What do you need consent for?

You need the consent of patients to disclose information about them. In order to provide appropriate care, you may have to share information with other healthcare professionals, unless a patient specifically objects. You should make patients aware of this.

Express consent is only needed if the information identifies the patient, except in relation to notification of infectious diseases

You may be asked to disclose information about patients that will have no effect on them personally, for example for:

• Education and research
• Clinical audit
• Health service administration
• Public health safety.

Express consent is only needed if the information identifies the patient, except in relation to notification of infectious diseases – otherwise anonymising the data will suffice. All such disclosures should be kept to a minimum.

If the patient will be personally affected by the disclosure, eg, if you are giving personal information to their employer or an insurance company, you must have their express consent.

A common example in general practice is an approach from an insurance company wanting a report on a patient who is making a claim. You must make sure the patient has consented to this and that they are well-informed in order for consent to be valid. You may wish to invite the patient in to discuss the disclosure.

Public interest

You can disclose information without consent if it is in the public interest

You can disclose information without consent if it is in the public interest. The GMC advises that you should consider disclosing information without the consent of a patient where this will “assist in the prevention, detection or prosecution of a serious crime”. For example, if someone is at risk of death or serious harm, or for child abuse or manslaughter.

Some communicable diseases are notifiable by statute, and notification should preferably be made with the knowledge of the patient. See the editions of GP Registrar on medical records and confidentiality for more information.

Screening

As the results of screening may have serious implications, consent should be taken carefully. In particular:

• There may be uncertainties with the test, such as false-positive or false-negative results.
• Some tests could have serious consequences for patients and relatives – affecting their health, social circumstances and finances.

Remember to look at how the testing will be followed up, for example with counselling or other support.

Research and teaching

Patients need to consent to their involvement in any part of the teaching process

Consent for any research project should be taken carefully, and refusal to participate must not influence the care of the patient in any way. Patients need to consent to their involvement in any part of the teaching process.

The practice should make it clear that they are a training practice. You should be honest with patients that you are a trainee GP. It is unlikely that any patient will object to you treating them. If they do, you may wish to reassure them about your qualifications and experience, but if they still refuse their consent you should respect their wishes.

Similarly, if you are using information about patients for training purposes you will need their consent.

Minor procedures

Many general practices carry out minor surgical procedures, but the way that consent is taken for these procedures is variable. Consent that is taken should be recorded properly – using one of the DH consent forms (Form 3 is most suitable for primary care).

Audio-visual recordings

The GMC’s latest guidance, Making and Using Visual and Audio Recordings of Patients (2011), applies to originals and copies of all photographic, visual and audio recordings of patients made and used in any circumstances, within or outside the UK, where doctors are working in a professional capacity.

This does not include pathology slides containing human tissue. When making recordings you must:

• Get the patient’s consent for the recording
• Explain the purpose of the recording and how it will be used and, where possible, whether you plan to use it for any secondary purposes, eg, teaching
• Summarise the discussion in the medical record
• Explain how long it will be kept and how it will be stored
• Stop recording if a patient asks you to do so.

Recordings made as part of the patient’s care form part of the medical record and should be treated in the same way as written material, in terms of security and decisions about disclosure.

For more information see our factsheet Making Audio and Visual Recordings of Patients.