1. What has changed?
We’ve re-structured our popular guidance on confidentiality so it’s easier for doctors to navigate. The fundamental principles outlined in our 2009 guidance haven’t changed, but we’ve added some clarifications and some new resources including an interactive flowchart, case studies and a factsheet on legislation.
GPs need to follow this guidance to meet GMC standards.
2. What are some specific things I should change?
During our consultation we heard how some doctors could be reluctant to listen to the views of a patient’s family and friends, citing patient confidentiality. We’ve clarified that confidentiality is not in itself a reason to refuse to listen, and that it can be helpful to the patient’s care. For example, a family member may be able to provide insights into a patient’s condition that the patient is not able to give.
However, we also acknowledge there can be reasons for not listening to the views of close family and friends – for example if the patient has specifically asked the doctor not to listen to particular people.
In addition, the revised guidance highlights that doctors must consider how to keep patient confidentiality in the open areas of a practice, which was not featured as explicitly in previous guidance. One of the biggest concerns raised during our consultation was about how patient privacy is maintained in open environments such as surgery reception areas, and the extent to which administrative staff can access records. We know the vast majority of GP practices take this concern seriously, and ensure their employees are trained in confidentiality and data protection, but unfortunately this isn’t universal.
3. When can I rely on implied consent?
Our revised guidance gives clearer information on when doctors can rely on implied consent. It places stronger emphasis on the importance of sharing appropriately for direct care, recognising the multi-disciplinary and multi-agency context doctors usually work in. GPs can rely on implied consent when:
- The information is being shared to provide or support the individual patient’s direct care.
- Patients have easy access to details of how their information is to be used, and how they can object.
- The patient hasn’t objected.
- The person receiving the information will treat it as confidential.
To ensure a patient is not surprised at any information being shared, we suggest that if in doubt the doctor should ask the patient if they give consent for you to share their information.
4. When is disclosing information without consent in the public interest?
In our guidance we state that the benefits to an individual or society arising from the disclosure must outweigh both the patient’s and the public interest in keeping the information confidential. Sometimes, doctors can disclose information without consent, for example if others are at risk of death or serious harm, but the judgement on this can only be made on the specific facts of an individual case.
In our new guidance, we’ve clarified the factors doctors should take into account when deciding when disclosure is in the public interest. These are:
- The potential harm or distress to the patient arising from the disclosure.
- The potential harm to trust in doctors generally.
- The potential harm to others if the information is not disclosed.
Mary Agnew is assistant director of standards at the GMC