An adult male patient attends for a routine appointment. He mentions he is planning to travel to Syria on his own for several months. You are concerned about the purpose of the trip. How should you proceed?
Dr Fiona Cornish: Be sceptical about the patient’s story
This scenario may ring alarm bells. Find out as much as possible from the patient, for example whether the trip is for a humanitarian aid purpose. Inform him that the Foreign Office advises against all travel to Syria.
Be very cautious about what you believe from the patient’s responses, as someone planning terrorist-related activities will probably try to conceal anything suspicious from their GP.
Since 2015, doctors have had a legal duty under the UK Government’s Prevent strategy to have ‘due regard to the need to prevent people from being drawn into terrorism’.1 As GPs, we are required to help identify and refer to the authorities individuals we deem as being at risk of being drawn into terrorism, including violent and non-violent ‘extremism’.
However, confidentiality and trust are at the heart of our relationship with patients. The GMC has reviewed its guidelines in the light of the Prevent strategy and reminds us that we have
a duty to disclose if the law requires it or it is in the public interest.2 As a general principle, doctors should ask for consent before disclosing information about a patient, but the GMC recognises that this is not always safe or feasible. The Department of Health sets out the steps to take if you are concerned that a patient may be involved in, or is at risk of being drawn into terrorist-related activity.3
If, after discussion with colleagues and further investigation, you are seriously concerned about potential terrorist activity, you should contact the local police or the confidential anti-terrorist hotline.4
Dr Fiona Cornish is a GP in Cambridge
Dr Pipin Singh: Identify risk factors before escalating concerns
Your approach should take account of a number of factors. You may have a large proportion of patients who are refugees, asylum seekers or from minority ethnic backgrounds. In that case, a trip to Syria may be understandable.
However, given the current national concerns over increased radicalisation, you may still wish to enquire why he is travelling.
If the patient does not appear to have obvious social links with Syria, explore the reasons for his visit in more detail.
As with any consultation, your style of questioning, level of empathy and overall relationship with the patient will determine how much information you are able to extract.
Does the reason for visiting sound plausible? Does the patient appear restless or anxious when discussing the trip? What is the initial reason for presenting? Your level of concern may escalate if there is any history of mental health problems. Explore the patient’s current social circumstances – his family life, employment situation and housing situation.
You may also wish to review notes of any family members registered with your practice. Be mindful of risk factors for radicalisation – social isolation, mental health problems, drug and alcohol misuse, unemployment, poverty and poor housing.
If after your assessment you have genuine concerns, you have a duty at least to discuss these with the local police who will then liaise with the multi-agency Channel team,5 which reviews cases to help prevent people being radicalised. If you feel there is an imminent risk of harm to others, you must notify the police immediately. Make sure to document your concerns and any advice given.
Dr Pipin Singh is a GP in Wallsend, Tyne and Wear
Medicolegal view: Remember your overriding duty to report concerns
Despite a number of high-profile cases of individuals travelling to the Middle East to take part in terrorist-related activities, your patient could have a perfectly innocent reason for his trip.
But if after trying to establish the purpose of his travel you fear this may potentially be linked to terrorist activity, you are required to take further action.
It is important to follow the guidance in the Government’s Prevent strategy for healthcare organisations and professionals.3 This advises that GPs are key partners in helping to prevent vulnerable individuals from being drawn into terrorist activities, while recognising that doctors are not required to take on surveillance or enforcement roles. You do not need to be certain of the purpose of travel, or interrogate the family, in order to act on your concerns.
Foreign travel potentially linked to terrorism falls under Section 38B of the Terrorism Act 2000, which requires any individual to inform the police, as soon as reasonably practicable, if they have information that may be of material assistance in preventing the commission, preparation or instigation of an act of terrorism. Your duty of confidentiality is unlikely to be considered a reasonable excuse not to disclose information. And GMC confidentiality guidance recognises that doctors may be justified in disclosing confidential patient information – even where patients have withheld consent – if it is in the public interest to do so, such as assisting in the prevention, detection or prosecution of serious crime.2 It may not be safe or practicable to seek the patient’s consent in the usual way as there may be, for example, a risk of absconding.
In view of the complex and case-specific nature of such a scenario, it is strongly recommended that you also contact your defence organisation for advice.
Dr Harpreet Sarna is a medicolegal adviser at Medical Protection
1 UK Government. Prevent strategy. 2011. tinyurl.com/gov-prevent
2 GMC. Good medical practice. Confidentiality: good practice in handling patient information. 2017 tinyurl.com/2017-GMC
3 Department of Health. Building Partnerships, Staying Safe: guidance for healthcare organisations. tinyurl.com/prevent-guidance-hcps
4 Anti-terrorist hotline, telephone number: 0800 789 321
5 UK Government. Channel Duty Guidance. tinyurl.com/channel-guidance