1. Introduction

2. Scope

3. Aims

4. General Principles

5. Information Which Must be Provided

6. Response to Requests for Information

7. Charging for Information

8. Personal Health Records

9. Information Which May be Withheld

10. Complaining About the Provision of Information

11. Implementation of the Code of Practice

Annexes

Annex A
NHS Trusts

Annex B
Purchasers of Health Care: District Health Authorities and Family Health Services Authorities

Annex C
General Medical Practitioners, General Dental Practitioners, Community Pharmacists and Optometrists

Annex D
General Practitioner Fundholders

1. Introduction

This Code of Practice sets out the basic principles underlying public access to information about the NHS. It reflects the Government's intention to ensure greater access by the public to information about public services and complements the Code of Access to Information which applies to the Department of Health, including the NHS Executive. It also builds on the progress already made by the Patient's Charter which sets out the rights of people to a range of information about the NHS.

Because the NHS is a public service, it should be open about its activities and plans. So, information about how it is run, who is in charge and how it performs should be widely available. Greater sharing of information will also help to foster mutual confidence between the NHS and the public.

The basic principle of this Code is that the NHS should respond positively to requests for information, except in certain circumstances identified in the Code. For example, patients' records must be kept safe and confidential.

2. Scope

The Code of Practice covers the following NHS organisations in England: Regional Health Authorities, Family Health Services Authorities, District Health Authorities, Special Health Authorities, NHS Trusts, the Mental Health Act Commission and Community Health Councils. It also covers family doctors, dentists, optometrists (opticians) and community pharmacists.

Specific requirements for most of these organisations are detailed in separate annexes. Organisations not covered in the annexes must apply the general principles of the Code in their dealings with the public.

3. Aims

The aims of the Code are to ensure that people:

• have access to available information about the services provided by the NHS, the cost of those services, quality standards and performance against targets;

• are provided with explanations about proposed service changes and have an opportunity to influence decisions on such changes;

• are aware of the reasons for decisions and actions affecting their own treatment;

• know what information is available and where they can get it.

4. General Principles

In implementing the Code, the NHS must:

• respond positively to requests for information (except in the circumstances identified in paragraph 9);

• answer requests for information quickly and helpfully, and give reasons for not providing information where this is not possible;

• help the public to know what information is available, so that they can decide what they wish to see, and whom they should ask;

• ensure that there are clear and effective arrangements to deal with complaints and concerns about local services and access to information, and that these arrangements are widely publicised and effectively monitored.

5. Information Which Must be Provided

Apart from the exemptions set out in paragraph 9 below, NHS trusts and authorities must publish or otherwise make available the following information (further details are given in Annexes A, B, C and D):

• information about what services are provided, the targets and standards set and results achieved, and the costs and effectiveness of the service;

• details about important proposals on health policies or proposed changes in the way services are delivered, including the reasons for those proposals. This information will normally be made available when proposals are announced and before decisions are made;

• details about important decisions on health policies and decisions on changes to the delivery of services. This information, and the reasons for the decisions, will normally be made when the decisions are announced;

• information about the way in which health services are managed and provided and who is responsible;

• information about how the NHS communicates with the public, such as details of public meetings, consultation procedures, suggestion and complaints systems;

• information about how to contact Community Health Councils and the Health Service Commissioner (Ombudsman);

• information about how people can have access to their own personal health records.

6. Response to Requests for Information

Requests for information, whether made in person or in writing, must be answered promptly. An acknowledgement must be sent within 4 working days and, where possible, the information should follow within 20 working days.

NHS organisations are not required to make available:

1. copies of the documents or records containing the information (although in some cases it may be simpler to do so if they contain nothing but the information requested);

2. information which the organisation does not possess (eg comparable data with other organisations);

3. individual copies of documents or other forms of information which are already widely publicly available.

If the information is not to be provided under the terms of the Code, an explanation must be provided within 20 working days of receipt of the request.

Each NHS organisation must publish the name of an individual who has responsibility for the operation of this Code of Practice. This should be a senior officer directly accountable to the Chief Executive of the organisation. Details of how to request information through this individual must also be publicised locally.

7. Charging for Information

NHS Trusts and Authorities may make a charge for providing information but are not required to do so. It is recommended that charging should be exceptional but that where charges are made the following ground rules should be observed:

1. no charge for individuals enquiring about services or treatment available to them; press and other media; Community Health Councils; MPs; Local Authorities; Citizen's Advice Bureaux;

2. for requests from people not listed above, no charge for the first hour and a charge not exceeding £20 per hour for each hour thereafter.

8. Personal Health Records

The NHS must keep patients' personal details confidential but people normally have a right to see their own health records. Depending on who made the records, patients can obtain access through the relevant Trust, Health Authority, family doctor or dentist. Access must be given within the timetable in the Access to Health Records Act 1990 (or, for records held on computer, the Data Protection Act 1984). Under these Acts, patients may be charged for access to their records.

9. Information Which May be Withheld

NHS Trusts and Authorities must provide the information requested unless it falls within one of the following exempt categories:

1. Personal information. People have a right of access to their own health records but not normally to information about other people.

2. Requests for information which are manifestly unreasonable, far too general, or would require unreasonable resources to answer.

3. Information about internal discussion and advice, where disclosure would harm frank internal debate, except where this disclosure would be outweighed by the public interest.

4. Management information, where disclosure would harm the proper and effective operation of the NHS organisation.

5. Information about legal matters and proceedings, where disclosure would prejudice the administration of justice and the law.

6. Information which could prejudice negotiations or the effective conduct of personnel management or commercial or contractual activities. This does not cover information about internal NHS contracts.

7. Information given in confidence. The NHS has a common law duty to respect confidences except when it is clearly outweighed by the public interest.

8. Information which will soon be published or where disclosure would be premature in relation to a planned announcement or publication.

9. Information relating to incomplete analysis, research or statistics where disclosure could be misleading or prevent the holder from publishing it first.

10. Complaining About the Provision of Information

People may wish to complain about a decision to refuse to provide information, a delay in providing information or levels of charges. In the first instance, complaints should be made within 3 months to the local individual responsible for the operation of the Code (see paragraph 6 above). If the complainant remains dissatisfied, a complaint should be made to the Chief Executive of the organisation, or the Chief Executive of the Family Health Services Authority in the case of family doctors, dentists, pharmacists and optometrists (opticians). Community Health Councils may be able to help people to pursue their complaint. NHS Trusts and Authorities must acknowledge complaints within 4 working days and reply within 20 working days.

The NHS Trust or Authority will provide people with information about how to take their complaint further to the Health Service Ombudsman if they remain dissatisfied.

[ ... Passage deleted since obsolete ... ]

11. Implementation of the Code of Practice

The NHS organisations described in paragraph 2 above must implement the Code of Practice from 1 June 1995. Detailed guidance notes, to help them respond to requests for information in accordance with the Code, will be available by the implementation date.

ANNEX A - NHS Trusts

1. Introduction

This Annex describes the information which NHS Trusts must publish or make available. It also lists examples of information which it is recommended should be made available as a matter of good practice, either through publication or on request.

2. Information Which Must be Published

The following are the documents which Trusts must publish by given dates:

• an annual report describing the Trust's performance over the previous financial year, and including details of board members' remuneration; the report should be written and presented in a way that can be readily understood by the general public;

• an annual summary of the Trust's business plan, describing the Trust's planned activity for the coming year;

• a summary strategic direction document (not published annually), setting out the Trust's longer term plans for the delivery of health care services over a five year period; and

• audited accounts published annually.

In addition to the documents described above, NHS Trusts must also make available, on request:

• the register of board members' private interests required under the Code of Accountability for NHS boards;

• such information as is required by the Patient's Charter and NHS performance tables.

2.1 Public Meetings

NHS Trusts must hold at least one public meeting a year. An agenda, papers, the accounts and the annual report must be publicly available at least 7 days in advance of the meeting. Provision must be made for questions and comments to be put by the public. Public meetings must be held in readily accessible venues and at times when the public are able to attend. Providing the public with access to more frequent general meetings or to board meetings is good practice already followed by an increasing number of Trusts.

3. Good Practice in Providing Information

3.1 Examples of Additional Information Which May be Published

• quarterly board reports (financial, activity, quality and contract information);

• Patient's Charter
  • local performance against national targets;
  • local performance against local targets;

• information on service changes;

• agenda and papers relating to other meetings held in public in addition to the Annual Public Meeting.

3.2 Examples of Information Which May be Available on Request

The following list is a guide to some of the information which is routinely held by most NHS Trusts. Much of the information will be detailed in the previous year's annual report. Where more up-to-date information is available, this may be given:

• patient information leaflets;

• description of facilities (numbers of beds, operating theatres etc.);

• performance against Patient's Charter national and local standards and targets;

• waiting times by specialty;

• detailed information on activity;

• broad conclusions of clinical audit;

• number and percentage of operations cancelled, by specialty;

• price lists for extra-contractual referrals;

• information about clinicians (including qualifications, areas of special interest, waiting times for appointment);

• areas which have been market-tested, with details of decisions reached;

• tenders received by value, but not by name of tenderer;

• information on manpower and staffing levels and staff salaries by broad bandings;

• policies for Trust staff, eg equal opportunities, standards of conduct;

• environmental items, eg fuel usage;

• volume and categories of complaints and letters of appreciation (without identifying individuals), and performance in handling complaints;

• results of user surveys and action to be taken;

• standing orders and waivers of standing orders;

• standing financial instructions;

• external audit management letter, and Trust response, at the time when response is made;

• details of administrative costs;

• funds held on trust, such as bequests and donations;

• performance against quality standards in contracts;

• clinical performance, by specialty, eg proportion of surgery done on day surgery basis, by condition;

• performance against national and local targets for inpatient and day case waiting times;

• names and contact (office) numbers of board members and senior officers;

• basic salaries, ie excluding PRP and distinction awards, of staff, by bandings and in anonymised form;

• response times for ambulances;

• information about the use of outside management consultants, including expenditure.

4. Procedures for Obtaining Information

Trusts must ensure that people know whom to ask for information. They must publish the name of the person responsible, along with full details of how to go about obtaining information and how to complain if the information is not provided. The person responsible should be a senior officer who is directly accountable to the Chief Executive of the Trust.

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ANNEX B - Purchasers of Health Care:
District Health Authorities and Family Health Services Authorities

1. Introduction

1.1

Purchasers have an essential role in the successful development of local services and achieving a strategic balance of care. The purchasers covered by this Annex are District Health Authorities, Family Health Services Authorities and District Health Authorities and Family Health Services Authorities acting jointly. (Annexes C and D give complementary advice for General Practitioner Fundholders.)

1.2

This Annex describes the information which they must publish or make available. It also lists examples of information which it is recommended is made available as a matter of good practice, either through publication or on request.

2. Information Which Must be Published

2.1 District Health Authorities/Family Health Services Authorities

The following are the documents which Authorities must publish by given dates:

• an annual report, describing the performance over the previous financial year, and including details of board members' remuneration; the report should be in a form that can be readily understood by the general public;

• an annual report by the Director of Public Health;

• an annual report on performance against Patient's Charter rights and standards;

• a full list of General Medical Practitioners, General Dental Practitioners, pharmacists and optometrists in their locality;

• papers, agendas and minutes of board meetings held in public;

• audited accounts published annually;

• a strategy document (not published annually) setting out the health authority's plans over a five year period. They must consult with the public before and after developing the strategy.

In addition to the documents described above, authorities must also make available, on request:

• annual purchasing plans;

• contracts with providers, both NHS and non-NHS;

• the register of board members' private interests required under the Code of Accountability for NHS boards;

• such information as is required by the Patient's Charter.

2.2 Public Meetings

District Health Authorities and Family Health Services Authorities must hold all their board meetings in public, though there is provision for certain issues (eg personnel and commercial matters) to be taken in a private part of the meeting. The agenda for these meetings must always be provided to the press and on request to members of the public. Public meetings must be held in easily accessible venues, and at times when the public are able to attend.

2.3 Consultation

District Health Authorities must consult with the Community Health Council and other interested parties on any plans to change the service which they purchase or plan for their residents.

They must publish well in advance a timetable to enable the public to know when and how they can influence the commissioning process.

3. Good Practice in Providing Information

3.1 Examples of Additional Information Which May be Published

• information on services purchased by the Authority;

• information about consultation exercises undertaken and outcomes;

• full reports of any user or attitude surveys and action to be taken;

• total available financial resources;

• District Health Authority allocation;

• Family Health Services Authority allocation;

• proposed and actual expenditure on services, analysed by:
  • providers;
  • contracts (including by specialty, if available);
  • treatments purchased separately from contracts (extra contractual referrals);

• changes in providers and contracts from previous years;

• performance against quality standards in contracts;

• clinical performance, by specialty, of providers contracted with, eg proportion of surgery done on day surgery basis, by condition;

• performance against national and local targets for in-patient and day case waiting times;

• numbers of complaints dealt with and response times;

• names and contact (office) numbers of Authority board members and senior officers;

• basic salaries ie excluding PRP and distinction awards, of staff, by bandings and in anonymised form;

• information about the use of outside management consultants, including expenditure.

3.2 Examples of Information Which May be Available on Request

• future year resource plans;

• information about expenditure on different types of healthcare, such as primary, secondary or community care;

• price comparisons of all providers used by the purchaser;

• total expenditure per head of population;

• costs of authority administration;

• standing orders and waivers of standing orders;

• standing financial instructions;

• external audit management letter, and response, at the time when the response is made.

4. Procedures for Obtaining Information

Authorities must ensure that people know whom to ask for information. They must publish the name of the person responsible, along with full details of how to go about obtaining information and how to complain if the information is not provided. The person responsible should be a senior officer who is directly accountable to the Chief Executive of the Authority.

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ANNEX C - General Medical Practitioners, General Dental Practitioners, Community Pharmacists and Optometrists

1. Introduction

1.1

This Annex describes the information which General Medical Practitioners, General Dental Practitioners, Community Pharmacists and Optometrists must publish or make available. It also describes the information about these services which Family Health Services Authorities must provide. In addition, the Annex lists examples of information which it is recommended Family Health Services Authorities should publish or make available on request as a matter of good practice.

1.2

General Medical Practitioners, General Dental Practitioners, Community Pharmacists and Optometrists provide services to the public which are paid for by the NHS. The public should therefore have access to information about services they provide. Although they are self-employed independent contractors, and cannot therefore be required to publish sensitive information about their businesses, their contracts for services specify information that is important to patients and which must be made available.

2. Information Which Must be Published

The following are the statutorily required documents which must be published.

2.1 General Medical Practitioners

Practice Leaflets - Essential information for patients about individual doctor's practices is published in practice leaflets which can be obtained from the practice or the Family Health Services Authority. These must contain the following information:

• name, sex, medical qualifications and date and first place of registration of the General Practitioner;

• details of availability (including arrangements for cover when the General Practitioner is not available), appointments system and how to obtain an urgent appointment or home visit;

• arrangements for obtaining repeat prescriptions and dispensing arrangements;

• frequency, duration and purpose of clinics;

• numbers and roles of other staff employed by the practice, and information about whether the General Practitioner works alone, part-time or in partnership;

• details of services available - for example, child health surveillance, contraception, maternity, medical, minor surgery, counselling and physiotherapy;

• details of arrangements for receiving and responding to patient's comments and complaints;

• geographical boundary of the practice area;

• details of access for the disabled.

In addition, some leaflets also:

• contain information about Patient's Charter standards;

• contain information detailing any other professional staff employed by the practice, including their registration status;

• are available in languages other than English which are commonly used locally.

2.2 General Dental Practitioners

Practice Leaflets - Essential information for patients about individual dental practices is published in practice leaflets which can be obtained from the practice or the Family Health Services Authority. These contain:

• name, sex and date of registration as a dental practitioner;

• address, opening hours and details of partners/associates;

• whether a dental hygienist is employed;

• details of access to the premises;

• whether only orthodontic treatment is available;

• with consent, whether the dentist speaks any languages in addition to English;

• General Dental Practitioners are required to inform patients of any emergency arrangements in place.

Charges

• General Dental Practitioners must provide patients with individual costed treatment plans. They must display a notice of the scale of NHS charges and information about entitlement to exemption from or remission of charges.

It is good practice:

• to provide information about their cross-infection control procedures, giving examples as appropriate.

2.3 Community Pharmacists

Practice Leaflets - Pharmacists are not obliged to produce practice leaflets but those dispensing more than 1500 prescriptions a month normally do so. These leaflets detail the range of services available to the public and, if produced, must contain the following information:

• a list of services provided by the pharmacist;

• name, address and telephone number of the pharmacy;

• normal opening hours and arrangements for out of hours services and emergencies;

• procedures for receiving comments on services provided.

As good practice:

• an increasing number of Community Pharmacists make health promotion leaflets available to the public.

2.4 Optometrists

Optometrists are not currently required to produce practice leaflets, but many do so as a matter of good practice.

Results of Eye-Tests

Optometrists must provide patients with a copy of the results of their eye-tests (ie their prescription) or a statement that no prescription is required.

2.5 Family Health Services Authorities

Directory of Local Services - A list of all General Medical Practitioners, General Dental Practitioners, Community Pharmacists and Optometrists must be published by Family Health Services Authorities. This contains details of all Practitioners in the area and includes information about out of hours services by pharmacists. Local General Practitioner Practice Charters are also available from Family Health Services Authorities.

Changing Family Doctors

Information must be provided to help people wishing to change their family doctor. It is good practice to publish this information in a leaflet.

2.6 Personal Records

All Family Health Services Authority contractors must allow a patient access to their own health records under the Data Protection Act 1984 and the Access to Health Records Act 1990.

3. Information from Family Health Services Authorities

A Family Health Services Authority is well placed to take an overview of primary care services in its area and the following indicates additional information which may be provided.

3.1 Information about General Medical Practitioners

Within the restriction outlined in paragraph 1.2 about confidential contractual information, Family Health Services Authorities (or Health Commissions) may make available aggregate information about General Medical Practitioners in respect of:

Spend:

• expenditure on General Medical Services;

• prescribing.

Numbers:

• average list size of General Medical Practitioners;

• primary health care teams;

• aggregated numbers of district nurses, health visitors and midwives attached to practices;

• aggregated number of practice nurses.

Service Information:

• aggregated numbers of fundholding practices;

• aggregated levels of immunisation;

• aggregated levels of screening for cervical cytology;

• percentage of practices achieving top targets for smears and vaccinations;

• achievement of health promotion targets (percentage achieving band 3);

• time taken to transfer medical records;

• information about type of premises (eg main surgeries, branch surgeries);

• percentage of practices with General Practitioner Practice Charters in place.

Initiatives:

• initiatives to promote the work of primary care teams;

• involvement of General Practitioners in purchasing.

Complaints:

• numbers;

• response times;

• people's rights as patients;

• how people can make complaints.

3.2 Information about Dentists

• Numbers and location of NHS dentists, including details of late opening and specialist services offered.

3.3 Information about Community Pharmacists

Numbers and location of pharmacists, and those offering:

• late opening;

• oxygen supplies;

• supplies to residential homes;

• health promotion information;

• out of hours services for urgent prescriptions;

• needle exchange facilities.

3.4 Information about Optometrists

Numbers and location of optometrists, and those offering:

• late opening;

• domiciliary visits to carry out sight tests.

4. Information Which Must Not be Disclosed Without the Agreement of Individual Family Health Service Contractors

• Commercially sensitive data relating to the operation of a practice as a business, eg salaries, buildings;

• information on specific practices, where the disclosure has not been agreed with the practices concerned.

5. Procedures for Obtaining Information

5.1

Information about individual General Medical Practitioners, General Dental Practitioners, Pharmacists and Optometrists and their practice leaflets must be available from the practice. Family Health Services Authorities must ensure that people know whom to ask for additional information. The Authority should publish the name of the person responsible. This should be a senior officer who is directly accountable to the Chief Executive of the Authority.

5.2

Complaints about failure to obtain information should be dealt with as far as possible by the practice. If the complainant remains dissatisfied he/she should be directed to the Family Health Services Authority. The assistance of the Community Health Council may also be sought.

[ ... Passage deleted since obsolete ... ]

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ANNEX D - General Practitioner Fundholders

1. Introduction

This Annex extends Annex C and describes the additional information which General Practitioner Fundholders, as purchasers of services, must publish or make available. The requirements of Annex C relating to General Medical Practitioners also apply to General Practitioner Fundholders, in their role as providers of General Medical Services (GMS).

2. Information Which Should be Published

The following are the documents which General Practitioner Fundholders should publish or make available by given dates:

• plans for major shifts in purchasing;

• annual practice plan describing how the practice intends to use its fund and management allowances over the coming year and demonstrating the practice's contribution to national targets and priorities as well as any locally-agreed objectives. The plan should include an outline longer term view and may optionally include the practice's primary health care team charter (Practice Charter) and plans for the practice's general medical services (GMS) activity;

• Practice Charter (if available and not included above);

• annual performance report;

• audited annual accounts.

Consultation

General Practitioner Fundholders must ensure that a copy (or a summary) of their major shifts in purchasing intentions, annual plans, Practice Charter (if separate) and performance reports is available at their practice for consultation by patients. A copy of the above documents should be sent to the Family Health Services Authority and a copy (or a summary) to the local Community Health Council.

In addition, General Practitioner Fundholders are required to produce annual accounts for audit. Once audited, these are public documents and are available for inspection at the Family Health Services Authority.

General Practitioner Fundholders are developing a range of models for involving patients in service planning. The NHS Executive will be publishing examples of best practice in this area later in 1995. General Practitioner Fundholders should ensure that they have effective complaints procedures in place.

3. Procedures for Obtaining Information

3.1

Information about individual practices should be requested direct from the practice. Complaints about failure to provide information should be dealt with as far as possible by the practice.

3.2

If the complainant remains dissatisfied he/she should be directed to the Family Health Services Authority. The assistance of the Community Health Council may also be sought.

[ ... Passage deleted since obsolete ... ]

3.3

Requests for information which is not about an individual practice should be directed to the Family Health Services Authority. They must ensure that they publicise the name of the officer within the Family Health Services Authority who is responsible for providing this information and for the operation of the Code of Practice. This should be a senior officer who is directly accountable to the Chief Executive of the Authority.

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