Practice Policies & Patient Information

Access to your Records

All information held about patients is completely confidential and everyone working for the NHS has a legal duty to maintain the highest level of confidentiality about patient information.

Your Medical Record

If you wish to access your own personal health records you can do so online via Patient Access. Please click here to go to the Patient Access page for information. Due to current data protection legislation we will ask you to request the access in writing by completing specific forms. This will allow as to set up Patient Access for you. The request will have to be processed by our administration team which due to large number of requests made may take a few days.

If you wish to request a copy of your medical records the quickest way to do so is through Patient Access. They will not only be available to you at time of you choosing but also will be current including your recent consultations. If you cannot access your medical records online then an encrypted disc can be created for you. Please contact the reception for more information.

If you would like a third party to view your records (solicitor/other) you will need to complete one of our consent forms. We will then contact the third party company and advise them of this process. Please contact us for more information.

You will not be charged for accessing your medical records.

What information do we hold about you?

We ask you for information about yourself so we can give you the most appropriate care and treatment. This information is kept together with details of the care you receive for future reference. For a full list of the information we keep/share please contact the surgery or click on the documents below:

How do I know it will be kept in a confidential way?

Everyone working for the NHS or in General Practice has a legal, ethical and contractual duty to keep information confidential and anyone who receives information from us is bound by the same legal duty.

Will my information be shared with anyone?

If you are receiving care from other people as well as the NHS, we may need to share information to enable us all to work together for your benefit. We only ever use or pass on information about you if people have a genuine need for it in your and everyone’s interest.

For a full list of the information we share please contact the surgery or see the documents above.

The sharing of some information is strictly controlled by law, so unless there are exceptional circumstances, such as when the safety of others is at risk, we will not disclose your information to other parties without your permission.

Requesting access on behalf of someone else (child/carer etc)

If you would like to request medical records access on behalf of another person (carer etc) then please request this via our appropriate consent form.

Average GP Net Earnings

NHS England require that the net earnings of doctors engaged in the practice is publicised and the required disclosure is shown below.

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 spend working in the practice and should not be used to for any judgement about GP earnings, nor to make any comparisons with other practices.

The average earnings for GPs working in the Firdale Medical Centre in the last financial year ending in 2023/24 was £67,135 before taxation and National Insurance.

This is for 2 full time GPs, 6 part time GPs and 2 locum GPs who worked in the practice for more than 6 months.

Cheshire Care Records

Fair Processing Notice

This notice briefly explains why the doctor’s surgery collects information about you, and how that information may be used.

The health and social care professionals who provide you with care maintain records about your health and any treatment or care you have received previously (e.g. NHS Trust, GP Surgery, Walk-in clinic, social care package etc.). These records help to provide you with the best possible health and social care.

Records may be held in electronic or manual (written down) format, and may include the following information;

Details about you, such as address and next of kin
Any contact the surgery has had with you, such as appointments, clinic visits, emergency appointments, etc.
Notes and reports about your health
Details about your treatment and care
Results of investigations, such as laboratory tests, x-rays, etc.
Relevant information from other health professionals, relatives or those who care for you and know you well

To ensure you receive the best possible care, your records are used to facilitate the care you receive and will be shared with other health and social care professionals to aid decision making about your total care package.

Information held about you may also be used to help protect the health of the public and to help us manage the NHS. Information may be used for clinical audit to monitor the quality of the service provided. Where we do this, we take strict measures to ensure that individual patients cannot be identified.

Some of this information will be held centrally and used for statistical purposes. Where we do this, we take strict measures to ensure that individual patients cannot be identified.

Sometimes your information may be requested to be used for research purposes – the surgery will always endeavour to gain your consent before releasing the information.

Should you have any concerns about how your information is managed at the surgery please contact the Patient Services Manager to discuss how the disclosure of your personal information can be limited.

How do we maintain the confidentiality of your records?

Every member of staff who works for an NHS or social care organisation has a legal obligation to keep information about you confidential. Anyone who receives information from an NHS or social care organisation has a legal duty to keep it confidential.

We maintain our duty of confidentiality to you at all times. We will only ever use or pass on information about you if others involved in your care have a genuine need for it. We will not disclose your information to any third party without your permission unless there are exceptional circumstances (i.e. life or death situations), or where the law requires information to be passed on.

Who are our partner organisations?

We may also have to share your information, subject to strict agreements on how it will be used, with the following organisations:

NHS Trusts / Specialist Trusts / Independent Contractors such as dentists, opticians, pharmacists
Private Sector Providers / Voluntary Sector Providers
Ambulance Trusts / Clinical Commissioning Groups /Social Care Services
Local Authorities / Education Services / Fire and Rescue Services / Police / Other ‘data processors’

Access to your Information

You have a right under the Data Protection Act 1998 to access/view what information the surgery holds about you, and to have it amended or removed should it be inaccurate. This is known as ‘the right of subject access’. If you would like to make a ‘subject access request’, please contact the Patient Services Manager in writing.

Medication for patients having MRI scans and other investigative procedures

After very careful consideration, Firdale Medical Centre have decided to no longer prescribe diazepam for patients having MRI scans or other investigative procedures. This is not a decision we took lightly; we have a duty of care to provide safe, consistent, and appropriate care for our patients. I hope the reasons outlined below help to explain our main concerns.

Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic for most adults for any effective sedation. Conversely anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.
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 sub optimal.
GPs are not regularly involved, skilled, trained or appraised in sedation skills.
All hospital consultants, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs. 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.
Sedated patients should be regularly monitored, and we have been made aware of a case where a GP provided sedative was given, the patient not monitored, and subsequently had a respiratory arrest in an MRI machine.
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:

Sedation, analgesia and anaesthesia in the radiology department

You may wish to discuss this with your radiologist or consultant regarding the next steps.

Patient Privacy Notice

Prescribing Medication for Anxiety Surrounding Flying

The practice does not provide diazepam, temazepam, zolpidem or any other anxiolytic drugs for use on flights or for travel. The rationale for this decision is related to the clear risks of using this class of medication during travel, which are well documented in online medical resources.

Use of Benzodiazepines (and related medications) for flying

Benzodiazepines (e.g., Diazepam/ Lorazepam/Temazepam/Alprazolam/ Clonazepam) are drugs which have been in use since the 1960s for treatment of a wide range of conditions including alcohol withdrawal, agitation and restlessness, anxiety, epilepsy and seizures, neurological disorders. muscle spasms, psychiatric disorders, and sleep disturbance.

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 deleterious 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 may request a doctor or nurse prescribes diazepam for fear of flying or to assist with sleep during flights. Diazepam is a sedative, which means it makes you sleepy and more relaxed. There are several 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. [i] It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” [ii] 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 [iii]. 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 [iv] 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 some countries [v]. 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.

Given the above we will no longer be providing Diazepam or similar drugs for flight anxiety and instead suggest the below aviation industry recommended flight anxiety courses.

For further information:

[i] British National Formulary; Diazepam – bnf.nice.org.uk/drug/diazepam.html

[ii] British National Formulary; Hypnotics and anxiolytics – bnf.nice.org.uk/treatment-summary/hypnotics-and-anxiolytics.html

[iii] Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical guideline [CG113] Published date: January 2011 Last updated: July 2019 www.nice.org.uk/guidance/cg113

[iv] Acute and delayed effects of Alprazolam on flight phobics during exposure. Behav Res Ther. 1997 Sep;35(9):831-41

[v] Travel Health Pro; Medicines and Travel; Carrying medication abroad and advice regarding falsified medication – travelhealthpro.org.uk/factsheet/43/medicines-abroad

Prescribing Opioid Medication Policy

Many of our patients take strong, potentially addictive medication to help manage their condition(s). Of concern are ‘drugs of dependence’ (e.g., opioid medications and benzodiazepines), particularly when these are prescribed on an on-going basis.

Due to increasing reports of abuse of prescription drugs and patient behavioural problems, Firdale Medical Centre has established a policy to ensure adequate treatment of your condition, while reducing the risk of problems with prescription drugs.

If you are a new patient to the practice:

It may take time to get accurate medical information about your condition. Until such information is available, your GP may choose not to prescribe any medication. It is our policy that GPs do not prescribe drugs of dependence until they have a full clinical picture.
Your GP may decide not to continue prescribing an opioid medication previously prescribed for you. It may be determined that such medication is not suitable. It is our policy that GPs do not prescribe drugs of dependence if they feel that previous prescriptions were inappropriate. Following current prescribing guidance, we will no longer be prescribing Tramadol.
Your GP will evaluate your condition and only prescribe an opioid of the strength necessary for you. This may be different to the strength you had prescribed at your previous GP Practice.

General practice standards:

If the decision to prescribe is taken after a shared discussion of goals, plans, risks, and benefits, you may be required to confirm your consent in writing.
You will be asked to complete an opioid management plan treatment agreement that gives details of our practice’s expectations when prescribing drugs of dependence. This agreement also describes your responsibilities as a patient when taking a drug of dependence; any prescriptions issues; advice on taking your medications; how we will monitor your care; and the standards of behaviour that are expected.
Patients may need to acknowledge that their care requirements are complex, and that referral for on-going support for all or part of your healthcare may be required. It is our practice policy that patient care is matched with the level of complexity.
Patients are reminded that we have zero tolerance on issues relating to staff abuse.
Prescribing Opioid Medication Policy

Private Shared Care Agreements for Adults and Children with ADHD

Firdale Medical Centre took a decision to suspend acceptance of shared care agreements for adults and children with ADHD currently under care of private providers. We are also suspending acceptance of new shared care agreements for children under NHS providers.

Rationale:

Shared care agreements should guarantee continuation of care and clinical oversite by consultant including regular reviews, testing and investigations as well as access to advise should GP require it to continue prescribing medication safely.

Our experience is that those agreements are not adhered to and as such we cannot continue engaging with them.

Please note there is no contractual requirement for a GP to enter shared care with private provider. Practices can decline on capacity or clinical grounds.

For more information, please read following article:

General practice responsibility in responding to private healthcare (bma.org.uk)

Research Statement

Our practice is a research active practice. This means we actively support and conduct different types of research with the intention of improving outcomes for patients. New treatments, technologies, care approaches and devices all need to be carefully and safely tested in real life healthcare environments. Clinical research in these environments is separately funded and adds value to patient care.

The COVID-19 pandemic illustrated the importance of clinical research, which was crucial to the development of vaccines and treatments that have saved millions of lives globally. Clinical research is essential for discovering new treatments for diseases, as well as new ways to detect, diagnose, and reduce the chance of developing the disease and by improving the efficiency and efficacy of care it can be a vital tool in tackling waiting list backlogs and reducing the pressure on the NHS.

You may be approached or invited to consider taking part in research from time to time. Participation in research is completely voluntary and your decision to take part or not will not affect your clinical care in any way.

Our practice works with the NIHR Clinical Research Network North West Coast, who provide support to enable us to offer research to our patients. Every research study is different, and patient involvement varies- depending on the type of study. You will be provided with information on the study to help you decide whether you want to be part of it or not. Below are some examples of what you may be asked to do for a research study:

Complete a questionnaire
Take part in an interview
Use a new therapy / device / website
Take a treatment under supervision

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. The CQC now has a remit to assess how care organisations are supporting and using health and care research to improve population health. The 2021 CQC Strategy specifically refers to the value of research in population care. If you do not wish to be approached for research please contact the practice.

Site Research Staff – who they are ( GP Lead / Admin support / Nurses / HCAs) and are they GCP trained?

Current studies / Past Studies

Research Accreditations / Award nominations etc – for example: RCGP Research Ready

Your Patient Participation Group (PPG) should be aware and supportive of your drive to get ready to do research. They can also help to suggest what research might be welcomed by your patients.

Patient Research Links:

Join Dementia Research connects registered volunteers with dementia researchers across the UK who are looking for people to join their studies: Join dementia research
Research for The Future has opportunities to get involved in research across all health conditions as well as for healthy volunteers: Research for the Future
NIHR Evidence makes health and care research findings informative, accessible, relevant and ready for use for all: https://evidence.nihr.ac.uk/

Useful links for organisations to look at:

Best Patient Care, Clinical Research and You staff guide Best Patient Care, Clinical Research and You – NHS R&D Forum

Embedding Research in Health and Care Services https://express.adobe.com/page/pV98Q9HG5cZCW/

Maximising the benefits of research: Guidance for integrated care systems NHS England » Maximising the benefits of research: Guidance for integrated care systems

We are a teaching practice

Postgraduate Training – Firdale Medical Centre is a teaching practice and offer placements for registrar and trainee doctors who have worked in hospitals for a number of years. This is valuable work experience and also benefits us by stimulating new ideas within the practice.
Teaching Medical Students – We also teach in association with the University of Manchester and students may be present at your consultation but we will give you notice of this in advance. Please speak to one of our receptionists if you would prefer to see the doctor on your own.