GPs should take ‘proportionate approach’ to patient consent, says GMC

Doctors should take a ‘proportionate approach’ to gaining patient consent, which does not always need to be a ‘formal, time-consuming process’, the GMC has said.

The GMC has released updated guidance on decision making and consent that takes effect on 9 November, and which is less prescriptive than previous versions.

It states that while some medical interventions may require a patient to sign a form, for most decisions doctors can rely on verbal consent, as long as the patient has considered the relevant information.

Doctors should consider the complexity of the decision and its potential impact when deciding how to gain consent and what level of detail needs to be recorded.

Under a section entitled ‘Taking a proportionate approach’, the guidance says: ‘Not every paragraph of this guidance will be relevant to every decision that you make with or about a patient. Your judgement about how to apply the guidance will depend on the specific circumstances of each decision.’

It sets out seven principles of decision making and consent, including:

• All patients have a right to be involved in decision making;
• Decision making is an ongoing process focused on meaningful dialogue;
• All patients have the right to be listened to and given the information they need to make a decision, and the time and support they need to understand it;
• Doctors must try to find out what matters to patients so they can share relevant information;
• Doctors must presume all adult patients have capacity to make decisions about their treatment and care;
• The choice of treatment or care for patients who lack capacity must be of overall benefit to them, and the decisions should be made in consultation with those close to them;
• Patients whose right to consent is affected by law should be supported to be involved in the decision-making process and to exercise choice if possible.

The guidance later adds: ‘You should take a proportionate approach to the level of detail you record. Good medical practice states that you must include the decisions made and actions agreed – and who is making the decisions and agreeing the actions – in the patient’s clinical records. This includes decisions to take no action.’

GMC medical director Professor Colin Melville said: ‘Doctors are working in pressured environments and in challenging circumstances, impacting on the time they have with patients.

‘It is therefore critical their conversations with patients are meaningful and that they support patients to make decisions that are right for them.’

He added: ‘Obtaining a patient’s consent need not be a formal, time-consuming process, but should be part of having good conversations.’

Dr John Holden, head of medical division at medical defence organisation MDDUS, said: ‘The publication by the GMC of updated guidance on decision making and consent is particularly timely. It recognises the pressure on doctors of time and resources which is highly relevant during the current pandemic.

‘Decision making and gaining consent is so much more than just a signature on a piece of paper.

‘I am also pleased to see the GMC recognise that not every aspect of the guidance must be met to avoid the risk of a regulatory investigation; rather, the guidance may be applied proportionally, with regard to the complexity and potential impact of an individual decision.’

Dr Helena McKeown, BMA representative body chair, said: ‘This guidance is helpful insomuch as it underlines best practice already followed by doctors around the country, and it is particularly reassuring that the GMC has recognised the intensely pressurised environments medical professionals are working  in, none more so than right now during the Covid-19 pandemic.’

It comes after the GMC said ‘unpredictable circumstances’ of the Covid-19 pandemic will be taken into account when investigating doctors’ fitness to practise.