Notes on Medical Record Access

Data Protection Act 2018 and GDPR gave individuals the right to their medical records.

Who has the right of Access?

The patient/ A child’s parent/ Someone acting on behalf of patient.

How should the application be made?

Individuals wish to access their medical record should make an application online. The practice may require identify the individual.

How long should application take?

Access should be given within 30 days of application being made. The period can be extended for further two months where requests are complex or numerous.

Fees

Access to medical records is free. However, practice can charge reasonable fee where an individual or body makes repeated request for the same information.

Apply For Access To Medical Records

• Online Access To Medical Records
• Proxy Access To Medical Records (For An Adult)
• Proxy Access To Medical Records (For A Child)

LumiraDX Care Solutions anti-coagulation clinics data is being moved to INRstar to a Cloud-First technology. Your anti-coagulation clinics data will be continued to be held in England. For further details about how this data is handled, please refer to the notice here. If you have any queries, please contact the practice manager.

For more information about this visit NHS Digital

As of 1st September 2021 your data will be shared with NHS Digital to help improve health, care and services.

Patient data from GP medical records kept by GP practices in England is used every day to improve health, care and services through planning and research, helping to find better treatments and improve patient care. The NHS is introducing an improved way to share this information – called the General Practice Data for Planning and Research data collection.

NHS Digital will collect, analyse, publish and share this patient data to improve health and care services for everyone.

This includes:

• informing and developing health and social care policy
• planning and commissioning health and care services
• taking steps to protect public health (including managing and monitoring the coronavirus pandemic)
• in exceptional circumstances, providing you with individual care
• enabling healthcare and scientific research

Any data that NHS Digital collects will only be used for health and care purposes. It is never shared with marketing or insurance companies.

READ MORE HERE

NHS Digital will not collect any patient data for patients who have already registered a Type 1 opt-out in line with current policy. If this changes patients who have registered a Type 1 opt-out will be informed.

If you do not want your patient data shared with NHS Digital, you can register a Type 1 opt-out with us. You can register a Type 1 opt-out at any time. You can also change your mind at any time and withdraw a Type 1 opt-out.

Data sharing with NHS Digital will start on 1st September 2021.

If you have already registered a Type 1 opt-out with your GP practice your data will not be shared with NHS Digital.

If you wish to register a Type 1 opt-out with your GP practice before data sharing starts with NHS Digital, this should be done by completing this form by 24 August 2021 to allow time for processing it.

If you have previously registered a Type 1 opt-out and you would like to withdraw this, you can also use the form to do this.

If you register a Type 1 opt-out after your patient data has already been shared with NHS Digital, no more of your data will be shared with NHS Digital. NHS Digital will however still hold the patient data which was shared with us before you registered the Type 1 opt-out.

If you do not want NHS Digital to share your identifiable patient data with anyone else for purposes beyond your own care, then you can also register a National Data Opt-out (also known as a Type 2 opt out).

What do you need to do?

If you are happy for your data to be shared as above, and you have not previously opted out – you do not need to do anything.

Type 1 OPT-OUT – to stop sharing your details with NHS digital (or to opt back in, if you have previously opted out) – Complete this form 

Type 2 OPT-OUT (also known as National Data Opt-out) – if you do not want NHS Digital to share your identifiable patient data with anyone else for purposes beyond your own care (or to opt back in, if you have previously opted out)

You need to, either:

• Call 0300 303 5678
• or complete their online form

As a GP practice WE CANNOT opt you out of Type 2 (National Data Opt-out)

However it should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors working in the practice and should not be used for any judgement about GP earnings, nor to make comparisons with other practices.

Introduction

Patient registration is determined by the provisions of the practice GMS or PMS contract and terms of service. This policy is based on the NHS England Standard General Medical Service Contract, the General Medical Services Contract Regulations, Primary Medical Care Policy and Guidance Manual (PGM) and CQC guidance.

Practices are assumed to have open lists unless they have complied with the procedures for list closure as detailed in the General Medical Services Contracts Regulations. Where a practice has an open list it is  required to:

• accept the registration of a new patient unless it has fair and reasonable grounds for not doing so
• accept allocations by the ICB to its list.

The practice can formally close their list to new patients by requesting permission from its commissioner. Formal list closure lasts between three to twelve months, and cannot last less than three months.

In some cases, it may be possible to request an ‘informal’ or ‘temporary’ list closure, lasting less than three months, for example where staffing difficulties result in suspension of registrations being necessary. GMS  and PMS contracts do not allow for these types of list closures, but taking into consideration possible risk to patient care, the practice can discuss these circumstances with their commissioner, who can either  provide further support or approve temporary closure, if appropriate.

Patient Choice of GP Practice

From 5th January 2015, all GP practices in England are free to register new patients who live outside their practice boundary area, without obligation to provide home visits. This will provide patients with greater  choice and aims to improve the quality of access to GP services.

Patients may wish to register as out of area patients to:

• register with a practice in more convenient locations, such as a practice near their work or closer to their children’s schools, or they reside within the area during the week, but their permanent address is in another area
• stay registered with their current GP if they have moved home but do not want to change GP
• register in an area with better access to services

These new arrangements are voluntary for GP practices. If the practice has no capacity at the time, or feels it is not clinically appropriate or practical for patients to be registered so far away from their home  address, they can still refuse registration for out of area patients. The practice should explain their reason for refusing registration to patients. When registration is refused, patient choice is not fully realised.

New Patient Acceptance/Refusal

New patients should submit a New Patient Registration/Health Questionnaire and the new style GMS1 Form.

The practice will accept patients onto its list while it remains “open”. If the list is closed, the practice will only accept registrations of immediate family members of patients who are already registered and only if such  relatives reside permanently at the registered patient’s address.

For patients who self-declare that they hold either a non-UK issued EHIC, PRC or S1 form, the practice is required to manually record this information in the patient’s medical record and then send a copy of the  GMS1 form to NHS Digital – NHSDigital-EHIC@nhs.net (for Non-UK issued EHIC/PRC details) or the Department of Work and Pensions (DWP) overseas.healthcare@dwp.gsi.gov.uk (for S1 forms).

Patients will not be unreasonably refused registration. This includes refusal based on:

• Medical condition
• Race
• Social class
• Gender or sexual orientation
• Disability
• Age
• Immigration status
• Religious group or religious beliefs
• Political beliefs
• Appearance or lifestyle

The practice will, however, refuse registration if the commissioner has agreed that they can close their list to new patients. The practice can also refuse registration (subject to a partners’ discussion and agreement) if:

• The patient has been previously removed from the list
• The patient has a known history of violence
• The patient lives outside the practice boundary
• If they have other reasonable grounds

The reason for refusal will be in writing and recorded in a permanent record for that purpose. This excludes temporary residents, where no record is necessary. The permanent record will consist of the original  GMS1 registration form endorsed with the reason for refusal, together with a copy of the refusal letter, filed in surname order. Where a GMS1 has not been completed, a “dummy” GMS1 will be prepared and filed. The record is subject to inspection by the ICB, who may require the practice to justify a refusal to register.

ID and Proof of Address

There is no regulatory requirement to prove identity, address, immigration status or the provision of an NHS number in order to register. ID and/or proof of address can be requested to assist with the administrative process, but the practice must apply the same process for requesting documents to all patients requesting registration equally. The majority of patients will not find it difficult to produce documents.

However, there will be some patients who do live in the practice area, but are legitimately unable to produce any of the listed documentation. Examples include:

• People fleeing domestic abuse staying with friends, family or in a shelter
• People living on a boat, in unstable accommodation or street homeless
• People staying long term with friends but who aren’t receiving bills
• People working in exploitative situations whose employer has taken their documents
• People who have submitted their documents to the Home Office as part of an application
• People trafficked into the country who had their documents taken on arrival
• Children born in the UK to parents without documentation.

Reasonable exceptions need to be considered and the individual registered with sensitivity to their situation. As there is no requirement under the regulations to produce identity or residence information, the patient MUST be registered on application unless the practice has reasonable grounds to decline. Lack of ID/proof of residence would not be considered reasonable grounds to refuse to register a patient and access to appointments should not be withheld in these circumstances. If a patient cannot produce any supportive documentation but states that they reside within the practice boundary then practices should accept the registration.

Where necessary, (e.g. homeless patients), the practice may use the practice address to register the patient, putting CO (care of) at the start of the address (as per CQC and PCSE advice). If possible, the practice  should try to ensure they have a way of contacting the patient if they need to (for example with test results).

If a practice suspects a patient of fraud (such as using fake ID) then they should register and treat the patient but hand the matter over to the NHS Counter Fraud Authority (NHSCFA).

Access to online services

It is important to note that whilst there is no requirement for ID when initially registering at this organisation, this should not be confused with those patients that wish to have access to online services. Should any  patient request online access, then full identification is required and the process should be followed as detailed within the Access to online services policy.

Temporary Residents

If a patient is resident in the practice area for more than 24 hours, but less than three months, they should be offered the option of registering as a temporary patient. In some cases (e.g. someone housed in  temporary accommodation) a prospective patient may not know how long they will reside in the area.

Please note: If there is uncertainty around the length of time a patient will reside in the practice area, NHS England advises that the patient should be registered as a permanent patient. For example, asylum  seekers residing in Home Office accommodation should be registered as permanent patients.

Emergency Treatment

All GP practices have a contractual duty to provide emergency treatment and immediately necessary treatment free of charge for up to 14 days. This applies to any person within their practice area who:

• Has been refused application for inclusion in the practice’s list of patients
• Is not registered with another provider of essential services
• Has had their application for acceptance as temporary resident rejected

Immediately necessary treatment in relation to people who are visiting England should be viewed as treatment of new and pre-existing conditions that have become worse during their stay. This is subject to the GP’s clinical judgement.

Support and Additional Needs

If a prospective patient requires additional support in order to register, the practice will do its best to accommodate this. This includes (but is not limited to):

• Walking them through the registration process in a more private area of the practice
• Using a translator/ interpreter
• Noting any accessibility requirements on the patient’s record so that the practice team is aware and can support them as necessary.

Once the patient is registered, the patient may benefit from other forms of support, including but not limited to:

• Provision of double appointments
• Reducing/ increasing prescription duration as necessary
• Promoting clear boundaries for consultations
• Providing fast access to a named GP
• Waiving normal charges for housing letters or medical reports

Ensuring services are accessible to everyone who needs them is mandatory. This includes following the Accessible Information Standard and provision of interpreting and translation services.

Registering Vulnerable Groups

Children

If a child under the age of 16 attempts to register alone, or with an adult who does not have parental responsibility for the child, the safeguarding lead should be informed.

It is recommended that the GP practice gains assurance by:

• Obtaining proof of identity for each child registering (e.g. a passport, or birth certificate). If a child does not have any form of ID, this should not prevent them from being registered. In this case, register the child,  but ensure that the safeguarding lead is made aware of the registration.
• Ensuring that an adult with parental responsibility is present at registration (and that they can prove parental responsibility).
• Offering a child a new patient health check
• Obtaining supporting documentation from other official sources (e.g. previous GP, social workers etc).

Where any doubt exists, the GP surgery’s safeguarding lead is to be informed and appropriate actions taken.

People with Insecure Immigration Status

Everyone in England, regardless of their immigration status, is entitled to free primary care and to register with a GP. This includes temporary visitors/ tourists, asylum seekers, refugees and other vulnerable migrants. When registering a patient, do not ask about their immigration status, or to see proof of it. People seeking asylum should be registered as permanent patients.

The GMS1 registration form includes supplementary questions about immigration status. These questions are optional – patients do not have to complete this section if they do not want to and this should be  communicated clearly to patients. If a patient does opt to complete this section, they should not be asked to provide proof for the information they have provided.

People Experiencing Homelessness

Individuals experiencing homelessness, those without a fixed address, or afraid to share their address, should be registered under either:

• an address of their choosing (e.g. a friend’s address, religious institution, or community centre). Advise the patient that they may receive confidential medical letters to this address, and that they should have the  occupiers consent
• under the practice address. When registering the patient, enter the full address, including postcode for the GP practice, putting ‘Care of’ at the start of the address. Writing ‘no fixed abode’ in any field will cause
• the registration request to be rejected.

Ensure that patients are advised to regularly check for post at the address they are registered at, so as not to miss any important medical correspondence (e.g. secondary care appointments).

Duty to refer

The Homelessness Reduction Act (2017) came into force in 2018. It places renewed emphasis on homelessness prevention. Section 10 requires public authorities in England to notify a local housing authority  (LHA) of service users they think may be homeless or at risk of becoming homeless.

This statutory duty to refer applies to:

• NHS organisations that provide inpatient care
• emergency departments
• urgent treatment centres.

It is not mandatory for primary care providers. However, it is still beneficial for GP practices to refer patients who are homeless, or are at risk of becoming homeless, to a local housing authority for further support.

Referrals must include:

• the service user name
• their contact details and
• an agreed reason for referring the user.

You can refer without consent to safeguard children and vulnerable adults. Guidance on the duty to refer can be found here.

Patients About to be Released from Prison

The process for registering patients prior to their release from the “secure residential estate” which includes prison, immigration removal centres, young offender institutions or secure training centres, is outlined  here.

Veterans

Ex-service personnel or reservists will be provided with copies of their medical records by DPHC (Defence Primary Health Care) on leaving the Armed Forces and becoming a veteran. These records should be  given to their new GP practice on registering.

Armed Forces veterans are entitled to priority treatment if their injury or condition came about because of their service (subject to clinical need). This is regardless of whether they receive a war pension. Further  guidance can be found here and here.

When registering veterans, the following SNOMED code should be entered at the time of registration: Military veteran SCTID: 753651000000107. Having this code will enable access to specialist care or charity  support as necessary for the patient.

Mental Capacity Act

If a person is unable to register because they are unable to make decisions about their care, registration can be done by:

• A relative
• The main carer
• A lasting power of attorney
• A person appointed by a court under the Mental Capacity Act

NHS Health Checks and New Patient Health Checks

All newly registered patients should be offered a New Patient Health Check. Some patients may also be entitled to an NHS Health Check. Please refer to the health check policy for further guidance.

Please also see below patient health questionnaires for people seeking asylum and refugees which can be shared during registration to improve efficiency and effectiveness of New Patient Health Checks.

Further Resources and Guidance

• Resources Hub

NHS guidance:

• How to register with a GP surgery
• Asylum seeker and refugee one-page registration guide
• Primary Medical Care Policy and Guidance Manual (PGM)

BMA support:

• Guidance on patient registration
• Toolkit for asylum seekers and refugees

PCSE support:

• PCSE guidance on registration
• PCSE contact details and enquiries form

CQC guidance:

• Registration mythbusters
• Registration of migrants, asylum seekers and refugees
• People experiencing homelessness

OHID

• Migrant Health Guide

Doctors of the World

• Safe Surgeries network
• Patient health questionnaires for refugees and people seeking asylum

Introduction

Patient registration is determined by the provisions of the practice GMS or PMS contract and terms of service. This policy is based on the NHS England Standard General Medical Service Contract, the General Medical Services Contract Regulations, Primary Medical Care Policy and Guidance Manual (PGM) and CQC guidance.

Practices are assumed to have open lists unless they have complied with the procedures for list closure as detailed in the General Medical Services Contracts Regulations. Where a practice has an open list it is  required to:

• accept the registration of a new patient unless it has fair and reasonable grounds for not doing so
• accept allocations by the ICB to its list.

The practice can formally close their list to new patients by requesting permission from its commissioner. Formal list closure lasts between three to twelve months, and cannot last less than three months.

In some cases, it may be possible to request an ‘informal’ or ‘temporary’ list closure, lasting less than three months, for example where staffing difficulties result in suspension of registrations being necessary. GMS  and PMS contracts do not allow for these types of list closures, but taking into consideration possible risk to patient care, the practice can discuss these circumstances with their commissioner, who can either  provide further support or approve temporary closure, if appropriate.

Patient Choice of GP Practice

From 5th January 2015, all GP practices in England are free to register new patients who live outside their practice boundary area, without obligation to provide home visits. This will provide patients with greater  choice and aims to improve the quality of access to GP services.

Patients may wish to register as out of area patients to:

• register with a practice in more convenient locations, such as a practice near their work or closer to their children’s schools, or they reside within the area during the week, but their permanent address is in another area
• stay registered with their current GP if they have moved home but do not want to change GP
• register in an area with better access to services

These new arrangements are voluntary for GP practices. If the practice has no capacity at the time, or feels it is not clinically appropriate or practical for patients to be registered so far away from their home  address, they can still refuse registration for out of area patients. The practice should explain their reason for refusing registration to patients. When registration is refused, patient choice is not fully realised.

New Patient Acceptance/Refusal

New patients should submit a New Patient Registration/Health Questionnaire and the new style GMS1 Form.

The practice will accept patients onto its list while it remains “open”. If the list is closed, the practice will only accept registrations of immediate family members of patients who are already registered and only if such  relatives reside permanently at the registered patient’s address.

For patients who self-declare that they hold either a non-UK issued EHIC, PRC or S1 form, the practice is required to manually record this information in the patient’s medical record and then send a copy of the  GMS1 form to NHS Digital – NHSDigital-EHIC@nhs.net (for Non-UK issued EHIC/PRC details) or the Department of Work and Pensions (DWP) overseas.healthcare@dwp.gsi.gov.uk (for S1 forms).

Patients will not be unreasonably refused registration. This includes refusal based on:

• Medical condition
• Race
• Social class
• Gender or sexual orientation
• Disability
• Age
• Immigration status
• Religious group or religious beliefs
• Political beliefs
• Appearance or lifestyle

The practice will, however, refuse registration if the commissioner has agreed that they can close their list to new patients. The practice can also refuse registration (subject to a partners’ discussion and agreement) if:

• The patient has been previously removed from the list
• The patient has a known history of violence
• The patient lives outside the practice boundary
• If they have other reasonable grounds

The reason for refusal will be in writing and recorded in a permanent record for that purpose. This excludes temporary residents, where no record is necessary. The permanent record will consist of the original  GMS1 registration form endorsed with the reason for refusal, together with a copy of the refusal letter, filed in surname order. Where a GMS1 has not been completed, a “dummy” GMS1 will be prepared and filed. The record is subject to inspection by the ICB, who may require the practice to justify a refusal to register.

ID and Proof of Address

There is no regulatory requirement to prove identity, address, immigration status or the provision of an NHS number in order to register. ID and/or proof of address can be requested to assist with the administrative process, but the practice must apply the same process for requesting documents to all patients requesting registration equally. The majority of patients will not find it difficult to produce documents.

However, there will be some patients who do live in the practice area, but are legitimately unable to produce any of the listed documentation. Examples include:

• People fleeing domestic abuse staying with friends, family or in a shelter
• People living on a boat, in unstable accommodation or street homeless
• People staying long term with friends but who aren’t receiving bills
• People working in exploitative situations whose employer has taken their documents
• People who have submitted their documents to the Home Office as part of an application
• People trafficked into the country who had their documents taken on arrival
• Children born in the UK to parents without documentation.

Reasonable exceptions need to be considered and the individual registered with sensitivity to their situation. As there is no requirement under the regulations to produce identity or residence information, the patient MUST be registered on application unless the practice has reasonable grounds to decline. Lack of ID/proof of residence would not be considered reasonable grounds to refuse to register a patient and access to appointments should not be withheld in these circumstances. If a patient cannot produce any supportive documentation but states that they reside within the practice boundary then practices should accept the registration.

Where necessary, (e.g. homeless patients), the practice may use the practice address to register the patient, putting CO (care of) at the start of the address (as per CQC and PCSE advice). If possible, the practice  should try to ensure they have a way of contacting the patient if they need to (for example with test results).

If a practice suspects a patient of fraud (such as using fake ID) then they should register and treat the patient but hand the matter over to the NHS Counter Fraud Authority (NHSCFA).

Access to online services

It is important to note that whilst there is no requirement for ID when initially registering at this organisation, this should not be confused with those patients that wish to have access to online services. Should any  patient request online access, then full identification is required and the process should be followed as detailed within the Access to online services policy.

Temporary Residents

If a patient is resident in the practice area for more than 24 hours, but less than three months, they should be offered the option of registering as a temporary patient. In some cases (e.g. someone housed in  temporary accommodation) a prospective patient may not know how long they will reside in the area.

Please note: If there is uncertainty around the length of time a patient will reside in the practice area, NHS England advises that the patient should be registered as a permanent patient. For example, asylum  seekers residing in Home Office accommodation should be registered as permanent patients.

Emergency Treatment

All GP practices have a contractual duty to provide emergency treatment and immediately necessary treatment free of charge for up to 14 days. This applies to any person within their practice area who:

• Has been refused application for inclusion in the practice’s list of patients
• Is not registered with another provider of essential services
• Has had their application for acceptance as temporary resident rejected

Immediately necessary treatment in relation to people who are visiting England should be viewed as treatment of new and pre-existing conditions that have become worse during their stay. This is subject to the GP’s clinical judgement.

Support and Additional Needs

If a prospective patient requires additional support in order to register, the practice will do its best to accommodate this. This includes (but is not limited to):

• Walking them through the registration process in a more private area of the practice
• Using a translator/ interpreter
• Noting any accessibility requirements on the patient’s record so that the practice team is aware and can support them as necessary.

Once the patient is registered, the patient may benefit from other forms of support, including but not limited to:

• Provision of double appointments
• Reducing/ increasing prescription duration as necessary
• Promoting clear boundaries for consultations
• Providing fast access to a named GP
• Waiving normal charges for housing letters or medical reports

Ensuring services are accessible to everyone who needs them is mandatory. This includes following the Accessible Information Standard and provision of interpreting and translation services.

Registering Vulnerable Groups

Children

If a child under the age of 16 attempts to register alone, or with an adult who does not have parental responsibility for the child, the safeguarding lead should be informed.

It is recommended that the GP practice gains assurance by:

• Obtaining proof of identity for each child registering (e.g. a passport, or birth certificate). If a child does not have any form of ID, this should not prevent them from being registered. In this case, register the child,  but ensure that the safeguarding lead is made aware of the registration.
• Ensuring that an adult with parental responsibility is present at registration (and that they can prove parental responsibility).
• Offering a child a new patient health check
• Obtaining supporting documentation from other official sources (e.g. previous GP, social workers etc).

Where any doubt exists, the GP surgery’s safeguarding lead is to be informed and appropriate actions taken.

People with Insecure Immigration Status

Everyone in England, regardless of their immigration status, is entitled to free primary care and to register with a GP. This includes temporary visitors/ tourists, asylum seekers, refugees and other vulnerable migrants. When registering a patient, do not ask about their immigration status, or to see proof of it. People seeking asylum should be registered as permanent patients.

The GMS1 registration form includes supplementary questions about immigration status. These questions are optional – patients do not have to complete this section if they do not want to and this should be  communicated clearly to patients. If a patient does opt to complete this section, they should not be asked to provide proof for the information they have provided.

People Experiencing Homelessness

Individuals experiencing homelessness, those without a fixed address, or afraid to share their address, should be registered under either:

• an address of their choosing (e.g. a friend’s address, religious institution, or community centre). Advise the patient that they may receive confidential medical letters to this address, and that they should have the  occupiers consent
• under the practice address. When registering the patient, enter the full address, including postcode for the GP practice, putting ‘Care of’ at the start of the address. Writing ‘no fixed abode’ in any field will cause
• the registration request to be rejected.

Ensure that patients are advised to regularly check for post at the address they are registered at, so as not to miss any important medical correspondence (e.g. secondary care appointments).

Duty to refer

The Homelessness Reduction Act (2017) came into force in 2018. It places renewed emphasis on homelessness prevention. Section 10 requires public authorities in England to notify a local housing authority  (LHA) of service users they think may be homeless or at risk of becoming homeless.

This statutory duty to refer applies to:

• NHS organisations that provide inpatient care
• emergency departments
• urgent treatment centres.

It is not mandatory for primary care providers. However, it is still beneficial for GP practices to refer patients who are homeless, or are at risk of becoming homeless, to a local housing authority for further support.

Referrals must include:

• the service user name
• their contact details and
• an agreed reason for referring the user.

You can refer without consent to safeguard children and vulnerable adults. Guidance on the duty to refer can be found here.

Patients About to be Released from Prison

The process for registering patients prior to their release from the “secure residential estate” which includes prison, immigration removal centres, young offender institutions or secure training centres, is outlined  here.

Veterans

Ex-service personnel or reservists will be provided with copies of their medical records by DPHC (Defence Primary Health Care) on leaving the Armed Forces and becoming a veteran. These records should be  given to their new GP practice on registering.

Armed Forces veterans are entitled to priority treatment if their injury or condition came about because of their service (subject to clinical need). This is regardless of whether they receive a war pension. Further  guidance can be found here and here.

When registering veterans, the following SNOMED code should be entered at the time of registration: Military veteran SCTID: 753651000000107. Having this code will enable access to specialist care or charity  support as necessary for the patient.

Mental Capacity Act

If a person is unable to register because they are unable to make decisions about their care, registration can be done by:

• A relative
• The main carer
• A lasting power of attorney
• A person appointed by a court under the Mental Capacity Act

NHS Health Checks and New Patient Health Checks

All newly registered patients should be offered a New Patient Health Check. Some patients may also be entitled to an NHS Health Check. Please refer to the health check policy for further guidance.

Please also see below patient health questionnaires for people seeking asylum and refugees which can be shared during registration to improve efficiency and effectiveness of New Patient Health Checks.

Further Resources and Guidance

• Resources Hub

NHS guidance:

• How to register with a GP surgery
• Asylum seeker and refugee one-page registration guide
• Primary Medical Care Policy and Guidance Manual (PGM)

BMA support:

• Guidance on patient registration
• Toolkit for asylum seekers and refugees

PCSE support:

• PCSE guidance on registration
• PCSE contact details and enquiries form

CQC guidance:

• Registration mythbusters
• Registration of migrants, asylum seekers and refugees
• People experiencing homelessness

OHID

• Migrant Health Guide

Doctors of the World

• Safe Surgeries network
• Patient health questionnaires for refugees and people seeking asylum

Subject Access Request – Churchill Medical Centre

We are committed to provide best possible care. If however, you have suggestions for improving our service or have a complaint about any aspect of our service you may ask for a suggestion slip/complaints pack or ask to speak to the Assistant Practice Manager of the site.

How to Complain

We hope that most problems are sorted out easily and quickly. Often at the time they arise and with the person concerned. If your problem cannot be sorted out in this way and you wish to make a complaint, we would like you to let us know ASAP. This would be within a matter of days or at most a few weeks because this will enable us to establish what had happened more easily.

If it is not possible to do that, please let us have details of your complaint:

• Within 6months of the incident that caused the problem;

Or

• Within 6months of discovering that you have a problem, provided this is within 12months of the incident

Complaints should be addressed to the Practice Manager. Alternatively you may ask for an appointment with the Practice Manager in order to discuss your concerns. They will explain the complaints procedure to you and will make sure that your concerns are dealt with promptly.

What we shall do

• We may ask you to put your complaint in writing
• We will acknowledge your complaint within two working days
• We will investigate the cause of your complaint
• We will aim to resolve your problem within ten working days

We will then be able to offer you an explanation or a meeting. When we look into your complaint we shall aim to;

• Find out what happened and what went wrong
• Make it possible for you to discuss the problem with those concerned (if you would like this)
• Where appropriate make sure you receive an apology
• Identify the problem and take steps to make sure the problem doesn’t happen again

Complaining on behalf of someone else

Please note that we keep strictly to the rules of medical confidentiality. If you are complaining on behalf of someone else, we must have his/her signed consent / permission.

SUGGESTIONS AND COMPLAINTS

Patient charter: our commitment to you as a veteran of the UK Armed Forces

The NHS is here to help improve your health and wellbeing and keep you mentally and physically well. It is also here to help you get better when you are ill and, when you cannot fully recover, to stay as well as you can until the end of your life.

This means that you can expect the following from our practice

• We will ask all patients if they have served in the UK Armed Forces (as a regular or reservist). If you have, we will note this in your medical record, with your permission.
• We will ask you to share details of your time in service to help us to assess the best support and treatment for you.
• The information you share will be kept confidential and we will always speak to you before sharing this with other services you may be referred to.
•     You can make an appointment to see our clinical lead for veteran’s health. This person has a comprehensive understanding of the Armed Forces, health conditions linked to service, and the dedicated support you can access.
• The NHS has a duty to support the health commitments of the Armed Forces Covenant. This means that you will get priority treatment for any medical condition which has been caused by your service, subject to the clinical needs of other patients.
• We will let you know what choices are available for your care and treatment and help you to make informed decisions on what to do.
• Where appropriate and with your consent, we can refer you to dedicated veterans health services.
• If you need to be seen by another service, we will let them know you’re a veteran and make sure they have an understanding of your health and wellbeing needs, so you don’t have to keep repeating your ‘personal story’.
• We can give advice and support to your loved ones who may be affected by your health conditions.
• We will investigate any issues and complaints that you may have about your care. If you have any concerns about the services we offer, please speak to one of the practice team.

Top tips for veterans

1. It is important to register with a GP, rather than wait until you need treatment. Visit the NHS website to find details of GP practices in your local area.
2. If you’ve recently left the forces, it is important to give your GP the paperwork that your military medical centre gave you, including any medical records. This will help to make sure your military health record transfers to your NHS health record. This will also give your GP information on your health and ensure that any ongoing care and treatment is continued.
3. Regardless of when you left the military, tell your GP that you’ve served in the UK Armed Forces. This will help your GP to better understand any military related health conditions that you may have and ensure that you are referred, where appropriate, to dedicated services for veterans.
   • This includes the specialist mental and physical health services, Op COURAGE: The Veterans Mental Health and Wellbeing Service and the Veterans Trauma Network.
   • When using these services, you will be able to speak to people who:
     • understand the Armed Forces and military life
     • are either from the Armed Forces community or highly experienced in working with serving personnel, reservists, veterans and their families
     • will work with you to make sure you get the right type of specialist care, support, and treatment
     • work closely with a range of organisations and charities, including military charities, to support your wider health and wellbeing needs.
4. With your agreement, it can sometimes be helpful for your doctor to refer you to Armed Forces charities, such as SSAFA, the Royal British Legion, Combat Stress or Help for Heroes. They can often offer significant help and support, even if they do not all deliver healthcare.
5. You may be worried about sharing information about your time in the Armed Forces. Please note that the NHS is bound by a confidentiality code of practice to ensure GPs, nurses and other people working within the NHS deliver a confidential service bound by law.