In the practice

A GP practice is closely involved with its local community. Practice staff and other patients may know the patient you are dealing with. Be careful about conversations that can be overheard, eg, is the reception area open? If you take a telephone call there or chat with one of the receptionists, will the whole room hear the details?

You will find that many procedures in a practice balance the best interests of a patient with the need to maintain confidentiality. For example, many practices would allow a patient to pick up his wife’s prescription. Strictly speaking, this could be a breach of confidentiality without patient consent, but it would usually be reasonable to assume the patient’s implied consent.

Using manual records

• Make yourself familiar with the procedure for booking out and returning records, and follow it. Return files as soon as possible after use.
• Do not leave files unattended – even for a short time – where they can be seen by members of the public.

Out and about

When travelling or on visits, do not leave information lying unattended in a car or easily accessible area. Keep laptop computers, records and files locked away.

Security in the surgery

• Shut and lock doors and cabinets as required.
• Do not be afraid to query the status of strangers.
• Do not tell anyone how the security system works.

On the telephone

When making a telephone call, you do not always know who is on the other end. You may have breached confidentiality simply by saying: “Hello it’s Doctor Green here, please could I speak to Mrs Jones?”

There are circumstances in which letting a third party know that a doctor is calling them could be embarrassing and breach confidentiality. It is safer to identify yourself only after you have confirmed that you are talking to the patient.

Mobile phones

Although invaluable in allowing you to be contacted anywhere, they do need to be used carefully:

• Many people talk more loudly on a mobile phone, particularly if the signal is poor. Be aware of this, and the fact that you may be overheard in rooms that you would normally consider safe.
• Patients who sign up to a practice text message service, eg, to inform them of appointments or flu vaccinations, should be advised of the importance of informing the surgery of any changes to their contact details. This is important because patients may change their mobile phones at regular intervals, and if they choose to give their old phone to a friend or family member, there is obvious potential for a breach of confidentiality.

Using a computer

Computers are an essential part of surgery life, but you should make sure that you use them carefully. The GMC states that “you must not abuse your access privileges and must limit your access to information you have a legitimate reason to view”.

Always clear a previous patient’s details from the screen before the next patient arrives.

Do not leave a computer logged in and unattended – always lock it, even if you are only leaving it briefly.

Change your password regularly, making sure you do not use short or easily guessable passwords. Never share your password with anyone.

Make sure your screen cannot be overlooked by others – eg, through a window. If it is helpful and you are comfortable doing so, you can show patients their records on the screen.

Remember that if patients are accompanied, they may not be happy about their companion seeing the details.

Restrict access to relevant staff.

Faxes

Consider developing a “fax policy” which should include the use of “fast dial” stored numbers used regularly (such as to a hospital safe haven) and the process to be followed if a confidential fax was to be sent to another location.

Breaching confidentiality

A study of Lincolnshire practices in the British Journal of General Practice found 44 confidentiality breaches in 26 hours of observation. The breaches reflected the layout of the practice, the systems in place and the professionalism of practice staff. Positive practice included patients being given numbered, coloured cards on arrival, and receptionists not repeating the information they were given during phone calls. Negative practice included GPs announcing the full name of each patient, and receptionists speaking loudly.

Source: Scott K, Middlemass JB, Dyas JV and Siriwardena AN, Confidentiality in the Waiting Room: An Observational Study in General Practice, Br J Gen Pract 57; 490-3 (2007)