How long does consent last?

For many elective procedures, consent is taken in the outpatient department weeks or sometimes months prior to admission for surgery. There is no specific time limit on consent taken in advance, but further questions may occur to patients, or doubts about the wisdom of their decision may creep in during the interim. Patients’ conditions may also change during the intervening period, or new information about the procedure may have become available.

NHS consent forms have a space at the end for confirming consent prior to the procedure; this should be used as a prompt to find out if there have been any material changes since consent was first taken, and to ask the patient if there are any further questions.

Implied and express consent

Patients should be told about the nature and purpose of any examination, investigation or procedure beforehand

Patients undergoing investigations or treatment that carry a higher risk will normally give express consent – either by signing a consent form or stating that they agree to go ahead with treatment.

The GMC says that written consent should be taken where:

  • the investigation or treatment is complex or involves significant risks
  • there may be significant consequences for the patient’s employment, or social or personal life
  • providing clinical care is not the primary purpose of the investigation or treatment
  • the treatment is part of a research programme or is an innovative treatment designed specifically for their benefit.12

Written consent is required by law for fertility treatment – the relevant forms can be obtained from the Human Fertilisation and Embryology Authority. The Mental Health Act 1983 also requires written consent to be taken in some specific cases.

However, consent is often implied by the patient’s compliance, an obvious example being when a patient rolls up a sleeve so that a blood sample can be taken. Nevertheless, patients should be told about the nature and purpose of any examination, investigation or procedure beforehand.

Patient information leaflets

Before sharing any literature with a patient, it should be checked to make sure that it’s accurate and up to date

Numerous studies have shown that patients retain comparatively little information given to them during a consultation, particularly if they are anxious or in pain. Many patients find it helpful if they are given written information as a reminder of the key points discussed. However, written information is not a substitute for detailed discussion with patients and must be seen as an adjunct to, not a replacement for, that discussion.

If information leaflets are used to augment discussion with a patient, this should be documented in the patient’s notes. Before sharing any literature with a patient, it should be checked to make sure that it’s accurate and up to date.

When patients are being asked to absorb a great deal of detailed and complex information, it may be helpful to audio-record the consultation and give the patient a copy to take home and mull over to help their decision-making.

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