Sedative Prescribing for Flying Phobias

People often come to us requesting diazepam for fear of flying or assisting with sleep during flights. Diazepam in the UK is a Class C/Schedule IV controlled drug.

Mayford House Surgery does NOT prescribe sedatives for fear of flying. There are a number of very good reasons why prescribing this drug is not recommended.

  1. Diazepam is a sedative, which means it makes you sleepy and more relaxed. In the event of an emergency during the flight it may impair your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences for you and those around you.
  2. 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 you would during natural sleep. This can cause you to be at increased risk of developing a blood clot (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 four hours.
  3. There is a statistically significant reduction in oxygen saturation in all passengers travelling long haul and short haul flights. High-altitude flights make it difficult to saturate the blood with oxygen because the cabin pressure is very low. In such moments, oxygen-carrying blood cells do not perform their duties adequately resulting in the tissues to be fed with less oxygen. Healthy individuals may not be affected by low cabin pressure at high altitudes; but patients with lung or heart problems may experience visual impairment, respiratory failure, shortness of breath or loss of consciousness.
  4. Whilst most people find benzodiazepines like diazepam sedating, a small number react in a contradictory manner and become agitated or even aggressive. The drugs can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.
  5. According to the prescribing guidelines doctors follow, Benzodiazepines are contraindicated (not allowed) in phobia. Your doctor would be taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis involving generalised anxiety i.e. not specific to flying. If this is the case, you should be getting proper care and support for your mental health and not going on a flight.
  6. Diazepam and similar drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the police.
  7. 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.

We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines and we have listed a number of these below. This decision has been made by the GP Partners and is adhered to by all prescribers working in the practice.

Fear of Flying Courses

Easy Jet
www.fearlessflyer.easyjet.com
A free downloadable e-book is available or on line courses from £89
Tel: 0203 8131644

British Airways
http://flyingwithconfidence.com/courses/venues
Online courses are available from £79.99
Tel: 01252 793 250

Virgin Atlantic
https://flyingwithoutfear.co.uk/collections
Face to face courses are available at various airports with prices from £267
Tel: 01423 714900 1252250

Safeguarding at Mayford House Surgery

What is safeguarding?

Safeguarding simply means keeping people safe from harm. It is about protecting children and adults from abuse or neglect. There are many different types of abuse.

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Types of abuse that children can suffer include:

  • physical abuse
  • sexual abuse
  • neglect
  • emotional abuse
  • domestic abuse
  • bullying and cyberbullying
  • child sexual exploitation
  • child trafficking
  • criminal exploitation and gangs
  • female genital mutilation
  • grooming

For more information on these types of abuse and how you can spot them, you can visit:

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Types of abuse that adults can suffer include:

  • physical abuse
  • sexual abuse
  • domestic abuse
  • psychological or emotional abuse
  • financial or material abuse
  • modern slavery
  • discriminatory abuse
  • organisational or institutional abuse
  • neglect
  • self-neglect

For more information on these types of abuse, you can visit:

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Who is responsible for safeguarding?

Safeguarding is everyone’s responsibility. Here at Mayford House Surgery, all staff members play a role in safeguarding. Safeguarding is not just something we choose to do, it is also something we are required by law to do.

At Mayford House Surgery, the Safeguarding Lead is Dr Ailsa Mitford and the Deputy Safeguarding Lead is Dr Ambar Duree.

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How does Mayford House Surgery safeguard children and adults who are, or who might be, experiencing abuse or neglect?

Keeping children and adults safe from abuse and neglect cannot be done by one person or one agency. At the heart of any safeguarding process is the child or adult who may be suffering abuse. We work in partnership with our patients who are, or who are at risk of, experiencing  abuse as well as their families and advocates as appropriate.

We work closely with our health colleagues such as health visitors, the school nursing team, midwives, paediatricians, mental health teams and other hospital colleagues.  We also work with our partner agencies locally such as child and adult social care, education and the police to ensure any child or adult suffering abuse can be supported and protected and any concerns about abuse can be properly investigated.

To find out more about how agencies work together in North Yorkshire to keep children and adults safe visit:

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Safeguarding Training

All staff at Mayford House Surgery have the appropriate levels of safeguarding training for their job role. Safeguarding training standards are set nationally for all healthcare professionals and we follow this national guidance. Safeguarding training is essential to ensure all staff are able to spot signs of abuse or neglect and take action. We work hard to make safeguarding a key priority for our practice and our patients.

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What will happen if a GP or any member of staff at the practice is worried that a child or adult is being abused or neglected?

All staff in the practice have a duty and responsibility to speak up and say something if they are worried a child or adult might be being abused or neglected. If any staff member has concerns they will discuss this with the practice Safeguarding Lead or with one of the other GPs who will decide what needs to happen next.

If a doctor is concerned that a child or young person is at risk of abuse or neglect, they must take steps to make sure the child or young person is protected. It can be very upsetting and stressful for families when this happens and parents often have questions about what their doctor may or may not do.

This leaflet from the General Medical Council (GMC) helps to answer those questions.

If a doctor is concerned that an adult is at risk of abuse or neglect, they will

  • Ask the person if they require any immediate support to keep themselves safe
  • Explain how safeguarding works
  • Ask the person what they would like to happen
  • Support the person in a way to give them choice and control to improve their quality of life, wellbeing, and safety.

To do this the doctor will:

  • Listen to the person
  • Understand their views and wishes
  • Take them seriously
  • Treat them with respect
  • Support them to feel as safe as they want
  • Support them to make their own decisions
  • Keep them informed and involved
  • Tell the person what will happen next.

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Capacity

When making decisions about what action is necessary to safeguard an adult, healthcare professionals have to consider whether the person has capacity to understand their situation and make decisions about what should happen to them.

What is capacity?

  • Capacity means the ability to use and understand information to make a decision, and communicate any decision made.
  • A person lacks capacity if their mind is impaired or disturbed in some way, which means they’re unable to make a decision at that time.

For more information on capacity visit the NHS’s Accessing Capcity webpage.

All professionals have to follow The Mental Capacity Act which empowers and protects people who are not able to make their own decisions. This covers decisions about property and financial affairs, health, welfare and where they live.

For more information on The Mental Capacity Act visit the Safeguarding Adults Mental Capacity Act webpage.

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Information Sharing

Sharing information with other relevant professionals is an important part of safeguarding. Sadly, reviews of cases where a child or adult has been killed or seriously harmed due to abuse or neglect, have often found that professionals have not shared the right information with the right person at the right time to keep the child or adult safe.

All staff at the practice must comply with the law and national guidance when making decisions about information sharing. The General Medical Council (GMC) provide guidance for doctors making decisions about information sharing. The practice also follows the Caldicott Principles:

  1. Justify the purpose(s) for using confidential information
  2. Don’t use personal confidential data unless it is absolutely necessary
  3. Use the minimum necessary personal confidential data
  4. Access to personal confidential data should be on a strict need-to-know basis
  5. Everyone with access to personal confidential data should be aware of their responsibilities
  6. Comply with the law
  7. The duty to share information can be as important as the duty to protect patient confidentiality

As a general rule we will ask for the person’s (or relevant parent/guardian, advocate, Power of Attorney) permission before sharing information for safeguarding purposes.

However, there are circumstances where we will need to share information even without the person’s permission (consent). Examples of these circumstances include:

  • Other people are, or may be, at risk, including children
  • Sharing the information could prevent a serious crime
  • A serious crime has been committed
  • Someone in a position of trust is implicated in causing abuse/neglect
  • The risk of serious harm or death is very high in a domestic abuse situation
  • A court order  has requested the information

Again as a general rule, we will inform the person that we will need to share information about them in order to keep them or others safe from serious harm, as long as this does not increase risk of harm to the person or others.

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Where can you get help if you are worried you or someone else is suffering abuse or neglect?

Remember:

  • Abuse is always wrong
  • No one should have to live with abuse
  • By reporting abuse you can help bring it to an end

Worried about a child?

Where there are significant immediate concerns about the safety of a child, you should contact the police on 999.

if you are worried about any child and think they may be a victim of neglect or abuse, you can make a referral (depending on which county you live in) to:

  • North Yorkshire Multi-Agency Screening Team(MAST) by ringing 01609 780780.
  • City of York Multi Agency Screening Hub (MASH) Monday to Friday, 8.30am to 5.00pm: telephone, 01904 551900; or email, MASH, Outside of these hours phone, 01609 780780
  • East Riding Safeguarding Children’s Hub on 01482 395500; Out of hours service: 01482 393939

You can also contact the NSPCC helpline on 0808 800 5000, email them or submit an online form. Further details are on the NSPCC website here.

You can also speak in confidence to any member of Mayford House Surgery.

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Worried about an adult?

If you or the person you are concerned about is in danger and immediate action is required, you should ring the emergency services on 999.

If you or the person you are concerned about is not in immediate danger, you should ring (depending on which county the person lives in):

  • North Yorkshire customer services centre on 01609 780780. This includes outside of office hours. The Minicom number is 01609 779838.
  • City of York Adult Social Care on 01904 555111 (office hours) or fax 01904 554055; hearing impaired customers can use the text facility 07534 437804; Out of hours, tel:  01609 780780
  • East Riding Safeguarding Adults team on 01482 390940

You can also speak in confidence to any member of Mayford House Surgery.

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Free Resources to support Children and Young People’s Mental Health in North Yorkshire

Together your local NHS and North Yorkshire County Council have launched a new pool of resources which have been developed with partners and young people to help children and young people and their parents, carers and professionals’ access mental health support in North Yorkshire.

The resources were launched during Safeguarding Awareness Week to ensure children and young people across North Yorkshire are aware of services available to support with their social and emotional mental health and include:

  • Young Person’s guide to Mental Health Support A resource created and designed by young people across North Yorkshire for young people to help them find the right support, whether it be finding out more information, talking to someone or accessing more specialised support. A printable version can also be accessed by clicking here

The above information plus lots more can be found at, The Go-To – Emotional wellbeing and mental health (thegoto.org.uk)

Zero Tolerance to Abuse and Violence Policy

The practice takes zero tolerance very seriously if a member of staff is treated in an abusive or violent way.

The practice supports the government’s Zero Tolerance campaign for health service staff. This states that GPs and their staff have a right to care for others without fear of being attacked or abused.

To successfully provide these services a mutual respect between all the staff and patients has to be in place.

All our staff aim to be polite, helpful, and sensitive to all patients’ individual needs and circumstances whilst they are following NHS England and practice policies, procedures and protocols.

We ask you to treat your practice staff courteously at all times.

We understand that ill patients do not always act in a reasonable way and will take this into consideration when trying to deal with a misunderstanding or complaint. However, unacceptable behaviour, be it violent or abusive, will not be tolerated and may result in you or a family member(s) being removed from the practice list.

In order for the practice to maintain good relations with their patients the practice would like to ask all its patients, their carers and families to read and take note of the occasional types of behaviour that would be found unacceptable, they include but are not limited to:

  • Offensive language or swearing at practice staff
  • Any physical violence towards staff, visitors or other patients, such as pushing or shoving
  • Any threat of physical violence, taking legal proceedings and/or complaining to regulatory services
  • Verbal abuse towards the staff in any form including insults and emotional intimidation
  • Racial abuse and sexual harassment
  • Persistent or unrealistic demands
  • Causing damage/stealing from the practice’s premises, staff or patients
  • Bullying, intimation and/or harassment
  • Inappropriate use of personal email addresses
  • Obtaining drugs and/or medical services fraudulently
  • Submitting habitual or vexatious complaints
  • Persistently, acting inconsiderately or unreasonably

 

Removal from the practice list

A good patient-practice relationship, based on mutual respect and trust, is the cornerstone of good patient care. The removal of patients from our list is an exceptional and rare event and is a last resort in an impaired patient-practice relationship. When trust has irretrievably broken down, it is in the patient’s interest, just as much as that of the practice, that they should find a new practice. An exception to this is on immediate removal on the grounds of violence e.g. when the police are involved.

 

Removing other members of the household

In rare cases, however, because of the possible need to visit patients at home it may be necessary to terminate responsibility for other members of the family or the entire household. The prospect of visiting patients where a relative who is no longer a patient of the practice by virtue of their unacceptable behaviour resides, or being regularly confronted by the removed patient, may make it too difficult for the practice to continue to look after the whole family. This is particularly likely where the patient has been removed because of violence or threatening behaviour and keeping the other family members could put doctors or their staff at risk.

 

Our complaints procedure

If you have a complaint or concern about the treatment you have received from the doctors or any of the staff working at this practice, please let us know.

 

How to make a complaint

If you feel you need to make a complaint in relation to the surgery, please email your complaint to the surgery email address or post it to,

FAO Practice Manager
Mayford House Surgery
Boroughbridge Road
Northallerton
DL7 8AW

If you need to complain about any other providers of healthcare, please contact the Patient Advice and Liaison Service (PALS) on, 01642 854807.  More information is available on the Patient Advice and Liaison Service (PALS) website.

Statement of Intent Regarding Developments in IT

Introduction

New contractual requirements came in from 1st April, 2014 and Practices are required to announce / advertise what they intend to do with regards to developing Information Technology (IT).

Statement of Intent 2015-16

Practice contact details

Practice Name: Mayford House Surgery
Address: Boroughbridge Road, Northallerton, DL7 8AW
Telephone: 01609 772105
Email: hnyicb-ny.mayfordsurgeryreception@nhs.net
Website: mayfordhouse.co.uk

Current online patient services

GP system supplier – The Phoenix Partnership
GP system version – SystmOne

Plan to Meet GMS / PMS 2015-16 Contractual Requirement for Patient Online Service

This practice plans to offer the facility for patients to view online, export or print detailed coded information held in their own records from 1st February 2016.

These dates are subject to the necessary NHS GP systems and software being available to the practice.

This practice currently offers the facility for patients:
• to book, view, amend, cancel and print appointments online
• to order online, view and print a list of their repeat prescriptions for drugs, medicines or appliances
• to view online, export or print summary information from their record, relating to medications, allergies, adverse reactions and any other items agreed between the practice and individual patient.

We will publicise and promote our online services to our practice’s patients through the practice website, practice waiting room leaflets, posters and the Patient Participation Group by 1st February 2016.

Statement of Intent 2014-15

New contractual requirements came into force from 1 April 2014 requiring that GP Practices should make available a “statement of intent” in relation to the following IT developments:

  • Summary Care Record (SCR)
  • GP to GP Record Transfers (GP2GP)
  • Patient Online Access to their GP medical record

The same contractual obligations require that we have a “statement of intent” regarding these developments in place and publicised by 30 September 2014.

Please find below details of the practice’s stance with regards to these points:

Summary Care Record (SCR)

NHS England require practices to enable successful automated uploads of any changes to patient’s summary information, at least on a daily basis, to the summary care record (SCR) or have published plans in place to achieve this by 31st of March 2015.

Having your Summary Care Record (SCR) available will help anyone treating you without your full medical record. They will have access to information about any medication you may be taking and any drugs that you have a recorded allergy or sensitivity to. Of course if you do not want your medical records to be available in this way then you will need to let us know so that we can update your record.

Mayford House Surgery confirms that your SCR is automatically updated on at least a daily basis to ensure that your information is as up to date as it can possibly be.

GP to GP Record Transfers

NHS England requires practices to utilise the GP2GP facility for the transfer of patient records between practices, when a patient registers or de-registers (this does not apply to temporary patient registrations).

It is very important that you are registered with a doctor at all times. If you leave your previous practice and register with a new GP, your medical records will be removed from your previous doctor and forwarded on to your new GP via NHS England. It can take up to 2 weeks for your paper records to reach your new surgery. However, GP2GP record transfers your electronic medical record is transferred to your new practice much sooner.

Mayford House Surgery confirms that GP2GP transfers are already active, and we send and receive patient records via this system.

Patient Online Access to Their GP Record

NHS England require practices to promote and offer the facility to enable patients’ online access to appointments, prescriptions, allergies and adverse reactions or have published plans in place to achieve this by 31st of March 2015.

We currently offer the facility for booking and cancelling appointments and also for ordering your repeat prescriptions on-line. This is done by the clinical system on-line facility. If you do not already have a username and password for this system – please register for on-line access at the surgery.

Green Impact for Health

We are pleased to announce the practice has recently signed up to the national ‘Green Impact for Health’ scheme. This is a toolkit to help practices improve their sustainability. We feel this is a positive investment to the running of the practice as it is important to reduce waste and our impact on the environment. You may see modifications to the practice going on such as us changing to LED lights and other projects. We would also like to highlight our inhaler recycling scheme where further information about this is available at our dispensary.

We can all make changes to reduce our carbon footprint and we would like to invite you to help us do this by:

  1. informing us of your preferred local pharmacy (if you are not a dispensing patient) so we can send your prescriptions electronically which will reduce paper print outs
  2. inform us of your consent and confirm your mobile phone number is correct so we can send you text notifications to reduce letters
  3. checking your prescriptions carefully prior to requesting them to ensure only required medication is obtained to reduce medication wastage
  4. feeding back to us any ways you feel we could reduce wastage or improve sustainability that you identify during your experience with the practice

Thank you for your support with this, All at Mayford House

DNA Policy (Did Not Attend)

Should a patient fail to attend/cancel 2 appointments within 12 months they will receive a warning letter from the Practice.  Should a patient then fail to attend a 3rd appointment in 12 months they will receive a letter from the Partners stating that they may be removed from the Practice List.

Please always attend your appointments and if you cannot for any reason, please cancel them as soon as you can and preferably at least 24 hours prior to the appointment.  This then allows the Practice to offer an appointment to one of your fellow patients.

Thanks, you.
The Partners.

Chaperones

This policy is designed to protect both patients and staff from abuse or allegations of abuse and to assist patients to make an informed choice about their examinations and consultations.

The medical consultation is a challenge to both clinician and patient, whether in the community or in hospital. The need for more detailed discussions with patients, along with their increasing autonomy and right to make choices in relation to their clinical care and treatment, has affected the traditional role of the doctor-patient relationship. This has made maintaining appropriate professional boundaries in the doctor-patient consultation more challenging, however, the guidance from national and regulatory bodies is clear that it is always the health professional’s responsibility to do so.

Continue reading our Chaperones policy

Subject Access Requests

You can request parts, or complete copies of your medical record by completing and returning a subject access request form, which you can print off here.

This information will be provided via our accuRx system which is sent by text, or this can be provided via e-mail.  If you want this information provided in paper format, please specifically request this.  You will need to collect this from the surgery, this information will not be posted out to you.

Only one copy can be requested, if you want a second copy there may be a charge for this

Transferring Your Electronic Health Record

Your GP practice holds copies of your patient health record electronically and in paper format. Both contain the healthcare information about you that your GP needs including your medical history, medications, allergies, immunisations and vaccinations.

If you have previously registered with a different GP in England, upon registering at this practice your electronic health record will, where possible, be transferred automatically from your previous practice through the use of an NHS system called GP2GP.

Transferring Your Electronic Health Record information leaflet.

NHS Summary Care Records

As part of a mandatory, national programme each GP Practice will have to make a summary care record for each patient (unless the patient has already opted out).

If you wish to opt out download and complete the opt out form and return to the Practice (see below).

Summary Care Record Sharing Options

1. Express consent for medication, allergies and adverse reactions only. You wish to share information about medication, allergies and adverse reactions only.

2. Express consent for medication, allergies, adverse reactions and additional information. You wish to share information about medication, allergies and adverse reactions and further medical information that includes: Your significant illnesses and health problems, operations and vaccinations you have had in the past, how you would like to be treated (such as where you would prefer to receive care), what support you might need and who should be contacted for more information about you.

3. Express dissent for Summary Care Record (opt out). Select this option, if you DO NOT want any information shared with other healthcare professionals involved in your care.

Information Website

Read about Summary Care Records on the NHS Digital website.

Information Leaflets & Opt-Out Form