Vulnerable Adults

Introduction

The purpose of this document is to set out the policy of the Practice in relation to the protection of vulnerable adults. Further guidance may be available on local inter-agency procedures via the Primary Care Organisation and / or Social Services.

What is a vulnerable adult?

The definition is wide, however this may be regarded as anyone over the age of 18 years who may be unable to protect themselves from abuse, harm or exploitation, which may be by reason of illness, age, mental illness, disability or other types of physical or mental impairment.

Those at risk may live alone, be dependent on others (care homes etc.), elderly, or socially isolated.

Forms of Abuse

  • Neglect – ignoring mental or physical needs, care, education, or basic life necessities or rights
  • Bullying – family, carers, friends
  • Financial – theft or use of money or possessions
  • Sexual – assault, rape, non-consensual acts (including acts where unable to give consent), touching, indecent exposure
  • Physical – hitting, assault, man-handling, restraint, pain or forcing medication
  • Psychological – threats, fear, being controlled, taunts, isolation
  • Discrimination – abuse based on perceived differences and vulnerabilities
  • Institutional abuse – in hospitals, care homes, support services or individuals within them, including inappropriate behaviours, discrimination, prejudice, and lack of essential safeguards

Abuse may be deliberate or as a result of lack of attention or thought, and may involve combinations of all or any of the above forms. It may be regular or on an occasional or single event basis, however it will result in some degree of suffering to the individual concerned. Abuse may also take place between one vulnerable adult and another, for example between residents of care homes or other institutions.

Indications

  • Bruising
  • Burns
  • Falls
  • Apparent lack of personal care
  • Nervousness or withdrawn
  • Avoidance of topics of discussion
  • Inadequate living conditions or confinement to one room in their own home
  • Inappropriate controlling by carers or family members
  • Obstacles preventing personal visitors or one-to-one personal discussion
  • Sudden changes in personality
  • Lack of freedom to move outside the home, or to be on their own
  • Refusal by carers to allow the patient into further care or to change environs
  • Lack of access to own money
  • Lack of mobility aids when needed

Action Required

Where abuse of a vulnerable adult is suspected the welfare of the patient takes priority. In deciding whether to disclose concerns to a third party or other agency the GP will assess the risk to the patient.

  •  Ideally the matter should be discussed with the patient involved first, and attempt made to obtain consent to refer the matter to the appropriate agency. Where this is not possible, or in the case of emergency where serious harm is to be prevented, the patient’s doctor will balance the need to protect the patient with the duty of confidentiality before deciding whether to refer.
  • The patient should usually be informed that the doctor intends to disclose information, and advice and support should be offered.
  • Where time permits, the medical defence organisation will be telephoned before any action is taken.

Due regard will be taken of the patient’s capacity to provide a valid consent.

In assessing the risk to the individual, the following factors will be considered:

  • Nature of abuse, and severity
  • Chance of recurrence, and when
  • Frequency
  • Vulnerability of the adult (frailty, age, physical condition etc.)
  • Those involved – family, carers, strangers, visitors etc.
  • Whether other third parties are also at risk (other members of the same household may being abused at the same time)

Subject to the local procedures in force, consideration will be given to;

  • Report to Social Services Mental Health team
  • Report to Police
  • Report to PCT lead
Contact List
Service
Contact Number
Police (local) Ealing Police Station: 020 86493573 

Or national police service: 999
Community Mental Heath Avenue House: 020 8483 1720 

Out of Hour contact: 0300 1234244
Adult Support Services/ Safeguarding Adult 020 8825 8000
Adult Support Services (out of hours) 

Adult Protection Officer

 020 8825 5000
Age Concern 020 8567 8017
Social Services 020 8825 8000 / 020 8566 2360
MIND in Ealing 020 8992 0303
Ealing CAMHS 020 8354 8160
Drug Misuse RISE: 020 8843 5900 

020 8825 9888
Medical Defence Organisation MDU – via doctor/nurse or management membership details
Ealing CCG 

3rd Floor, Perceval House

14/16 Uxbridge Road

Ealing, W5 2HL

 020 8280 8080
NHS England 

North West London Area Team

 020 7322 3700

Your Rights and Responsibilities

Patient’s Rights

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.

Patient’s Responsibilities

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 2 working days.
  • 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 10 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.

NHS Constitution

The NHS Constitution establishes the principles and values of the NHS in England. For more information see these websites:

Zero Tolerance

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.

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.

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 (i.e. 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 not 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 list 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.