Practice Statements

1. Shared care requests from private providers

Some patients choose to see a private specialist or clinic. The private provider may then ask your NHS GP to take over prescribing, monitoring or blood tests. This is called a shared care agreement. Eastgate Surgery does not enter into shared care agreements with private providers.

This applies to all conditions and medicines, including:

• ADHD medication.
• Hormone treatment for gender dysphoria.
• Weight-loss injections.
• Testosterone.
• Other treatment started privately.

Why we have this policy

• Taking on prescribing makes our clinicians legally responsible for treatment they did not start and cannot fully oversee.
• Shared care with private providers is not part of our NHS contract and is not funded.
• Local NHS guidance in Bedfordshire, Luton and Milton Keynes advises keeping NHS and private care separate.
• Treating every request in the same way is fairer to all our patients.

What this means for you

• Your private provider will need to continue your prescriptions, monitoring and follow-up for as long as you need treatment. Please check the ongoing costs with them before you start.
• We will not issue NHS prescriptions recommended by a private provider, and we will not arrange blood tests or monitoring on their behalf.
• You can still see us for anything else, and you can ask us about referral to the relevant NHS service if one is available.

We will still consider shared care requests from NHS hospital and community specialist services on a case-by-case basis.

If you already receive medication from us under a shared care agreement, nothing will change without a conversation with you first.

2. Right to Choose: ADHD and autism assessments

Under the NHS Right to Choose, you can ask to be referred for an ADHD or autism assessment to any provider that holds an NHS contract, rather than waiting for the local NHS service. We are happy to make these referrals where a referral is clinically appropriate.

Please read before choosing a provider:

Eastgate Surgery does not enter into shared care agreements with Right to Choose providers. We will not take over prescribing or monitoring of ADHD medication after your assessment or after treatment starts.

Before asking us to refer you, please choose a provider that will:

• Diagnose you and, if needed, start your medication.
• Continue to prescribe your medication on the NHS for the whole length of your treatment; and
• Carry out your ongoing monitoring and reviews.

Many Right to Choose providers can issue NHS prescriptions directly to you, so you should not need to pay for medication. Please confirm this with the provider before your referral.

How to request a referral

• Choose a provider and check that it offers ongoing NHS prescribing.
• Complete any forms the provider asks for.
• Send the forms to us using our online consultation form, or hand them in at reception.
• We aim to process referral requests within [10] working days.

If a provider later asks us to take over prescribing, we will decline the request and your care will stay with the provider.

3. Requests from private providers for tests and investigations

If you see a private doctor, clinic or online service, they may suggest that your GP arranges blood tests, scans, ECGs or other investigations.

We do not carry out tests or investigations requested by private providers. Requesting a test makes the requesting clinician responsible for reviewing the result, acting on it and explaining it to you. A clinician who has not assessed you cannot safely do this, and this work is not part of our NHS contract.

What to do

• Ask your private provider to arrange the tests themselves. Most can arrange private blood tests and scans directly.
• If you have new symptoms or are worried about your health, you can still contact us in the usual way and we will assess you as an NHS patient.

4. Requests from NHS hospitals

National NHS guidance sets out what hospitals and specialist services should do for their own patients. This means you should not need to contact the surgery to complete care that a hospital team has started.

The hospital team should:

• Arrange and give you any blood tests or investigations they need for your hospital care, and tell you the results.
• Give you a fit note covering the full time they expect you to be off work, if one is needed.
• Make any onward referral to another hospital specialist themselves.
• Supply enough of any new medicine to last until your GP practice has received their letter, usually at least [14] days; and
• Give you a contact number for questions about your hospital care, appointments or results.

If a hospital team asks you to see your GP for something on this list, please contact the hospital department first. If you are unsure, our reception team can tell you who to contact.

This does not stop you contacting us about any new or worsening problem. We will always see you for that.

5. Medication for fear of flying

We understand that fear of flying is real and can be very distressing. However, our clinicians do not prescribe diazepam or other sedatives for fear of flying, or to help you sleep on a flight. This decision has been made by the GP partners and applies to every prescriber at the practice.

Why we do not prescribe sedatives for flying:

• National prescribing guidance (the British National Formulary) does not recommend benzodiazepines such as diazepam for phobias, including fear of flying.
• Sedatives slow your reactions. In an emergency on a plane you may not be able to respond quickly or follow instructions.
• Sedated sleep reduces how much you move, which can increase the risk of blood clots on long flights.
• Diazepam is a controlled drug in some countries and can be illegal to carry, even with a UK prescription.
• It can stay in your system for days and may cause a positive result in workplace drug tests.
• Fear of flying alone is not part of the services covered by our NHS contract.

What can help instead

• Fear-of-flying courses run by airlines, such as easyJet Fearless Flyer, British Airways Flying with Confidence and Virgin Atlantic Flying Without Fear.
• Self-help resources and breathing techniques for anxiety on the NHS website.
• If anxiety affects other parts of your life, speak to us or refer yourself to the local NHS Talking Therapies service.

6. Sedation for scans, dental treatment and procedures

We do not prescribe sedatives such as diazepam to help you through an MRI scan, dental treatment or another procedure. Safe sedation needs the right monitoring, which we cannot provide in general practice. The team carrying out your scan or procedure is responsible for deciding whether you need sedation and providing it safely.

What to do

• If you feel anxious or claustrophobic about a scan, contact the department that arranged it. Many offer open scanners, a visit beforehand or sedation on site.
• If you are anxious about dental treatment, speak to your dentist, who can arrange sedation or refer you to a specialist dental service.

7. Over-the-counter medicines for minor conditions

In line with national NHS guidance, we will not usually prescribe medicines that you can buy from a pharmacy or shop for short-term, minor conditions.

Examples include coughs and colds, hay fever, mild acne, head lice, indigestion, minor aches and pains, mouth ulcers, nappy rash, threadworm and travel sickness. Medicines for these are often cheaper to buy than an NHS prescription charge.

Where to get help

• Your local pharmacist can advise on minor illnesses without an appointment.
• Under Pharmacy First, pharmacists can assess and treat some common conditions, including some that need prescription-only medicines.
• There are exceptions, for example long-term conditions, more serious symptoms, or where a medicine is not licensed for over-the-counter use in your circumstances. Our clinicians will decide with you when an exception applies.

8. Medicines for travel and time abroad

Your regular medicines
If you are travelling abroad, please order your repeat medicines in good time. We can usually provide a supply of your regular medicines to cover a trip of up to 3 months.  The NHS is not responsible for prescribing for people who live abroad or are away for longer than 3 months. You will need to get further supplies from a doctor in the country you are staying in.

Medicines just for travel
Medicines that are only needed because you are travelling, such as antimalarial tablets, altitude sickness medicines or standby antibiotics, are not provided on the NHS. These are available from
travel clinics and many pharmacies.

Travel vaccinations
Some travel vaccinations are free on the NHS and some are private. Please contact us at least 8 weeks before you travel. Further details are on our travel health page.

Living abroad
If you move abroad for more than 3 months, you may no longer be eligible to stay registered with the practice. Please let us know your plans.

9. Medicines recommended by doctors abroad

If you have seen a doctor outside the UK, please bring any letters or prescriptions to your appointment, translated into English where possible. Our clinicians will review the recommendation, but we may not be able to continue the same treatment. This may be because the medicine is not licensed or available in the UK, is not recommended by NHS or local guidance, or needs specialist monitoring. Where possible we will offer the nearest suitable NHS alternative or refer you to the right NHS service.

10. Non- NHS work and fees

Why do GPs charge for some work?
The NHS provides most care free of charge, but not everything GPs are asked to do is part of NHS care. GPs are not employed by the NHS. Our NHS contract covers the medical care of our registered patients. It does not cover work such as reports for insurers, employers or solicitors. For this work we charge a fee, which covers the time and practice costs involved. Our fees are based on guidance from the British Medical Association (BMA). Examples of non- NHS work:
• Insurance claim forms and reports, including holiday cancellation.
• Medical reports for employers, solicitors and insurance companies.
• Fitness-to-participate letters (sports, gyms, events) and pre-employment medicals.
• Driving medicals (HGV, PSV, taxi).
• Letters for schools, housing or travel.
• Private prescriptions for travel.
• Some travel vaccinations.

Do GPs have to do this work?
No. Apart from a few exceptions, such as confirming that a patient is unfit for jury service, GPs are not required to do non-NHS work. Requests are accepted at the GP’s discretion.

How long will it take?
Non- NHS work is done outside time set aside for NHS patient care, so that NHS care is not affected. You will be advised on the estimated turn around for required documents. We are unable to offer same-day or urgent turnaround.

Payment
Fees must be paid in advance, before the work is completed. A list of our current fees is available at reception and on request. Things that are free:
• Fit notes for illness lasting more than 7 days.
• Your first copy of your own medical records (subject access request).
• NHS referrals and NHS prescriptions.

Things that do not need a GP
• Passport photo and form countersignatures can be done by other professionals. Please check the guidance on gov.uk.
• For sickness of 7 days or less, you can self-certify with your employer.

11. Ear wax

Ear wax is normal and usually clears on its own. Please do not use cotton buds, which can push wax further in. Try self-care first:
• Use ear drops or olive oil spray (available from pharmacies) 2 to 3 times a day for 2 to 3 weeks.
• Your pharmacist can advise you on suitable products.

If symptoms continue
If your hearing is still affected after using drops for 3 weeks, or you have pain, discharge, dizziness or sudden hearing loss, please contact us. Our clinicians will assess whether you need wax removal or another treatment.

12. Firearms and shotgun certificates

We do not complete paperwork for shot gun licences.

13. Letters we can and cannot provide

We regularly receive requests for letters to support applications or explain absences. Many of these are not part of NHS care or are not needed at all. We do not usually provide:
• “To whom it may concern” letters for housing, council or benefit applications. The organisation will contact us directly if it needs medical information, usually with your consent.
• Letters confirming school absence for short-term illness. Schools should not normally ask for medical evidence. Copies of appointment cards or prescriptions can be used if needed.
• Letters confirming fitness to travel, fly or take part in sport, unless arranged as paid non-NHS work.
• Letters supporting Blue Badge, PIP or similar applications. The assessing organisation will request information from us if it needs it.

If you need a copy of a hospital letter or test result, you can view many of these in the NHS App.

14. AI scribes (ambient voice technology)

Some of our clinicians use an AI scribe during consultations. This is software, also known as ambient voice technology, that listens to the conversation and writes a draft of the clinical notes or a letter. Our clinicians then check and correct the draft before anything is saved to your record. What this means for you:
• We only use AI scribe tools that meet NHS standards and appear on the NHS Ambient Voice Technology registry.
• The clinician will tell you at the start if the scribe is being used.
• You can ask for it not to be used, at any point. This will not affect your care.
• If a carer, relative or interpreter is with you, their voice may also be captured.
• Audio is not kept as part of your medical record. Drafts are deleted after the record has been made.
• Your information is not used to train the AI and is not shared outside the practice and the approved supplier.

More information is in our privacy notice.

15. Recording consultations and filming on the premises

Recording your own consultation
You may record your consultation for your own personal use, for example to help you remember advice. Please tell the clinician before you start. A recording of your consultation is confidential to
you, and you should think carefully before sharing it with others.

Filming and photographs
• Please do not film or photograph staff or other patients, including in the waiting room, at reception or in the car park.
• Posting images or recordings of staff online without consent, or using them to harass or abuse staff, will be treated under our zero-tolerance policy.
• Staff will not record you without your knowledge. Telephone calls to the practice are recorded for training and monitoring purposes, as explained in our privacy notice.

16. Contacting us online and by email

For medical or admin requests
Please use our online consultation form, SystmConnect, or telephone us. The form is open throughout our core hours, there is no limit on the number of requests, and every request is reviewed
by our team. Urgent requests get a response the same day, and all other requests will be actioned within 48 working hours.

Email
Our practice email address is for documents and administrative matters only. Please do not use it for medical questions or urgent problems, as it is not monitored by clinicians throughout the day.

Social media
We use Facebook to share news. We cannot respond to medical questions or complaints through social media. Please contact us directly instead.

Urgent help
If you need urgent help when we are closed, call 111 or visit 111.nhs.uk. In an emergency, call 999.

17. Young people and confidentiality

Young people under 16 can see a doctor or nurse on their own and can ask for their consultation to be kept confidential. The clinician will check that the young person understands their care and the choices involved. We will only share information without a young person’s consent if we believe they or someone else is at serious risk of harm. In that case, we will usually tell them first.

Parents and online access
Parents and guardians can apply for online access to a young child’s record. Around the age of 11, we review this access to protect the young person’s growing right to confidentiality. From age 13,
young people can usually set up their own NHS App account.

18. Proxy access: acting on someone else’s behalf

Proxy access lets a family member, carer or other trusted person book appointments, order repeat prescriptions or view parts of a patient’s record on their behalf, through the NHS App or SystmOnline.

How to apply
• The patient needs to give their consent, unless the applicant has a legal right to act for them, for example a Lasting Power of Attorney for health and welfare, or a court order.
• Both the patient and the proxy will need to provide identification.
• Ask reception for a proxy access form or complete it online.

We will review each request to make sure it is in the patient’s best interests. We may refuse or limit proxy access if there is a risk of harm, or if the patient does not want it.

19. Interpreters and communication support

If English is not your first language, or you are deaf or hard of hearing, we can arrange a professional interpreter or British Sign Language interpreter for your appointment free of charge.

Please tell us when you book, so we can arrange this in advance.

We prefer not to use family members or friends as interpreters, and we do not use children, as this can affect confidentiality and accuracy.

If you have other communication needs, such as large print, easy read or a different contact method, please tell us and we will record this on your record.

20. What to do after a death

We are very sorry for your loss. This page explains what happens next and where to find support.

If the death was expected and happened at home
During our opening hours, contact the surgery. When we are closed, call 111. A clinician will arrange for the death to be verified. You can then contact a funeral director.

If the death was unexpected
Call 999. The police and the coroner may need to be involved.

Medical certificate and registration
The doctor who looked after the person will complete a Medical Certificate of Cause of Death. This is reviewed by an independent medical examiner, who may contact the family. The register office will then contact you to arrange registration. In England, a death should usually be registered within 5 days.

Register office: https://www.centralbedfordshire.gov.uk/registration-services/register-death

Support
• Tell Us Once lets you report a death to most government organisations in one go.
• Cruse Bereavement Support (0808 808 1677).
• You can also contact us if you are struggling after a bereavement.

21. Taking part in research

Eastgate Surgery supports NHS research that helps to improve care for patients in the future. We take part in studies approved by the National Institute for Health and Care Research
(NIHR).

• We may contact you about a study you might be suitable for. Taking part is always voluntary, and saying no will not affect your care.
• Your identifiable information will not be shared with researchers without your consent.
• You can choose whether your confidential information is used for research and planning through the National Data Opt-Out at nhs.uk/your-nhs-data-matters.
• If you do not want to be contacted about research, please tell reception.

22. If you have more than one problem

We want to give every problem the time it needs. If you have several things to discuss, please tell us when you book, or list them on the online form. We can then offer a longer appointment, a follow-up, or an appointment with the most suitable member of the team. If there is not enough time to deal safely with everything in one appointment, the clinician will discuss
with you what to cover now and arrange the next step for anything else. You will not be asked to call back another day.