Information for patients (b)

Summary of Indicators

	B. Information for Patients
Information 1 0.5	The practice has a system to allow patients to contact the out-of-hours service by making no more than two telephone calls
Information 2 0.5 points	If an answering system is used out of hours, the message is clear and the contact number is given at least twice
Information 3 1 point	The practice has arrangements for patients to speak to GPs and nurses on the telephone during the working day
Information 4 1 point	If a patient is removed from a practice's list, the practice provides an explanation of the reasons in writing to the patient and information on how to find a new practice, unless it is perceived that such an action would result in a violent response by the patient
Information 5 2 points	The practice supports smokers in stopping smoking by a strategy which includes providing literature and offering appropriate therapy
Information 6 0.5 points	Information is available to patients on the roles of the GP, community midwife, health visitor and hospital clinics in the provision of ante-natal and post-natal care
Information 7 1.5 points	Patients are able to access a receptionist via telephone and face to face in the practice, for at least 45 hours over 5 days, Monday to Friday, except where agreed with the PCO
Information 8 1 point	The practice has a system to allow patients to contact the out-of-hours service by making no more than one telephone call

Information Indicator 1

The practice has a system to allow patients to contact the out-of-hours service by making no more than two telephone calls

Information 1.1 Practice guidance
In an emergency, it is important that a patient can contact a clinician quickly. This was a recommendation of out-of-hours reviews in both Scotland and England.

A practice should ensure that its system does not include any additional telephone calls for patients to make over and above the two calls stated in the indicator. This may be particularly relevant in areas where contacting the duty doctor may involve phoning the practice, then the doctor's home, and then a mobile phone number.

Information 1.2 Written evidence
The system for contacting the out-of-hours service should be described. (Grade C)

Information 1.3 Assessment visit
The practice should be telephoned after 6.30 pm on a weekday, or at some other time during the out-of-hours period.

Information 1.4 Assessors' guidance
The practice should be telephoned after 6.30 pm on a weekday, or at some other time during the out-of-hours period, to confirm that no more than two telephone calls are needed to contact the out-of-hours service. This confirmation will need to have taken place prior to the visit.

Information Indicator 2

If an answering system is used out of hours, the message is clear and the contact number is given at least twice

Information 2.1 Practice guidance
It is useful for the answering system message to be clearly posted near the telephone so that all staff are aware of the approved wording. This minimises the risk of staff re-recording the message and changing the agreed format. Patients with hearing impairment find messages with background noise, eg ringing phones etc, difficult to hear. Staff or doctors should be encouraged to speak slowly when recording the message. This indicator will only be assessed if an answering system is used.

If the practice does not use the answer machine then it would be exempt from this indicator.

Information 2.2 Written evidence
The practice will state the exact message used. (Grade C)

Information 2.3 Assessment visit
The answering system will be demonstrated.

Information 2.4 Assessors' guidance
The assessor should listen to the message in order to confirm that background noise on the tape does not obscure the message and that the number is clear and repeated at least twice. This can be checked along with Information Indicator 1.

Information Indicator 3

The practice has arrangements for patients to speak to GPs and nurses on the telephone during the working day

Information 3.1 Practice guidance
Good Medical Practice for General Practitioners states that the excellent GP "has a system for receiving or returning phone calls from patients" and that the unacceptable GP "provides no opportunity for patients to talk to a doctor or a nurse on the phone".

Some practices have specific times to speak to a clinician and others make arrangements for the clinician to phone the patient back.

It is useful for this information to be advertised to patients eg through the practice leaflet, notices in the practice, slips given to patients when being asked to phone back for a result, the tear-off side of a prescription, the practice newsletter etc.

Information 3.2 Written evidence
The practice has a written policy on telephone availability (Grade A)

Information 3.3 Assessment visit
The assessors should seek out evidence on when the practice team is available to answer telephone calls by checking practice leaflets, observing the office and asking reception and clinical staff.

Information 3.4 Assessors' guidance
The receptionists should be able to respond positively to a request by a patient to speak to a clinician on the telephone. The assessors should confirm with reception staff the information they give patients who require to speak to a GP or practice-employed nurse. Patients do not require to speak to a clinician immediately unless it is an emergency, but at least one clinician in the practice should be available every working day. The assessors should confirm with staff how patients are informed of the policy and check the stated sources, eg practice leaflet, notices at the reception desk or in the waiting area, etc.

Information Indicator 4

If a patient is removed from the practice's list, the practice provides an explanation of the reasons in writing to the patient and information on how to find a new practice, unless it is perceived that such an action would result in a violent response by the patient

Information 4.1 Practice guidance
It is good practice to explain to a patient the reasons for being removed from the list. This is the recommendation of both the BMA and the RCGP. Normally, this will be based on a perceived breakdown in the doctor/patient relationship but it will often be useful to give a fuller explanation than simply stating this. The letter should not normally be a standard letter of removal but tailored to the individual situation. The reason for removal should not be solely that a patient has made a complaint against the practice (see Good Medical Practice for General Practitioners).

Many patients will not be aware of the procedure for registration with another practice and will not be aware that the Primary Care Organisation can assist them. They should be given relevant guidance and contact details.

In exceptional circumstances, it will be felt that a written explanation of the reasons for removal for the list will further inflame a difficult situation, potentially endangering the safety of practice team members. In these circumstances, the omission of a written explanation will be justified. It may be useful to discuss this issue and include guidance in the practice's policy.

Information 4.2 Written evidence
There should be a written policy on removing patients from the list. (Grade 2)

Information 4.3 Assessment visit
The written policy statement should be inspected or the practice team should be questioned on the policy.

Information 4.4 Assessors' guidance
The practice should submit a written policy. It may also be useful to check with team members that the policy is consistently used. Patients should normally be given a written reason for their removal and the letter should contain both the elements in the criterion.

Information Indicator 5

The practice supports smokers in stopping smoking by a strategy which includes providing literature and offering appropriate therapy

Information 5.1 Practice guidance
There is good evidence about the effectiveness of healthcare professionals in assisting patients to stop smoking.

A number of studies have recently shown benefits from the prescription of nicotine replacement therapy or buproprion in patients who have indicated a wish to quit smoking.

Further Information: http://www.nice.org.uk/pdf/NiceNRT39GUIDANCE.pdf

The strategy does not need to be written by the practice team. A local or national protocol could be adapted for use specifically by the practice and implemented. The provision of dedicated smoking cessation services remains the responsibility of the PCO.

Information 5.2 Written evidence
There should be a practice protocol concerning smoking cessation. (Grade A)

Information 5.3 Assessment visit
Prescribing data should be reviewed, and literature available for patients who wish to quit should be examined.

Information 5.4 Assessors' guidance
The strategy should take into account current evidence in this area. Signs of implementation may be evident in the practice's prescribing data or in the patient leaflets that are used by the practice.

Information Indicator 6

Information is available to patients on the roles of the GP, community midwife, health visitor and hospital clinics in the provision of ante-natal and post-natal care

Information 6.1 Practice guidance
The provision of information to patients which clearly defines the roles of the team members involved in their care will contribute to their satisfaction with the service and help them to use it appropriately. It is particularly useful if the information can name the individuals who may be involved in the patient's care.

Information 6.2 Written evidence
The practice gives ante-natal patients written information on the roles of each member of the practice team. (Grade B)

Information 6.3 Assessment visit
The information given to ante-natal patients should be inspected.

Information 6.4 Assessors' guidance
The availability of copies of information given to ante-natal patients should be checked with team members.

Information Indicator 7

Patients are able to access a receptionist via telephone and face to face in the practice, for at least 45 hours over 5 days, Monday to Friday, except where agreed with the PCO

Information 7.1 Practice guidance
Good Medical Practice for General Practitioners states "patients appreciate being able to contact the surgery throughout the working day." To satisfy this indicator, reception staff will have to be available face to face and on the telephone for the stated hours, spread through Monday to Friday. This indicator may be difficult and inappropriate to satisfy in some single-handed and remote and rural practices. In these circumstances, the level of receptionist cover should be agreed with the PCO. The practice should have written confirmation that this level of cover has been agreed.

Information 7.2 Written evidence
There should be a written summary of the times when telephone/face-to-face access to receptionists is available. (Grade A)

Information 7.3 Assessment visit
Reception staff should be questioned concerning the arrangements for access to receptionists.

Information 7.4 Assessors' guidance
Assessors should confirm with reception staff that their hours of work as a team cover the hours of telephone and face-to-face availability as stated in the summary. In single-handed or remote and rural practices where it is not appropriate or possible to provide this amount of cover, the practice should have available written confirmation from the PCO of the agreed level of coverage.

Information Indicator 8

The practice has a system to allow patients to contact the out-of-hours service by making no more than one telephone call
Information 8.1 Practice guidance
This is an aspiration of the Carson report on out-of-hours care in England. The Scottish review on out-of-hours services also recommends that, ideally, those services should be contactable by making no more than one telephone call.

It is recognised that this may put an additional burden on out-of-hours services and the introduction of this indicator will be linked to the movement of responsibility for out-of-hours care to PCOs in April 2004.

The ability to do this will depend on the technology available. If this is not available in a practice area, then exemption may be applied for from the PCO.

Practices should ensure that their system does not include a requirement that patients should make additional telephone calls over and above the one call stated in the criterion. This may be particularly relevant in areas where contacting the duty doctor may involve phoning the practice, then the doctor's home, and then being passed to a mobile phone number. If, in order to satisfy this indicator, the practice has to leave another number on the answering system, please refer also to Information Indicator 2 regarding the quality of the message.

Information 8.2 Written evidence
No written evidence is required.

Information 8.3 Assessment visit
The practice should be telephoned after 6.30 pm.

Information 8.4 Assessors' guidance
The practice should be telephoned after 6.30 pm to confirm that no more than one telephone call is needed to contact the out-of-hours service. This phone call should take place prior to the visit. Exemptions agreed by the PCO will need to be specified in writing.