Policies

28 day repeat prescription PIL

Online Access to Medical Records

Our practice offers access to your online medical records.  Read more about this service, including how to set up your account, here: Online Access Patient Information Leaflet.

Once you have set up your account at reception, you can request access to your full online medical record by completing this form.

If you would like to allow someone else to have proxy access to your online records, please complete this form: Online Access Proxy Consent Registration Form.

Access to Medical Records

General Data Protection Regulations (GDPR) means you, as the ‘data subject’, have the right to access your own data.

All requests for access must be in writing via an Access to Medical Records Form, which can be provided on request or downloaded from our website by clicking here

A response will be provided as soon as possible and in any event within 28 days.  Where an application is denied, a reason will be given.  In some circumstances, some parts of your record may be withheld.

Charges

Under GDPR, the practice does not charge for providing a copy of requested information.

However, should a request be deemed either “unfounded, excessive or repetitive”, a reasonable fee may be charged.

A reasonable fee may be charged when requests for additional copies of the same information are made.

Provision of Information to Third Parties

The practice may share your personal information with other NHS organisations where this is appropriate for your healthcare.

In other circumstances we may approach you for specific consent to release personal information to third parties.

Information will not normally be released to other family members without written patient consent.

In some circumstances there are statutory or ethical obligations to disclose information to others (such as public health issues) which may not require your consent; however you may be consulted about these in advance.

All staff have access to your medical and personal details which is required in relation to their roles, and have completed confidentiality agreements.

Policy: Primary Care Management of Antidepressants for Patients Under 18

Purpose: This policy outlines why primary care does not initiate antidepressant treatment for patients under 18 years of age, ensuring evidence-based, safe, and effective care in compliance with national guidelines.

Policy Statement

In primary care, antidepressants are not initiated for individuals under 18 years old. Management of depression or other mental health conditions in this age group requires specialized input due to the complexities of diagnosis, treatment, and monitoring. Initiation of antidepressants should occur under the guidance of a specialist in child and adolescent mental health.

Rationale

Specialist Expertise: Depression and other mental health conditions in children and adolescents are multifaceted and may present with overlapping symptoms with other conditions, including developmental disorders. Specialist assessment ensures accurate diagnosis and treatment tailored to the developmental and psychosocial context of the patient.

National Guidelines: The National Institute for Health and Care Excellence (NICE) recommends that antidepressants should only be prescribed for under-18s following assessment by a Child and Adolescent Mental Health Services (CAMHS) clinician and as part of a broader treatment plan, including psychological interventions. NICE also specifies fluoxetine as the first-line antidepressant for under-18s, initiated only after psychological therapy has been attempted unless symptoms are severe.

Safety Considerations: The under-18 population has an increased risk of adverse effects from antidepressants, including heightened suicidal ideation, agitation, and behavioural changes. Specialist care ensures close monitoring for these risks, particularly during the initiation and adjustment phases of treatment.

Psychological Therapies as First-Line Treatment: Evidence supports psychological therapies, such as cognitive-behavioural therapy (CBT), as the most effective and safest initial treatment for mild to moderate depression in young people. Antidepressants are generally reserved for moderate to severe cases or when psychological therapies alone have not been effective.

Continuity and Coordination of Care: Initiating antidepressants in primary care without specialist involvement may disrupt the coordinated care provided by CAMHS, which includes ongoing monitoring and access to multidisciplinary expertise. Collaboration with CAMHS ensures the patient and family receive holistic support.

Procedure

Referral to Specialist Services: Any young person presenting with symptoms of depression or other mental health concerns should be referred to Healthy Minds or the Primary Care Network Child and Adolescent Mental Health Worker for comprehensive assessment and management. Urgent referral should be considered for severe cases, including those with suicidal ideation or significant functional impairment.

Primary Care Role: Provide initial support, including psychoeducation, signposting to self-help resources, and liaison with schools or other agencies as appropriate. Monitor symptoms while awaiting specialist input and escalate concerns if necessary. This will normally be provided by the PCN mental health worker.

Shared Care: If antidepressant treatment is initiated by a specialist, primary care may take on a shared care role, including prescribing and monitoring under specialist guidance. This is decided on a case by case basis.

Exemptions: In exceptional cases, where immediate specialist input is unavailable and the patient’s condition is severe or life-threatening, primary care clinicians may consider initiating treatment but only in consultation with CAMHS or a consultant psychiatrist.

Practice Policy in relation to prescription of sedatives for patients attending hospital or dental appointments, for imaging investigations or other procedures.

Sometimes we are asked to prescribe ‘a low dose sedative’ for patients attending hospital or dental appointments, for imaging investigations or other procedures. These are the reasons we do not prescribe this medication:

1. Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic (too low a dose to be effective) for most adults for any effective sedation.  Conversely sedatives can have the opposite response in patients, and even very small doses can cause increased agitation in some patients.
2. A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the anxiolytic being no longer appropriate.
3. GPs are not regularly involved, skilled, trained or appraised in sedation skills.
4. All hospital consultants and dentists, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs for these medications. If a patient needs a certain medication to enable an investigation to go ahead, they are just as well positioned to provide a prescription, either through the hospital pharmacy or a hospital FP10. Dentists have similar prescriptions, although you may need to get a private prescription if your dentist is not an NHS dentist.
5. Sedated patients should be regularly monitored, and this is not likely to be arranged if a GP issues the prescriptions
6. The Royal College of Radiologists‘ own guidelines on sedation for imaging makes no mention of GP involvement or provision of low dose anxiolytics and stresses the importance of experienced well trained staff involved and the monitoring of sedated patients.
7. During the course of any investigation or procedure, other medications or contrast may be needed. The clinician in charge of the procedure knows which medications are likely to be needed and any interactions or risks associated with them in combination with sedatives.

Your Data Matters to the NHS

Information about your health and care helps us to improve your individual care, speed up diagnosis, plan your local services and research new treatments. The NHS is committed to keeping patient information safe and always being clear about how it is used.

How your data is used

Information about your individual care such as treatment and diagnoses is collected about you whenever you use health and care services. It is also used to help us and other organisations for research and planning such as research into new treatments, deciding where to put GP clinics and planning for the number of doctors and nurses in your local hospital.  It is only used in this way when there is a clear legal basis to use the information to help improve health and care for you, your family and future generations.

Wherever possible we try to use data that does not identify you, but sometimes it is necessary to use your confidential patient information.

You have a choice

You do not need to do anything if you are happy about how your information is used. If you do not want your confidential patient information to be used for research and planning, you can choose to opt out securely online or through a telephone service. You can change your mind about your choice at any time.

Will choosing this opt-out affect your care and treatment?

No, choosing to opt out will not affect how information is used to support your care and treatment. You will still be invited for screening services, such as screenings for bowel cancer.

What do you need to do?

If you are happy for your confidential patient information to be used for research and planning, you do not need to do anything.

To find out more about the benefits of data sharing, how data is protected, or to make/change your opt-out choice visit www.nhs.uk/your-nhs-data-matters

• You can read more about how the practice collects, uses and shares your data in our privacy notice.

This Practice does not discriminate against any person on grounds of nationality, skin-colour, age, religion, marital status, sexual orientation or disability.

The Practice will not tolerate any form of discrimination or harassment against our staff or patients by any patient or visitor.  Anyone who acts in this manner will be required to leave the premises forthwith.  If the offender is a patient, he or she may be removed from the Practice’s list.

The practice does not write letters stating patients are fit to fly or participate in other activities. We don’t offer this service because assessing a patient’s fitness for specific activities requires specialised expertise. Determining someone’s suitability for activities like flying or sports is outside the scope of a GP’s medical training and qualifications. It is also not an NHS service.

We can provide a printout of your medical summary or a letter detailing your medical history.

We can complete forms that only require factual medical details and don’t ask us to make any judgments about your suitability or fitness for the activity.

Private doctors in the relevant fields may be able to help with any documentation you require.

GP Publication of Earnings 2022

GP Publication of Earnings 2021

GP Publication of Earnings 2020

GP Publication of Earnings 2019

GP Publication of Earnings 2018

View the practice’s Infection Prevention and Control statement here. 

Understandably, following recent media coverage we’re receiving a lot of requests regarding weight loss injections.

These aren’t available on the NHS for Lincolnshire residents and we’re unable to refer you to providers. We are also unable to discuss whether they’re appropriate for you or safe to use with your other medication. This will require a consultation with a private provider.

We do have several options to support weight loss including OneYou Lincolnshire, Orlistat, or Weight Loss surgery (although the criteria for the surgery are very strict unfortunately). You can read about all the options at the sites below:

https://www.nhs.uk/conditions/obesity/treatment/
https://www.oneyoulincolnshire.org.uk/

At the practice we take patient confidentiality very seriously and endeavour to preserve your confidentiality on all occasions.  We therefore do not give out any information about you, leave messages or send you texts/emails unless you have expressed your consent for us to do so.

The following consent forms cover a number of areas that you may wish to complete.

• Patient Consent Form (how you prefer to be contacted by the practice and consenting to a named individual accessing your medical records)
• Summary Care Record Consent Form (sharing key information from your medical record with other healthcare organisations that you may need to be treated by)
• Enhanced Sharing Form (sharing your data with other organisations and viewing your data from other organisations)

The practice has created a poster to show visually the values for Nettleham Medical Practice. The poster can be opened by clicking on the following link: Practice Values – poster

We are often asked by patients to prescribe “just in case” antibiotics, especially when travelling abroad.

There are two scenarios where it is recommended:

1. Patients with COPD with predictable exacerbations
2. Patients with recurrent urine infections reliably related to sexual intercourse

In all other scenarios it is not recommended. This is for several reasons:

1. it is not covered by our contract as an NHS service
2. it is not recommended in terms of antibiotic stewardship as likely leads to inappropriate targeting of antibiotic use and increased resistance
3. it is not recommended for patient safety (it’s likely the antibiotics won’t be the correct ones for the infection you get, or even delay you seeking medical help if unwell)
4. it is not recommended by our medicolegal insurance company as we are prescribing a drug without an indication or follow up or clinical assessment
5. it leads to increased waste as the antibiotics are likely to expire before use

You can view further information about antibiotic stewardship here:

What is Antibiotic Resistance? – YouTube – video by PHE -could add this to your practice website?

Antibiotic resistance – NHS (www.nhs.uk)– brief explanation on antibiotic resistance and superbugs.

Awareness of Antimicrobial Resistance (AMR) Animation – YouTube

NHS England » Antimicrobial resistance (AMR)

Use of Benzodiazepines (and related medications) for flying

For the following reasons we will no longer be providing Diazepam or similar drugs for flight anxiety and instead suggest the links to aviation industry recommended flight anxiety courses at the end of the page. Flight anxiety does not come under the remit of General Medical Services as defined in the GP contract and so we are not obliged to prescribe for this. Patients who still wish to take benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.

Initial use of benzodiazepines, including the well-known Diazepam also known as ‘Valium’, was enthusiastic and they were hailed as a wonder drug. However, it became increasingly clear that, as well as having short term effects on memory, co-ordination, concentration and reaction times, they were also addictive if used for a long time, with withdrawal leading to fits, hallucinations, agitation and confusion, and further had long-term effects on cognition and balance. Unfortunately, benzodiazepines have also become a widely used drug of abuse since they first came on the market. Because of these reasons the use of benzodiazepines has been a lot more controlled around the world since the 1980-90s, especially in the UK. Diazepam in the UK is a Class C/Schedule IV controlled drug. The following short guide outlines the issues surrounding its use with regards to flying and why the surgery no longer prescribes such medications for this purpose.

People often come to us requesting the doctor or nurse to prescribe diazepam for fear of flying or assist with sleep during flights. Diazepam is a sedative, which means it makes you sleepy and more relaxed. There are a number of very good reasons why prescribing this drug is not recommended. · According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) in treating phobic states. It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” Your doctor would be taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight. · NICE guidelines suggest that medication should not be used for mild and self-limiting mental health disorders. In more significant anxiety related states, benzodiazepines, sedating antihistamines or antipsychotics should not be prescribed. Benzodiazepines are only advised for the short-term use for a crisis in generalised anxiety disorder in which case they are not fit to fly. Fear of flying in isolation is not a generalised anxiety disorder.

· Although plane emergencies are a rare occurrence there are concerns about reduced awareness and reaction times for patients taking Diazepam which could pose a significant risk of not being able to react in a manner which could save their life in the event of an emergency on board necessitating evacuation.

· The use of such sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at an increased risk of developing a blood clot (Deep Vein Thrombosis – DVT) in the leg or even the lungs. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than 4 hours, the amount of time which has been shown to increase the risk of developing DVT whether in an aeroplane or elsewhere.

· Whilst most people find Diazepam sedating, a small number have paradoxical agitation and aggression. They can also cause disinhibition and lead you to behave in a way that you would

not normally which can pose a risk on the plane. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law. A similar effect can be seen with alcohol, which has led to people being removed from flights.

· A study published in 1997 from the Stanford University School of Medicine showed that there is evidence use of Benzodiazepines stops the normal adjustment response that would gradually lessen anxiety over time and therefore perpetuates and may increase anxiety in the long term, especially if used repeatedly. · Diazepam and similar controlled drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the police. The passenger may also need to use a different strategy for the homeward bound journey and/or other legs of the journey.

· Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing, you may fail this having taken diazepam.

· It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.

Please see below links for more information:

https://www.fearlessflyer.easyjet.com/

https://www.flyingwithoutfear.com/

https://www.britishairways.com/content/information/travel-assistance/flying-with-confidence

This surgery operates a Zero Tolerance policy towards verbal or physical abuse towards any member of our staff. Patients are asked to be considerate and act reasonably. All incidents will be followed up and you will be sent a formal warning or removed from the practice list if your behaviour has been unreasonable. We will have no hesitation in having you removed from the building by the police should your behaviour warrant it.

The full practice policy is here: – Zero Tolerance policy