Measles and Management of Staff
There is some confusion as to what practices need to do for staff with regard to the recent measles outbreak. Practices should review the immunisation status of staff as appropriate, particularly those whose work involved face to face contact with patients. This means you should check staff have 2 recorded doses of MMR or recorded confirmed exposure (pre 1970 age group). If not then you may consider testing immunity of staff or recommending MMR if appropriate though there is no obligation to do either unless a confirmed case has been recorded within your practice/patients. If specific action is required by your practice the HPA will usually contact you (usually following a confirmed case within your locality or practice). Immunity testing falls under occupational health obligations and, as such, the cost sits with the practice. If your staff have been exposed to measles (you have had confirmed cases within your practice/patients), you should follow this guidance on the management of healthcare workers. If you are still unsure of the action you need to take please contact Janice Foster 01642 745 813 or Julia Waller (HPA) on 0844 2253550.

Chest Pain Patients Checklist
We have been working with NEAS with regard to 12 lead ECG recording and vital signs on chest pain patients referred to the 999 ambulance service and have agreed this checklist as good practice for all practices. NEAS understand the concerns primary care clinicians will have when they come across patients at the surgery who have a history of chest pain and need prompt hospital assessment/subsequent management. As treatment for MI is time critical, it is standard practice for the surgery staff to request a 999 ambulance. While awaiting the ambulance, a patient with an infarct/severe ischaemia is at risk of abrupt deterioration due to ventricular arrhythmias. For this reason they should be observed in a suitable clinical area until the paramedics arrive. Aspirin should be given as soon as possible, in doing so, and whilst waiting for the ambulance to arrive, the vital signs should be measured and the ECG should be recorded, where possible.

Copies of Medical Records Fees
To further clarify advice we have previously given and questions we are receiving; the following fees apply to copies of medical records. This guidance applies to the fees only and does not cover consent. If you have specific questions on consent or what information should be included please contact Janice Foster – 01642 745 813.

Deceased Patient:
Request should be made under Access to Health Records Act (AHRA)

Fees:
For access only = £10 max
For copies = £10 + cost of copying and postage
For access or copies of records pre Nov 1991 = practice to set charge (possibly in line with collaborative arrangement fee if it is considered appropriate to disclose this information at all as there is no right of access)
To provide advice to the PCT = practice to set charge (possibly in line with collaborative arrangement fee where the PCT holds the records and, therefore, responsibility as the statutory provider and copier of the data)

Living Patient:
Request should be made under Data Protection Act (DPA)

Fee:
For electronic records (including access and/or copies) = £10 max including postage (very few, if any practices have ALL electronic records so check if you are unsure)
For paper or part paper (including access and/or copies) = £50 max including postage

We appreciate the agreed fees under the DPA rarely cover the cost of postage etc as they were set such a long time ago. You can raise this with the person making the request and ask that they cover the reasonable charges (e.g. additional postage) involved as the guidance does state that the charges should be proportionate and justifiable and reflect the actual costs incurred. However, should the requestor decline, unfortunately, you are still obliged to provide the information at the agreed fee.