Policy Statement:

As of the 12^th October, 2023, Torrington Park Group Practice has implemented a new policy refraining from prescribing benzodiazepines or sedatives, such as diazepam, for fear of flying. This decision is aligned with the understanding that benzodiazepines pose risks to passenger safety, contribute to potential abuse, and are inconsistent with recommended medical practices. Flight anxiety does not fall under the remit of General Medical Services as defined in the GP contract. Consequently, the practice is not obligated to prescribe benzodiazepines for this purpose.

Rationale:

1. Flight Safety Risks: The use of benzodiazepines causes longer reaction times and slowed thinking, posing a significant risk during flights, especially in emergency situations that require swift action.

2. Health Hazards: Sedative effects of benzodiazepines can lead to an increased risk of blood clots, particularly during flights exceeding 4 hours, potentially resulting in serious health consequences, including Deep Vein Thrombosis (DVT) [v].

3. Paradoxical Effects: While most individuals find benzodiazepines sedating, a subset may experience paradoxical agitation and aggression, posing safety risks to themselves and fellow passengers.

4. Combined Risks: Combining benzodiazepines with alcohol intensifies the aforementioned risks, compromising passenger safety.

5. Legal and Guideline Compliance: Prescribing benzodiazepines for fear of flying contradicts British National Formulary guidelines, contraindicating their use for phobic states and emphasizing inappropriate usage for short-term anxiety [i].

6. NICE Guidelines: National Institute for Health and Care Excellence (NICE) guidelines discourage the use of medication for mild mental health disorders and advocate against prescribing benzodiazepines, sedating antihistamines, or antipsychotics for significant anxiety-related states [iii].

7. Legal Implications Abroad: In some countries, importing benzodiazepines is illegal, potentially leading to legal consequences for travellers.

8. Occupational Implications: Benzodiazepines, including diazepam, remain in the system for an extended period, leading to potential issues for individuals subjected to random drug testing.

9. Long-Term Health Concerns: Studies suggest a link between benzodiazepine use and the onset of dementia, as well as evidence indicating a perpetuation of anxiety over time [iv].

Alternative Recommendations:

In lieu of benzodiazepines, individuals seeking assistance for flight anxiety are encouraged to explore aviation industry recommended courses, such as those offered by:

-EasyJet (https://www.fearless-flyer.com/ff-vsl-gbp/?utm_source=bing&utm_medium=ffuk&utm_campaign=JMCPC1&ff_plat=bing&ff_aid=&msclkid=c01cec50cff914d453cb8936c51957fe),

-British Airways: https://flyingwithconfidence.com/courses

-Virgin: https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html

–https://www.flyingwithoutfear.com/

Private Consultation:

Patients seeking benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.

Insurance Advisory:

Patients are reminded to declare all medical conditions and medications to their travel insurer to avoid nullifying insurance policies [v].

References:

[i] British National Formulary; Diazepam – https://bnf.nice.org.uk/drug/diazepam.html

[iii] Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical guideline [CG113] Published date: January 2011 Last updated: July 2019 https://www.nice.org.uk/guidance/cg113

[iv] Acute and delayed effects of Alprazolam on flight phobics during exposure. Behav Res Ther. 1997 Sep;35(9):831-41

[v] Travel Health Pro; Medicines and Travel; Carrying medication abroad and advice regarding falsified medication – https://travelhealthpro.org.uk/factsheet/43/medicines-abroad

Torrington Park Group Practice

COMPLAINTS PROCEDURE

We are always pleased to receive suggestions for improving our services and we like getting compliments as well. We hope you will never have cause for serious complaint but if you do, we have a complaints procedure aimed at quick resolution of problems. Please initially either speak directly to your GP or write to our Practice Manager, Amanda Reilly. You can also email your complaint to torringtonparkrgrouppractice@nhs.net 

The doctors and staff at Torrington Park Group Practice strive to deliver high quality patient care at all times and in all areas of contact with the patient or patient’s representative, and are realistic enough to appreciate that there are times when less than efficient service may be given or instances where the patient is less than happy with the service received.

In order to attain and maintain high standards of care, feedback is needed from those to whom the care is delivered; one mechanism is the complaints procedure.

1. As a patient, you have a right to complain about any aspect of the service with which you are less than satisfied, and the Practice has produced this Complaints Procedure to assist you through this.

2. Any complaint you wish to make can be accepted either in writing or verbally, and should preferably be addressed in either case to the Practice Manager. If you feel the doctor is the most appropriate person to approach, you are free to do so.

3. If your complaint is written, you will receive acknowledgment within three working days from receipt.

4. If your complaint is verbal, you will receive written acknowledgment within two working days, with a factual statement of what is perceived to be the complaint.

5. Any complaint you make will be investigated and you will receive a written report from the Practice as to the outcomes of the investigations and, where appropriate, the steps taken to ensure the situation does not recur.

6. If considered appropriate by all parties, you will be invited to attend the surgery to discuss the matter with the Practice Manager and, where appropriate, one or more of the doctors, following which you will receive a written statement from the Practice as to the discussion and the outcome.

7. Where other parties are involved, you will be kept informed as to the steps being taken to obtain their statements.

8. The Practice will strive to deal with complaints in a methodical and efficient manner in order to bring about an equitable conclusion.

It is sincerely hoped that any complaint you have about the Practice can be dealt with by those responsible for ensuring patient care and delivery of services within the Practice, but there are times when you may feel this is inappropriate, or you may not be happy with the results of the complaints procedure. You have the right, therefore to complain to the Barnet CCG.

Should you wish to discuss any part of this document with the Practice Manager, please ask the Receptionist or your doctor to arrange this for you.

Practice-Privacy-Notice

Subject-Access-Request-Form

Subject-Access-Request-Policy

As an employer, the practice has a duty of care for the health, safety and wellbeing of its staff. The practice also has a legal responsibility to provide a safe and secure working environment for staff. Staff mental health is as important as their physical health.

All patients and staff are expected to behave in an acceptable, respectful manner.

The practice follows the NHS guidance concerning Zero Tolerance.

Any incident in which an employee is abused, threatened or assaulted in circumstances relating to their work is unacceptable and not tolerated.

This includes the serious or persistent use of verbal abuse, aggressive tone and/or language and swearing/foul language.

Staff should not be left upset and distressed following an interaction with a patient.

All instances of actual physical abuse or threatening behaviour on any doctor or member of staff, by a patient or their relatives will be reported to the police as an assault.

We expect all patients to be responsible and avoid attending the surgery under the influence of alcohol or illegal drugs. Any alteration of prescriptions is illegal and will not be tolerated.

The General Medical Council states In Good Medical Practice that: “In rare circumstances, the trust between you (the Practice) and a patient may break down, and you may find it necessary to end the professional relationship. For example, this may occur if a patient has been violent to you or a colleague, has stolen from the premises, or has persistently acted inconsiderately or unreasonably.”

This includes unnecessarily persistent or unrealistic service demands that cause disruption. Examples of this include, but are not limited to :

• Demanding to only speak to a specific team member
• Refusing appointments with an appropriate clinician for the presenting care need i.e. insisting on a GP appointment when seeing a pharmacist or nurse prescriber is appropriate
• Refusing to access the service in the appropriate manner i.e. sending emails/texts instead of using the NHS Digital approved digital consultation service
• Demanding a same day appointment for a routine clinical need – this deprives access to urgent care services for those who genuinely need it
• Contacting individuals directly via social media or personal email instead of through the practice contact channels

The practice has a finite number of available appointments and you may be directed to a clinician who is not a GP, or your preferred GP, but who is appropriately qualified to manage the presenting care need. We provide a named GP service but we cannot always accommodate requests to speak to the same GP due to high patient demand for appointments.

If you are seriously unhappy with the quality of service you have the right to register with another practice without notifying us. Similarly, on the very rare occasions when a patient breaches this policy, we have the right to remove the patient from our Practice list.

Examples of Unacceptable Standards of Behaviour

In exceptional circumstances, a breakdown may occur between a doctor and their patient. If the breakdown is of a serious nature e.g. serious physical or verbal abuse to any member of the practice team, the doctors may feel that the doctor/patient relationship has been compromised. Steps may be taken to have the patient removed immediately from the practice list. Where possible, conciliation would always be the preferred route. Reasons for removal will be given in writing.

Where we deem an incident is not serious enough to warrant immediate removal, we will issue a first and final warning.

You will be removed from our patient list immediately when we have needed police assistance or have made a report to the police.

The following are example of when you may be issued with a first and final warning or removed from our patient list dependent on the severity of the incident.

• Violence.
• Excessive noise eg recurrent loud or intrusive conversation or shouting.
• Threatening or abusive language involving swearing or offensive remarks.
• Racial or sexual remarks.
• Aggressive, forceful tone and/or language that upsets staff.
• Malicious allegations relating to members of staff, other patients or visitors.
• Offensive gestures or behaviours.
• Abusing alcohol or drugs on practice premises.
• Drug dealing on practice premises.
• Wilful damage to practice property.
• Threats or threatening behaviour.
• Theft.
• Persistent and/or unrealistic demands on the service
• Repeated derogatory comments about the practice or individuals either verbally, in writing/digitally or on social media platforms

This list is not exhaustive and there may be other occasions where we have cause to issue a warning or remove you from our patient list. If you are unhappy with the practice we have a complaints procedure to assist you or you have the choice to register with another practice – there really is no need for unpleasant behaviour with these options available to support you.

We trust this policy is clear and supports a mutually respectful environment for patients and staff.