Dr and Mrs Robert Lefever

1. Letter to All Patients Attending the PROMIS Unit
2. The PROMIS Unit
3. The PROMIS Unit Offers a Wide Range of Services on the Premises
4. Statement of Purpose of the PROMIS Unit
5. Policies and Procedures of the PROMIS Unit
6. The Patients’Guide to the PROMIS Unit
7. Standard Letter to All Specialists Visiting the PROMIS Unit
8. Notification of Untoward Events in the PROMIS Unit
9. Business Plan for the PROMIS Unit
10. Research at the PROMIS Unit
11. Complaints Procedures at the PROMIS Unit
12. The Medical Political Belief of Dr Robert Lefever
13. The Commission for Healthcare Audit and Inspection

Letter to All Patients Attending The PROMIS Unit

Welcome to the PROMIS Unit for whatever reason you are here and for whichever doctor or other specialist you have come to see.

The range of services offered in the PROMIS Unit is summarised in this brochure. The dual clinical aims of the PROMIS Unit are:

1. To provide a range of simple diagnostic facilities in order to assist in the early diagnosis of significant disease. Appointments can be made for annual general medical check-ups for patients of any age but are particularly recommended for those over the age of 75. For patients on regular medications, repeat prescriptions may be obtained by post or by attending the surgery by appointment. Clinical examination will be required every six months, or more frequently as determined by the doctor, before further prescriptions are issued.

2. To provide time for consultations so that the emotional problems of today do not develop into the physical problems of tomorrow.

The PROMIS Unit provides a range of diagnostic and therapeutic facilities so that patients can get most straightforward clinical needs met in one visit. All consultations are by appointment and these will usually be on that same day. All staff and patients will be expected to keep as close as possible to appointment times and to show respect for race, gender and disability.

Please give the reception staff the name and address of any regular general medical practitioner (if you have one) to whom you wish us to send records of the consultations you receive in the PROMIS Unit. Please indicate, on the slips provided, whether you wish your GP to receive these records and if you wish to have a chaperone while being clinically examined in the PROMIS Unit.

There are steps at the entrance to the premises.A handrail is fitted and there is also a handrail in one of the lavatories. Disabled patients requiring wheelchair access will be seen,by appointment through telephoning 020 7584 6511, either at 10 Kendrick Mews, London, SW7 3HG or in their own homes. A Braille copy of this brochure can be provided. Sign language interpreters can be arranged.

The PROMIS Unit is fully private and is outside the National Health Service. The police will be called to remove abusive or violent patients. Fees will be charged for all services in the PROMIS Unit. The nearest NHS walk-in centre is at Charing Cross Hospital, Fulham Palace Road, London, W6. The PROMIS Unit accepts patients from any area, national or international. Non-English speakers must therefore provide their own interpreters.Home visits are restricted to central London.

Questionnaires will be given in order to seek your opinion on the services of the PROMIS Unit. Please, at any time, let us have your suggestions on how the services of the PROMIS Unit might be improved.

Sincerely

The PROMIS Unit

X-ray unit

The PROMIS Unit was established in 1976 as a “one-stop shop”, aiming to provide patients with a convenient opportunity to be examined, investigated and treated in one visit for simple ailments or in two or three visits where the problems are more complex.

The PROMIS Unit is run in conjunction with The PROMIS Counselling Centre, also in South Kensington, where treatment is provided for any form of stress affecting individuals or families.

Payment of fees has to be made at the time of consultation unless prior arrangement has been made specifically with Dr Robert Lefever for accounts to be held in the name of individuals, families or companies.

The cost of x-rays, ultrasound, pathology tests and other diagnostic tests and the cost of physiotherapy may subsequently be reimbursable through patients’ own private medical insurance.

Treatment of acute illness

Emergency services for minor injuries

Travel immunisations and medicines

Contraception services

Well women health checks

Full health check-ups

24 hour emergency cover

Limited pharmacy

Limited physiotherapy

Computer assisted clinical assessments

Health education

Counselling

Limited range of diagnostic X-rays

Limited diagnostic ultrasound

Eye tests

Hearing tests

Lung function tests

Electrocardiography (ECG)

Allergy tests:

• inhalants
• foods
• contact substances

Laboratory tests taken for:

• haematology
• bacteriology
• biochemistry
• serology
• cytology

Reception and Records

In accordance with the requirements of The Commission for Healthcare Audit and Inspection:

SECTION ONE

Aims and Objectives of The PROMIS Unit:
1 To provide private (fee-paying) general medical practice services to patients attending the premises during office hours at 2a Pelham Street, London, SW7 3HU.

2 To provide cover for home visits by deputies for 24 hours a day for the full year.

3 To provide facilities for x-ray, ultrasound, laboratory, pharmacy, physiotherapy and other clinical investigations, treatments or consultations as may be decided upon at any time by Dr Robert Lefever, the owner and manager of The PROMIS Unit.

4 To provide facilities for visiting specialist staff to have consultations with patients as decided upon at any time by Dr Robert Lefever.

5 To provide responsible care for patients in accordance with General Medical Council guidelines on good standards of clinical practice and in accordance with the recommendations of the National Institute for Clinical Excellence, theHealth and Safety Executive and the Patient Safety Agency.

SECTION TWO

The registered provider of services at The PROMIS Unit is:
Dr Robert Lefever, 2a Pelham Street, London, SW7 3HU.

SECTION THREE

The Registered manager of The PROMIS Unit is:
Dr Robert Lefever MA MB BChir ARCM, a registered general medical practitioner under the General Medical Council (registration number: 0447650), trained at Corpus Christi College, Cambridge and The Middlesex Hospital, London and registered as a medical practitioner since 1965.

SECTION FOUR

The staff of The PROMIS Unit, all of whom are cleared by the Criminal Records Bureau, are as follows:

1 Mrs Margaret Lefever, BEd, MCSP, AIMLS, 1961 physiotherapist and medical laboratory scientist.

2 Mrs Karen St.Clair MAMS, 1994. Medical secretary

3 Mrs Anne Ngan-Hoe Ng, DCR, College of Radiographers, 1976. Radiographer.

4 Mrs Heather Strong DCR Queens Medical Centre,Nottingham, 1973. Radiographer.

5 Mrs Peggy Moles. Housekeeper

6 Various visiting specialists also attend The PROMIS Unit on a regular basis to provide services for patients attending The PROMIS Unit. Specialists attend solely by invitation from Dr Robert Lefever and are not part of the staff of The PROMIS Unit.

7 All staff cooperate in providing single care management for patients.

SECTION FIVE

The organisational structure of The PROMIS Unit is that all staff and visiting specialists are answerable directly to Dr Robert Lefever.

SECTION SIX

Services provided at The PROMIS Unit: General medical practice, physiotherapy and simple diagnostic facilities using medical laboratory facilities, x-ray and ultrasound units, various clinical investigation procedures for tests of ear, eye, lung and heart function and other clinical investigation equipment. Also there is a limited pharmacy.

Consultations with visiting specialists are provided as and when deemed appropriate by Dr Robert Lefever or his deputies. The range of services is designed to provide a simple but comprehensive range of diagnostic and therapeutic services suitable for an ambulant population.

Living wills may be formulated with patients if they so wish. Antenatal care and care for young children will only be provided in emergencies. The PROMIS Unit does not stock childhood inoculations but does stock travel inoculations for adults.

SECTION SEVEN

Consultations are by appointment on Monday to Thursday between the hours of 9.00 am and 7.00 pm and on Friday between 9.00 am and 1.00 pm or at such longer or shorter hours as may at any time be determined by Dr Robert Lefever.

Out of hours cover is provided on a full 24 hour basis for the full year by telephoning the practice telephone number 020 7584 6511.

SECTION EIGHT

Written contact with patient's friends, relatives, representatives or other providers of medical services may be requested by patients. UK resident patients who do not have a registered NHS doctor, or who do not wish the PROMIS to contact their NHS doctor, will be sent copies of their own medical records.

SECTION NINE

Complaints over any service at The PROMIS Unit should be addressed directly to Dr Robert Lefever who will attend to the matter himself, as may be appropriate within reasonable constraints of time. Further complaints should be made directly to The General Medical Council, 178 Great Portland Street, London, W1W 5JE Tel 020 7580 7642 Fax 020 7915 3641 or to The Commission for Healthcare Audit and Inspection, 11th Floor, 26-28 Hammersmith Grove,London W6 7SE. Tel: 020 8735 6370 Fax: 020 8735 6386.

SECTION TEN

The privacy and dignity of patients will be respected as far as possible within a medical setting and a chaperone for physical examinations will be provided on request.

SECTION ELEVEN

The variability of clinical need among patients attending The PROMIS Unit will necessarily result in appointments being delayed on some occasions and more attention being paid to some patients than to others. Dr Robert Lefever himself will determine on any occasion the length of time considered appropriate for a particular consultation. Dr Robert Lefever himself will determine the overall clinical services to be provided at The PROMIS Unit at any time.

Waiting Room

In accordance with section nine of the Private and Voluntary Healthcare (England) Regulations 2001:

SECTION ONE

1 Patients are accepted for consultation and treatment at The PROMIS Unit on registration. This implies agreement to pay fees for the services provided or to be seen free in cases of life-saving emergency as stipulated by The General Medical Council.

2 Patients are seen by appointment and given standard assessment, diagnosis and treatment as would be expected in any general medical practice.

3 The staffing of The PROMIS Unit is in accordance with the services offered at any time. The diagnostic and therapeutic equipment is maintained in a serviceable condition on a regular basis.

4 The diagnostic and therapeutic equipment is updated over the years according to the appropriateness of each particular clinical assessment in general practice.

5 The x-ray unit is equipped in accordance with safety regulations established by the Radiological Protection Board. The equipment, staff and procedures are supervised by a consultant radiologist and a consulting physicist. The clinical room equipment, staffing and procedures, are supervised by a consultant pathologist. The nursing room procedures and equipment and the pharmacy are supervised by Dr Robert Lefever. The secretarial and administration services are monitored on a regular basis by Dr Robert Lefever and the equipment is serviced on a regular basis.

6 Medical records are kept in a secure Kardex file. Abstracts of these records are kept on computer files that are secure to the PROMIS Unit and not in any way accessible by other agencies.

7 This brochure of The PROMIS Unit, including the Patients’Guide to The PROMIS Unit and The Statement of Purpose of The PROMIS Unit, is available to all patients, as are copies of their own medical records if they so wish.

8 Recruitment, induction and retention of employees and the employment conditions of staff at The PROMIS Unit are established in their contracts. Staff are chosen and retained according to their professional competence and on personal compatibility. At no time will staff be appointed on any form of positive discrimination.

9 All doctors and other health care professionals providing services at any time within The PROMIS Unit, do so solely on the invitation of Dr Robert Lefever. They are charged no fee for this service and have no independent rights to practise in The PROMIS Unit. This arrangement can be terminated by Dr Robert Lefever at any time for any reason whatever.

10 Monitoring of patients’ clinical conditions and recall systems on the computer files of The PROMIS Unit is conducted in accordance General Medical Council standard guidance on the conduct of research projects and within the requirements of the Data Protection Act. Staff contracts include a confidentiality clause.

SECTION TWO

Patients are transferred from The PROMIS Unit to hospital care, when clinically appropriate, in accordance with General Medical Council guidelines on good quality care.

SECTION THREE

1 Simple assessment on a patient’s competence to consent to treatment in a general medical practice is made at the time of registration as a new patient of The PROMIS Unit and at such further times as may be appropriate, depending upon the clinical condition of the patient.

2 Proposals for investigation or treatment of clinical conditions are discussed with the patient at each consultation as appropriate. Patients also have their own responsibility in ensuring that they understand the nature and risks of any clinical procedure or therapeutic process, and the costs involved, before agreeing to have them carried out at The PROMIS Unit or elsewhere at the suggestion of doctors and other practitioners in The PROMIS Unit. In the case of practitioners other than Dr Robert Lefever and the employed staff - secretaries, radiographers, physiotherapist and medical laboratory scientists - the patients will need to ensure that they understand all the implications of the recommendations of those practitioners who are not on the employed staff of The PROMIS Unit and shall not in any way hold Dr Robert Lefever or The PROMIS Unit responsible for any action by those independent practitioners.

3 The provision of care to young children will be provided only for emergencies and will be discussed with a competent adult responsible for them. The provision of care to patients who are mentally incompetent will be discussed, wherever possible, with a competent adult who has responsibility for that patient or, alternatively, care will be discussed with, or transferred to, a mental health professional who would have the competence to deal with the care of such patients within the General Medical Council guidelines on good quality care and within the terms of the Mental Health Act.

4 Information about a patient's health and treatment in The PROMIS Unit is confidential and will be disclosed to other persons only if they need to be aware of the information in order to ensure that the patient receives effective treatment and if that disclosure minimises the risk of the patient harming self or others or, as specified in The Commission for Healthcare Audit and Inspection regulations, "for the purposes of the proper administration of the establishment".

SECTION FOUR

Policy and procedures at The PROMIS Unit are reviewed every three years.

SECTION FIVE

Copies of statements in accordance with their regulations are made available for inspection by The Commission for Healthcare Audit and Inspection.

Nursing Room

The Statement of Purpose on page four in this brochure of The PROMIS Unit is available to all patients, potential patients or their representatives on request.

SECTION TWO

The PROMIS Unit provides fully private (feepaying) services to patients. Consultation fees will vary, as determined by Dr Lefever, according to the time and complexity of the clinical issue in each consultation. A list of our range of consultation fees is available from the staff at the reception counter. A list of the costs of all diagnostic tests, therapeutic procedures and pharmaceutical and other treatments can also be obtained from staff at the reception counter.

Patients are required to pay for all services at the time of the consultation. Patients have full responsibility for all costs even though some of these may subsequently be reimbursable by their employing companies or by medical insurance companies. Thus, the contract that patients may have with their employers or other institutions or with their medical insurance companies does not in any way affect this contract between patients and The PROMIS Unit for full payment for services provided.

SECTION THREE

Dr Robert Lefever and the staff of The PROMIS Unit reserve the right to refuse consultation, investigation and therapeutic services to any patient at any time other than as required by the General Medical Council in the provision of emergency services. By filling in the personal details on new patient record forms, each patient specifically makes a contract to pay for the costs incurred in each consultation. In the case of children, the parents or other representatives will be considered responsible for that contract when they fill in the new patient record forms.

SECTION FOUR

The complaints procedure of The PROMIS Unit is outlined in section nine of The Statement of Purpose on page five of this brochure and also on page twelve.

SECTION FIVE

Patients may obtain copies of their medical records if they so wish.

SECTION SIX

The address and telephone number of The Commission for Healthcare and Inspection, with which The PROMIS Unit is required to be registered, is as follows: The Commission for Healthcare Audit and Inspection, 11th Floor, 26/28 Hammersmith Grove, London, W6 7SE Tel: 020 8735 6370 Fax: 020 8735 6386

SECTION SEVEN

Inspection reports on The PROMIS Unit prepared by The Commission for Healthcare Audit and Inspection may be obtained from Dr Robert Lefever or from The Commission for Healthcare Audit and Inspection.

Physiotherapy

NOTES

1 The computerised recall system run by the secretarial staff and clinical staff follows up specific clinical conditions affecting patients of The PROMIS Unit.

2 The medical records are fully problem oriented, according to the Problem Oriented Medical Information System (PROMIS) designed by Professor Lawrence Weed of the University of Vermont.

3 The PROMIS Unit possesses the software for fully computerised records but generally we find our paper records to be more practicable.

4 The PROMIS Unit possesses the software for Problem/Knowledge Couplers, also designed by Professor Lawrence Weed at the University of Vermont, and we may sometimes use it for diagnostic assistance.

5 The PROMIS Unit is a fully private general medical practice in competition with other private practices in the local area as well as being in competition with National Health Service practices that provide services free of charge. All patients at The PROMIS Unit have the capacity to vote with their feet if they are dissatisfied with any aspect of the services provided.

6 The turnover of the local population in some parts of South Kensington is almost 100% in four years. It is therefore vital for the survival of The PROMIS Unit general medical practice that it should attract new patients on a regular basis. The PROMIS Unit does no advertising whatever and is therefore totally dependent, as it always has been, upon recommendation by existing patients. Consideration for all patients, or for their representatives, and concern for the quality of all aspects of treatment at The PROMIS Unit are therefore necessary components of every consultation.

7 The provision of some specific clinical services (such as baby clinics, infant inoculations, antenatal services, non-essential home visits and some other services often provided in some other general medical practices) are not generally provided by The PROMIS Unit. The services provided in The PROMIS Unit reflect the clinical interests of Dr Robert Lefever and the clinical needs of the majority of patients attending The PROMIS Unit. As a general principle, The PROMIS Unit does not provide services for which it has little call but recommends patients to seek the provision of those particular services in other general medical practices (of which there are many) in the local area.

8 Dr Robert Lefever is answerable to the General Medical Council. The PROMIS Unit was one of the pilot practices for their establishment of the re-validation process for private general medical practitioners.

In accordance with Section 28 of The Private and Voluntary Healthcare (England) Regulations 2001:

1 The death of any patient in The PROMIS Unit or during treatment at The PROMIS Unit or as a consequence of treatment provided at The PROMIS Unit will be notified orally within 24 hours and in writing as soon as practicable to The Commission for Healthcare Audit and Inspection.

2 Any serious injury to a patient in The PROMIS Unit, during treatment or as a consequence of treatment at The PROMIS Unit, will be notified to The Commission for Healthcare Audit and Inspection orally within 24 hours and in writing as soon as practicable.

3 The outbreak of any infections in The PROMIS Unit, if it is of such serious nature as to merit notification, will be notified to The Commission for Healthcare Audit and Inspection orally within 24 hours and in writing as soon as practicable.

4 Any allegation of misconduct by Dr Robert Lefever or any of the employed staff at The PROMIS Unit resulting in actual or potential harm to a patient, or by any medical practitioner or any associated healthcare professional working within The PROMIS Unit, will be notified to The Commission for Healthcare Audit and Inspection orally within 24 hours and in writing as soon as practicable.

Clinical Room

The PROMIS Unit has been established since 1976 and has continued its business purpose of providing private medical care since that time.

The philosophical, clinical and financial business plan for the future is to continue as before.

There are no plans to expand or contract or to franchise. There are no plans to change the provision of services. There are no plans to take on partners or assistants. There are no plans to work in association with any other enterprise, state or private, other than The PROMIS Recovery Centre and The PROMIS Counselling Centre.

The financial purpose of The PROMIS Unit is to make profits from the sick. The PROMIS Unit is concerned with care of patients who are ill in body, mind or spirit and it needs to make profits in order to pay the staff and remain in independent clinical practice. Dr Robert Lefever, the owner and manager of The PROMIS Unit, is a member of the Independent Doctors Forum.

The business plan is therefore that The PROMIS Unit will continue in operation, and be similarly profitable, in the future as in the past.

Research at The PROMIS Unit involves solely the monitoring of the care of patients in order to improve quality of standards of care.

No research involving new drugs or clinical procedures is carried out at The PROMIS Unit.

Pharmaceutical company representatives are not seen at The PROMIS Unit at any time.

The PROMIS Unit is not involved in research for any other agency, state or private, other than The PROMIS Recovery Centre and The PROMIS Counselling Centre under the supervision of Professor Geoffrey Stephenson,Emeritus Professor of Social and Applied Psychology at the University of Kent at Canterbury.

A Consultation

In accordance with Section 23 of the Private and Voluntary Healthcare (England) Regulations 2001, the complaints procedures for The PROMIS Unit are as follows:

1 Complaints about the services offered by Dr Robert Lefever or any of his employed staff at The PROMIS Unit should be addressed directly to Dr Robert Lefever. Complaints about the services provided by any visiting specialists or healthcare providers who are not on the employed staff of The PROMIS Unit should be addressed directly to those professionals, who have total responsibility for their own clinical services and personal behaviour.

2 Complaints about services provided by Dr Robert Lefever or any of the employed staff at The PROMIS Unit will be fully investigated initially by Dr Robert Lefever within the constraints of time appropriate for the clinical significance of the complaint. Requests for further independent assessment of any complaint may be made to the Independent Doctors Forum, www.independentdoctorsforum.net, who will appoint an independent medical assessor.

3 Further complaints may be made to The Commission for Healthcare Audit and Inspection, 11th Floor, 26/28 Hammersmith Grove, London,W6 7SE, Tel: 020 8735 6370, Fax: 020 8735 6386. Complaints may also be made to The General Medical Council, 178 Great Portland Street, London, W1W 5JE. Tel 020 7580 7642 Fax 020 7915 3641.

4 Copies of this complaints procedure can be supplied, upon request, to any person acting on behalf of a patient or to any person considering whether to become a patient at The PROMIS Unit.

5 Details of any complaint will be recorded in The PROMIS Unit together with investigations made and the outcome and action taken in consequence.

6 Details of complaints made concerning Dr Robert Lefever or the employed staff at The PROMIS Unit will be supplied to The Commission for Healthcare Audit and Inspection annually together with details of actions taken in consequence.