The Surgery prides itself in maintaining professional standards. For certain intimate examinations during consultations an impartial observer (a “Chaperone”) will be required. This is usually a nurse or a health care assistant.
The chaperone will:
- be sensitive and respect the patient’s dignity and confidentiality
- reassure the patient if they show signs of distress or discomfort
- be familiar with the procedures involved in a routine intimate examination
- stay for the whole examination and be able to see what the doctor is doing, if practical
- be prepared to raise concerns if they are concerned about the doctor’s behaviour or actions.
If you have a complaint or concern about the service you have received from the doctors or any of the staff working in this GP surgery, please let us know. This includes Primary Care Network staff working as part of our GP surgery. We operate a complaints procedure as part of an NHS system for dealing with complaints. Our complaints system meets national criteria.
How to complain
We hope that most problems can be sorted out easily and quickly when they arise and with the person concerned. For example, by requesting a face-to-face meeting to discuss your concerns.
If your problem cannot be sorted out this way and you wish to make a complaint, we would like you to let us know as soon as possible. By making your complaint quickly, it is easier for us to establish what happened. If it is not possible to do that, please let us have details of your complaint:
- Within 6 months of the incident that caused the problem; or
- Within 6 months of discovering that you have a problem, provided this is within 12 months of the incident.
Complaints should be addressed to the GP surgery team verbally or in writing to Mr Vijay Jambulingam, Practice Manager, or any of the doctors. Alternatively, you may ask for an appointment with the GP surgery to discuss your concerns. They will explain the complaints procedure to you and make sure your concerns are dealt with promptly. Please be as specific as possible about your complaint.
What we will do
We will acknowledge your complaint within three working days. We will aim to have investigated your complaint within ten working days of the date you raised it with us. We will then offer you an explanation or a meeting with the people involved, if you would like this. When we investigate your complaint, we will aim to:
- Find out what happened and what went wrong.
- Make it possible for you to discuss what happened with those concerned, if you would like this.
- Make sure you receive an apology, where this is appropriate.
- Identify what we can do to make sure the problem does not happen again.
Complaining on behalf of someone else
We take medical confidentiality seriously. If you are complaining on behalf of someone else, we must know that you have their permission to do so. A note signed by the person concerned will be needed unless they are incapable (because of illness) of providing this.
Complaining to NHS England
We hope that you will use our Practice Complaints Procedure if you are unhappy. We believe this will give us the best chance of putting right whatever has gone wrong and an opportunity to improve our GP surgery.
However, if you feel you cannot raise the complaint with us directly, please contact NHS England. You can find more information on how to make a complaint at https://www.england.nhs.uk/contact-us/complaint/complaining-to-nhse/.
Unhappy with the outcome of your complaint?
If you are not happy with the way your complaint has been dealt with by the GP surgery and NHS England and would like to take the matter further, you can contact the Parliamentary and Health Service Ombudsman (PHSO). The PHSO makes final decisions on unresolved complaints about the NHS in England. It is an independent service which is free for everyone to use.
To take your complaint to the Ombudsman, visit the Parliamentary and Health Service Ombudsman website or call 0345 015 4033
Need help making a complaint?
If you want help making a complaint, Healthwatch Hounslow can help you find independent NHS complaints advocacy services in your area.
Alternatively, POhWER is a charity that helps people to be involved in decisions being made about their care. Call POhWER’s support centre on 0300 456 2370 for advice.
The practice complies with the Data Protection Act. All information about patients is confidential: from the most sensitive diagnosis, to the fact of having visited the surgery or being registered at the Practice. All patients can expect that their personal information will not be disclosed without their permission except in the most exceptional of circumstances, when somebody is at grave risk of serious harm.
All members of the primary health care team (from reception to doctors) in the course of their duties will have access to your medical records. They all adhere to the highest standards of maintaining confidentiality.
As our reception area is a little public, if you wish to discuss something of a confidential nature please mention it to one of the receptionists who will make arrangements for you to have the necessary privacy.
The duty of confidentiality owed to a person under 16 is as great as the duty owed to any other person. Young people aged under 16 years can choose to see health professionals, without informing their parents or carers. If a GP considers that the young person is competent to make decisions about their health, then the GP can give advice, prescribe and treat the young person without seeking further consent.
However, in terms of good practice, health professionals will encourage young people to discuss issues with a parent or carer. As with older people, sometimes the law requires us to report information to appropriate authorities in order to protect young people or members of the public.
If you have any special needs please let our staff know so that we can help and ensure you get the same support in the future.
The Surgery has been specially designed to make it easier for disabled patients to visit. There are no steps at the entrance of the building giving patients easy access. Due to fire regulations, we do have heavy fire doors, however if you have trouble opening these please ask Reception for assistance as they are always happy to help.
There are several dedicated disabled car parking spaces available immediately outside the front entrance of The Surgery.
We have a wheelchair for patient’s use, at their own risk, should you require one whilst visiting our premises.
We have two disabled toilets one on each floor.
Disabled Parking – Blue Badge Scheme
The Blue Badge scheme is for people with severe mobility problems. It allows Blue Badge holders to park close to where they need to go.
We have a loop induction system at the reception desk to assist the hearing impaired. For more information on the loop hearing system visit Hearing Link website.
- British Deaf Association
- British Sign Language Healthy Mind
- Action Hearing Loss
- Royal Association for Deaf People
- National Deaf Children’s Society
If you or family members are blind or partially sighted we can give you a CD or large print of our practice leaflet upon request. Please ask Reception for further information.
For more advice and support for blind people please see the following websites:
- Royal National Institute of Blind People (RIND)
- Action for Blind People
- Blind in Business
- British Blind Sport
Guide dogs are welcome at the surgery but we ask that you be aware of other patients and staff who may have an allergy or fear of dogs.
Other Disability Website
Freedom of Information
The Freedom of Information Act creates a right of access to recorded information and obliges a public authority to:
- Have a publication scheme in place
- Allow public access to information held by public authorities.
The Act covers any recorded organisational information such as reports, policies or strategies, that is held by a public authority in England, Wales and Northern Ireland, and by UK-wide public authorities based in Scotland, however it does not cover personal information such as patient records which are covered by the Data Protection Act.
Public authorities include government departments, local authorities, the NHS, state schools and police forces.
The Act is enforced by the Information Commissioner who regulates both the Freedom of Information Act and the Data Protection Act.
The Surgery publication scheme
A publication scheme requires an authority to make information available to the public as part of its normal business activities. The scheme lists information under seven broad classes, which are:
- who we are and what we do
- what we spend and how we spend it
- what our priorities are and how we are doing it
- how we make decisions
- our policies and procedures
- lists and registers
- the services we offer
You can request our publication scheme leaflet at the surgery.
Who can request information?
Under the Act, any individual, anywhere in the world, is able to make a request to a practice for information. An applicant is entitled to be informed in writing, by the practice, whether the practice holds information of the description specified in the request and if that is the case, have the information communicated to him. An individual can request information, regardless of whether he/she is the subject of the information or affected by its use.
How should requests be made?
- be made in writing (this can be electronically e.g. email/fax)
- state the name of the applicant and an address for correspondence
- describe the information requested.
What cannot be requested?
Personal data about staff and patients covered under Data Protection Act.
For more information see these websites:
GP2GP enables patients’ electronic health records to be transferred directly and securely between GP practices. It improves patient care as GPs will usually have full and detailed medical records available to them for a new patient’s first consultation.
When patients move practices, paper medical records can take weeks to arrive but GP2GP transfers are faster, more reliable and more secure than the existing paper-based method of transferring patient records. This means your new practice will have your full and detailed medical record available in time for your very first appointment.
- What is GP2GP?
GP2GP is the technology that transfers your electronic health record directly and securely from your previous GP when you register at this practice.
- Does my old practice need to be using GP2GP for my electronic health record to be transferred electronically?
Yes, both practices need to be using GP2GP. If they are not, only your paper medical record will be sent and will include a print-out of your electronic health record from your previous practice.
- What happens to my paper record?
Your paper medical record will also be transferred to this practice. This usually takes about six to eight weeks. In the future when all practices are using GP2GP the need for sending paper records may be reviewed.
- What information will be transferred in my electronic health record?
The information contained within your electronic health record at your previous practice will be transferred. This includes information about your medications, allergies, adverse reactions, immunisations and vaccinations, laboratory results, diagnoses, medical history and letters from specialists.
- Will my repeat prescriptions be automatically transferred as well?
Yes, GP2GP transfers all the information about your medications. Your new GP will review all the medicines you are taking before authorising any repeat prescription.
- I am registering as a temporary resident. Will my electronic health record still be transferred electronically?
No. If you are registering as a temporary resident your health records remain at your usual practice and are not transferred either as paper or via GP2GP. Your temporary practice will contact your registered GP if they require any information.
- Where can I find out more about GP2GP
Our practice staff should be able to answer any queries you may have. You can also read about GP2GP on the Health and Social Care Information Centre website: www.hscic.gov.uk/gp2gp
Infection Control Statement
We aim to keep our surgery clean and tidy and offer a safe environment to our patients and staff. We are proud of our modern, purpose built Practice and endeavour to keep it clean and well maintained at all times.
If you have any concerns about cleanliness or infection control, please report these to our Reception staff.
Our GPs and nursing staff follow our Infection Control Policy to ensure the care we deliver and the equipment we use is safe.
We take additional measures to ensure we maintain the highest standards:
- Encourage staff and patients to raise any issues or report any incidents relating to cleanliness and infection control. We can discuss these and identify improvements we can make to avoid any future problems.
- Carry out an annual infection control audit to make sure our infection control procedures are working.
- Provide annual staff updates and training on cleanliness and infection control
- Review our policies and procedures to make sure they are adequate and meet national guidance.
- Maintain the premises and equipment to a high standard within the available financial resources and ensure that all reasonable steps are taken to reduce or remove all infection risk.
- Use washable or disposable materials for items such as couch rolls, modesty curtains, floor coverings, towels etc, and ensure that these are laundered, cleaned or changed frequently to minimise risk of infection.
- Make Alcohol Hand Rub Gel available throughout the building
Non NHS Work
What is non-NHS work and why is there a fee?
The National Health Service provides most health care to most people free of charge, but there are exceptions: prescription charges have existed since 1951 and there are a number of other services for which fees are charged.
Sometimes the charge is because the service is not covered by the NHS, for example, providing copies of health records or producing medical reports for insurance companies, solicitors or employers.
The Government’s contract with GPs covers medical services to NHS patients but not non-NHS work. It is important to understand that many GPs are not employed by the NHS; they are self-employed and they have to cover their costs – staff, buildings, heating, lighting, etc. – in the same way as any small business.
In recent years, however, more and more organisations have been involving doctors in a whole range of non-medical work. Sometimes the only reason that GPs are asked is because they are in a position of trust in the community, or because an insurance company or employer wants to ensure that information provided to them is true and accurate.
Examples of non-NHS services for which GPs can charge their own NHS patients are:
- accident/sickness certificates for insurance purposes
- school fee and holiday insurance certificates
- reports for health clubs to certify that patients are fit to exercise
- private prescriptions for travel purposes
Examples of non-NHS services for which GPs can charge other institutions are:
- life assurance and income protection reports for insurance companies
- reports for the Department for Work and Pensions (DWP) in connection with
- disability living allowance and attendance allowance
- medical reports for local authorities in connection with adoption and fostering
- copies of records for solicitors
Do GPs have to do non-NHS work for their patients?
With certain limited exceptions, for example a GP confirming that one of their patients is not fit for jury service, GPs do not have to carry out non-NHS work on behalf of their patients. Whilst GPs will always attempt to assist their patients with the completion of forms, they are not required to do such non-NHS work.
Is it true that the BMA sets fees for non-NHS work?
The British Medical Association (BMA) suggest fees that GPs may charge their patients for non-NHS work (ie work not covered under their contract with the NHS) in order to help GPs set their own professional fees. However, the fees suggested by them are intended for guidance only; they are not recommendations and a doctor is not obliged to charge the rates they suggest.
Why does it sometimes take my GP a long time to complete my form?
Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy workload and paperwork takes up an increasing amount of their time. Our GPs do non-NHS work out of NHS time at evenings or weekends so that NHS patient care does suffer.
I only need the doctor’s signature – what is the problem?
When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. In order to complete even the simplest of forms, therefore, the doctor might have to check the patient’s ENTIRE medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the Police.
If you are a new patient we may not have your medical records so the doctor must wait for these before completing the form.
What will I be charged?
It is recommended that GPs tell patients in advance if they will be charged, and what the fee will be. It is up to individual doctors to decide how much they will charge. The surgery has a lists of fees based on these suggested fees which is available on request.
What can I do to help?
- Not all documents need a signature by a doctor, for example passport applications. You can ask another person in a position of trust to sign such documents free of charge. Read the information that comes with these types of forms carefully before requesting your GP to complete them.
- If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them at the same time to speed up the process.
- Do not expect your GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this may cost more. Usually non-NHS work will take 2 weeks.
We are committed to protecting your privacy. You can access our website without giving us any information about yourself. But sometimes we do need information to provide services that you request, and this statement of privacy explains data collection and use in those situations.
In general, you can visit our web site without telling us who you are and without revealing any information about yourself. However there may be occasions when you choose to give us personal information, for example, when you choose to contact us or request information from us. We will ask you when we need information that personally identifies you or allows us to contact you.
We collect the personal data that you may volunteer while using our services. We do not collect information about our visitors from other sources, such as public records or bodies, or private organisations. We do not collect or use personal data for any purpose other than that indicated below:
- To send you confirmation of requests that you have made to us
- To send you information when you request it.
Our website may contain links to other websites of interest. However, once you have used these links to leave our site, you should be aware that we do not have any control over the other website. Therefore, we cannot be responsible for the protection and privacy of any information which you provide whilst visiting these sites.
We intend to protect the quality and integrity of your personally identifiable information and we have implemented appropriate technical and organisational measures to do so. We ensure that your personal data will not be disclosed to State institutions and authorities except if required by law or other regulation.
Choose and Book
What is Choose and Book?
Choose and book is a service that lets you choose the hospital or Clinic you wish to attend for your first appointment. It also gives you the choice of date and time that is convenient for you to fit in with your day to day life.
For more information and access the choose and book service, see the Choose and Book website.
How Choose and Book Works
When you and your GP agree that you need an appointment with a specialist, Choose and Book shows your GP which hospitals or clinics are available for your treatment.
A referral letter is then dictated by the GP and this is passed to the secretary for typing and then an Appointment Request is raised on the Choose and Book system and an Appointment Request letter is printed off which lists your unique booking reference number, your NHS number and a list of hospitals or clinic options for your to choose from. It also gives you a password with your appointment request letter. This is then sent to you through the Royal Mail.
Once you have received your paperwork you can then decide how you wish to book your appointment; this can be via the telephone, using a national number on the letter or via the internet. Please note that whilst the vast majority of appointments can be booked this way, in some cases you will need to telephone your chosen hospital directly to make your appointment. This is because the hospital appointments system does not link to Choose and Book.
Can I Book all my Appointments through Choose And Book?
When you and your GP agree that you need an appointment with a specialist, you can book your FIRST hospital or clinic appointment using Choose and book. Any follow up appointments are arranged by the hospital themselves.
If a patient has a query regarding an appointment made then the patient should contact that hospital direct. You can usually find their direct contact number on your clinic letter on the top right. Or you can ring the hospital directly as ask the switch board to transfer you to the appropriate consultant secretary.
If you have a query with regards to booking an appointment through the Choose and Book system they can phone the Choose and Book number which you will have on the paperwork you received through the post. If you still have a problem you can speak to the Practice Secretary directly or ask the practice online.
Role of the Practice Secretary
The role of the Practice Secretary is to type all of the referral letters for the patient and then raise the appointment request onto the Choose and Book System, so that the patient can then book an appointment.
Once the Practice Secretary has raised the request onto the system, they will then print off the request which will have a Unique Booking Reference Number, list of hospitals that the patient can choose from to attend and a Password. This will then be sent to the patient for the patient to book the appointment.
If the patient knows they are being referred via the Choose and Book system and they haven’t received there paperwork within 3 weeks they should contact the Secretary directly or ask the practice online, for her to reprint the information off again, which can either be sent or the patient could come and collect from the Surgery.
Statement of Intent
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
- Patient Online Access to Their GP Record
- Data for commissioning and other secondary care purposes
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 practices 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. You can do this via the opt out form.
The practice 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 require practices to utilise the GP2GP facility for the transfer of patient records between practices, when a patient registers or de-registers (not for temporary registration).
It is very important that you are registered with a doctor at all times. If you leave your GP 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 your paper records up to two weeks to reach your new surgery.
With GP to GP record transfers your electronic record is transferred to your new practice much sooner.
The practice confirms that GP to GP 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 and viewing a summary of your medical records on-line. If you do not already have a user name and password for this system – please register your interest with our reception staff.
Data for commissioning and other secondary care purposes
It is already a requirement of the Health and Social Care Act that practices must meet the reasonable data requirements of commissioners and other health and social care organisations through appropriate and safe data sharing for secondary uses, as specified in the technical specification for care data.
At our practice we have specific arrangements in place to allow patients to “opt out” of care.data which allows for the removal of data from the practice. Please see the page about care data on our website
The Practice confirm these arrangements are in place and that we undertake annual training and audits to ensure that all our data is handled correctly and safely via the Information Governance Toolkit.
Summary Care Records
About your Summary Care Record
Your Summary Care Record contains important information about any medicines you are taking, any allergies you suffer from and any bad reactions to medicines that you have previously experienced.
Allowing authorised healthcare staff to have access to this information will improve decision making by doctors and other healthcare professionals and has prevented mistakes being made when patients are being cared for in an emergency or when their GP practice is closed.
Your Summary Care Record also includes your name, address, date of birth and your unique NHS Number to help identify you correctly.
You may want to add other details about your care to your Summary Care Record. This will only happen if both you and your GP agree to do this. You should discuss your wishes with your GP practice.
Healthcare staff will have access to this information, so that they can provide safer care, whenever or wherever you need it, anywhere in England.
Who can see my Summary Care Record?
Healthcare staff who have access to your Summary Care Record:
- need to be directly involved in caring for you
- need to have an NHS Smartcard with a chip and passcode
- will only see the information they need to do their job and
- will have their details recorded every time they look at your recordHealthcare staff will ask for your permission every time they need to look at your Summary Care Record. If they cannot ask you (for example if you are unconscious or otherwise unable to communicate), healthcare staff may look at your record without asking you, because they consider that this is in your best interest.
If they have to do this, this decision will be recorded and checked to ensure that the access was appropriate.
What are my choices?
You can choose to have a Summary Care Record or you can choose to opt out.
If you choose to have a Summary Care Record and are registered with a GP practice, you do not need to do anything as a Summary Care Record is created for you.
If you choose to opt out of having a Summary Care Record and do not want a SCR, you need to let your GP practice know by filling in and returning an opt-out form (PDF, 245.9kB). Opt-out forms can be downloaded from the website or from your GP practice.
If you are unsure if you have already opted out, you should talk to the staff at your GP practice. You can change your mind at any time by simply informing your GP practice and either filling in an opt-out form (PDF, 245.9kB) or asking your GP practice to create a Summary Care Record for you.
Children and the Summary Care Record
If you are the parent or guardian of a child under 16, you should make this information available to them and support the child to come to a decision as to whether to have a Summary Care Record or not.
If you believe that your child should opt-out of having a Summary Care Record, we strongly recommend that you discuss this with your child’s GP. This will allow your child’s GP to highlight the consequences of opting-out, prior to you finalising your decision.
Where can I get more information?
For more information about Summary Care Records you can
- talk to the staff at your GP practice
- phone the Health and Social Care Information Centre on 0300 303 5678
- Read the Summary Care Record patient leaflet (PDF, 888.2kB)
Your Rights and Responsibilities
We are committed to giving you the best possible service. This will be achieved by working together. Help us to help you. You have a right to, and the practice will try to ensure that:
- You will be treated with courtesy and respect
- You will be treated as a partner in the care and attention that you receive
- All aspects of your visit will be dealt with in privacy and confidence
- You will be seen by a doctor of your choice subject to availability
- In an emergency, out of normal opening hours, if you telephone the practice you will be given the number to receive assistance, which will require no more than one further call
- You can bring someone with you, however you may be asked to be seen on your own during the consultation
- Repeat prescriptions will normally be available for collection within two working days of your request
- Information about our services on offer will be made available to you by way of posters, notice boards and newsletters
- You have the right to see your medical records or have a copy subject to certain laws.
With these rights come responsibilities and for patients we would respectfully request that you:
- Treat practice staff and doctors with the same consideration and courtesy that you would like yourself. Remember that they are trying to help you
- Please ensure that you order your repeat medication in plenty of time allowing 48 working hours.
- Please ensure that you have a basic first aid kit at home and initiate minor illness and self-care for you and your family.
- Please attend any specialist appointments that have been arranged for you or cancel them if your condition has resolved or you no longer wish to attend
- Please follow up any test or investigations done for you with the person who has requested the investigation
- Attend appointments on time and check in with Reception
- Patients who are more than 20 minutes late for their appointment may not be seen.
- If you are unable to make your appointment or no longer need it, please give the practice adequate notice that you wish to cancel. Appointments are heavily in demand and missed appointments waste time and delay more urgent patients receiving the treatment they need
- An appointment is for one person only. Where another family member needs to be seen or discussed, another appointment should be made
- Patients should make every effort to present at the surgery to ensure the best use of nursing and medical time. Home visits should be medically justifiable and not requested for social convenience
- Please inform us when you move home, change your name or telephone number, so that we can keep our records correct and up to date
- Read the practice leaflets and other information that we give you. They are there to help you use our services. If you do not understand their content please tell us
- Let us have your views. Your ideas and suggestions whether complimentary or critical are important in helping us to provide a first class, safe, friendly service in pleasant surroundings.
The NHS Constitution establishes the principles and values of the NHS in England. For more information see these websites:
The practice fully supports the NHS Zero Tolerance Policy. The aim of this policy is to tackle the increasing problem of violence against staff working in the NHS and ensures that doctors and their staff have a right to care for others without fear of being attacked or abused.
We understand that ill patients do not always act in a reasonable manner and will take this into consideration when trying to deal with a misunderstanding or complaint. We ask you to treat your doctors and their staff courteously and act reasonably.
All incidents will be followed up and you will be sent a formal warning after a second incident or removed from the practice list after a third incident if your behaviour has been unreasonable.
However, aggressive behaviour, be it violent or verbal abusive, will not be tolerated and may result in you being removed from the Practice list and, in extreme cases, the Police will be contacted if an incident is taking place and the patient is posing a threat to staff or other patients.
Removal from the Practice List
A good patient-doctor 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 Surgery, 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.