Benzodiazipine Requests for Non Clinical Needs

We are occasionally asked to prescribe sedating medication for flying, procedures, or other non-clinical reasons.

We regret that we will not action these requests on the grounds of patient safety and our need to prioritise the provision of NHS care on the basis of patients’ clinical needs.

We have outlined additional information regarding our practice decision to refuse such requests.

Flying:

Sedating medication, e.g. benzodiazepines such as diazepam, can render someone either paradoxically aggressive, or less able to follow instructions in an emergency, thus putting crew and other passengers at risk.

Sleeping tablets similarly have no indication for flying, and again could make a passenger difficult to rouse or transfer if there was a genuine in-flight emergency. Often passengers mix these medications with alcohol, with deleterious consequences. We would not wish you to to be barred from a flight or face prosecution, or find yourself incapacitated due to the unpredictable effects of said medication. The drug driving legislation which came into effect in recent years would also potentially prohibit onward driving from an airport.

Flight anxiety should be treated by Cognitive Behavioural Therapy – a form of counselling, which has long lasting benefits and is safe. Airline carriers offer excellent courses for free, so do speak with your flight provider to arrange to go on a course well in advance of when you know you will be flying.

We acknowledge that you may have previously received a prescription for this purpose, however, we are unable to agree to such requests any longer.

Patients are reminded that they are able to arrange a consultation at a private travel clinic should they wish to pursue the option of in-flight medication.

Appointments, including Procedures and Dental Appointments:

Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic for most adults for any effective sedation. Conversely anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.

A patient may take a sedative ‘an hour’ before their procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the anxiolytic being sub optimal.

GPs are not regularly involved, skilled, trained or appraised in sedation skills.

All hospital consultants, and dentists have access to the same prescribing abilities as GPs. If a patient needs a certain medication to enable an investigation/appointment to go ahead, they are just as well positioned to provide a prescription.

Sedated patients should be regularly monitored, and this cannot be organised through the GP.

This policy enables us to adhere to our duty of care to provide safe, consistent, and appropriate care for our patients. 

Why does my GP appointment need to be triaged?

Riverport Medical Practice provides care under the General Medical Services contract. The changes to the GMS contract in May 2023 meant we were asked to change the way we deal with, and respond to, GP appointment requests.

Firstly we have increased the number of ways our patients can request a GP appointment. This has been designed to improve accessibility, and has not restricted any of the previous ways in which patients can request an appointment.

You can request a GP appointment by:

  • Speaking to a member of our Reception Team at one of our surgeries in person
  • Telephoning the Practice on 01480 466611
  • Completing our online appointment request form
  • Accessing our online appointment request form via the NHSapp

Our team will aim to review and respond to your appointment request on the same day, and within 1 working day. We will respond to your GP appointment request in one of four ways:

  1. invite the patient to an appointment with a suitable clinician (usually face-to-face, but occasionally telephone appointment if clinically appropriate)
  2. provide appropriate advice to the patient
  3. direct the patient towards other appropriate services
  4. communicate with the patient to:
    1. request further information, or
    2. convey when and how the patient will receive further information.

Riverport Medical Practice has a Triage Team of Care Navigators and Duty Doctors who review all our incoming GP appointment requests. This process allows us to safely allocate patients to appropriate services, both within and outside our Practice. Below are the various care pathways our team can recommend:

  • on-the-day assessment by another clinician for cases perceived to be urgent assessment at another time by a clinician for cases relating to longer-term and non-urgent conditions
  • signpost to another service where another service is appropriate e.g. mental health support, community services, community pharmacy
  • signpost to 111, A&E, or an overflow hub when capacity in the practice is reached
  • request further information – for example via digital tools such as a text message, or asking for a photo.

We are working hard to deliver care that is both safe and effective for patients, as well as safe and sustainable for the Practice. This is challenging, as we understand that demand for GP appointments continually exceeds our supply of appointments. For this reason, we have to carefully consider each appointment request to determine an appropriate response and care pathway. Instead of triaging appointment requests after our capacity has been exceeded, we triage appointments all day, every day. This prevents appointments being allocated on a first-come-first-served basis, and allows clinical prioritisation of all appointments.

More information on challenges facing General Practice can be found at bma.org.uk/

If you would like to join our Patient Participation Group, to discuss solutions and ideas for providing safe and effective services, please visit link

Expedite Letters

If you have been referred to a hospital you can check the latest average wait time for appointments and operations by visiting NHS My Planned Care website.

Once your referral has been accepted by the hospital, any queries about when you will be seen should be directed to them, not your GP.

Patients are sometimes requested by the hospital to obtain a letter from their GP so their appointment can be expedited. This is unnecessary and creates an additional administrative burden on GP services. For this reason, we are not able to provide expedite letters.

If you are experiencing worsening symptoms, we advise you to contact your specialist directly so they can assess your condition and make the necessary arrangements if an expedite of your appointment is appropriate. If you have difficulty in accessing your consultant, you should contact PALS for assistance.

Local PALS contacts are:

Peterborough City Hospital AND Stamford & Rutland Hospital

Hinchingbrooke Hospital

Cambridge University Hospitals (Addenbrooke’s)

Access to medical records

You can now see your test results and read notes from your appointments in your NHS account.

This will help you see your test results and read notes from your appointments.

What’s changed

You will now be able to see all the information within your health record automatically.

If you are over 16 and have an online NHS account, such as through the NHS App or NHS website, you can now see all your notes from your GP.

For most people, access will be automatic and you won’t need to do anything.

What health information you can see

You will be able to access:

  • notes from GP appointments
  • test results
  • any letters saved on your records

This only applies to records from your GP, not from hospitals or other specialists.

Privacy advice

If you do not want to see your health record or if you have any concerns, please talk to your GP.

The NHS app and website are secure so no one is able to access your information except you.

If you do not have the NHS app or an online account

These changes only apply to people with the NHS app or an online NHS account.

If you do not want an online account, you can still access your health records by asking at reception.

Did not attend (DNA) policy

What a DNA is

A DNA appointment is when a patient does not turn up for appointments, and does not contact the surgery to cancel or change the appointment.

This creates a significant strain on the NHS.

We understand that there are situations that can make it impossible for you to cancel your appointment, for example being admitted to hospital.

Our DNA policy

  1. If you fail to attend 2 or more appointments in the the previous month, you will get a warning letter.
  2. If you’ve had a warning letter and you miss another appointment, you’ll get another letter. This will say that you can only book appointments on the day, and not in advance.
  3. If you do not attend same day appointments, we will invite you to discuss a contract and an appointment plan. This will include you calling to confirm an appointment, if not it will be cancelled.

Warning letters last 12 months.

Cancelling appointments

To avoid DNA appointments, you can use the NHS app or online services to cancel your appointments.

You can also get a text reminder of your appointment, and you can reply to this to cancel if necessary. Please make sure we have the right mobile number for you.

GP net earnings

All GP Practices are required to declare the mean earnings (average pay) for GP’s working to deliver NHS services to patients at each practice.

The average pay for GPs working at Riverport Medical Practice in the financial year ended 31 March 2022 was £47,518 before tax and national insurance. This is for 1 full-time GP, 1 part-time GP, 5 salaried GPs and 7 Locum GPs who worked in the practice for more than 6 months.

It should be noted that the prescribed method for calculating is potentially misleading because it takes no account of how much time Doctors spend working in the Practice, and should not be used to form any judgement about GP earnings, nor to make any comparison with other Practices.

Patient confidentiality

We respect your right to privacy and keep all your health information confidential and secure. It is important that the NHS keeps accurate and up-to-date records about your health and treatment so that those treating you can give you the best possible care.

This information may be used for management and audit purposes. However, it is usually only available to, and used by, those involved in your care. You have the right to know what information we hold about you. If you would like to see your records please contact the Practice Manager.

Your confidentiality is important to us

You can be sure that anything you discuss with any member of this practice – family doctor, nurse, receptionist – will stay confidential.

Even if you are under 16 nothing will be said to anyone – including parents, other family members, carer workers or tutors – without your permission. The only reason why we might want to consider passing on confidential information without your permission, would be to protect you or someone else from serious harm. We would always try to discuss this with you first.

If you are being treated elsewhere – for example at a hospital or Brook centre – it is best if you allow the doctor or nurse to inform the practice of any treatment you are receiving.

If you have any worries about confidentiality please feel free to ask a member of staff.

Privacy policy

Our full practice privacy notice can be found here.

General practice data for planning and research (GPDfPR)

NHS Digital has been collecting data from GPs through its trusted General Practice Extraction Service.

This system is now being replaced with their new General Practice Data for Planning and Research (GPDPR) service, a broader general-purpose collection which will enable faster access to pseudonymised patient data for planners and researchers.

The NHS needs data about the patients it treats in order to plan and deliver its services and to ensure that care and treatment provided is safe and effective. The General Practice Data for Planning and Research data collection will help the NHS to improve health and care services for everyone by collecting patient data that can be used to do this.

GP practices already share patient data for these purposes, but this new data collection will be more efficient and effective.

This means that GPs can get on with looking after their patients, and NHS Digital can provide controlled access to patient data to the NHS and other organisations who need to use it, to improve health and care for everyone.

Opting out of NHS Digital collecting your data (‘Type 1 opt-out’)

If you do not want your identifiable patient data to be shared outside of your GP practice for purposes except for your own care, you can register an opt-out with your GP practice. This is known as a Type 1 opt-out.

Type 1 opt-outs were introduced in 2013 for data sharing from GP practices, but may be discontinued in the future as a new opt-out has since been introduced to cover the broader health and care system, called the National Data Opt-out. If this happens people who have registered a Type 1 Opt-out will be informed.

NHS Digital will not collect any patient data for patients who have already registered a Type 1 opt-out in line with current policy. If this changes patients who have registered a Type 1 opt-out will be informed.

How to register a Type 1 opt-out

To register a Type 1 opt-out you need to do the following.

  1. Download the Type 1 opt-out form from the NHS website
  2. Complete the form and return it to your GP practice – you can do this by post or email, or leave it in person.

You can also contact us for a form to be sent out to you.

You can register a Type 1 opt-out at any time. You can also change your mind at any time and withdraw a Type 1 opt-out. If you have already registered a Type 1 opt-out with your GP practice your data will not be shared with NHS Digital.

If you have previously registered a Type 1 opt-out and you would like to withdraw this, you can also use the form to do this.

Violent and abusive behaviour

As an employer, the practice has a duty to care for the health and safety of its staff.

The practice also has a legal responsibility to provide a safe and secure working environment for staff.

All patients are expected to behave in an acceptable manner and violent or abusive behaviour towards staff or patients may result in removal from our practice list or even criminal proceedings. The practice follows the NHS guidance concerning zero tolerance.

The practice has a policy of zero tolerance of verbal and physical violence towards GPs, staff or other patients.

The practice will request the removal of any patient from the practice list who is aggressive or abusive towards a doctor, member of staff, other patient, or who damages property.

We report all physical abuse to the police as an assault.

We expect all patients to be responsible and avoid attending the surgery under the influence of alcohol or illegal drugs.

Any alteration of prescriptions is illegal and will not be tolerated.

If you’re unhappy with the quality of service you have the right to register with another practice without notifying us.

On the very rare occasions when a patient repeatedly ignores their responsibilities to the Practice, we have the right to remove the patient from our Practice list.

Unacceptable behaviour

Examples of unacceptable behaviour include:

  • violence
  • excessive noise eg recurrent loud or intrusive conversation or shouting
  • threatening or abusive language involving swearing or offence remarks
  • derogatory racial or sexual remarks
  • malicious allegations relating to members of staff, other patients or visitors
  • offensive sexual gestures or behaviours
  • abusing alcohol or drugs on practice premises
  • drug dealing on practice premises
  • wilful damage to practice property
  • threats or threatening behaviour
  • theft

Zero tolerance

Our staff have the right to be treated with dignity and respect at all times.

They should be able to do their jobs without being physically or verbally abused.

Anyone found abusing the staff in person or on the telephone will be asked to leave the practice.

This behaviour will not be tolerated.

Removal from the patient list

In exceptional circumstances, a breakdown may occur between a doctor and their patient.

If the breakdown is serious, for example physical or verbal abuse to any member of the practice team, the doctors may feel that the relationship has been compromised.

We may take steps to remove the patient from the doctor’s list. Where possible, we prefer to discuss with the patient to try to find a solution.

We give reasons for removal in writing.

Get a document signed by your GP

You can ask your GP to sign a document for you. This will prove that they are true and accurate.

This includes:

  • private sick notes
  • insurance certificates
  • benefit claims
  • reports for adoption and fostering

We do not provide:

  • reports proving you are fit to exercise
  • fitness for travel certificates
  • bus pass forms
  • driving medicals

In person

If you do not have a digital copy or a good quality photograph of the document, you can bring a physical copy in to the surgery.

By post

You can send us a copy of the document by post.

When you post the documents, please include:

  • the forms or documents you need completing
  • why you need them
  • who they should be addressed to
  • your contact details

We will contact you when the documents are ready or if we need more information. In some cases, we may ask you to request an appointment.

Fees

You may have to pay for some types of documents to be signed by a GP, as not all of them are covered by the NHS.

We will let you know if you need to pay in advance.

It’s up to each GP to decide how much they charge. Most GPs use the British Medical Association’s suggested fees.

How long it takes

It can sometimes take a several weeks to have a GP sign a document for you.

Not all documents need a signature by a GP, for example passport applications. You can ask another person in a position of trust to sign some documents free of charge.

To check if someone else can sign for you, read government advice on certifying document.