Section 1: What You Can Expect From Us
Welcome to Direct Medics. We are very glad you have chosen to work through our company, and we aim to give you a very positive experience.
Direct Medics is an agency that provides temporary and permanent assignments to healthcare staff. We have been established since 2000 and employ recruitment staff spread between our offices in the UK and Republic of Ireland.
Achieving the highest level of professional standards is at the centre of the recruitment, placement and assessment of our healthcare staff. The company has several facilities in place to support and guide you in meeting the required professional standards within our programme of recruitment, review and reassessment.
We do hope you enjoy working with us; if ever you have any comments, queries or suggestions please do not hesitate to contact your Recruitment Consultant in the first instance.
Thank you and we look forward to working with you.
The team structure of Direct Medics is designed to ensure that registering and working with us is as straightforward and simple as possible. As a responsible recruiter we take our legislative obligations seriously, and we offer several options to support you in completing and maintaining your pre-employment checks.
When you first contact us, the following will happen:
- You will be assigned a Compliance Officer who will send an introductory email outlining the company’s pre-employment checks;
- The Compliance Officer will add your details to relevant contact lists to allow you to receive information on job opportunities immediately (this is on the understanding that no booking can be made until all checks are completed);
- You will be assigned a Recruitment Consultant who carries out an introductory interview where any preferences for job opportunities are confirmed;
- You will receive an advisory telephone call from your Compliance Officer aimed at ensuring that you fully understanding the registration the documents you need to submit;
- Once your pre-employment checks are well underway, your file will be referred to the company’s Nursing Manager, who will arrange a suitable time with you for a final interview. In advance of the interview, you will be asked to complete and submit a ‘Skills List’ on your chosen area, which supports the interview itself in ensuring the presence of specialty-specific skills. The interview also focusses upon a complete understanding of our procedures and suitability to work in chosen area(s).
You will be booked for work through Direct Medics only with the express approval of the Nursing Manager. After interview, the Nursing Manager completes an interview record advising the Nursing team as to:
- Whether you can be accepted for work through Direct Medics Ltd.;
- Your current skills, experience and qualifications; and
- The type(s) of work the Registered Manager would permit through the company
The NHS Employment Check Standards set out the pre-employment assessments that must take place for all staff providing services to NHS patients. As a responsible recruiter of healthcare staff, Direct Medics will support you in meeting the requirements of these checks.
The following links outline the requirements of the Standards. Your Compliance Officer will advise on the provisions made by Direct Medics to assist you in meeting these requirements:
Dependent upon your preferred location(s) through Direct Medics, and the specific job role you wish to undertake, you will be required to complete mandatory training modules, and maintain their validity. Direct Medics Ltd. will meet the cost of your standard Mandatory Training.
We will ensure that learning facilitators or outsourced service provided will have the appropriate experience, background and qualifications to deliver training to a satisfactory standard and are accredited by Skills for Health to provide training to the required standard.
The training modules you may be offered may include (but is not limited to):
- Blood Transfusion (in line with the “Right Patient Right Blood” circular)
- COSHH (Control of Substances Hazardous to Health regulation)
- Counter Fraud
- Equality, Diversity and Human Rights
- Fire Safety
- First Aid
- Food Hygiene Awareness
- Handling Medication
- Handling Violence & Aggression and Complaint Handling
- Health, Safety and Welfare
- Infection Prevention and Control
- Information Governance
- Information Governance and Data Security
- Interpretation of cardiotocograph traces
- Life Support
- Lone Worker Training
- Management of Actual or Potential Aggression (MAPA) Training
- Maternal resuscitation training
- Medication Management
- Mental Capacity Act
- Mental Health Act
- Moving and Handling
- NHS Conflict Resolution
- Personal Safety and Control and Restraint Training
- Physical Restraint Skills and Techniques
- Preventing Radicalisation
- Prevention and Management of Violence (PMVA) Training
- Resuscitation of the new-born
- RIDDOR (Reporting of Injuries, Diseases & Dangerous Occurrences Regulations)
- Safeguarding Adults
- Safeguarding Children
- Safe Holding
- Tissue Viability
Any other mandatory training required by the Client for a specific role (e.g. Sedation, Duty of Care, Person-Centred Care, Communication, Consent, Privacy and Dignity, Fluids and Nutrition, Mental Health Awareness and Dementia Awareness) will be communicated as and when needed.
Once your mandatory training is complete, we shall keep written records of all training undertaken which will include full details of the facilitator of any training undertaken; the date or dates upon which you received the training; where the training was undertaken, and the extent of the training including but not limited to, the duration of the course and its content. This shall be retained on your file for the purpose of fulfilling the requirements of regular Compliance Audits under the Terms of our Framework Agreements.
Your Compliance Officer will make contact with you as and when your training is due for renewal. We will, as part of any annual appraisal process, support you in complying with all relevant requirements of CPD to your Professional and Regulatory Body if needed.
Keeping you informed:
You will begin to receive job alerts from the company’s email and SMS alert systems as and when opportunities arise. You will typically receive at least two updates per week.
Direct Medics Ltd. prohibits its staff from booking assignments for its Candidates without their express permission. This means you can be assured that your availability for and interest in a job role will never be misrepresented by the Company.
In order to ensure that you are informed promptly by your Recruitment Consultant about your preferred roles, it is vital that you regularly update your Consultant with your availability. This is an opportunity to be informed about jobs first so it is important that you keep regular contact; this is especially important when you change location or banding and we appreciate your updates as it allows us to provide the best possible service to you with the most relevant job opportunities.
Before beginning work with us, you will receive a “Key Information Document” in accordance with the “Good Work Plan”.
Confirming an assignment:
When you are interested in booking an assignment, you should contact your Recruitment Consultant as soon as possible. You will be referred to your Compliance Officer in the event that your registration documents have expired, otherwise you will be proposed immediately for booking.
you have been booked, we will confirm the details with you verbally and follow up with a written confirmation via email. Any queries you may should be addressed immediately to allow for a smooth start to your assignment.
We will take all reasonable steps to confirm our Clients’ requirements in terms of qualifications, registration requirements, experience etc. when communicating job opportunities to you. In turn, acceptance of a job role from us is taken as acceptance that you will adhere to:
- Your Professional and Regulatory Body’s standards of competence, training and proficiency as well as best practice guidelines;
- The relevant Job Profile provided to you; and
- The relevant band or grade you have been assigned to
If you cannot attend an assignment:
In the event that you cannot attend an agreed assignment, you are required to give as much notice as possible, to allow the Client to make alternative arrangements. Repeated failure to give at least four hours’ notice, or not arriving for your assignment at all (“No Show”) will be treated as a disciplinary matter by the Company, which could result in your removal from our register.
It is our aim to ensure that you are completely satisfied with your assignment, that it is within the range of your skills and it is everything you expected it to be. Our contact with you during your assignment may include:
- an arrival call on the first day in a new setting (to confirm your safe arrival and receipt of induction)
- service calls during the assignment (to check that the assignment is proceeding as expected)
- records maintenance calls (to update documents that may be due to expire during the assignment)
We seek Client feedback, both verbal and written during and after your assignment. This allows us to maintain a record of your performance for all placements as far as reasonably practicable.
Feedback is of course a two-way process and we will regularly encourage you to provide us with your impressions both of our service and the settings in which you have worked.
Rates of Pay
Different pay rates may apply to different assignments. Before commencing an assignment you will be informed both verbally and in writing, the rate of pay applicable to your assignment.
Timesheets and Pay
Payment is made to staff only on submission of a timesheet, without exception. All information given must be accurate and timesheets must be completed in full and every shift must be authorised with an appropriate signature. You must also identify the position at which you worked, and any cost centres/reference numbers relevant to your shift (arrangements for reference numbers will vary from one Client to another so please ask us if you are unsure as to what information you need to provide).
Payroll takes place weekly, with all timesheets submitted by 11am on Monday paid to arrive by the following Monday.
Method of Payment
Payment will be made by Banker’s Automated Clearing Services (BACS) directly into your bank/building society account, with a pay slip forwarded to your email address. Please remember to advise your local office should you change your personal circumstances, e.g. change of address, email address or bank account.
If you wish to be paid for your assignments by any method outside PAYE, you are reminded of your obligation to adhere to IR35 requirements. A list of approved umbrella companies is available from our Finance department.
The Company is required by law to deduct PAYE and Class 1 National Insurance Contributions. Therefore, you are required to pay income tax on your earnings (if they exceed the threshold for the current financial year). The rules affecting people working through agencies are contained in Section 134 TA 1988 (formerly section 38, Finance (No.2) Act 1975). Dependent upon your earnings, you may also be eligible for auto-enrolment onto the company’s pension scheme (which you can choose to opt out of if you so wish).
Should you have any queries relating to your pay, please contact our Belfast office and ask to speak with a member of the Finance team; alternatively you can email queries to firstname.lastname@example.org.
If for some reason, you have been under/overpaid, the money will automatically be adjusted in your next payment.
Holidays and Holiday Pay
As an Agency Worker you start accruing holiday pay as soon as you begin work through us which is paid as a proportion of your ongoing payments (detailed on your payslip). We require 4 weeks’ notice in writing of your intention to take a holiday during an assignment. Note: Holiday pay is not applicable to any Agency Worker registered as a Limited Company.
The main principle of the regulations directive, which came into force on 1 October 2011, is to give equal treatment to someone who has been with a hirer for 12 continuous weeks in a given job. The agency worker will be entitled to at least the basic working and employment conditions such as pay and working time which are equal to the hirer's own employees.
What rights do agency workers have under AWR?
Immediate entitlements include:
- The same access to facilities such as staff canteens, childcare and transport asa comparable employee of the hirer;
- To be informed about job vacancies
When the 12-week qualifying period has been achieved, an agency worker will
be entitled to the same basic conditions of employment as if they had been directly employed on day one of the placement, specifically equal pay and statutory employee benefits such as Statutory Maternity Pay, paid for by the employer.
Does the 12-week qualifying period have to be continuous?
No, most breaks between or during an assignment to the same job that are less than six weeks in length will simply pause the accrual of the 12-week qualifying period. However a break between or during a placement, where no shifts have been booked, that is more than six weeks will reset the 12-week qualifying period. Please note however, that the assignment has to be with the same Client.
When you register with us, you are matched appropriately to vacancies according to your skills and expertise. The aim of reviewing and reassessing our Candidates on an ongoing basis is to maintain and update our records as new skills and expertise are gained, which may impact on your suitability for specific vacancies. The process also provides assurances as to the ongoing suitability of our nurses.
The following reviews and reassessments typically take place:
Prior to booking an assignment: Each time you request that an assignment be booked for you, your Recruitment Consultant performs a check with the Nursing and Midwifery Council’s Online Confirmation Service, which identifies any new stipulations or restrictions on your registration which may affect a booking;
During/after assignments: You are expected to alert your Recruitment Consultant if you feel that the assignment is not within the scope of your skills or if you are uncomfortable with the duties expected of you. The agency contacts the Client for feedback when you work in a clinical setting for the first time, and any areas of concern raised are reported to the Manager. Such concerns will be provided to you, with a development plan put in place to include required actions with agreed timescales for completion;
On an ongoing basis: Our Compliance team works with you to update and maintain your file to ensure that we can always offer the roles suitable for you;
Six months after the first booking, and annually thereafter: The Manager will invite you to take part in clinical supervision, provided you have carried out at least sixty shifts with the company in the previous six months. You are not obliged to take part. The supervision exercise is an opportunity for candidates to raise any concerns and provide feedback on clinical settings. Any specific support you might require will be identified and documented, and progress against these actions will be reviewed and documented at follow up supervision sessions.
Twelve months after the first booking, and annually thereafter: The Registered Manager will invite you to an annual appraisal. You are not obliged to take part. Your preparation for the appraisal meeting would include a self-assessment, and the appraisal meeting itself is aimed at constructing a Personal Development Plan for you, identifying your learning and development objectives for the coming year in agreement with the Manager.
Your professional development is of utmost important to Direct Medics. Shortly after you start working with us, we will discuss with you your performance, standards of practice and any issues arising.
We will help you to complete an annual appraisal by an appropriately experienced and qualified practitioner of the same discipline. The appraisal will include a review of documents relating to your work with us and may include (but is not limited to) the following:
- Any prior appraisal form you have completed with us, and any Actions outstanding from it;
- Your End of Placement Assessment reports completed by Clients;
- The results of any review by our Clients into your clinical practices; and
- Your written portfolio detailing your professional experience and attendance at professional development courses
The appraisal will review your training and development needs (including CPD requirements) and will include a written and agreed ‘Personal Development Plan’ on a standard form as agreed at the appraisal.
Revalidation requirements for nurses and midwives are as below:
- A minimum of 450 practice hours (900 hours for those revalidating as both a nurse and midwife (including Nurse/SCPHN and Midwife/SCPHN)); and
- 35 hours of Continuing Professional Development (CPD), of which at least 20 hours must be participatory learning; and
- Five pieces of practice-related feedback; and
- Five written reflective accounts on their CPD and/or practice-related feedback and/or an event or experience in their practice, and how this relates to the Code; and
- Reflective discussion with another nurse or midwife; and
- Health and character declaration; and
- Professional indemnity arrangements
These requirements need to have been met during the three years since your registration was last renewed or since you joined the register. Once you have collected evidence that you have met these requirements, you need to have a confirmation discussion in which you demonstrate to an appropriate “confirmer” that the requirements have been met. You must obtain confirmation during the final 12 months of your three-year renewal period.
You may be removed from the register if your conduct or standard of work has seriously fallen below the level required by the Company, the NMC Code of Conduct or the Framework Agreements under which you have been placed.
Examples of such conduct are as follows. This list is not exhaustive:
- Failure to attend a Client having accepted an engagement, or repeated lateness
- Failure to provide care in a fashion consistent with the NMC Code of Conduct
- Failure to carry out reasonable instructions of the Client.
- Breach of trust involving the Company or the Client.
- Disclosure of confidential information to a third party relating to either a Client or the Company.
- Misconduct, affecting either the Client or the Company. This includes being under the Influence of alcohol or any substance that will adversely affect your performance; theft, abusive or violent behaviour; harassment, criminal conviction etc.
The company reserves the right to remove you from your assignment and not re-assign until the matter has been investigated and resolved, in line with its Disciplinary and Grievance Procedure.
You are advised to read your Nursing handbook in full, to ensure you fully understand what is required of you. Candidates cannot work if their health or physical ability impedes them from carrying out their duties effectively, or if they do not have a current Access NI Disclosure, mandatory training and valid NMC registration.
Direct Medics Ltd. aim to provide the highest quality of service to all individuals and bodies served. We aim to enable all of our customers to make complaints quickly and simply, and we will investigate and resolve a complaint in accordance with strict timescales.
Subject to any restrictions on our customers relating to confidentiality or Data Protection Legislation, we expect to receive the necessary information surrounding any complaint, to enable us to investigate it fully.
If a customer needs to raise a formal complaint to the company, any details regarding the issue, previous attempts to resolve by informal means and contact details (email address and phone number) should be submitted. This must be made in writing and sent to our Recruitment Director at the following address:
Direct Medics Ltd.
33A Stockman’s Way,
All written complaints will be dealt with as follows:
- As soon as the complaint is received, it will be logged and the complainant will receive acknowledgement or receipt of the complaint in writing within two working days;
- We will keep a full written record of the nature of the complaint and the actions taken as a result;
- We may contact the complainant to clarify the detail of the complaint and to discuss it with them and we will follow up any conversation in writing;
- We will use reasonable endeavours to ensure that all complaints are resolved within ten calendar days, unless the nature of the complaint requires additional investigation or action by a Professional or Regulatory Body or other Government Body. In that case, we will ensure that the complaint is resolved as soon as possible
Throughout the investigation we will be careful to ensure that any information about the complainant is kept confidential and steps will then be taken, where possible, to prevent a reoccurrence.
We will ensure that our Candidates are promptly and fully informed about any complaints relating to them, and we will take action to ensure no repeat of the action complained of.
At any point through this process, should a customer require it an independent advocacy services may be engaged with in an attempt to resolve outstanding issues fairly. If required assistance will be provided to any person requiring help to access the support needed need to articulate concerns and successfully navigate the system.
The company keeps records of all complaints and including details of all communications with complainants, the results of any investigations and the action taken.
Complaints about Candidates: Reporting and Recording Procedure
When a complaint is reported to the company concerning a candidate, the following steps are completed:
- A complaints case file is opened with an entry on the Complaint Log created alongside a separate file folder in which to store documents specific to the complaint;
- The complaint is reported to the relevant Manager (e.g. Nursing Manager) who is responsible for overseeing follow-up and close-off in collaboration with the Candidate, Direct Medics staff, Complainant and/or Professional/Regulatory Bodies as appropriate;
- All relevant documents are stored in the appropriate case file folder, and a log of contacts and close-off is stored in the Complaint Log;
- At close-off, the Candidate’s appraisal and supervision schedule is reviewed with any adjustment to the schedule in light of the complaint, in addition to any enhancement to quality monitoring at the Manager’s discretion
Where a complaint relates to evidence of malpractice, Direct Medics Ltd. reserves the right to report the Candidate to the relevant Professional/Regulatory Body. Where this occurs, Direct Medics Ltd. will monitor such complaints until an outcome is reached, and will liaise with the relevant Client as to whether an Alert Notice is required.
Where a complaint relates to poor performance, Direct Medics Ltd. will not supply the Candidate to further Clients until the issues identified have been resolved.
Candidates will be provided with a copy of this procedure upon registration and will sign a declaration confirming receipt and understanding.
Whilst this handbook outlines our own policies and standards, these do not supersede the guidelines of your Professional/Regulatory Body.
Direct Medics communicates relevant updates from Professional/Regulatory Bodies either via email to all candidates or on the company website, www.directmedics.com.
Direct Medics exists to serve our candidates and clients, and we rely on your input and feedback to keep building upon the excellent service you have come to expect from us.
Please contact our Recruitment Director at Head Office with your comments:
Direct Medics Ltd.
33A Stockmans Way
Section 2: What We Expect From You
Your commitment to professional standards is fundamental to being part of a healthcare profession. You need to be aware that at all times whilst on the Client’s premises you are under the direction and control of the Client. As such, you, as a minimum:
- Must work as directed by the Client and follow all reasonable requests, instructions, policies, procedures and rules, including the accepting of alternative work that falls within the scope of your clinical competence when requested to do so as required;
- Must not neglect, nor without due and sufficient cause omit, to discharge promptly and diligently a required task within the terms of your assignment;
- Must not make unnecessary use of authority in connection with the discharge of services and assignment instructions;
- Must abide by the Working Time Regulations 1998;
- Must not act in a manner reasonably likely to bring discredit upon the Client or Direct Medics Ltd;
- Must not unlawfully discriminate within the realms of Equality legislation;
- Must not falsify records, timesheets, expenses or attempt to de-fraud the Client or Direct Medics Ltd. in any way (falsification of documents will be pursued on the grounds of Fraud with the appropriate Counter Fraud Service and will be reported to your Professional or Regulatory Body);
- Must seek to authorise your timesheet following the end of the required shift or assignment in a timely manner and submit to Direct Medics Ltd. within seven (7) days to ensure prompt payment to both yourself and Direct Medics Ltd.;
- Must not corruptly solicit or receive any bribe or other consideration from any person, or fail to account for monies or property received in connection with duties performed on an assignment;
- Must maintain proper standards of appearance and deportment whilst at work;
- Must be properly and presentably dressed in such uniform and protective clothing, or otherwise, as agreed between the Parties;
- Must display your photo ID badge on clothing at all times during an assignment;
- Must not wear your uniform, protective clothing, photo ID badge or use the equipment on the Authority’s premises unless fulfilling the terms of an assignment;
- Must not engage in any form of physical or verbal abuse, threatening behaviour, harassment/bullying or be otherwise uncivil to persons encountered in the course of work;
- Must not at any time be, or appear to be, on duty under the influence of alcohol or drugs;
- Must not at any time be, or appear to be, in possession of firearms or other offensive weapons;
- Must report any injury or accident sustained and/or witnessed whilst on assignment;
- Must on being charged with any criminal offence, notify Direct Medics Ltd. immediately;
- Must not misuse or abuse the Client’s property; and:
- Must report any patient safety incidents that could have or did harm a patient receiving care so they can be learnt from and allow for any necessary action to be taken by the Client to prevent similar incidents from occurring in the future. Incidents should be reported to a Client member of staff at the time and Direct Medics Ltd. as soon as reasonably practical.
You will receive from us a written confirmation for each assignment agreed with the company. The confirmation will include:
i. the location of your assignment;
ii. reporting instructions;
iii. any other relevant information provided to us by the Client within its Job Profile
Before commencing your assignment, you should review your confirmation and contact your Recruitment Consultant with any queries or concerns (the Company provides a 24-hour service).
Reliability and punctuality are of prime importance; for handover and induction purposes, try to arrive early for an assignment and report to the person as advised by our office. In the event that person is not available, report to the person in charge. If, in exceptional circumstances, you expect to be late for duty, you should inform us immediately so we can inform the Client.
You have an obligation to adhere to the Client’s policies and procedures including, but not limited, those relating to resuscitation, fire safety, medical devices, medicine safety, moving and handling, incident handling, infection control and health & safety.
The following induction list is designed to help you in familiarising yourself both with your working environment and with specific information relating to the unit:
- Confirm name of Nurse in Charge
- Check understanding of the role you are covering and any specific duties, responsibilities of the post
- Confirm hours of work, shift patterns, and breaks
- Check you have identified competencies required
- Do not use equipment or carry out any procedures you are not trained or competent to do so
- Check location of toilets/washroom facilities, staff room and catering facilities within the unit
- Confirm any ID badge, access codes etc. and identify the bleep arrangements and how to use the telephone systems
- Identify who you go to when you need your timesheet signed at the end of the shift
- Identify what documentation is in use and what the handover procedure is
- Equipment and location of crash trolley, oxygen and suction
- How to summon help
- Resuscitation procedure equipment checking
- Medical Emergency telephone number 6666- inform the operator of the nature of the emergency including ward/dept.
Fire Safety Procedures:
- Fire alarms and fire exits
- Fire equipment
- Location of break glass point
- Fire procedure including evacuation
- Overview of equipment likely to be used
- Equipment storage areas
- Medical devices skills assessment
- Faulty equipment procedures
Medicine Safety Procedure:
- Medicines- safe and secure handling and administration, including allergy checking procedures
- Standard operating procedures
- Medicines common to area
- Pharmacy and local policy
Moving and Handling Procedures:
- Lifting and Handling regulations
Incident Reporting Procedures:
- How to report an incident
- Completing the forms/online data
- Reporting arrangements
Infection Control Requirements:
- Hand Hygiene procedures
- Infection status of clinical setting
- Management of sharps injury
Health and Safety Procedures:
- Security (phone numbers)
- Waste and sharps disposal
- Violence and Aggression Policy
Identify how to access the following policies:
- Safeguarding Children
- Safeguarding Adults
- Data Protection/Caldicott Principles
- Racial Discrimination Policy
- Equal Opportunities Policy
Upon registration, you will be provided with an induction checklist card which you should take with you to your assignments and ask for relevant induction information if it is not provided.
Where the Client fails to provide such policies, it is acknowledged that Direct Medics is unable to ensure that you are aware of such policies and procedures however you still have an obligation to adhere to the Client’s policies and procedures.
Direct Medics Ltd. understands that comprehensive, up-to-date knowledge of clinical skills procedures is a fundamental aspect of nursing care. This includes the underlying theory and evidence for procedures related to every aspect of a person′s care, aimed at enabling nurses to deliver the highest level of clinically effective, patient–focused care. The company believes that, in maintaining practices that encourage agency staff to consistently update and maintain their knowledge in clinical nursing procedures, nurses thus gain the confidence they need to remain safe, informed and skilled practitioners.
Here is the list of the broad duties and responsibilities of a registered nurse.
- Observing and recording patients’ behavior;
- Coordinating with physicians and other healthcare professionals for creating and evaluating customized care plans;
- Provide emotional and psychological support to the patients and their families;
- Diagnosing the disease by analyzing patient’s symptoms and taking required actions for his/her recovery;
- Maintaining reports of patients’ medical histories, and monitoring changes in their condition;
- Carrying out the requisite treatments and medications;
- Checking the stock on a regular basis for maintaining the inventory level, and placing orders if required;
- Changing patient’s medication as indicated by their conditions and responses;
- Adhering with the protocols, norms, rules and regulations in order to maintain complete medical records;
- Maintaining hygienic and safe working environment in compliance with the healthcare procedures;
- Conducting research for improving the nursing practices and healthcare outcomes;
- Providing instant care during medical emergencies, like heart attacks and strokes;
- Discussing treatment with pharmacists and physicians in the critical cases;
- Providing necessary guidance on health maintenance and disease prevention;
- Keeping an eye on each and every aspect of patient care that includes physical activity plus proper diet;
- Preparing rooms, and decontaminating equipment and instruments;
- Preparing patients for examinations;
- Educating patients’ families about the disease and its treatment;
- Resolving patients’ problems and fulfilling their requirements by applying multifaceted team strategy;
- Interacting with the healthcare teams for maintaining harmonious relationships;
- Attending educational workshops for enhancing professional and technical knowledge;
- Recommending drugs and other forms of treatment, like inhalation therapy, physical therapy, etc.
Addressing knowledge of procedures concerned with the above headings form the basis of annual appraisals for agency staff. To assist staff both in terms of maintaining their knowledge and in preparing for appraisal, the Royal Marsden Hospital Manual of Clinical Nursing Procedures is recommended to all nurses. This Manuel contains the procedures and changes in practice that reflect modern acute nursing care its updated evidence underpins all procedures it is organised and structured to represent the needs of a patient along their care pathway. This is recommended particularly to those nurses returning to clinical practice following a period of absence, by way of enhancing their induction back into their nursing practice; Nurses must maintain the standards of competence throughout their career to remain on the register NMC 2015 this is measured through Revalidation.
Although the broad topics listed above do not tend to see much variation between organisations in terms of procedures undertaken, nurses must be aware that some hospitals or institutions may have their own local policies, assessment forms and clinical guidelines in place. Agency staff should be aware that some local variation could exist, however the company expects its client organisations to make agency staff aware of such practices.
Direct Medics Ltd. requests all relevant data from its clients in advance of booking and will provide all agency staff with information received.
Direct Medics Ltd. will provide all staff with two tunics for use during assignments. These tunics will be replaced by the company a maximum of once per year; any additional tunics will be provided at a cost of £14.00 per tunic. Staff are expected to supply their own trousers and shoes, which must be clean and suitable for purpose on arrival at each assignment. Long hair must be tied back, and no jewellery other than plain gold wedding rings may be worn, unless next to the skin and covered by the uniform.
All staff are provided with an agency identification badge upon registration, which must be displayed clearly at all times whilst on assignment. An induction checklist card will also be provided; this must also be stored within the lanyard supplied alongside the identification badge and used as a reference to the information required when entering a clinical setting for the first time.
Clinical Staff who wear a uniform should change into & out of uniform at the workplace. Anyone permitted by the client to wear a clinical uniform to and from work should have it covered completely when travelling. A clean uniform should be worn for each shift.
Staff must change as soon as possible if uniform or clothes become visibly soiled or contaminated with blood or body fluids.
When commencing an assignment with Direct Medics Ltd. you commit to upholding the standards of the Professional Registrations you hold, which is fundamental to being part of a healthcare profession. Your Professional Body can take action if you are found to have failed to uphold its principles, up to and including removal from the register.
We will support you in demonstrating your clinical competence, qualifications, training and skills by sourcing appropriate assignments for you. You are expected to familiarise yourself with, and adhere to, key policies within this Handbook and also all relevant policies, rules, procedures and standards of our Clients (including any racial discrimination and equal opportunities policies).
Further, you must observe the highest standards of hygiene, customer care, courtesy and consideration when working in a health service environment, and keep confidential information howsoever acquired, including but not limited to patient identity, clinical conditions and treatment.
English Language Competence:
In the course of your work with us, you must be able demonstrate competence in understanding and using both written and oral English. Upon registration, we may be required to ask for evidence of your competence via your original International English Language Test Skills (“IELTS”) or Occupational English Test (“OET”) certificate as appropriate (current IELTS and OET standards are available from your relevant Professional and Regulatory Body if appropriate).
Our requirements in respect of language competence shall mirror the latest position of the NHS European Office Guidelines.
Direct Medics Ltd. is committed to best practice in relation to the sharing of appropriate and relevant information about the conduct or performance of a healthcare worker, particularly where there is an identified risk to public and/or patient safety. If a risk to public or patient safety is identified during an assignment relating to your conduct, performance or language skills, our Clients are entitled to share such information with other healthcare organisations including Direct Medics Ltd. Any issue/risk to public or patient safety must be fully and satisfactorily resolved.
This policy has been designed to protect our staff and Clients from exposure to second-hand smoke. All enclosed premises are strictly smoke-free as are any semi-enclosed premises, semi-enclosed or enclosed premises leading to an entrance or any open structure located on the premises. The term ‘semi-enclosed’ in this context refers to any porch, veranda, balcony or stairwell that is located on work premises;
Any individual who wishes to smoke, whether on Direct Medics premises or on Clients premises, must first exit the premises and locate to the designated smoking area. Designated disposal points must be used for the disposal of waste while smoking, whether smoking related or otherwise.
Local and/or company disciplinary procedures will be followed if a member of staff does not comply with this policy. Those who do not comply with Parliamentary Acts in respect of smoking may also be liable to a fixed penalty fine and possible criminal prosecution.
Alcohol and Substances
This policy is based on the following aims:
- To maintain a safe and healthy environment for all service users and staff;
- To minimise drug and alcohol related injuries to persons or property;
- To comply with applicable laws and legislation;
The use of drugs and/or alcohol by members of staff is strictly prohibited at all times and under all circumstances.
The company recognises its duty as an employer to provide and monitor for employees, so far as is reasonably practicable, a working environment which is reasonably suitable for the performance of their contractual duties and this includes providing a drug and alcohol-free environment. However, the company makes a distinction between patterns of alcohol or drug misuse which point to addiction in staff, such as drinking or drug taking to excess continually, regularly or in intense episodes and, on the other hand, random instances of drug taking or excessive drinking which effect work.
The company regards alcohol and drug misuse of the first kind as first and foremost a health problem and its approach will be informed by this understanding. Other forms of drink and drug consumption that affect work will be treated as conduct or performance issues and dealt with according to the disciplinary procedure. This includes cases where employees attend work under the influence of drugs or alcohol. In all such circumstances, where a member of staff either attends work under the influence of drugs or alcohol or uses drugs or alcohol while at work:
- The member of staff will be sent home;
- The disciplinary procedure will be applied;
- The police will be informed (in the case of drug use)
iv. As far as is practicable, job security will be maintained for any member of staff participating in treatment and/or counselling in an attempt to deal with drug or alcohol abuse. Where a member of staff has to be away from work to undergo treatment, their job will be held in accordance with contractual sickness procedures. However, it must be accepted that, in the long-term, job security must depend upon work returning to an acceptable level;
- Drug or alcohol abuse will not in itself constitute grounds for dismissal, unless the staff member’s actions or performance reached an unacceptable level. Such cases will be dealt with under normal disciplinary procedures.
The Client may require you to declare before each occasion on which you are deployed in the provision of the Services that you are fit to practice at that time. You should not declare yourself to be fit to practice if you are suffering from any of the following conditions: vomiting, diarrhoea or a rash. You should inform the Client, and Direct Medics, if you become injured or diagnosed with any medical condition.
You MUST also let us know if you are pregnant, to allow us to carry out a risk assessment and make any reasonable adjustments that may be necessary to support you. If you are concerned that your assignment involves unnecessary risks to your health or fitness, or that of your unborn child, you should contact us immediately with your concerns.
The Client may request that you undergo a medical examination before any occasion on which you are involved in assignments. The Client shall instruct you of the circumstances and reasons for the medical examination. The Client shall be entitled to refuse to allow you to be involved in assignments unless the medical examination demonstrates that it is safe for you to work. The Client shall also be entitled to refuse to allow you to be involved in assignments if you decline to be examined.
Your Criminal Record:
Your registration with Direct Medics Ltd. is subject to an enhanced disclosure. In the event that you are charged or cautioned with any criminal offence, you must notify Direct Medics immediately. Any resulting criminal conviction would not necessarily bar you from being offered job roles through Direct Medics, however please note we are not permitted to book you for positions without an updated disclosure certificate.
Your Rest Breaks:
The European Working Time Directive (EWTD) sets out a maximum working week of 48 hours, calculated over a standard reference period of 17 weeks. Hours are normally averaged over this reference period by taking actual hours worked divided by the number of weeks (excluding rest days or absences due to annual, sickness or maternity/paternity leave).
You can opt out of the 48 hour weekly limit when you register with us by signing the appropriate declaration on our registration form. The decision to exercise the opt-out option is a voluntary one and in doing so, you are agreeing to monitor your own working hours and ensure you take appropriate rest. You can reverse this at any time by giving seven days’ notice in writing to Direct Medics Ltd.
Irrespective of whether you opt out of EWTD, in the interest of your own wellbeing we would encourage you to take appropriate rest breaks and days off work, and not to exceed the maximum average working week of 48 hours.
Your Professional Registration:
You must inform Direct Medics if you are under investigation by your professional body or if you are suspended from your professional register. You are required to participate in the investigation of any clinical complaints either during assignments or subsequently. If you fail to participate, Direct Medics may not deploy you to any other Client until such time that the matter has been fully and satisfactorily resolved.
Purpose of policy
This policy is intended to help candidates of Direct Medics Ltd. make appropriate decisions about the use of social media such as Twitter, Facebook, Google+ and LinkedIn. Other social media includes but is not exclusive to blogs, video, picture blogging and audio.
Who is covered by the policy
This policy covers all candidates working at all levels and grades, including senior managers, officers, directors, employees, consultants, contractors, trainees, homeworkers, part-time and fixed-term employees, casual and agency staff and volunteers.
Why use social media
Social media enables us to attract new clients, recruit for missions or events or to seek feedback on key services.
Personal use of social media
The following conditions must be met for personal use to continue:
- use must be minimal and take place substantially outside of normal working hours, for example, breaks, lunchtime
- use must not interfere with business or office commitments
- use must comply with our policies including the Equal Opportunities Policy, Data Protection Policy and Disciplinary Procedure
You are also personally responsible for what you communicate on social media sites outside the workplace, for example at home, in your own time, using your own equipment.
General rules for social media use
Whenever you are permitted to use social media in accordance with this policy, you must adhere to the following general rules. The same rules would also apply when using social media outside of work:
- Do not post or forward a link to any abusive, discriminatory, harassing, derogatory, defamatory or inappropriate content.
- A member of staff who feels that they have been harassed or bullied, or are offended by material posted by a colleague onto a social media website should inform the Human Resources Manager.
- Never disclose commercially sensitive, anti-competitive, private or confidential information. If you are unsure whether the information you wish to share falls within one of these categories, you should discuss this with the Marketing Co-ordinator.
- Do not post material in breach of copyright or other intellectual property rights.
- Be honest and open, but be mindful of the impact your contribution might make to people’s perceptions of the company.
- You are personally responsible for content you publish – be aware that it will be public for many years.
- When using social media for personal use, use a disclaimer, for example: ‘The views expressed are my own and don’t reflect the views of my employer’. Be aware though that even if you make it clear that your views on such topics do not represent those of the organisation, your comments could still damage our reputation.
- You should avoid social media communications that might be misconstrued in a way that could damage our business reputation, even indirectly.
- Do not post anything that your colleagues or our customers, clients, business partners, suppliers or vendors would find offensive, insulting, obscene and/or discriminatory.
- If you have disclosed your affiliation as an employee of our organisation you must ensure that your profile and any content you post are consistent with the professional image you present to client and colleagues.
Monitoring use of social media
Staff should be aware that any use of social media websites (whether or not accessed for work purposes) may be monitored and, where breaches of this policy are found, action may be taken under the company’s Disciplinary Procedure.
Misuse of social media websites can, in certain circumstances, constitute a criminal offence or otherwise give rise to legal liability against you and the company.
Where it is believed that an employee has failed to comply with this policy, they will face the company's disciplinary procedure. If the employee is found to have breached the policy, they will face a disciplinary penalty ranging from a verbal warning to dismissal.
The penalty applied will depend on factors such as the seriousness of the breach; the nature of the posting; the impact it has had on the organisation or the individual concerned; whether the comments cause problems given the employee’s role; whether the employer can be identified by the postings; other mitigating factors such as the employee's disciplinary record etc. Remember the same test of reasonableness applies when dismissing for improper use of social media as it would for any other misconduct dismissal.
Section 3: Working Polices
The Code contains the professional standards that registered nurses and midwives must uphold. UK nurses and midwives must act in line with the Code, which are not negotiable or discretionary.
In joining the NMC register, you commit to upholding these standards. This commitment to professional standards is fundamental to being part of a profession, and we hope to provide some guidance in the practical application of its principles in the following policies.
For reference, the overriding facets of the Code are as follows:
You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.
You assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay and to the best of your abilities, on the basis of the best evidence available and best practice. You communicate effectively, keeping clear and accurate records and sharing skills, knowledge and experience where appropriate. You reflect and act on any feedback you receive to improve your practice.
You make sure that patient and public safety is protected. You work within the limits of your competence, exercising your professional ‘duty of candour’ and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.
Promote professionalism and trust:
You uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other healthcare professionals and the public
Consent is defined as “permission for something to happen or agreement to do something” (Oxford English Dictionary). In relation to health care, it is a general legal and ethical principle that valid consent must be obtained before commencing an examination, starting treatment or physical investigation, or providing care.
This principle reflects the rights of a person to determine what happens to their own bodies or what shapes the care and support they receive. It is fundamental to good practice. The Nursing and Midwifery Council (NMC) professional practice document for nurses and midwives, The Code (NMC, 2015) states that registered nurses must:
(4.1) “balance the need to act in the best interests of all people at all times with the requirement to respect a person’s right to accept or refuse treatment”, and
(4.2) “make sure that you get properly informed consent and document it before carrying out any action”.
Registered nurses who do not respect this principle may be liable to both legal action by the person in their care and action by the NMC.
What is meant by “valid consent”?
For consent to be valid, it must be given voluntarily and freely, without pressure or undue influence, by an appropriately informed person who has the capacity to consent to the intervention in question. Some people may feel pressurised, by relatives or carers for example, to accept a particular investigation or treatment.
You should be aware of this, and of other situations in which people might be vulnerable, for example, those resident in a care home, or in prison. In these situations it is essential to ensure that the person has considered the available options and has voluntarily reached their own fully informed decision.
In emergency situations, the need to initiate immediate treatment may limit the quantity of information necessary for the patient to give an informed consent.
However, due care should be exercised to ensure that any legally binding wishes of the patient, expressed in advance of the emergency, are not overlooked. If the patient is well enough and has the sufficient capacity to understand the situation he/she has the right to refuse treatment, even if this decision may have a negative impact on health or wellbeing.
Such decisions should be recorded in the patient’s care plan and reflect the involvement of the patient in the decision-making process. If the patient is unconscious, or an emergency occurs when a patient is under general anesthetic, staff may act in his/her best interests without consent in order to protect life and future health.
On occasions, you may need to seek legal advice before initiating treatment or care, although this may not always be practicable in an emergency situation.
Children and young people
It is particularly important that registered nurses working with children and young people understand the laws around capacity, and child and parental consent, including giving and refusing consent for the implementation of any treatment or intervention.
In Northern Ireland the legal age of capacity is 18. However, under section 4 of the Age of Majority Act (Northern Ireland 1969) young people aged 16 -17 are entitled to provide consent for their own medical treatment in the same way as adults this provides a legal basis for a young person under the age of 16 years to consent on his or her own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending them, they are capable of understanding the nature and possible consequences of the procedure or treatment. These provisions need to be considered in conjunction with the rights of those with parental responsibility and human rights law.
In other circumstances, current case law is based on the view that persons aged under 16 years, may be competent to make decisions about their care and treatment when provided with sufficient information in a suitable format.
This is sometimes referred to as “Gillick” competence. This principle recognises the concept of emerging capacity in children and young people. Cognitive and emotional skills are acquired differentially throughout adolescent development. Whilst decision-making is primarily dependent on information retention and processing, emotional maturity is needed
Consent of people who are mentally incapacitated
Relevant mental health legislation and capacity legislation includes The Mental Capacity (Act 2005) Mental Health (Northern Ireland) Order 1986, Mental Capacity Act Northern Ireland (2016), make provision for the possibility of detention/deprivation of liberty and/or treatment for a mental disorder and its complications without the consent of the adult, or a young person aged under 18 years.
If an adult has been assessed as lacking the capacity to make a specific decision then there are formal legislative processes that allow for a decision about care, treatment or support to be made on their behalf.
These are commonly known as “best interests’ decisions”. Best interests are not confined to best medical interests. Most organisations will have established protocols based on legislative requirements and recognised good practice principles.
Professional accountability means being personally answerable to the law of the land for all actions or omissions (including what is written or is not written, what advice/ information/communication is given or is not given) while fulfilling a contract as a health and social care employee.
Registered nurses must act first and foremost to care for and safeguard those in their care. Registered nurses must display a personal commitment to the standards of practice and behaviors set out in the NMC Code. NMC states that registered nurses must “show professionalism and integrity and work within recognised professional, ethical and legal frameworks” (NMC, 2015).
Further detail and advice concerning Consent, including Forms of Consent; Information sharing and further examples as to how the “Gillick Principle” may be applied in cases involving children and young people can be accessed within the company’s Consent Policy.
Confidentiality is covered by Article 5 of the Code, which states, “As a nurse or midwife, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately. To achieve this, you must:
- respect a person’s right to privacy in all aspects of their care;
- make sure that people are informed about how and why information is used and shared by those who will be providing care;
- respect that a person’s right to privacy and confidentiality continues after they have died;
- share necessary information with other healthcare professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality, and
- share with people, their families and their carers, as far as the law allows, the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand.
A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that the information will be held in confidence. This duty of confidence is derived from:
- common law – the decisions of the Courts
- statute law which is passed by Parliament.
The common law of confidentiality reflects that people have a right to expect that information given to a nurse or midwife is only used for the purpose for which it was given and will not be disclosed without permission. This covers situations where information is disclosed directly to the nurse or midwife and also to information that the nurse or midwife obtains from others. One aspect of privacy is that individuals have the right to control access to their own personal health information.
It is not acceptable for nurses and midwives to:
- discuss matters related to the people in their care outside the clinical setting
- discuss a case with colleagues in public where they may be overheard
- leave records unattended where they may be read by unauthorised persons.
Record keeping is a professional requirement under the NMC Code (article 10). The code states that you must “Keep clear and accurate records relevant to your practice This includes but is not limited to patient records. It includes all records that are relevant to your scope of practice. To achieve this, you must:
10.1 complete all records at the time or as soon as possible after an event, recording if the notes are written some time after the event
10.2 identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need
10.3 complete all records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements
10.4 attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation
10.5 take all steps to make sure that all records are kept securely, and
10.6 collect, treat and store all data and research findings appropriately.
Principles of good record keeping:
- Handwriting should be legible.
- All entries to records should be signed. In the case of written records, the person’s name and job title should be printed alongside the first entry.
- In line with local policy, you should put the date and time on all records. This should be in real time and chronological order, and be as close to the actual time as possible.
- Your records should be accurate and recorded in such a way that the meaning is clear.
- Records should be factual and not include unnecessary abbreviations, jargon, meaningless phrases or irrelevant speculation.
- You should use your professional judgement to decide what is relevant and what should be recorded.
- You should record details of any assessments and reviews undertaken, and provide clear evidence of the arrangements you have made for future and ongoing care. This should also include details of information given about care and treatment.
- Records should identify any risks or problems that have arisen and show the action taken to deal with them.
- You have a duty to communicate fully and effectively with your colleagues, ensuring that they have all the information they need about the people in your care.
- You must not alter or destroy any records without being authorised to do so.
- In the unlikely event that you need to alter your own or another healthcare professional’s records, you must give your name and job title, and sign and date the original documentation. You should make sure that the alterations you make, and the original record, are clear and auditable.
- Where appropriate, the person in your care, or their carer, should be involved in the record keeping process.
- The language that you use should be easily understood by the people in your care.
- Records should be readable when photocopied or scanned.
- You should not use coded expressions of sarcasm or humorous abbreviations to describe the people in your care.
- You should not falsify records.
Failure to maintain records could potentially cause considerable difficulties in respect of any legal proceedings, e.g. an allegation of negligence. Information is essential to the delivery of high quality evidence-based health care on a day-to-day basis. Records are a valuable resource because of the information they contain. This information can facilitate clinical decision making, improved patient care through clear communication of the treatment rationale and progress, and facilitate a consistent approach to team working. However, a record is only of use if it is correctly recorded in the first place, regularly up-dated, and easily accessible when it is needed. Everyone working in healthcare that records, handles, stores, or otherwise comes across information, has a personal common law duty of confidence to comply with this.
All patient attendance, non-attendance, and refusal of treatment and advice must be noted. It is advisable to note when telephone contacts are made. It is imperative that the agency worker dealing with a particular patient on a specific day can be identified; this means the patient’s attendance is dated and signed either in the agency workers records or on a register, or both. All patient records should be kept confidential in line with the Date Protection Act 1998.
Care is provided in return for agreed fees. Under no circumstances should you seek any other money, gifts, favours, or rewards services rendered, either for yourself or for any third party.
It is not uncommon for a patient, their friend or relative to offer a voluntary gift as a mark of appreciation for care they have received. The Company believes that giving and receiving such gifts is not generally appropriate to the provision of professional care, however in the event that refusal is likely to cause serious offence to your patient, the gift may be accepted and disclosed to our Nursing Manager who will explain the Company policy to the patient.
Wherever possible, any offer of a gift should be politely refused with an explanation that acceptance would be against the Company policy.
The protection of adults at risk of harm is not an option but a responsibility across agencies. The expectation for all “at risk” adults in our communities is that they are empowered, through support from all the public services including social work services, police, health, housing and care organisations to be free from any preventable harm or exploitation. They are enabled to make their own choices about their lives and to live as independently as their personal circumstances may permit.
You must be alert to the possibility that you may become aware of adults requiring support and protection who are not patients e.g. relatives, friends, visitors etc. You must also recognise that the protection of adults at risk of harm is placed above all other operating principles and supersedes the principle of confidentiality in relation to disclosure to the relevant authorities. It is everyone’s responsibility to report concerns regarding any adult who is, or who appears to be, at risk of harm to relevant Agencies. If you are concerned that a vulnerable adult is at risk of exposure to criminal activity such as fraud then Police must be notified. However, in order to avoid confusion and to have clear lines of accountability, Direct Medics Ltd. staff should report concerns directly to the Line Manager on-site in the first instance.
Factors which may indicate harmful behaviour towards an adult at risk
These can include one or a combination of the following actions. The following indicators must, however, be used only as a guide.
Harm can be a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an adult. It can take the form of physical, sexual, emotional, psychological or domestic abuse, acts of neglect or omission, financial and material abuse and the withholding of information. The abuse can be multiple, involving some or all of the above.
Types of Harm
Physical Abuse - involving actual or attempted injury to an adult defined as at risk. For example:
- Physical assault by punching, pushing, slapping, tying down, giving food or medication forcibly, or denial of medication
- Use of medication other than as prescribed
- Inappropriate restraint.
Emotional/Psychological Abuse - resulting in mental distress to the adult at risk. For example:
- Excessive shouting, bullying, humiliation
- Manipulation of, or the prevention of access to, services that would be of benefit to the adult
- Isolation or sensory deprivation
- Denigration of culture, religion, gender, age or sexuality
Financial or Material Abuse - involving the exploitation of resources and property belonging to the adult at risk. For example:
- Theft or fraud
- Misuse of money, property or resources without the informed consent of the adult at risk.
Sexual Abuse - involving activity of a sexual nature where the adult at risk cannot or does not give consent. For example:
- Acts of gross indecency
- Inappropriate touching or verbal or physical sexual harassment.
Neglect - and acts of omission by others charged with the care of the adult, including ignoring medical or physical care needs. For example:
- Failure to provide access to appropriate health, social care or educational services
- Withholding of the necessities of life such as nutrition, appropriate heating, etc.
Exploitation - the deliberate targeting of vulnerable adults for personal benefit.
Discriminatory abuse - for example, treating one person less favourably than another.
Information abuse - deliberately giving erroneous information or withholding information.
Human rights abuse - for example deprivation of a right to family life or to a fair hearing.
Multiple Forms of Abuse - This may occur in an ongoing relationship or service setting or to more than one person at a time. It is important therefore to look not only at a single incident, but to also consider the underlying dynamics and patterns of harm
Random Violence - An attack by a stranger on an adult defined as at risk is an assault; this is a criminal matter and should be reported to the Police. However, where there is the possibility that the violence may be part of a pattern of victimisation in a community or neighbourhood, local authority Adult Protection procedures may also apply in respect of effective multi-agency intervention.
Domestic Violence - any form of physical, non-physical or sexual abuse which takes place within the context of a close relationship committed either in the home or elsewhere. In most cases this relationship will be between partners (married, cohabitating or otherwise) or ex-partners. The similarity between the above acts of harm in relation to adult protection is recognised. However, the key factor in relation to activating adult protection procedures in such situations is that the victim (or suspected victim) must be an adult at risk of harm.
Responsibilities of Direct Medics Ltd. Staff
Any report that an adult may be at risk of harm, including anonymous referrals, should be taken seriously. All cases should be considered with an open mind. In all instances, the information given must be reported immediately to your Line Manager on-site.
In the event that you become aware that an adult may be at risk of harm or you are told directly by a person that they are being/have been abused, you should be aware that the adult may be feeling vulnerable or upset when disclosing this information. You should be supportive and reassure the adult by listening carefully, but do not ask unnecessary questions. It is not your role to investigate. You should take steps to ensure the safety of the vulnerable adult involved.
You should advise the adult that the information will have to be passed on to your Line Manager on-site and that Social Work Services may be required to investigate further. When you feel it is appropriate to leave the person who is disclosing the abuse, the information given by the person should be passed on immediately to your Line Manager on-site.
Where you are concerned for the immediate safety and well-being of a person, contact emergency services i.e. ambulance and Police immediately. Do not delay. You can contact your Line Manager on-site once you are satisfied that the person is safe.
If you are unhappy with the response from your Line Manager on-site, you should contact Social Services directly at the appropriate office and outline your concerns and the basis for them
NOTE: You should follow the above procedure for all instances of suspected abuse, for example where you become aware of
- Abuse by another person
- Abuse by someone from within the community (family or friend)
- Abuse by a member of staff
Write down the nature of your concern and anything the person may have told you using, as far as possible, the words used by the person. Remember to sign and date the notes taken by both staff member and vulnerable adult (if appropriate). This information will form the basis of the referral, and will also be required if there is an investigation. As much information as possible should be recorded, please record the facts only and no opinions or assumptions should be included.
Any physical evidence should be preserved if possible.
Allegations involving other site staff
If you have observed other staff acting in a way that has caused you to be concerned you should contact the Line Manager on-site outlining your concerns and the basis for them. They will take your concerns seriously, make appropriate enquires into them and thereafter decide on the appropriate course of action.
If your concerns are about your Line Manager on-site, then you should inform their manager, or contact Social Services directly to pass on your concerns and seek further advice.
In situations where the alleged abuser is a member of staff, Direct Medics Ltd. Disciplinary Procedures should be followed, but will not supersede an adult protection referral or investigation by statutory agencies. In other words, care must be taken to ensure that implementation of any internal procedures (for example, fact finding) does not undermine or impede any investigation externally by statutory agencies. Direct Medics Ltd.’s Whistleblowing policy is available as required and can be found in your policy handbook.
Frequent Complaints without Foundation
A situation where a person makes frequent complaints alleging abuse, which after full investigation are found to be vexatious, cannot be ignored. In such cases it is good practice to always follow the above reporting procedures. The allegation must be reported to their care manager and the pattern of allegations must be reviewed regularly in case abuse is taking place.
Comprehensive information and advice in respect of Child Protection can be found in the company’s Child Protection Policy and Procedure. This includes reporting procedures and should be read in conjunction with the relevant local Inter Agency Adult Protection Procedures (these can be sourced from the relevant local authority and should be available at your service).
What is child abuse?
Child abuse is broadly defined as, “Abuse and neglect are forms of maltreatment of a child. Somebody may abuse or neglect a child by inflicting, or by failing to act to prevent, significant harm to the child. Children may be abused in a family or in an institutional setting, by those known to them or, more rarely, by a stranger. Assessments will need to consider whether abuse has occurred or is likely to occur.”
The National Child Protection Guidance 2014 gives additional information on dealing with specific concerns that may impact adversely on children and young people. The guidance makes reference to areas of risk such as
- Child Sexual Exploitation
- Child Trafficking
- Non Engaging Families
- Children and Young People Placing Themselves At Risk
- Children and Young People Affected By Domestic Abuse
The following definitions show some of the ways in which abuse may be experienced by a child but are not exhaustive, as the individual circumstances of abuse will vary from child to child. Different types of abuse may overlap or co-exist. The following definitions are all taken from National Guidance for Child Protection in Scotland 2014.
Physical Abuse - Physical abuse is the causing of physical harm to a child or young person. Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning or suffocating. Physical harm may also be caused when a parent or carer feigns the symptoms of, or deliberately causes, ill health to a child they are looking after.
Neglect - Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. It may involve a parent or carer failing to provide adequate food, shelter and clothing, to protect a child from physical harm or danger, or to ensure access to appropriate medical care or treatment. It may also include neglect of, or failure to respond to, a child’s basic emotional needs. Neglect may also result in the child being diagnosed as suffering from “non-organic failure to thrive‟, where they have significantly failed to reach normal weight and growth or development milestones and where physical and genetic reasons have been medically eliminated. In its extreme form children can be at serious risk from the effects of malnutrition, lack of nurturing and stimulation. This can lead to serious long-term effects such as greater susceptibility to serious childhood illnesses and reduction in potential stature. With young children in particular, the consequences may be life-threatening within a relatively short period of time
Emotional Abuse - Emotional abuse is persistent emotional neglect or ill treatment that has severe and persistent adverse effects on a child’s emotional development. It may involve conveying to a child that they are worthless or unloved, inadequate or valued only insofar as they meet the needs of another person. It may involve the imposition of age- or developmentally-inappropriate expectations on a child. It may involve causing children to feel frightened or in danger, or exploiting or corrupting children. Some level of emotional abuse is present in all types of ill treatment of a child; it can also occur independently of other forms of abuse.
Sexual Abuse - Sexual abuse is any act that involves the child in any activity for the sexual gratification of another person, whether or not it is claimed that the child either consented or assented. Sexual abuse involves forcing or enticing a child to take part in sexual activities, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative or non-penetrative acts. They may include noncontact activities, such as involving children in looking at, or in the production of, pornographic material or in watching sexual activities, using sexual language towards a child or encouraging children to behave in sexually inappropriate ways.
Significant Harm - Significant harm can result from a specific incident, a series of incidents or an accumulation of concerns over a period of time. It is essential that when considering the presence or likelihood of significant harm that the impact (or potential impact) on the child takes priority and not simply the alleged abusive behaviour To understand and identify significant harm, it is necessary to consider:
- the nature of harm, either through an act of commission or omission;
- the impact on the child’s health and development, taking into account their age and stage of development;
- the child’s development within the context of their family and wider environment;
- the context in which a harmful incident or behaviour occurred;
- any particular needs, such as a medical condition, communication impairment or disability, that may affect the child’s development, make them more vulnerable to harm or influence the level and type of care provided by the family;
- the capacity of parents or carers to meet adequately the child’s needs; and
- the wider and environmental family context
What to do if you think a child or young person is at risk of abuse
- Be supportive to the child or young person. Listen with care, but do not ask any unnecessary questions. Take what the child or young person is saying seriously, and advise them you will have to pass the information on;
- Immediately report the grounds of your concern to the named person responsible for child protection within the Client organisation (if you are unsure as to who the appropriate person is, seek advice from Direct Medics Ltd.). The contact details for the named person responsible for child protection for the Client organisation (or, where appropriate for each section of the organisation) should be made available to you at induction stage, and is normally displayed within the Ward or unit. The named person will take steps to pass the information on to the relevant organisation(s) who will investigate the concerns. Do not delay in reporting your concerns. Where possible, advise the named person in the Client organisation on the same day the concern arises; and
- Write down the nature of your concern and anything the child or young person may have told you using, so far as possible, the words used by the child or young person. Remember to sign and date the notes taken;
- If you are unhappy with the response from the named person, you should contact the local Social Services Office and outline your concerns and the basis for them. When the local office is closed, the Emergency Social Work Service should be alerted. All telephone calls should be followed up in writing within 48 hours. If you are unhappy with the response from Social Work Services, you can contact Police Scotland or the Reporter to the Children’s Panel and outline your concerns to them.
If a child or young person may be at risk of harm, this will always override a professional or organisational requirement to keep information confidential. Those employed or involved with Direct Medics Ltd. have a responsibility to act to make sure that a child whose safety or welfare may be at risk is protected from harm. Children, young people and their parents will always be told this.
What to do in an emergency
If you are concerned about the immediate safety of a child, for example a child at risk of immediate harm or injury, contact Emergency Services immediately. Do not delay, as this could result in serious injury to a child.
Further guidance on Child Protection can be found in “Safeguarding Children and Young People: Roles & Competencies for Health Care Staff” - Royal College of Paediatrics and Child Health, April 2006.
The term ‘whistleblowing’ refers to the informing of management by staff, with the good of service users in mind, of any malpractice or mistakes or of causes for concern to do with other staff. Direct Medics Ltd. recognises its responsibility to identify such situations and to take the appropriate remedial actions. The company relies upon a culture of openness within the organisation to encourage the prevention of malpractice.
You are encouraged to raise any genuine concerns about any malpractice, suspected crime, breach of legal obligations, miscarriage of justice, danger to health and safety or the environment, financial malpractice, fraud, corruption and breach of any other statutory regulations, or any cover-up of these, that they may come across, which affects the agency, its service users or other staff.
The company’s Whistleblowing Policy details fully the types of disclosure and expected outcomes when the policy is invoked. It is designed to give you opportunity and protection and is intended to remove any concern over the possibility of victimisation. In brief:
- You should not hesitate to blow the whistle on suspected or actual malpractice;
- You have statutory protection in line with the Public Interest Disclosure Act 1998, provided that concerns are raised in the correct way and they are acting in good faith;
- The fear of being mistaken should not prevent you from raising concerns, provided you are acting in good faith, and have a reasonably held suspicion;
- If you have a reasonably held suspicion, and raise concerns in the correct way and are acting in good faith you will be protected from reprisal or victimisation and you will not be risking your job security.
In 2006 the Fraud Act came into effect, which recognises Fraud as a criminal offence. A person is guilty of fraud if they are in breach of the following:
- Fraud by false representation
- Fraud by failing to disclose information
- Fraud by abuse of position
Types of Fraud typically found within the NHS:
Payroll Fraud - payments made to fictitious employees or fraudulent manipulation of payment; false or inflated travel, expense claims, overtime or unsocial hours claims, timesheet fraud claiming for hours that have not been worked or putting in duplicate timesheets.
Requisition and Ordering Fraud - accepting inducements from suppliers; ordering goods and services for personal use and collusion with suppliers to falsify deliveries or order supplies not needed.
Overseas Patients Fraud - People not resident in the UK who come to the NHS for treatment must pay for their treatment before they leave the UK.
What to Do?
If you suspect fraud, the following are some simple guidelines to help you in what you should do.
DO make an immediate note of your concerns
DO report your suspicions confidentially to someone with the appropriate authority and experience
DO deal with the matter promptly if you feel your concerns are warranted
DON’T do nothing
DON’T be afraid to raise your concerns
DON’T approach or accuse individuals directly
DON’T try to investigate the matter yourself
DON’T convey your suspicions to anyone other than those with the proper authority
Section 4: Health & Safety
Health & Safety law in general is aimed at employers, as it is they who are most able to influence whether a place of work is safe. However when on assignment with us you also have a general duty to ensure that your work activities do not endanger yourself or others. This duty applies irrespective of where you are undertaking work.
Section 7 Health and Safety at Work Act 1974 places a legal duty on all employees: “to take reasonable care for the health and safety of themselves and of other persons who may be affected by their acts or omissions at work”.
Section 8 Health & Safety at Work Act 1974 States that:“no person shall intentionally or recklessly interfere with or misuse any item provided in the interest of Health, safety and welfare”.
Equally, the Client establishment has a general duty to ensure that the work environment is itself free from any dangers to health or safety. It is imperative that you familiarise yourself with the policies and procedures of the establishment within which you are working on arrival, particularly those relating to fire and other emergencies. So far as is reasonably practicable, the company will ensure that persons are not exposed to risks to their health and safety. The Company will notify you of any specific hazards relating to your place of work, which have been notified to us by the client.
The Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations (Northern Ireland) 1997 is the law that requires employers, and other people in control of work premises, to report and keep records of:
- work-related accidents which cause death;
- work-related accidents which cause certain serious injuries (reportable injuries);
- diagnosed cases of certain industrial diseases; and
- certain ‘dangerous occurrences’ (incidents with the potential to cause harm).
Serious accidents, building incidents and certain work related diseases must be reported to the regional Health and Safety Executive. This includes serious injury, over 3 day injuries, specified work related illnesses and serious building related problems.
The HSE defines the term ‘accident’ as “An undesired circumstance(s) which gives rise to ill health, injury, damage, production losses or increased liabilities." The company takes its responsibilities in relation to the health and safety of its staff seriously and as such will see to it that all reasonable steps are taken to avoid accidents. In turn, you are expected to behave in a manner which minimises the potential for accidents to take place, as far as is practicable. This applies both whilst on company premises and on assignment.
Any injury - including minor injuries – resulting from an accident whilst on assignment should be recorded both in the 'accident book' at the employing client and in the Agency’s ‘accident book’. This is mainly for your benefit, as it provides a useful record of what happened in case you need time off work or need to claim compensation later on. Recording accidents also helps the Agency and employing client to see what's going wrong and take action to stop accidents in future.
An incident is broadly defined as, “Any event or circumstances that could have or did lead to harm, loss or damage to people, property, environment or reputation”. The following occurrences would typically be regarded as ‘incidents’:
- Security Incident: Patient or Service user absence; theft of Client property and/or staff personal property; malicious damage; removal of non-prescribed substances and alcohol; removal of offensive weapons; restraint and any other issue which poses a threat to services users, staff or visitors;
- Fire Incident: any incident no matter how small, involving fire or fire warning systems (including false alarms);
- Vehicle Incident: any incident involving a vehicle e.g. Road traffic accident, excluding vandalism or theft which would be classified as a security incident;
- Violence, Abuse or Harassment Incident: any incident involving verbal abuse, unsociable behaviour, racial or sexual harassment or physical assault, whether or not injury results;
- Personal Accident or Injury Incident: any accident, no matter how small, which did or could have adversely affected any person;
- Ill health incident: any case of known or suspected work or environment related ill health;
- Clinical Incident: any incident, except medication error, directly related to patient treatment or care which did or could have resulted in adverse outcome (e.g. Treatment, medical equipment failure etc);
- Medication Incident: any medication incident which did or may have caused actual or potential harm to patient(s):
- Environmental Incident: Environmental incidents are those which have resulted in damage or danger to the natural environment. This may include damage to water courses or land or emissions to the air as a result of accidental pollution e.g. spillage, leakage or uncontrolled discharge of substances, emission to air of gas, dust, fumes or other pollutants, escape or improper storage or disposal of waste, etc.
Learning from incidents is a vital part of maintaining the safety of patients, staff and visitors in order that the Agency ensures safe standards of care are maintained. You are reminded also to check the corresponding policy at the client organisation to ensure that any additional requirements at the location of the assignment are adhered to. All incidents must be reported to Direct Medics Ltd. and the Agency will record all notifications and any further information or advice received from Clients or Regulatory Bodies in respect of such incidents.
The Health and Safety Executive (HSE) defines violence at work as “any incident in which an employee is abused, threatened or assaulted in circumstances relating to their work.” This covers the serious or persistent use of verbal abuse – which the HSE says can add to stress or anxiety, thereby damaging an employee’s health. It also covers staff who are assaulted or abused outside their place of work – for example, while going home, while working in the community or while travelling as long as the incident relates to their work.
The definition of physical assault used in the 2003 directions to the NHS from the secretary of state was “the intentional application of force against the person of another without lawful justification, resulting in physical injury or personal discomfort.” The HSE highlights some risk factors for violent behaviour to include impatience, frustration, anxiety, resentment and drink, drugs and inherent aggression/mental health problems.
Reducing the risk of violence
For all of our nurses, training on handling violence and aggression is mandatory. When on assignment, you should check the local protocols on recording incidents of physical assault or verbal abuse so that patterns can be discerned.
Addressing some of the factors which prompt individuals to commit abusive or violent behaviour can also help, such as looking at the way patients are given information on waiting times and what will happen to them to increase patient confidence in their care.
Treating violent and abusive patients
Whilst it would be unethical to deny care altogether – and many healthcare professionals would feel duty bound to care for violent and abusive patients, at least in an emergency - The Government’s 2001 health service circular, Withholding treatment from violent and abusive patients in NHS trusts, makes it clear that treatment can be withheld immediately in exceptional circumstances. Normally patients would be warned and each trust has its own policy. The National Institute for Clinical Excellence also has guidelines for the short-term management of violent or disturbed behaviour.
Direct Medics Ltd. operates in the belief that all agency staff should be able to attend their assignments without fear of humiliation, intimidation, sexual or racial harassment, oppression or any form of bullying. It is the responsibility of management both at the agency and its client organisations to ensure that agency staff can work in a caring and protective atmosphere.
To achieve this, the company will do the following:
- Ensure that there is a procedure to follow if there is an incident of bullying;
- Ensure that victims are given the required support in order to prevent a recurrence of the behaviour;
- Inform relevant staff of the action being taken, why it is being taken and what they can do to reinforce and support that action;
- Ensure the incident is handled sensitively at all times;
- Assist the bullied person to record the event, in writing, with dates if appropriate;
- Ensure that the alleged bully has the opportunity to record their version of events;
- Encourage all agency staff to be aware of the danger signs of abuse and bullying amongst their colleagues and pass on any worries they may have about a colleague.
Agency staff should always:
- Watch for signs of distress in their colleagues;
- Pass concerns to Direct Medics Ltd to allow the incident to be recorded
All instances of alleged harassment or bullying are investigated and if necessary, are dealt with under the company’s disciplinary procedure.
Infection control is the name given to a wide range of policies, procedures and techniques intended to prevent the spread of infectious diseases. Two core principles underpin effective infection prevention and control, namely:
- Infection prevention and control is an integral part of safe healthcare. It is not an add-on: it is as much a part of healthcare as arranging diagnostic tests, prescribing drugs or dressing a wound; and
- Infection prevention and control is everyone’s business. It is not just a matter for doctors, nurses, cleaners and managers, but for everyone involved in the planning and delivery of healthcare. Visitors to hospitals and patients themselves have their part to play in keeping infections at bay.
The work of our healthcare staff involves the risk of exposure to communicable diseases. General principles of infection control include effective handwashing:
- Use liquid soap and water or an alcohol-based hand rub when washing hands – make sure it comes into contact with all areas
- Remove nail varnish, wrist and hand jewellery at the beginning of each shift where you will be regularly decontaminating your hands. A plain wedding band may be worn
- Wear disposable gloves and aprons when attending to dressings or dealing with blood and body fluids (sterile gloves should only be worn when performing aseptic techniques)
- Dispose of gloves and aprons after use ensuring you use the correct clinical waste bins
- Cover cuts or breaks in your skin or those of patients / clients with waterproof dressings
Regional Infection Control manuals set out in detail both the basic principles of infection prevention and control, and protocols to follow in specific circumstances. All healthcare staff are expected to be conversant with the content of the manual and apply its principles throughout the course of their work. Regional Infection Control information can be sourced here:
Application to the agency register for staff requires the declaration of any communicable diseases. Good practice requires that staff also disclose any subsequent contraction of, or exposure to, such disease using the company’s occupational health review form. Having an infectious disease will not be grounds for refusal or termination of assignments, but may make agency staff temporarily unsuitable for certain assignments through the Company or restrict the types of work to which they may be assigned, both in their own interest and that of clients/patients.
It is the responsibility of agency staff to take adequate precautions to protect themselves from communicable diseases. If unsure of the appropriate steps to be taken, agency staff should discuss the assignment with the immediate Line Manager at the assignment location. All information regarding a Client’s condition or circumstances will be treated as confidential.
To avoid risks of cross infection, it is essential that all incidents that may result in the spreading of a disease be reported. Incidents in a hospital, nursing home, or other institutional setting should be reported in accordance with the policies of that institution.
All incidents should also be reported to the Agency for further advice on any appropriate further action.
Direct Medics Ltd. request that its healthcare staff should:
- At all times, observe high standards of hygiene to protect themselves and their service users from the unnecessary spread of infection;
- Adhere to our Uniform Policy and use appropriate Personal Protective Equipment in line with the role and local procedures; and
- Attend training on infection control when requested by the agency.
Direct Medics Ltd. recognises its responsibility to ensure that all reasonable precautions are taken to provide and maintain working conditions which are safe, healthy and compliant with all statutory requirements and codes of practice.
Direct Medics Ltd. recognises moving and handling as the transporting and supporting of loads by hand or by bodily force without mechanical help. This includes activities such as lifting, carrying, shoving, pushing, pulling, sliding or nudging heavy objects. In particular, it covers the lifting or moving of service users by staff.
Direct Medics Ltd. is committed to ensuring the health, safety and welfare of its staff, as far as is reasonably practicable, and of all other persons who may be affected by our activities including service users, their visitors and contractors. As all of these moving and handling activities carry a risk of injury if they are not performed carefully, it is a pre-requisite to registration with Direct Medics Ltd. that all nursing staff are fully trained in moving and handling and attend update training as required.
Staff are required to comply with the risk assessment requirements set out in the Management of Health and Safety at Work Regulations 1999 as well as the requirement in the Manual Handling Operations Regulations 1992 (as amended) (MHOR) to carry out a risk assessment on manual handling tasks.
In addition, employees have duties to take reasonable care of their own health and safety and that of others who may be affected by their actions. They must communicate with their employers so that they too are able to meet their health and safety duties.
Employees have general health and safety duties to:
- follow appropriate systems of work laid down for their safety
- make proper use of equipment provided for their safety
- co-operate with their employer on health and safety matters
- inform the employer if they identify hazardous handling activities
- take care to ensure that their activities do not put others at risk
In addition, no person shall intentionally or recklessly interfere with or misuse anything provided in the interests of health, safety and welfare in pursuance of any statutory provisions.
The client organisation's duty is to avoid Manual Handling as far as reasonably practicable if there is a possibility of injury. If this cannot be done then they must reduce the risk of injury as far as reasonably practicable. If agency worker is complaining of discomfort, any changes to work to avoid or reduce manual handling must be monitored to check they are having a positive effect. However, if they are not working satisfactorily, alternatives must be considered.
The regulations set out a hierarchy of measures to reduce the risks of manual handling. These are as follows:
- avoid hazardous manual handling operations so far as reasonably practicable;
- assess any hazardous manual handling operations that cannot be avoided;
- reduce the risk of injury so far as reasonably practicable.
Risk assessment for manual handling by staff:
- Staff should consider each task for risk of injury;
- If a risk is identified, staff should next consider whether there is a way to eliminate the need for moving manually altogether. For instance, can equipment be used instead?
- If the moving and handling task cannot be eliminated altogether, the specific risks involved must next be assessed. This is done in a similar way to any other health and safety risk assessment but the assessment does not need to be recorded provided it is easy to repeat;
- here a specific risk to injury is identified and moving and handling is unavoidable, then measures to reduce the risk must be introduced; e.g. the use of mechanical aids, changing the task to minimise the risk or altering the work environment to make moving and handling less awkward;
- Any measures taken to ensure moving and handling safety must be in proportion to the risk and cost-benefit involved.
Staff injured at work
Moving and handling accidents are covered by RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurances Regulations 1995). According to RIDDOR all moving and handling accidents and injuries should be recorded and also reported especially if they result in staff being absent from work for three days or more or involve faulty equipment.
All staff injured at work will receive appropriate support any staff injured as a result of moving and handling should see their GP as soon as possible.
The successful implementation of this policy requires total commitment from all staff. Each individual has a legal obligation to take reasonable care of their own health and safety, and of the safety of other people who may be affected by their own acts or omissions.