The Village Surgery has decided for patient safety reasons they will not issue prescriptions for sedating medications (such as diazepam) prior to dental procedures. Dentists may of course contact a GP for information or advice, if, for example the patient has a complex medical history.

However, we ask that dentists do not direct patients to the practice requesting they prescribe sedating medications, such as diazepam. 

If a dentist wishes to prescribe these medications for anxious patients, the dentist should be responsible for issuing the prescription. The dental practitioner’s formulary, which is the list of drugs a dentist can prescribe is found on the BNF dental practitioners formulary, includes Diazepam Tablets and Oral Solution. 

If the dentist is treating a patient within their practice NHS contract, then the prescription should be on a FP14D form.

If the dentist is treating a patient privately, they should issue a private prescription.   Dentists can access a patient’s summary care record via the DERs/Rego electronic referral system for NHS England Southeast dental referrals. 

THE VILLAGE SURGERY

TOTAL TRIAGE

A NEW APPOINTMENT SYSTEM FOR BOOKING A GP APPOINTMENT 

On 4^th March 2025,  The Village Surgery will be moving to a new improved way of access for patients called TOTAL TRIAGE. The partners have not taken this step lightly and have done considerable research working with other local practices who are already using this mode of access successfully to ensure that the new system will work well for our patients. Total Triage has been designed to facilitate equity of access to care.

All patients requesting an appointment or who have a query for their GP, will be asked to complete the ‘contact us’ online form on our website homepage www.thevillagesurgeries.co.uk.  

Many of our patients are already familiar with this form of access and for them it will not be a significant change. If you are one of these patients, what you will notice, is that changing to total triage should result in increased accessibility to the online form during the practice opening hours.

However, we do understand that there are some patients who for whatever reason do not have or find internet access challenging. We know that for this group, the only way you may have been able to access the surgery is through our reception team by phone or by visiting the surgery. For this group of patients we know that this will be a significant change and understand that you may feel anxious at the prospect. Please be rest assured that we have not forgotten you and want to reassure you that for those patients who need help with access, our reception team will be very willing to assist you by filling out the online form on your behalf. You can still contact them just as you have done in the past by phone or by visiting the surgery.

All online requests submitted however they come in will be directed to a central inbox which will be manned by the triage team and assessed by a GP. The clinician rather than a member of our administrative team will be the one to decide from the information you have given them on the form, the best way to assist you.

Data from other practices both national and local has shown that adopting this system avoids the 8am rush for appointments and results in increased patient satisfaction and better outcomes for patients. Our aim is for you to have your request assessed by someone with clinical expertise such as a GP to ensure that if you need advice or an appointment you are getting the right appointment or advice from the right person at the right time.

Please note that at present this change will not affect requests for home visits or nurse appointments which will continue to be dealt with by our reception team as before.

Kind regards

The Partners of The Village Surgery

Please see the resources below which you may find helpful

FAQs for patients https://support.accurx.com/en/articles/8608032-patient-support-a-better-way-to-contact-your-gp

How to complete the online form https://drive.google.com/file/d/139SOngCDrI-t0iy6wAuORLSKQB6SV4Gz/view

Afte careful consideration, The Village Surgery have decided to no longer prescribe diazepam for patients having MRI scans or other investigative procedures. This is not a decision we took lightly; we have a duty of care to provide safe, consistent, and appropriate care for our patients. We hope the reasons outlined below help to explain our main concerns.

Small doses of benzodiazepines such at 2mg diazepam are probably sub- therapeutic for most adults for any effective sedation. Conversely anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.

A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the anxiolytic being sub optimal.

GPs are not regularly involved, skilled, trained, or appraised in sedation skills.
All Hospital consultants, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs. If a patient needs a certain medication to enable an investigation to go ahead, they are just as well positioned to provide a prescription, either through the hospital pharmacy or a hospital FP10.

Sedated patients should be regularly monitored, and we have been made aware of a case where a GP provided sedative was given, the patient not monitored, and subsequently had a respiratory arrest in an MRI machine.
References:
https://www.rcr.ac.uk/publication/sedation-analgesia-and-anaesthesia-radiology-department-second-edition“Safe and effective analgesia and sedation should be delivered by an appropriately trained and credentialed team with good access to anaesthetics, pre-procedure assessment, sedation plan and checklist, with appropriate monitoring and availability of resuscitation equipment and reversal agents”

Sedative Prescribing for Fear of Flying

The Village Surgery does NOT prescribe sedatives for fear of flying. This policy decision has been made by the GP Partners and is adhered to by all prescribers working in the practice. The reasons for this can be found below:

1) Diazepam is a sedative, which means it makes you sleepy and more relaxed. If there is an emergency during the flight it may impair your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences for you and those around you.

2) Sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at increased risk of developing a blood clot (DVT) in the leg or even the lung. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than four hours.

3) Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and in aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.

4) According to the prescribing guidelines doctors follow (BNF) Benzodiazepines are contraindicated (not allowed)  in phobia. Your doctor is taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight.

5) Diazepam and similar drugs are illegal in a number of countries. They may be confiscated, or you may find yourself in trouble with the police.

6) Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing you may fail this having taken diazepam.

We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines and we have listed a number of these below.

Easy Jet www.fearlessflyer.easyjet.com Tel 0203 8131644

British Airways www.flyingwithconfidence.com  Tel 01252 793250

Virgin www.flyingwithoutfear.co.uk  Tel 01423 714900

We were very sad to see Dr Katharine Solomons leave the practice on the 12th May after 24 years of service. We thank her for all she has done for our practice and patients and wish her well for the future. We are glad to be able to announce to you that from the end of June, Dr Solomons' patients will be looked after by Dr Emma Wright who will be joining the team as a salaried GP working Wednesday, Thursday and Friday in the Harpenden surgery.

We are also delighted to inform you that Dr Louise Plumtree, who many of you will have already met when she was working as a locum for Dr Dass has joined us as a GP partner and will be working in both surgeries all day Monday and Tuesday and on Wednesday mornings. Dr Plumtree has a particular interest in dermatology. 

We have also recently welcomed Hannah Moor to our nursing team. Hannah has a lot of experience and is a wonderful addition to the nursing team. She will be working in both Harpenden and Wheathampstead surgeries. 

We are keen to vaccinate as many patients as possible who have not previously had the MMR (Measles/Mumps/Rubella) vaccine in line with the governemnt's 'MMR for all' campaign. This is particularly important when travelling and for patients born before MMR was introduced and after the illnesses were commonly circulating (approx born between 1970-1988). For more information please see: MMR for all: general guide - GOV.UK (www.gov.uk) and contact the surgery if you would like an appointment.

It is with great sadness that we advise that Dr Ingram is retiring after 34 years at the practice. He has been a joy to work with and we wish him all the best for his retirement. Dr Ingram and Dr Whiteford's patients will be allocated a new GP from our current partners following Dr Wall's decision not to take the partnership position. Please be patient whilst we complete this allocation and you will be informed of your named GP asap via text message.

This practice is delighted to be signed up to the Green Impact for Health Toolkit and is actively taking steps to reduce our carbon footprint. The climate emergency is also a health emergency, and health care in the UK contributes 5.4% of the UK's carbon emissions. We need to enhance the health of our current population without compromising the health of future generations, and this means operating within the sustainable boundaries of the planet. Fortunately most of the solutions for the planet also make our health better - for example eating a mainly plant-based diet, engaging in active travel and exercise in nature, avoiding smoking, reducing pollution etc all enhance our health and reduce our need for medications, with further benefits to the NHS, your health and the carbon footprint of healthcare. Take a look at www.greenerpractice.co.uk to learn more about this.

Today the Harpenden Vaccination Centre has administered 50,000 vaccinations! We are so proud of this and we would like to say 'thank you' to all our wonderful volunteers for your incredible efforts towards this amount.

FAQ