The GMC has revised its Confidentiality guidance and this will come into force on 25 April 2017. Medicolegal Adviser Dr Rachel Birch explains what doctors need to know about the changes
Read this article to:
- Find out more about the changes in the new GMC Confidentiality guidance
- Learn what effect the changes will have on your practice
- Protect yourself from accidentally breaching the new guidance
The GMC has revised its Confidentiality guidance and this will come into force on 25 April 2017. Doctors should ensure they are familiar with this guidance in advance of this date and The GMC have published a helpful summary of what is new in the guidance and doctors should ensure they are familiar with it in advance of the date of implementation. The explanatory guidance has also been updated and will be released at the same time.
The guidance outlines the duty of confidentiality that doctors have to their patients but emphasises the wider duty to protect the health of the public. There are also changes relevant to the newer working at scale care models for delivering primary care. Since general practice involves all staff working as a team, it would be helpful for partners and practice managers to ensure all members of the team are made aware of this guidance.
One of the most useful changes is the introduction of a flowchart that practices can use when there is a request for disclosure of patient information. It asks several questions and directs doctors to the relevant sections of the guidance.
A useful aide-memoir is that information should only be disclosed in one of four scenarios:
- with appropriate patient consent
- for patients lacking capacity if it is believed to be in their best interests
- if required by law
- if it is justified in the public interest.
Emphasis is placed on the importance of sharing information appropriately for the benefit of direct patient care, acknowledging that doctors are increasingly working in integrated care partnerships and multidisciplinary teams. However, if patients are likely to be surprised that doctors can access information from other healthcare providers, then explicit consent should be sought from the patient before doing so, whenever practicable.
If a patient refuses to provide consent for relevant information to be shared for a referral to secondary care, the GMC have outlined the requirement for doctors to explain the consequences of this. For example, that it may not be possible to refer the patient for treatment without this information being provided. Doctors should take time to explore the patient’s reasons for refusing and seek a compromise if possible.
The guidance also refers to the scenario where a family member raises concerns about a patient. Doctors should not refuse to listen to these concerns, but must take care not to disclose personal information unintentionally, for example by confirming or denying the person’s perceptions about the patient’s health. Consideration should be given as to whether the patient may consider it a breach of trust to listen to the relative. In some circumstances, doctors may need to inform relatives that they cannot guarantee the confidentiality of the discussion if it may influence the patient’s treatment.
Protection of patients and others
Amongst other things, the guidance now provides reference to legal requirements to disclose information about vulnerable adults, lacking capacity, who may be at risk of abuse or neglect.
Expanded advice is also provided regarding situations where relevant information is requested about patients who may pose a risk of harm to others. For more on this difficult scenario, see an article on the topic on the BMJ Careers website from my colleague Dr Marika Davies.
The guidance goes on to highlight further legal requirements to disclose information for the prevention of terrorism, the notification of certain infectious diseases and the reporting of female genital mutilation in girls under the age of 18.
It also states that doctors must participate in procedures set up to protect the public from both violent and sex offenders, such as MAPPA in England, Wales and Scotland and public protection arrangements in Northern Ireland. They must also seriously consider requests for information for formal reviews, such as formal inquiries and serious case reviews, which are established to improve systems and services and ensure future patient safety.
If doctors are unsure whether or not disclosure is justified in the public interest, they should consider seeking anonymous advice from Caldicott guardians or contact one of our expert medicolegal advisers.
The guidance also places greater significance on using anonymised information wherever possible, in preference to identifiable information for purposes other than direct care, with reference to the Information Commissioner’s Office code of practice guidance on anonymisation.
Things can go wrong in medical practice, and when this happens, doctors have a duty of candour to be honest with patients. It is also recognised that these incidents can provide good learning opportunities to help improve patient safety. There are various systems in the UK for reporting adverse incidents and near misses, however doctors should ask for patient consent before disclosing any identifiable information. The only instances where disclosure can be made without consent are if disclosure is required by law, if it is justified in the public interest, or if obtaining consent is not appropriate or practicable.
The GMC states that whilst in some practice environments it may be difficult to avoid conversations being overheard, for example in practice reception areas, steps should be taken to minimise breaches of confidentiality as much as possible. It also states that doctors must take steps to ensure communication with patients is secure, and highlights leaving messages on answerphones and email correspondence as being at risk of being intercepted by someone other than the patient.
These are just some of the changes within the new Confidentiality guidance that relate to General Practice but GPs are advised to ensure they are fully familiar with the document in time for 25 April 2017.
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