The daughter of an elderly female patient with dementia has written to the practice to complain about a delay in her mother's referral to mental health services. The patient no longer has capacity. However, when she previously had capacity she was adamant that she didn't want information regarding her health shared with her daughter. How should you respond to the complaint?
This is a tricky position for the GP and practice staff. Under the current NHS complaints regulations, a representative is able to make a complaint on behalf of a patient who lacks capacity. However, the responding body (i.e. the practice) needs to be assured that the complainant is acting in the patient's best interests before responding.
Assessment of a patient's best interests should take into account any previously expressed views by the individual, prior to losing capacity. In this case the patient has previously asked specifically for details of her healthcare not to be disclosed to her daughter.
The assessment should also consider any views the patient is currently able to give on the matter, even though she lacks capacity. Consideration should also be given to whether her daughter is an appropriate person to act as the patient's advocate – despite her mother's previous views, the daughter may now be one of the few people in a position to raise concerns about her mother's care.
If you decide it is appropriate to respond to the daughter, in view of her mother's previously expressed wishes you should only give essential medical information in your response. For instance, details of the date of the referral, the urgency given and the waiting time for an appointment may be sufficient to answer the concerns.
Further details of her mother's condition should only be given if it is directly relevant to the complaint, and you believe it is in the mother's best interests to provide that information to her daughter. In the end the amount of information disclosed is a judgement call, and the practice is unlikely to be criticised if the reasoning behind the decision is clear and well documented.
Dr Bryony Hooper is a medicolegal advisor at the Medical Protection Society