Primary care organisation and management issues Flashcards
What is a patient specific direction (PSD)?
an instruction by a prescriber to supply or administer medication to a named patient after prescriber has assessed the pt on an individual basis, must be written and signed by prescriber (signature can be written or electronic), e.g. for a HCA to administer a VitB12 injection.
Patient Group Direction (PGD)-for a group of patients with a specific illness or condition, written instruction. Cannot be used by HCAs to treat patients. Patients must have their suitability assessed. NOT a form of prescribing.
e.g. use in vaccination clinics, family planning clinic, minor illness clinics, travel clinics.
authors should include a pharmacist and a doctor or dentist
must state which HCP is giving the treatment, the condition to be treated and the pre defined groups covered
CANNOT be used for unlicensed medicines, medical devices, dressings, radiopharmaceuticals, abortifacients
What is the General Medical Services (GMS) contract?
a contract between general practices and primary care organisations
their global sum is calculated using the Carr-Hill formula-looks at age and deprivation of the population
What are Directed Enhanced Services (DES)?
Enhanced services are primary medical services other than essential services, additional services or out-of-hours services and Directed Enhanced Services are nationally commissioned through the GP contract by NHS England and legally directed by the Secretary of State
What does the Data Protection Act 1998 govern?
access to the health records of living people
*now been replaced by GDPR and DPA 2018
What act allows qualified access to a deceased persons health records where the person seeking access has an interest in the estate of the deceased?
Access to Health Records Act 1990-this allows a person to access the records of a deceased person if they have a legitimate reason (NOK, legal executor of will, previously got permission from relative)
note people who have rights to access this information either are personal representatives or anyone who may have a claim arising out of a patients death
access must be given within 21 days if application concerns records made in the 40 days immediately before access request made, within 40 days if not
must be given free of charge
health records must be kept for 10 years after pt has died
When must a response to information requested under the Freedom of Information Act be made?
within 20 working days
The Act gives a general right of public access to recorded information held by public authorities including Primary Care Organisations (PCOs)-Act covers general info held
Which Act conveys power to the secretary of state for health to make regulations to enable/require release of, patient information where disclosures would otherwise be restricted by common law e.g. info regarding cancer treatment or control of communicable disease?
Health and Social Care Act 2001
What does the Access to Medical Reports Act allow patients to do?
To see medical reports about them, for employment or insurance purposes, written by the doctor with who them normally have a patient/doctor relationship.
Insurance/employment companies must inform the patient of their intent to seek a medical report and patient consent MUST be obtained.
Which form can GPs complete to fast track a patient’s application for PIP/employment and support allowance/attendance allowance/universal credit, if the patient meets criteria for ‘Special Rules for Terminal Illness’?
DS1500-proves that a patient is eligible for these
In what situations should the FRAYED consultation model be used?
where unreasonable demands are being made by difficult patients
F-fact-finding R-refusal (ideally not absolute) A-acceptable alternative Y-yield or don't yield E-end the encounter D-document diligently
How long can a fit note be issued for in the first 6 months of a patients condition?
maximum of 3 months
What is the name given to the request made by a patient (or 3rd party if authorised by the patient) for access to their health records under the GDPR (and DPA 2018)
subject access request
note patients do not need to give reasons as to why they wish to access their records
cannot charge for access UNLESS request manifestly unfounded or excessive e.g. duplicate request
must ensure any 3rd party information is removed
Within what time frame must data be provided if a subject access request is made?
within 28 days
can be extended for 2 months if necessary (complex or numerous requests)
Who can patients complain to if their subject access request is refused?
the information commissioner’s office (ICO)
2 absolute contraindications to organ donation?
HIV
CJD
What is attendance allowance?
a tax free benefit for people aged 65 and over (reached pension age) who need help with personal care due to mental or physical disability.
Within what time frame can a patient make a formal complaint after an incident?
within 1 year of the incident or of becoming aware of it
a formal complaint must be acknowledged by telephone or letter within 3 working days of its receipt, stating that the complaint will be investigated
What form is used to temporarily register patients with a practice?
GMS3 form
must be temporarily registered if require care for more than 14 days
can receive emergency tx from any GP if not registered and need to see one
What form is used to register a patient on a permanent basis?
GMS1 form-entitles patients to free healthcare
What form is used to certify requirements for TOP?
HSA 1 form
must be kept by clinic performing TOP for 3 years after the termination
must be completed, signed and dated by 2 registered medical practitioners
How long can a patient be registered as a temporary resident for with a practice?
3 months
What is notional rent?
type of income for a GP practice-NHS will pay the practice if they own the building as building being used to see NHS patients, this will reflect current market
reasonable rent=PCO reimbursement for rented buildings used for NHS work
Form for patient to self certify sickness for 1st 7 calendar days?
SC2 form
SC1 is for someone who is self employed
Who is the general medical services (GMS) contract between?
GP practices and primary care organisations (PCO)
How long do patients from overseas need to be staying in the UK for to be entitled to free non-emergency healthcare?
6 months
Emergency tx or immediately necessary tx must be offered to visitors free of charge for a period less than or equal to 14 days
What are refugees entitled to in terms of free NHS treatment?
they are treated as ordinarily resident therefore entitled to free care irrespective of whether or not awarded leave to stay
as are asylum seekers and prisoners
At what age are patients entitled to free prescriptions on the NHS?
age 60
all children up to 15 years of age
age 16-18 and in full time education
What are patient group directions?
legal framework that allows some HCPs to supply/administer specified medicines to a pre defined group of patients without them having to see a prescriber e.g. administration of flu jab
What name is given to the criteria that should be met of a screening test?
Wilson-Jungner criteria
When is the NHS FP69 Regulation used to remove patients from a practice list?
where patient’s address cannot be confirmed, patient will be removed after 6 months
Process of removing a patient from practice list if violent towards staff?
immediate removal, police must have been called
in other cases of removal a written warning should be given beforehand and NHS England must be informed in writing which takes 8 days
Total entitlement time for both parents if taking shared parental leave?
50 weeks
can share up to 37 weeks of pay
Who is notified in order for patients to be removed from practice lists?
Primary Care Support England
Up to how long after a medical report is sent can a patient request access to see it?
6 months after
doctors must keep copies of report for 6 months
if pt requests a copy of the report doctor can charge a fee
How long does a patient have to see a medical report before it is sent if they have asked to do this?
21 days
reports should be sent within 20 working days of request
What should happen if a patient requests amendment to a medical report which the doctor does not agree with?
doctor should add a note to the report regarding the disputed information
What happens if a patient refuses to give permission for certain relevant information on a medical report?
doctor should indicate to the applicant (insurance/employment company) that they cannot write the report, being careful NOT to reveal the information that the patient did not want included
When does removal of a patient take effect after a written notice has been received by the PCO/NHS England?
will take effect on the eighth day after the request is received
Should a patient be issued a warning about removal from practice list if they have moved outside the area?
no
What is supplementary prescribing?
voluntary partnership between an independent prescriber (must be a doctor or dentist) and a supplementary prescriber-they work in accordance with an agreed patient specific management plan
can prescribe controlled drugs except diamorphine, dipipanone or cocaine for the treatment of drug addiction
dieticians and diagnostic radiographers can train to become supplementary prescribers but not independent prescribers
Difference between community nurse prescribers and nurse and pharmacist independent prescribers?
community nurse prescribers can only prescribe from the nurse prescriber’s formulary, whereas independent prescribers can px any licensed or unlicensed medication or controlled drug (except diamorphine, dipipanone or cocaine for drug addiction) that is not on the black list.
Form to apply for statutory paternity pay?
SC3
