Appendix 7 – Chaperone Procedure

Procedure

* The clinician will contact Reception to request a chaperone.

* The clinician will record in the notes that the chaperone is present, and identify the chaperone.

* Where no chaperone is available the examination will not take place – the patient should not normally be permitted to dispense with the chaperone once a desire to have one present has been expressed.

* The chaperone will enter the room discreetly and remain in room until the clinician has finished the examination.

* The chaperone will normally attend inside the curtain at the head of the examination couch and watch the procedure.

* To prevent embarrassment, the chaperone should not enter into conversation with the patient or GP unless requested to do so, or make any mention of the consultation afterwards.

* The patient can refuse a chaperone, and if so this must be recorded in the patient’s medical record.

Checklist for consultations involving intimate examinations

* Chaperones are most often required or requested where a male examiner is carrying out an intimate examination or procedure on a female patient, but the designation of the chaperone will depend on the role expected of them, whether participating in the procedure or providing a supportive role.

* Establish there is a genuine need for an intimate examination and discuss this with the patient and whether a formal chaperone (such as a nurse) is needed.

* Explain to the patient why an examination is necessary and give the patient an opportunity to ask questions. The chaperone would normally be the same sex as the patient and the patient will have the opportunity to decline a particular person as a chaperone, if that person is considered not acceptable for any reason.

* Offer a chaperone or invite the patient to have a family member / friend present.

* If the patient does not want a chaperone, record that the offer was made and declined in the patient’s notes.

* Obtain the patient’s consent before the examination and be prepared to discontinue the examination at any stage at the patient’s request.

* Record that permission has been obtained in the patient’s notes.

* Once the chaperone has entered the room, they should be introduced by name and the patient allowed privacy to undress / dress. Use drapes / curtains where possible to maintain dignity. There should be no undue delay prior to examination once the patient has removed any clothing.

* Explain what is being done at each stage of the examination, the outcome when it is complete and what is proposed to be done next. Keep discussion relevant and avoid personal comment.

* If a chaperone has been present, record that fact and the identity of the chaperone in the patient’s notes.

* During the examination, the chaperone may be needed to offer reassurance, remain alert to any indication of distress but should be courteous at all times.

* Record any other relevant issues or concerns in the patient’s notes, immediately following the consultation.

* Chaperones should only attend the part of the consultation that is necessary – other verbal communication should be carried out when the chaperone has left.

* Any request that the examination be discontinued should be respected.

* Healthcare professionals should note that they are at an increased risk of their actions being misconstrued or misrepresented, if they conduct intimate examinations where no other person is present.

Appendix 8 – Chaperone Policy Patient Poster

CHAPERONES

Chaperones are for the protection of both patients and staff.

You may request one at any time before or during your appointment by asking the receptionist or the clinician you are seeing.

Please note that a clinician may request a chaperone to be present during your appointment.

Appendix 9 – Mobile Phone Policy

MOBILE PHONES, I PHONES, BLACKBERRIES, I PODS ETC

13th July 2013

Following previous discussions and requests from management not to use mobile phones during working hours, it has come to our attention that this has continued on a regular basis.

From immediate affect employees are NOT permitted to use mobile phones during working hours. Anyone found doing so may be subject to disciplinary action.

All mobile devices must be kept on silent either in staff lockers/bags and not on desks. Phones may be checked during breaks only.

The practice will make available a telephone for emergency situations. Please ensure that authorisation is obtained from your line manager.

On behalf of the Partners of the Irwell Medical Practice