The GMC has revised its confidentiality guidance and came into force on 25 April 2017, and it's worth becoming familiar with these changes.
The GMC has published a helpful summary of what is new in the guidance, and outlines the duty of confidentiality that GPs 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.
One of the most useful changes is the introduction of a practical flowchart that GPs can use when there is a request for disclosure of patient information. It asks several questions and directs GPs to the relevant sections of the guidance.
A useful aide-memoir is that information should only be disclosed in one of the 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 GPs are increasingly working in integrated care partnerships and multidisciplinary teams. However, if patients are likely to be surprised that GPs 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 GPs to explain the consequences of this. For example, that it may not be possible to refer for treatment without this information being provided. GPs should take time to explore the patient’s reasons and seek a compromise if possible.
They also refer to the scenario when a family member provides information about a patient. GPs should not refuse to listen to 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 to whether the patient may consider listening to the relative a breach of trust. In some circumstances GPs 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
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.
It highlights 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.
Expanded advice is 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.
GPs must participate in procedures set up to protect the public from 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, that are established to improve systems and services and ensure future patient safety.
If GPs are unsure whether disclosure is justified in the public interest, they should consider seeking anonymous advice from Caldicott guardians or other expert advisers. GPs may also wish to discuss any concerns with their medical defence organisation.
Greater significance is placed 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.
GPs have a duty of candour to be honest with patients when things go wrong. There are various reporting systems in the UK regarding adverse incidents and near misses which are designed to improve patients safety and learn from mistakes. Unless required by law, GPs should ask for patient consent to disclose identifiable information, unless it is not appropriate or practicable to do so or if it may be justified without consent in the public interest.
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 is also outlined that GPs 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. It is important for sessional GPs to ensure they are fully familiar with the document in time for 25 April 2017. ●
Rachel Birch firstname.lastname@example.org
Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.