Copying patients into clinical letters - Ashford and St. Peter's ...

COPYING COPYING CLINICIANS
CLINICIANS’ CLINICIANS LETTERS LETTERS TO
TO
PATIENTS PATIENTS.
PATIENTS
POLICY POLICY AND AND PROCEDURE PROCEDURE FOR FOR CANCER
CANCER
SERVICES SERVICES
SERVICES
Date Page(
s)
Volume 8
Patient Care
Amendments
Amendments
Comments Approved by
Compiled Compiled by: by: Lesley Spencer – Consultant/Lead Nurse
for Cancer Services
Ratified Ratified Ratified by:
by:
Date Date Ratified Ratified:
Ratified :
Date Date Issued:
Issued:
Review Review Date:
Date:
Target Target Audience
Audience
Administrative staff
Impact Impact Assessment
Assessment
Assessment
CCarried
C arried out out by
by
Comments Comments Comments on on this
this
Document ocument to
to
Trust Executive Committee
13 th March 2009
13 th March 2009
First Ratified
March 2009
April 2011
All clinical, Managerial and
working within cancer Services
Lesley Spencer
Lesley Spencer, Consultant/Lead
Nurse for Cancer
Services ASPH
Acknowledgements With thanks to the Royal Surrey
County Hospital
For sharing their work in progress
Reviewed
March 2009
Issue 1 Page 1 of 9

INTRODUCTION
INTRODUCTION
Volume 8
Patient Care
ASHFORD ASHFORD & & & ST. ST. ST. PETER’S PETER’S HOSPITAL HOSPITAL NHS NHS NHS TRUST
TRUST
COPYING COPYING CLINICIANS’ CLINICIANS’ LETTERS LETTERS TO TO PATIENTS
PATIENTS
POLICY POLICY AND AND PROCEDURE PROCEDURE PROCEDURE FOR FOR CANCER CANCER SERVICES
SERVICES
The The Introduction Introduction of of a a National National National Policy
Policy
Following an NHS plan commitment, work by the Department of
Health (DOH) and the publication of Good Practice Guidelines
by the DOH the practice of making available to patients copies
of clinician’s letters became national policy on 1 st April 2004
It is now regularly mentioned in DOH publications, the Cancer
Reform Strategy and National Peer Review although it has been
left to individual Trusts to decide how to implement and
publicize this policy.
PURPOSE
PURPOSE
The Purpose of this policy is to provide a clear and safe
procedure for clinical and administrative staff to follow in
order to comply with National Guidelines, Peer review and
adhere to the principles of best practice.
THE THE TERMS ERMS OF OF THE THE NATIONAL NATIONAL POLICY
POLICY
The National Policy proposes that – where patients agree,
letters written by one health care professional to another
about a patient should be copied to the patient (or where
appropriate their parent or guardian).The general principle is
that it is the patients right to be copied into all letters
that help to improve their understanding of the health care
they are receiving.
In terms of the National Policy a ‘letter’ includes
communication between different health care professionals –
including GP’s, hospital doctors, nurses and therapists, and
may include letters, forms of referral and discharge
summaries.
.
Raw data such as blood results should not be copied until it
can be put into an appropriate context/explanation.
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FREQUENCY
FREQUENCY
Where there is frequent communication, the person responsible
for writing the letter should consider if it would be useful
for the patient to have a copy every time.
NO NO SURPRISES
SURPRISES
Where the letter contains abnormal results or significant
information that has not been discussed with the patient, it
will be important for arrangements to be made to give the
patient a copy of the letter after its contents have been
discussed in a consultation with the professional. As a
general rule the contents of copied letters should reflect the
discussion in the consultation with the sending healthcare
professional, and there should be no new information in the
letter that might surprise or distress the patient.
WHEN WHEN LETTERS LETTERS SHOULD SHOULD NOT NOT NOT BE BE BE COPIED
COPIED
There may be reasons why the general policy of copying letters
to patients should not be followed. These include:
Volume 8
Patient Care
Where the patient does not want a copy
Where the clinician feels that it may cause harm to the
patient
Where the letter includes information about a third party
who has not given consent
HARM HARM TO TO THE THE PATIENT
PATIENT
Giving of "bad news" is not in itself enough to justify not
copying a letter. The pilot studies showed that it is
sometimes the case that health professionals are anxious to
protect patients, who themselves often wish to have as much
information as possible, even if it may be ‘bad news’ or
uncertainty.
CONSENT
CONSENT
The copying letters policy is underpinned by a presumption of
the patient's informed consent to the receipt of any letter.
The aim is that within a consultation, the possibility of
receipt of the letter should be raised as part of the wider
discussion about 'what will happen next'. In other words,
patients should routinely be asked during a consultation
whether they want a copy of any letter written as a result of
that consultation and any related tests or interventions.
Agreement from the patient to receive copies of letters would
be seen as consent.
The circumstances of letters about an individual patient will
vary. It might be sufficient to seek consent once rather than
each time a letter is written. This is as long as it is
explained at the start of an episode that copies of letters
will be sent routinely to the patient or responsible person
unless the patient decides to opt out of receiving copies of
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letters, which can be done at any time. Good practice
suggests, however, that the patient be reminded each time a
letter is to be copied.
ISSUES ISSUES TO TO TO BE BE CONSIDE CONSIDERED
CONSIDE RED
Use of plain English to improve readability
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Patient Care
Setting out the facts and avoiding unnecessary
speculation
Reinforcing and confirming the information given in
discussion with the patient in the consultation.
Some healthcare professionals prefer to write letters
directly to patients, with a copy to the general
practitioner or other healthcare professionals. Evidence
shows that patients appreciate such practices, which give
the clinician the option of adding additional information
and advice about life style and management of the illness
or condition.
Patients should be able to say where they would like to
receive a copied letter and in what format. People with
special communication or language needs should be able to
specify how they would like to receive information. This
should be recorded in an appropriate way.
OPTIONS OPTIONS FOR FOR FOR PROVIDIN PROVIDING PROVIDIN G COPIES COPIES OF OF LETTERS LETTERS INCLUDE:
INCLUDE:
A printed copy of the letter
Copies in large print, or in some other format, such as
on audio - tape
Viewing letters on screen in the hospital or practice
Sending by post or collection from an appropriate place,
where there are concerns about privacy at home
Copies of letters dictated in the presence of the
patient.
CONFID CONFIDENTIALITY
CONFID CONFIDENTIALITY
ENTIALITY
Procedures should minimize the likelihood of information being
accessed by unauthorized people and ensure patients who choose
to have information posted or e-mailed are aware of the risks
such procedures might entail. Envelopes should be marked
‘confidential’ and patients’ addresses routinely checked.
Patients’ full names, rather than initials, should be used as
a matter of good practice. It should also be a matter of good
practice to check whether two people with the same name live
at one address.
ASHFORD ASHFORD AND AND ST ST ST PETER PETERS PETER PETERS
S NHS NHS TRUST’S TRUST’S POLICY
POLICY
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IMPLEMENTATION
Cancer Services supported by the Cancer Board proposes to
implement the National Policy across all the various tumour
groups. Initially this initiative will be publicised to
patients across the departments. From January 2009 all cancer
patients will be offered a copy of their consultations from
diagnosis onwards unless they have decided to opt out or there
is a reason as outlined above not to copy a letter to a
patient.
REFUSAL OF A REQUEST/WITHHOLDING A LETTER
If the health care professional should refuse a request for a
copy of the letter or should decide to withhold one, the
reason for the decision should be recorded in the patient’s
notes.
DISCLAIMER CONCERNING TECHNICAL INFORMATION
Any letters copied to patients should contain a disclaimer
advising that as it is a clinical letter it may contain
technical terms, and advise patients how they can receive
further explanation if required.
LINK WITH ACCESS TO MEDICAL RECORDS
This policy is not intended to retrospectively apply to
letters written before Jan 2009
The Trust Policy and Procedure in respect of patient access to
medical records remains unchanged and should be drawn to the
attention of any patient seeking retrospective access to
correspondence, or wider access to their medical records.
ARCHIVING ARCHIVING ARCHIVING ARRANGEMEN
ARRANGEMENTS
ARRANGEMEN
ARRANGEMENTS
TS
This is a Cancer Services policy. As Cancer patients are
treated in all departments throughout the Trust the archiving
arrangements are managed by the quality department who can be
contacted to request master or archived copies.
EQUALITY EQUALITY IMPACT IMPACT ASSE ASSESSMENT
ASSE ASSESSMENT
SSMENT
See Appendix 1.
REFERENCES
REFERENCES
Copying letters to patients: good practice guidelines
Department of Health 30 April 2003
Copying Letters to Non English Speakers Silkapp Consultants
1995
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Copying letters to patients: a report to the Department of
Health and draft good practice guidelines for consultation
Department of Health 18 April 2002
Advanced Communication Skills Training Handout for Senior
Healthcare professionals working in cancer care National
Cancer Action team 2007
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EQUALITY EQUALITY IMPACT IMPACT ASSE ASSESSMENT ASSE SSMENT TOOL
TOOL
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APPENDIX APPENDIX 1
1
To be completed and attached to any policy when submitted to
the appropriate committee for consideration and approval.
1.
Does Does Does the the policy policy/guidance policy policy /guidance affect
affect
one one one group group less less or or or more more
more
favourably favourably than than than another another on on the
the
basis basis of:
of:
Race and Ethnic origin
(include gypsies and
travellers) (consider
communication, access to
information on services and
employment, and ease of access
to services and employment)
Disability (consider
communication issues, access to
employment and services,
whether individual care needs
are being met and whether the
policy promotes the involvement
of disabled people)
Yes/No Yes/No
Comments Comments
Comments
For each category
describe how you
have involved
stakeholders
including service
users and employees
Yes The draft of this
policy has been
approved by the
Cancer board. The
patient
representative on
the board was
specifically asked
to comment on the
policy and the value
that this may have
for Cancer patients.
It is recognised
that patients whose
first language is
not English may have
difficulty reading
and interpreting
this policy.
Clinical staff need
therefore to go
through the policy
with the individual
or employ a
translator as
necessary. The
Copying letters to
Non English Speakers
document is
referenced
This policy may
impact on those
individuals who are
hearing or sight
impaired. Clinical
teams may need to
either produce
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Gender (consider care needs and
employment issues, identify and
remove or justify terms which
are gender specific)
Culture (consider dietary
requirements and individual
care needs)
Religion or belief (include
dress, individual care needs
and spiritual needs for
consideration)
Sexual orientation including
lesbian, gay and bisexual
people (consider whether the
policy/service promotes a
culture of openness and takes
account of individual needs
Age (consider any barriers to
accessing services or
employment, identify and remove
or justify terms which could be
ageist)
2. Is Is there there any any evidence evidence that that some
some
groups groups are are affected affected
affected
differently?
differently?
3. If If you you have have identified
identified
potential potential discrimination, discrimination, for
for
example, example, less less than than equal
equal
access, access, access, are are are any any any exceptions
exceptions
exceptions
valid, valid, legal legal and/or
and/or
justifiable, justifiable, justifiable, for for for example example a
a
genuine genuine occupational
occupational
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Yes/No Yes/No
Comments Comments
Comments
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March 2009
information in a way
that can be
understood by the
patient e.g. large
print or provide a
translator if
required
No impact
No Impact
It is recognised
that patients whose
first language is
not English may have
difficulty reading
and interpreting
this policy.
Clinical staff need
therefore to go
through the policy
with the individual
or employ a
translator as
necessary
No impact
No Impact
Yes
No
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qualification?
qualification?
4. 4. Is Is the the impact impact of of of the
the
policy/guidance policy/guidance likely likely to to to be be
be
negative?
negative?
negative?
5. 5. If If so so so can can the the impact impact be
be
avoided?
avoided?
6. Wha What Wha t alternatives alternatives are are there there to
to
achieving achieving the the the policy/guidance
policy/guidance
without without the the impact?
impact?
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Yes/No Yes/No
Comments Comments
Comments
7. Can Can we we reduce reduce the the impact impact by
by
Detailed above
taking taking different different action?
action?
If you have identified a potential discriminatory impact of
this policy, please refer it to the appropriate Action Group,
together with any suggestions as to the action required to
avoid/reduce this impact.
For advice in respect of answering the above questions, please
contact Maria Crosbie, HR Manager, on extension 2552.
No
N/A
N/A
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