Dear Miss Gillespie; Re: Cynthia Fretwell (deceased) dob 28.6.1928 Late of 7 Croft Crescent; Awsworth; Nottinghamshire Further to Regulation 28 report to prevent future deaths dated 19.12.2013, the Practice has discussed this case aS a Significant Event: The discussions have taken place during Medical meetings on several occasions, in the presence Of GP s, Practice Nurses, Reception Manager and Practice manager. As a result of OUr discussions; the following steps have been laken: The Practice has updated its MENTAL CAPACITY ACT 2005 POLICY. This is saved 0n the shared for all the to access it as necessary_ See attached. 2 A summary of the Mental capacity Act 2005 in also saved 0n the shared drive` for more detailed reference. Telephone Consultation Protoeol has been updated and copy of this has been submitted to Your office and been accepted by yourself: We have discussed the Mental Capacity Act during our Medical Meetings So that we are all updated 0n it. Particular attention has been to sections relating to the Principles of the Act; Purposes of the Act and Best interests, as highlighted in the copy Of summary of Mental Capacity Act attached. 5_ Attention is also paid to 5 core principles, basic rccording; assessment of capacity and assessment of capacity checklist in the Practice s Mental capacity act policy have previously attended Protected Learning time event on 23.5.2013 on Safeguarding Children and vulnerable adults, Mental Hama Medical Centre is the trading name of HMC (Kimberley) Limited Registered No: 8244108 This practice is & member of the Nottingham West Clinical Commissioning Group, group of local NHS practices, making iocal dccisions for local people NHS Nottingham West Clinical Commissioning Group drive staff paid

Hama Medical Centre 11 Nottingham Road, Kimberley, Nottingham NG16 2NB Telephone 0115 9382101 Fax 0115 9459208 Website: wwuhamamedicakcentrecouk Capacity Act and PREVENT: This event addressed the principles and application of the Mental Capacity Act, amongst Other issues: will continue to keep themselves updated by attending appropriate future courses wvill be attending such course in the near future. The Practice staff have attended a course to learn about Mental capacity Act in 2009 and will update themselves with e-learning this subject On *blue stream academy" The Praetice answers YOur queries in Ic, 2 and 3 as follows: Ic: The Practice will adopt a very low threshold for home visiting: This would especially be $0 in a patient who has not been seen face to face previously, in the elderly if the illness was on going Or if there was any doubt whatsoever about the nature of medical problem on the phone_ 2 A full assessment of the patient'$ mental capacity in a situation where are refusing medical treatment or admission to hospital will be made in accordance with guidelines in the Practice' $ mental capacity policy attached, If the clinical situation warranted hospitalisation GP would, with the help of the family, encourage the patient t0 go into hospital. If the patient refused, GP would reinforce the need for hospitalisation and the serious consequences of not SO As as the patient had mental capacity as judged per protocol attached, their choice would be respected: If the patient is assessed as lacking mental capacity the GP would with the help of the family make a choice that was in the patient s best interest. Please refer to the copy of summary of Mental Capaeity Act and attached_ 3_ A full and proper documentation of the discussions that would take place between GP, the patient/patient' s family in these circumstances would be made in patient notes. Please refer to basic recording in the Mental Capacity Act 2005 Policy. Hama Medical Centre is the trading nanc 0l HMC (Kim berley) Limited Registered No; 8244108 This practice is a member of the Nottingham West Clinical Commissioning Group, group of local NHS practices; making local decisions for local people. NHS Nottingham West Clinical Commissioning Group They very they the doing long Policy

Hama Medical Centre 11 Nottingham Road, Kimberley, Nottingham NG16 2NB Telephone 0115 9382101 0115 9459208 Website: HWwhamamedicalccsuk We the steps outlined above meet with your satisfaction We will be very pleased to engage with yourself on any matter YOU feel is not addressed. Yours sincerely_ Flama Medical centre_ Hautna Medical Centre is trading name of HMC (Kimberley) Limited Registered No: 8244108 This practice is member of the Nottingham West Clinical Commissioning Group, group of local NHS practices, making local decisions [Or local people NHS Nottingham West Clinical Commissioning Group Fax hope the