I feel the opening hours should be extended, as I work nine to five and cannot allow time off for doctor’s appointments. I find it very difficult to book appointments after five, as this is a very busy time. More information should be provided on what to do when the surgery is closed and a suggestion box should be put in reception. I also think there should a small vending machine in the waiting area as I always need a drink or a little something and there is no where to buy anything.
- Do you feel you are given enough freedom and independence to say no to certain treatments or not to tell other relatives of conditions or problems?
Yes, as I am getting older they are certain treatments I see no point in me having and the surgery completely respect me in my answer and do not try and pressure me into something I do not want to do.
I was recently made aware of a condition I had, I chose not to tell my partner about this and the staff at the surgery helped me though this decision and helped me get though the problem. Counsellors were offered and other specialists treatments.
- Would you recommend using this surgery to anyone new in the area?
Yes, I defiantly would.
Absolutely!
Thank you, Client one and two.
Generally my clients thought that the surgery cared for their needs efficiently and were there when needed. Although they did find some barriers to access. All of my clients agreed that the surgery could be open for longer and offer more ‘open surgeries’. My clients also thought that it was easy to gain access to the service provided.
The Needs of Clients using this service
Physical – Medical treatment and care
Intellectual – Treated as individuals, not patronised
Emotional – Support offer help comfort
Social – Treated equally regardless of social level
Psychological – Feel comfortable not threatened, welcomed into the surgery
This service is organised so that clients can use it by appointments at surgery, home visits and phone consultations. I have asked clients of this surgery and they think that there should be and ‘open surgery’, where clients can just drop in and be seen quickly.
It meets client’s needs by employing a sufficient number of staff these include:
- 6 GPs including 1 salaried GP and 1 GP Registrar
-
5 Practice nurses
- 1 Practice manager
- 2 Secretaries
- 10 Reception staff
- 1 Caretaker
- 2 Cleaners
This is the practice area
of Northlands Surgery
Calne.
The needs of clients will change over time for example a baby will need regular checks and jabs until they start school. They then will become a teenager and an adult, at this point they will only have to visit the Doctors if there is a problem. Then as the person becomes a pensioner they will again need regular jabs and check-ups again. This service provides a variety of clinics and has many different healthcare professionals including Chiropodists, Counsellors, Dieticians and Physiotherapists.
The practice offers advice on minor illness and travel vaccinations, as well as running a well woman service, and specialist clinics for asthma, diabetes, and the elderly.
The needs of clients are met efficiently but there are a few gaps in this service. For many of the specialist’s services clients must travel to a different part of town, this may be a problem for some as they may find travelling difficult. Surgery is open from 8:45-11:10 and 3:20 - 5:15. I think the opening hours are not very long and it may be better for the client if they were longer.
The results of my question show that this service is fairly easy to access all though closing times can be a problem; I therefore suggest the surgery look over the opening hours and lunch times etc. It also showed that the needs of clients are being efficiently met from the moment they walk into reception to when they leave.
The roles of the care workers
I interviewed two care workers one was a senior practice nurse and the other a practice manager.
The day-to-day tasks of each care worker differ greatly. Jane Smith, the practice nurse, carries out many different tasks and everyday is different. One day she may have a lot of blood tests to do, the next day none. It is as simple as that. Most days Jane has general surgery and writing up patient details. Some days she may be involved in a minor operation at the surgery.
Bob Jones is a practice manager; his typical day is still varied but a little less than Jane’s. Normal tasks carried out are staffing problems, Accounts, IT work and general admin and management work.
My chosen care workers use their skills and day-to-day activities to meet the needs of clients. They do this by using the Care Value Base, and communicating with clients effectively.
Jane’s qualifications include a R.N Orthopaedic. She did general nursing and study days.
Bob has very different qualifications, A Levels and general experience. Bob achieved these by college and career paths.
Both care workers need to be loyal and able to keep confidentiality, but this is where their skills differ.
Jane needs to take into consideration the entire care value base and needs to have good communication skills and be good with people. Whereas Bob must be good with money, IT and be patient and organised. He must still be able to communicate with people but on all levels. Both must have lots of common sense!
To get qualifications as a nurse such routes can be taken as distance learning and Open University.
Alternative ways to get Bob’s qualifications are college and F.E.
Care Value Base
All care work is about improving the client’s quality of life by meeting people’s intellectual, emotional and social needs, as well as their physical needs. One way of doing this is for care practitioners to empower their clients.
Care practitioners empower clients by promoting certain values, which are important to both the care practitioner and the client. These values form the basis for a set of principles that help care workers to give the kind of care each individual client requires. These principles form the basis for all care work and are sometimes referred to as the Care Value Base. This base describes the kind of attitude towards care you would appreciate if you were being cared for as a patient or client. The guidelines care practitioner’s follow in order to ensure that clients know what qualities of care to expect are based on this set of principles.
Care workers empower clients by:
1. Promoting anti-discriminatory practice
- Freedom from discrimination
- The right to be different
- Aware of assumptions made surrounding gender, race, age, sexuality, disability and class
- Understand prejudice, stereotyping and labelling and their effects
- Use of language (political correctness)
2. Maintaining confidentiality of information
- Secure recording systems
- The need and right to know
- Value and protect client
- Policies, procedures and guidelines
- Boundaries and tensions in maintaining confidentiality
3. Promoting and supporting individuals’ rights
- Dignity
- Independence
- Health
- Safety
- Choice
- Effective communication
4. Acknowledging individuals’ personal beliefs and identity
- The benefits of diversity
- Choice
- Respect
- The right to be different
5. Protecting individuals from abuse
- Hostile or negative
- Support
- Dignity
6. Promoting effective communication and relationships
- Provide and obtain information
- Express values
- Express and understand needs, fears and wishes
- Maintain identity
7. Providing individualised care
- Control of own life
- Respect
- Needs catered for
- Improve quality of life
- Provide independence
- Balance between control and assistance
My chosen care workers use the entire care value base but a few values are used daily and very often. The practice nurse, Jane Smith, must promote and support individuals’ rights every day and with every client she deals with. She also must keep confidentiality, promote anti-discriminatory views and protect from abuse, to name but a few. The practice manager, Bob Jones, doesn’t really deal with clients on a face-to-face basis but he does deal with patient notes and therefore must maintain confidentiality.
Jane deals with the care value base in a totally different way to Bob. She must take into consideration the whole of the care value base, as she deals with clients face to face and up close and personal. Whereas Bob works in his office and is not meeting and greeting patients as it were, he still must follow the care value base but he only needs to follow the parts that are relevant to him. Such as confidentiality and promoting anti-discriminatory practice.
If these workers do not follow the care value base then there will be a lot of problems. If Jane, the practice nurse, did not apply the base clients would not receive adequate treatment and would become more ill or maybe even die. If Bob, the practice manager, was to ignore the base then everyone would know everyone else’s private information and know about the employees notes and this would not be a very professional way of dealing with these kinds to occupations.
Care workers must be sensitive to people’s different cultures and beliefs. For example if a Jehovah’s Witness was to need a blood transfusion, the care worker must understand that this is against their beliefs. They should offer a different solution or try to persuade them into the blood transfusion, but whilst doing this they must not intimidate then, or force them into any thing they are not comfortable with.
Codes of Practice and Charters
– a hyperlink. These are the codes of practice Northlands surgery use. I found this information by searching for‘Codes of practice’ on the Google search engine and found this information on . I then pasted the relevant parts into this document.
Main Features of the Act
-
The main features of the are:
- a general right of access to recorded information held by public authorities, subject to certain conditions and exemptions;
- in cases where information is exempted from disclosure, except where an absolute exemption applies, a duty on public authorities to:
- inform the applicant whether they hold the information requested, and
- communicate the information to him or her, unless the public interest in maintaining the exemption in question outweighs the public interest in disclosure;
- a duty on every public authority to adopt and maintain a scheme, approved by the Commissioner, which relates to the publication of information by the authority, and to publish information in accordance with the scheme. An authority may adopt a model scheme approved by the Commissioner, which may have been prepared by the Commissioner or by other persons;
- a new office of Information Commissioner with wide powers to enforce the rights created by the Act and to promote good practice, and a new Information Tribunal;
- a duty on the Lord Chancellor to promulgate Codes of Practice for guidance on specific issues.
Copyright
-
Public authorities should be aware that information which is disclosed under the Act may be subject to copyright protection. If an applicant wishes to use any such information in a way that would infringe copyright, for example by making multiple copies, or issuing copies to the public, he or she would require a licence from the copyright holder. HMSO have issued guidance on this subject in relation to Crown Copyright, which is available on or by contacting HMSO at:
HMSO Licensing Division
St Clements House
2-16 Colegate
Norwich NR3 1BQ
Tel: 01613-621000
Fax: 01603-723000
VIII Freedom of Information and public sector contracts
- When entering into contracts public authorities should refuse to include contractual terms which purport to restrict the disclosure of information held by the authority and relating to the contract beyond the restrictions permitted by the Act. Public authorities cannot "contract out" of their obligations under the Act. Unless an exemption provided for under the Act is applicable in relation to any particular information, a public authority will be obliged to disclose that information in response to a request, regardless of the terms of any contract.
- When entering into contracts with non-public authority contractors, public authorities may be under pressure to accept confidentiality clauses so that information relating to the terms of the contract, its value and performance will be exempt from disclosure. Public authorities should reject such clauses wherever possible. Where, exceptionally, it is necessary to include non-disclosure provisions in a contract, an option could be to agree with the contractor a schedule of the contract which clearly identifies information which should not be disclosed. But authorities will need to take care when drawing up any such schedule, and be aware that any restrictions on disclosure provided for could potentially be overridden by their obligations under the Act, as described in the paragraph above.
- In any event, public authorities should not agree to hold information 'in confidence' which is not in fact confidential in nature. Authorities should be aware that the exemption provided for in section 41 only applies if information has been obtained by a public authority from another person, and the disclosure of the information to the public, otherwise than under the Act would constitute a breach of confidence actionable by that, or any other person.
- Any acceptance of such confidentiality provisions must be for good reasons and capable of being justified to the Commissioner.
- It is for the public authority to disclose information pursuant to the Act, and not the non-public authority contractor. However, the public authority may wish to protect from disclosure by the contractor, by appropriate contractual terms, information which the authority has provided to the contractor which would clearly be exempt from disclosure under the Act, by appropriate contractual terms. In order to avoid unnecessary secrecy, any such constraints should be drawn as narrowly as possible, and according to the individual circumstances of the case. Apart from such cases, public authorities should not impose terms of secrecy on contractors.
- Section 5(1)(b) of the Act empowers the Lord Chancellor to designate as public authorities for the purposes of the Act, persons (or bodies) who provide under a contract made with a public authority, any service whose provision is a function of that authority. Thus, some non-public authority contractors will be regarded as public authorities within the meaning of the Act, although only in respect of the services provided under the contract. As such, and to that extent, the contractor will be required to comply with the Act like any other public authority.
IX Accepting information in confidence from third parties
- A public authority should only accept information from third parties in confidence if it is necessary to obtain that information in connection with the exercise of any of the authority's functions and it would not otherwise be provided. In addition, public authorities should not agree to hold information received from third parties "in confidence" which is not confidential in nature. Again, acceptance of any confidentiality provisions must be for good reasons, capable of being justified to the Commissioner.
XI Refusal of request
- Where a request for information is refused in reliance on an exemption, the Act requires that the authority notifies the applicant which exemption has been claimed, and if it would otherwise not be apparent, why that exemption applies. Public authorities should not (subject to the proviso in section 17(4) i.e. if the statement would involve the disclosure of information which would itself be exempt information) merely paraphrase the wording of the exemption. The Act also requires authorities, when withholding information (other than under an "absolute" exemption), to state the reasons for claiming that the public interest in maintaining the exemption outweighs the public interest in disclosure. Public authorities should specify the public interest factors (for and against disclosure) which they have taken into account before reaching the decision (again, subject to the proviso in section 17(4)).
- For monitoring purposes public authorities should keep a record of all applications where either all or part of the requested information is withheld. In addition to a record of the numbers of applications involved where information is withheld, senior managers in each public authority need information on each case to determine whether cases are being properly considered, and whether the reasons for refusals are sound. This could be done by requiring all staff who refuse a request for information to forward the details to a central point in the organisation for collation. Details of information on complaints about applications which have been refused (see XII - "Complaints procedure" below) could be collected at the same central point.
My chosen service uses its codes of practice effectively by making sure that all employees are aware of them and use them in every day tasks. There is also a copy of the ‘Codes of Practice’ in the main reception office.
Therefore the standard of care provided is at a high standard and meets client physical, intellectual, emotional and social needs.
Referral to Services
People can access this service by making an appointment to see the nurse or doctor, through home visits and with phone consolations. People may be unable to access this service through physical, geographical and psychological barriers. The surgery does try to overcome any problems with solutions such as a home visit or referral to other surgery.
Care worker need to have good communication skills. They must be able to speak to people on all levels, understand them and not patronise them. Care workers need effective communication skills because if they where to not have these skills then talking to clients, diagnosing them would be very difficult and people would not want to see that doctor or nurse. If a person was deaf or dumb then a problem may arise, care workers may overcome this by, having a sign language translator in the room or getting the person to write down what is wrong with them.
I think it is fairly easy to gain access to this service, as there is a variety of ways. But there are still some gaps in the service. I think these could be overcome by making a few small adjustments. Automatic doors may be a good improvement as this can help wheelchair users and people with buggies. Information in different languages would also encourage people of different cultures to visit the surgery. I think the hours that staff are available for are not very long and could do with extending.
My chosen care service provides information to help clients to sort out their lives. For example providing information on job centres and education centres can help people to earn their own money and change their life’s for the better.
Users of the Service
Users of this service can be any age, any sex and any culture. The users do not have to pay fees, unless they need prescriptions and other treatments. The NHS pays for this service.
Barriers to access
Physical: doors are not automatic, which may cause a problem for wheelchair and buggy users. There are all so no ramps, which can cause a problem when I weather starts to worsen.
Psychological: fear of losing impendence can prevent people from using a service like this one, but I think Northlands does give an appropriate amount of freedom. For clients will mental health problems there is also a counsellor available.
Financial: the NHS does help to eliminate some of the financial barriers, although there can still be problems with prescriptions, treatments and operations etc.
Geographical: because the surgery is a fairly rural some client may have difficulty visiting the surgery, but this problem is overcome by the fact that the doctors and nurses do house calls when necessary. There is also a very good public transport service in Calne.
Resource: the surgery opening hours, in my opinion, is not open for a very long time, from 8:45-11:10 to 3:20 - 5:15. I think these could do with lengthening. A lot of information is provided on this service due to a website and phone being freely available.
Cultural and language: Northlands is very sensitive to the needs of all cultures and beliefs. The only problem I can think of is they may not be aware of beliefs of some cultures so I suggest an education session.
Bibliography
Source:
GCSE Health and Social Care for Edexcel (double award) Elizabeth Haworth, Carol Forshaw, Neil Moonie Heinemann
‘Your guide to the NHS’ leaflet
Employees of Northlands surgery – Deirdre Aldhous (alias Jane Smith) and Robert Baggs (alias Bob Jones)
M.E Payne Confidential Page
