General Medical Council Guidance on Confidentiality: Update

25 April 2017

Author: Rachael McAdorey
Practice Area: Healthcare

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The updated General Medical Council (‘GMC’) Guidance on Confidentiality (‘the Guidance’) came into effect on 25th April 2017. This updated Guidance ought to be considered in conjunction with the 2009 Guidance.

This updated Guidance outlines the framework for considering when to disclose patients’ personal information, as follows:-

  1. Disclosures to support the direct care of an individual patient;
  2. Disclosures for the protection of patients and others; and
  3. Disclosures for all other purposes (which can include training, research, or the administration of justice).

Key changes

  • Stronger emphasis on sharing information remotely for direct care, and recognising the multi-disciplinary context doctors usually work in;
  • Provides more detail as to when doctors can rely upon implied consent for sharing information;
  • A new statement on the significant role of a patients’ carer. Confidentiality is not a justification for refusing to acknowledge a carer’s views;
  • A requirement to explain to a patient the potential consequences of refusing to allow information to be shared;
  • Clearer reflection on legal requirements to disclose information about adults at risk of serious harm;
  • An extension of the professional obligation to inform an appropriate authority when a patient who lacks capacity, may be exposed to harm;
  • Maintenance of the position that adults with capacity are entitled to make their own decisions, even if this results in a risk of death or serious harm to themselves. Disclosure may be justified without consent to prevent a serious crime such as murder, manslaughter, or serious assault, even if only the patient is at risk;
  • A new expression of doctors’ duties to protect and promote the health of patients/the public, as well as respecting confidentiality;
  • Clearer reflection on legal requirements to disclose information;
  • Expansion of the list of factors that doctors should take into account when deciding whether to disclose information;
  • Expansion of the examples of circumstances in which patients may pose a risk to others, for example, fitness to drive (see below);
  • Addition of formal reviews, for example Inquests, to the section on responding to requests for information;
  • Placing greater prominence on using anonymised information where possible;
  • A new requirement that doctors should not disclose information without consent in the public interest for purposes such as research, when support has not been sought, or has been refused [Note – this arrangement will soon be introduced in Northern Ireland, and is currently in place in England and Wales];
  • Additional requirement for doctors to have knowledge of information governance;
  • Requires doctors to follow the principles set out in the Data Protection Act 1998;
  • Expansion of circumstances in which a patients’ privacy may be breached;
  • Requirement to ensure that staff are suitably trained, and that employment contracts contain necessary obligations regarding confidentiality and data protection;
  • Clarification on disclosures after a patient’s death which are mandatory, or a matter of professional judgement; and
  • Expansion of the legal annex to provide sources of legal rights to confidentiality, privacy and data protection.

Explanatory Guidance

The GMC has published explanatory guidance on the following, and a summary of each is set out below:-

  • Patients’ fitness to drive and reporting concerns to the DVLA or DVA
    • Emphasises the importance of doctors considering whether a patient’s condition/treatment may affect their ability to drive safely;
    • Overt expression of doctor’s duties to protect/promote the health of patients and the public, whilst respecting confidentiality; and
    • These principles apply to pilots/drivers of all regulated transport;
    • Reminds doctors to record the advice given.
  • Disclosing information about serious communicable diseases
    • Distinguishes more clearly between disclosures necessary for the safe care of the patient, and disclosures necessary to protect others;
    • Clarifies that healthcare workers are entitled to protection, however, disclosure of a patients’ infection status is unlikely to be justified without consent; and
    • Expands the guidance on informing contacts at risk of sexually transmitted communicable diseases.
  • Disclosing information for employment, insurance and similar purposes
    • Separate consent is not necessary for the examination, and disclosure of the resulting report, providing the original consent was sufficient;
    • Doctors may correct errors of fact if asked to do so by a patient, but should not amend reports in a way that would make them misleading;
    • it may be appropriate to explain the consequences of withholding a report, however, the doctor must abide by the patient’s wishes; and
    • It is reasonable for a doctor to inform the organisation who commissioned a report if a patient withdraws consent, but not disclose any further information.
  • Disclosing information for education and training purposes
    • Adds training records to the section on using patient information in case studies; and
    • Clarifies that doctors in training/medical/healthcare students part of a team providing care, can have access to a patient’s personal information, unless the patient objects.
  • Reporting gunshot and knife wounds
    • Clarifies that the decision to inform the police is a matter of professional judgement, and applies to all violent injuries.
  • Responding to criticism in the media
    • Clarifies that this goes wider than traditional media, and includes social media

Medical Practitioners are encouraged to consider the full Guidance: http://www.gmc-uk.org/Confidentiality2017.pdf_69037815.pdf. For more information, contact Rachael McAdorey or a member of Carson McDowell’s Healthcare Team.

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