Practice Policies & Patient Information
Call Recording
Please note some calls may be recorded. We use the recording of phone calls for a number of reasons; these include but are not limited to: investigating complaints, investigation of incidents, staff training and prevention and detection of fraud. Recordings will be stored securely for 3 years and are managed by Mid Mersey Digital Alliance
Chaperone Policy
Our Practice is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times and the safety of everyone is of paramount importance.
All patients are entitled to have a chaperone present for any consultation, examination or procedure where they consider one is required. The chaperone may be a family member or friend, but on occasions you may prefer a trained member of staff.
Patients are advised to ask for a chaperone if required at the time of booking an appointment, if possible, so that arrangements can be made and the appointment is not delayed in any way.
All staff are aware of and have received appropiate information relating to this policy.
Complaints
We aim to provide patients with the best care we can, but we will sometimes fall short of the mark. If you have a complaint or concern about the service you have received from the doctors or any of the personnel working in this practice, please do not be afraid to let us know. We operate a practice complaint procedure as part of the NHS complaints system, which meets national criteria. You will not be treated any differently because you have complained, we will just do our best to put right anything that has gone wrong.
We make every effort to give the best service possible to everyone who attends our practice.
However, we are aware that things can go wrong resulting in a patient feeling that they have a genuine cause for complaint. If this is so, we would wish for the matter to be settled as quickly, and as amicably, as possible.
To pursue a complaint please contact the practice manager who will deal with your concerns appropriately.
We will acknowledge your complaint within 3 working days and would aim to have looked into the matter within 10 working days.
We keep to the strict rules of medical and personal confidentiality. If you wish to make a complaint on behalf of somebody else then we will require written consent from the patient to confirm that they are unhappy with the service that we have provided and that we can deal with someone else about their complaint.
If you are dissatisfied with the outcome you have the right to contact either of the organisations below:
Ombudsman
The Parliamentary and Health Service Ombudsman
Millbank Tower
Millbank
London
SW1P 4QP
Website www.ombudsman.org.uk
Care Quality Commission
Tel no: 03000 616161
Email: enquiries@cqc.org.uk
If you need help to make your complaint, then you may wish to contact “Healthwatch Advocacy” who provide practical support and information to people who want to make and NHS complaint.
Healthwatch Advocacy is:
Free
Independent ofthe NHS
Confidential
Contact no: 0300 777 6543
HOW TO COMPLAIN
We hope that we can sort most problems out easily and quickly, often at the time they arise and with the person concerned. If you wish to make a formal complaint, please do so AS SOON AS POSSIBLE – ideally within a matter of a few days using the form that can be downloaded at the bottom of this page. This will enable us to establish what happened more easily. If doing that is not possible your complaint should be submitted within 12 months of the incident that caused the problem; or within 12 months of discovering that you have a problem. You should address your complaint in writing to the practice manager (you can use the attached form) who will make sure that we deal with your concerns promptly and in the correct way. You should be as specific and concise as possible.
COMPLAINING ON BEHALF OF SOMEONE ELSE
We keep strictly to the rules of medical confidentiality (a separate leaflet giving more detail on confidentiality is available on request). If you are not the patient, but are complaining on their behalf, you must have their permission to do so. An authority signed by the person concerned will be needed, unless they are incapable (because of illness or infirmity) of providing this. A Third Party Consent Form is provided below.
WHAT WE WILL DO
We will log and acknowledge your complaint within 3 working days. We will discuss with you how you would like your complaint to be taken forward, the outcome you are seeking and we will agree a reasonable timescale for us to prepare a response to your complaint. We will conduct a full investigation into your concerns with those concerned, make sure you receive an apology if this is appropriate, and take steps to ensure we address the issue of concern.
You will receive a final letter setting out the outcome of any practice investigations.
TAKING IT FURTHER
If you remain dissatisfied with the outcome you may refer the matter to either of the following:
The Parliamentary and Health Service Ombudsman
Millbank Tower
Millbank
London
SW1P 4QP
Tel 0345 0154033
http://www.ombudsman.org.uk/
Please click on the link below for a copy of the practice complaints form. If you would like to email the completed form back to the surgery please email hccg.brookvalemc@nhs.net
After 1 July 2023, members of the public wishing to make a complaint to the commissioner of a primary care service can contact NHS Cheshire and Merseyside by:
Telephone: 0800 132 996
E-mail: enquiries@cheshireandmerseyside.nhs.uk
Writing to us at: Patient Experience Team, No 1 Lakeside, 920 Centre Park Square, Warrington, WA11QY.
General Data Protection Regulations (GDPR)
GENERAL DATA PROTECTION REGULATIONS
The General Data Protection Regulations (GDPR) is a new law that determines how your personal data is processed and kept safe, and the legal rights that you have in relation to your own data.
The regulation applies from 25th May 2018, and will apply even after the UK leaves the EU.
What GDPR means for patients:
The GDPR sets out the key principles about processing personal data for patients:
- Data must be processed lawfully, fairly and transparently
- It must be collected for specific, explicit and legitimate purposes
- It must be limited to what is necessary for the purposes for which it is processed
- Information must be accurate and kept up to date
- Data must be stored securely
- It can be retained for as long as is necessary for the reasons it was collected
There are also stronger rights for patients regarding the information that practices hold about them. These include:
- Being informed about how their data is used
- Patients to have access to their own data
- Patients can ask to have incorrect information changed
- Restrict how their data is used
- Move their patient data from one health organisation to another
- The right to object to their patient information being processed (in certain circumstances)
For further information relating to how we process patient data, please click on the link below:
RE: COVID-19: Increased Patient Information for health and care professionals.
To help the NHS to respond to the COVID-19 pandemic, NHSX and NHS Digital are improving the access that doctors, nurses and authorised health and care professionals have to medical records and information. This will help them to more safely treat and advise patients who are not attending their usual GP practice, who have called NHS 111, or who are receiving care in another setting.
GP Connect Data Sharing of patient records has been enabled at a national level. This means that a clinician will be able to view the patient’s record via GP Connect if they have access to a GP Connect enabled clinical system. They will need to have a legitimate relationship with the patient i.e. they are registered, referred or self-referred to the service. This is a HTML view so no data is able to be saved or edited and a full audit of who access what, is possible. This also means that practices will be able to see the GP record of patients registered as temporary residents through the computer system. Further information is available on our supplementary Privacy Notice.
Privacy Notice COVID-19 Update
Accurx text messaging service
GP Net Earnings
All GP practices are required to declare the mean earnings (e.g. average pay) for GPs working to deliver NHS services to patients at each practice.
The average pay for GPs working in Brookvale Medical Practice in the 2023/24 financial year was £65,650 before tax and National Insurance. This is for 9 part time GPs who worked in the practice for more than 6 months.
IT – Our Contract
Contractual Requirements for IT/Electronic Patient Records
It is a requirement of General Medical Services 2014/2015 that all GP practices inform their patients of their current status in relation to a number of electronic services:
Electronic Transfer of Patient Record
The system (GP2GP) that electronically transfers patient medical records from one practice to another is already activated at Brookvale practice.
Electronic Appointment Booking
The practice provided patients with the facility to book an appointment online approximately 4 years ago and since installing the facility we have received some very positive feedback from patients.
Electronic Booking of Repeat Prescriptions
The practice provided patients with the facility to order repeat prescriptions online approximately 4 years ago and to date lots of patients now use the facility.
Patients Access to their GP Record
Patients will be able to view their medical record on line from March 2015. Patients will be able to view their medical records relating to medications, allergies, summary of conditions and adverse reactions. It is our aim to have the facility ready as soon as possible however this will be no later than March 2015.
Summary Care Record
The “summary care record” is an electronic summary of a patient’s key clinical information The practice has already activated a summary care record for all patients other than those who have expressed a wish to opt out of this service. For further information please see our “care data” page which can be located under the patient information tab on this web site.
This record can only be viewed in emergency or urgent care settings with the consent of the patient unless the patient is unable to give consent (for example if they are unconscious
EMIS Data-Sharing Agreements
Brookvale Practice uses an IT system called EMISWeb to store your medical records. This is a hosted system, which means your data is held on the EMIS servers in Leeds and is accessed by us via N3, a secure broadband network which is only accessible to the NHS.
The Practice has signed data-sharing agreements with other NHS organisations which mean that other NHS organisations can view your patient data and vice versa, the practice can view data held by other NHS organisations.
Patient confidentiality is paramount to Brookvale Practice. The practice will only sign a data sharing agreement with another NHS organisation if we feel sharing the data is safe to do so and is in the best interest of the patient.
Before any person can view your medical record they must have a legitimate relationship with you, i.e. you must be registered on their system as a current patient. Access to shared records is recorded and your consent should be obtained by the person accessing your medical record. EMISWeb has an audit trail facility which allows the host organisation to trace who has viewed any aspect of a patients record. All persons who are employed by an NHS organisation are governed by a strict “information governance” policy which prohibits them sharing any information relating to a patient outside of an NHS organisation.
The practice is also signed up to share data with local NHS commissioning organisations via EMIS Search & Report. This involves sharing the results of specific searches set up to identify the numbers of patients meeting the search criteria – patient-identifiable data is not shared as all data is anonymised.
For further details please click on the link below:
EMIS-to-EMIS-Data-Sharing Agreement
Sharing in emergency or urgent situations
There can on occasion be issues that need acting upon swiftly. In such circumstances it isn’t always possible to talk to you beforehand. If there is a concern that you or someone else might come to some harm or suffer avoidable distress, then information can be shared lawfully. For example if an elderly patient is visited by a care worker, who has serious concerns about their state of health, they may well speak to the person’s GP, nurse or call emergency services or if there are concerns of possible abuse or domestic violence, staff may discuss such cases to check whether their concerns need acting upon.
Sharing where there is a legal duty
There are a number of situations that can arise where the law makes it a duty that information is shared. In cases where children need to be protected organisations are duty bound to work together. If any suspected terrorist activity is identified, then organisations are duty bound to inform the authorities. If an individual contracts particular ‘communicable diseases’ then their Doctor is duty bound to notify authorities to ensure the spread of any disease is limited as far as possible (this includes Cholera, plague, smallpox and others).
Named Accountable GP
All patients registered at the practice have a named GP.
What does ‘accountable’ mean?
The new contract requires the named accountable GP to be responsible for the co-ordination of all appropriate services required under the contract and ensure they are delivered to each patient where required. However, this does not mean that they will be the only GP or clinician who will provide care to that patient. These responsibilities will be carried out within the opening hours of the Practice and do not change the way you currently access care outside these hours.
This is largely a role of oversight, with the requirements being introduced to reassure patients that they have one GP within the practice who is responsible for ensuring that this work is carried out on their behalf.
Does the requirement mean 24-hour responsibility for patients?
No. The named GP will not:
- take on vicarious responsibility for the work of other doctors or health professionals.
- take on 24-hour responsibility for the patient, or have to change their working hours. The requirement does not imply personal availability for GPs throughout the working week.
- be the only GP or clinician who will provide care to that patient.No. However, practices are required to inform patients of their named GP at the next appropriate interaction.If you have forgotten or would like to know who your named GP is please ask a member of the reception team when you are next in the surgery.Patients will be allocated a named GP on the based on who they historically were registered with. However, if a patient requests a different named GP, reasonable effort will be made to accommodate their preference.
- Do patients have to see their named GP when they book an appointment?
- Can patients choose their own named GP?
- Newly registered patients should be notified of their named accountable GP when the register.
- Will GP practices write to patients to inform them of their named GP?
No. Patients can, and should, feel free to choose to see any GP or nurse in the practice in line with current arrangements. If their preferred choice of GP or nurse is not available, an alternative will be offered. As all patients have an electronic medical record this ensures that all clinicians in the Practice have access to the most accurate and up to date information
NHS Halton Clinical Commissioning Group
No.1 Lakeside
920 Centre Park
Warrington
WA1 1QY
Telephone: 01925 303030
Patient Privacy Notice
Access to patient records by General Practice Solutions (GPS) on behalf of Brookvale Practice
Your privacy is of utmost importance to us. As your primary care organisation, we are committed to protecting your personal data and ensuring it is handled securely and transparently.
To enhance our ability to deliver high-quality healthcare services, we have engaged General Practice Solutions (GPS), a trusted specialist provider, to assist with the management, summarisation, and coding of patient records and clinical correspondence. This notice outlines how GPS, acting on our behalf, will process your personal data, the purposes for which this is necessary, and your rights under UK data protection law.
Who we are.
Brookvale Practice is responsible for providing your primary healthcare services. To support us in delivering the best possible care, we have authorised GPS to access, review, and accurately code patient records and correspondence. GPS acts as a data processor on our behalf, while we remain the data controller for all patient information, accountable for its protection and appropriate use.
What information GPS will access.
To fulfil their role in supporting our organisation, GPS may access and process the following types of personal data.
o Medical records.
Details of your medical history, including past and current diagnoses, treatments, medications, allergies, immunisations, test results, and any relevant health conditions.
o Clinical correspondence.
Communications such as referral letters, discharge summaries, specialist reports, and other documentation related to your care.
o Demographic information.
Your name, date of birth, NHS number, address, contact details, next of kin, ethnicity, first language, sexual orientation, gender identity, and other relevant demographic data.
- Preventive health information.
Data related to preventive screenings, recall dates, and vaccination history to ensure proactive patient management.
- Lifestyle information.
Relevant details about your lifestyle that may impact your health, such as smoking status, alcohol use, and occupation.
Why GPS needs access to your information.
GPS has been contracted to process your personal data for the following essential purposes.
- Accurate summarisation and coding.
To ensure your medical records are accurately summarised and coded, reflecting comprehensive and up-to-date information. This supports effective clinical decision-making, improves care continuity, and ensures data consistency within your records.
- Review and update of records.
To review and clarify existing medical records, particularly where they are incomplete or unclear (e.g., handwritten notes). This includes verifying any missing or illegible data by cross-referencing other sources, ensuring the accuracy and completeness of your health information.
- Coding of clinical correspondence.
To accurately code all incoming and outgoing clinical correspondence, such as referral letters, specialist notes, and discharge summaries, ensuring that this information is correctly recorded in your medical records and accessible to healthcare providers involved in your care.
- Maintenance of preventive screening and vaccination data.
To maintain up-to-date records of preventive screening recall dates and vaccination history, which helps in proactive management and timely patient reminders.
- Administrative and clinical support.
To support the administrative and clinical functions of our practice, ensuring compliance with regulatory requirements such as the Quality and Outcomes Framework (QOF) and other NHS standards.
How your information is protected.
We take your privacy very seriously and have established strict measures to protect your personal data. GPS is contractually required to adhere to our data protection policies and the following security standards.
o Access control.
Only authorised personnel at GPS who need access to your data for the performance of their duties will be granted access. Access is tightly controlled and monitored.
o Data security.
All personal data is stored securely, , using industry-standard security measures such as encryption, firewalls, and secure access controls to prevent unauthorised access, loss, or misuse.
o Regular audits and reviews.
Security protocols are regularly reviewed and updated to align with current best practices and legal requirements.
o Compliance with UK data protection laws.
GPS processes all personal data in compliance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.
How long we keep your information.
GPS will only retain your personal data for as long as necessary to fulfil the purposes for which it was collected, or as required by law.
Your rights.
As a patient, you have several rights under UK data protection law, including:
- Right of access.
You have the right to request access to the personal data we hold about you.
- Right to rectification.
You have the right to request correction of any inaccurate or incomplete data.
- Right to erasure.
You have the right to request the deletion of your personal data in certain circumstances (the ‘right to be forgotten’).
- Right to restrict processing.
You have the right to request that we restrict the processing of your personal data in certain situations.
- Right to data portability.
You have the right to request that your personal data be transferred to another data controller in a structured, commonly used, and machine-readable format.
- Right to object.
You have the right to object to certain types of processing, such as direct marketing or processing based on legitimate interests.
- To exercise any of these rights, please contact us using the details provided below. We will respond to your request in accordance with the statutory timeframes set out under UK data protection law.
Contact information.
If you have any questions or concerns about how your personal data is handled, or if you wish to exercise any of your rights, please contact:
Brookvale Practice
Email: cmicb-h.brookvalemc@nhs.net
Phone: 01928 718182
Address: Hallwood Health Centre Hospital Way Runcorn WA7 2UT
Alternatively, you may contact GPS directly:
General Practice Solutions (GPS)
Email: dataprotection@generalpracticesolutions.net
Address: 71-75 Shelton Street, London, WC2H 9JQ
If you are not satisfied with how we handle your data or our response to your concerns, you have the right to complain to the Information Commissioner’s Office (ICO), the UK’s independent authority for upholding information rights.
Information Commissioner’s Office (ICO).
Website: www.ico.org.uk
Phone: 0303 123 1113
Changes to this privacy notice.
We may update this privacy notice from time to time to reflect changes in our practices, legal requirements, or other factors. Any updates will be posted on our website, and we encourage you to review this notice periodically to stay informed about how we protect your privacy.
Safeguarding
Safeguarding at Brookvale Practice
Safeguarding Training
All staff at Brookvale Practice 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.
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.
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:
https://www.nhs.uk/conditions/consent-to-treatment/capacity/
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:
https://safeguardingadults.co.uk/keeping-safe/mental-capacity-act/
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:
- Justify the purpose(s) for using confidential information
- Don’t use personal confidential data unless it is absolutely necessary
- Use the minimum necessary personal confidential data
- Access to personal confidential data should be on a strict need-to-know basis
- Everyone with access to personal confidential data should be aware of their responsibilities
- Comply with the law
- 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.
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 to:
- Children’s Social Care Contact Centre –
Tel: 0151 907 8305 (Office Hours 9 am – 5 pm Mon – Thurs, 9 am – 4.30 pm Fri) - Children’s Social Care Out of Hours: 0345 050 0148
- iCART (Integrated Contact and Referral Team) Referral Form: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fchildren.haltonsafeguarding.co.uk%2Fdocs%2FICARTform.docx
- 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:
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
- Adults Social Care – Tel: 0151 907 8306
- Adults Social Care Out of Hours – Tel: 0345 050 0148
You can also speak in confidence to any member of Brookvale Practice.
Sedative Prescribing for Fear of Flying
Suggestions / Complaints
We try to provide the best possible service to our patients and will always welcome your views or suggestions for further improvements.
Brookvale Practice has a Patient Participation Group. If you have a suggestion, you may wish to contact the PPG. Alternatively, if you would prefer to discuss your issue, please ask to speak to the Practice Manager.
We realise that there may be occasions when our service to you falls short of our customary standard. If you have a complaint or concern about the service that you have received from the doctors or any of the staff working in the practice, please let us know.
Your Rights and Responsibilities
Aims and objectives
We aim to provide a high quality safe effective and equitable primary care service for our practice population. Our charter is a statement of what you can expect from the practice and what we feel we can expect from you in return.
Your rights as our patient:
We are committed to giving you the best possible service we can achieve by working together.
You will always be treated with courtesy and respect.
You will always be offered the treatment we believe is appropriate for you, by a suitably qualified person.
We will make every effort to see you promptly, but this may not always be possible. Medical emergencies will receive immediate attention and there will be a duty doctor available each working day for urgent problems.
We will aim to offer you an appointment with a clinician within two working days whenever possible. If the clinician you prefer is not available, we will arrange for you to see another clinician. You will be seen by a clinician on the same day if this is appropriate, although we cannot guarantee you will be seen by a particular clinician.
Medical advice is available 24 hours a day by dialling 111 for the NHS 111 service.
We will tell you when the results of tests and X-rays are likely to be available and how to obtain them.
Repeat prescriptions will normally be available for you to collect or be sent to the pharmacy of your choice within two working days.
We will strive to promote good health through advice and preventative medicine. We will work in partnership with other agencies to provide effective health care for all our practice population
We will respect your rights of confidentiality and access to your medical records, within the law.
We will try to deal at once with any problems or complaints which you bring to our attention and welcome your suggestions for improving our service to you.
What you can do for us:
Please treat surgery staff with due courtesy and respect.
If you are unclear about your treatment, please ask. Try to follow any medical advice given you.
If you need a home visit, if possible, please telephone before 11.00am.
Only ask for urgent appointments, emergency consultations or home visits when appropriate.
Let us know as soon as you can if you cannot keep an appointment.
Please telephone between 2.00 and 4.00pm to obtain the results of investigations and X-rays.
Whenever possible unless housebound or aged 75 and over please request repeat prescriptions by the following: online, using the slip on your prescription form, post enclosing a stamped self-addressed envelope or dropped into the prescriptions post box in the surgery foyer.
Please respond promptly to any letters we may send to you.
Be understanding when your own consultation is delayed by someone else’s unexpected emergency.
Many illnesses can be prevented through healthy living. Please ask us for health promotion advice.
Screening programmes are invaluable in the early detection of certain illness. Please take advantage of them.
Please ensure you address is correct and that we have the correct contact details
Zero Tolerance
The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.