GMC Confidentiality: Disclosing Information About Serious Communicable Diseases PDF

You can fnd the latest version of this guidance on our website at www.gmc-uk.org/guidance. Confdentiality: disclosing information about serious communicable diseases 1 In our guidance Confdentiality: good practice in handling patient information we say: 1 Trust is an essential part of the doctorp...

You can fnd the latest version of this guidance on our website at www.gmc-uk.org/guidance. Confdentiality: disclosing information about serious communicable diseases 1 In our guidance Confdentiality: good practice in handling patient information we say: 1 Trust is an essential part of the doctorpatient relationship and confdentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared. 17 You must disclose information if it is required by statute, or if you are ordered to do so by a judge or presiding offcer of a court. 18 You should satisfy yourself that the disclosure is required by law and you should only disclose information that is relevant to the request. Wherever practicable, you should tell patients about such disclosures, unless that would undermine the purpose, for example, by prejudicing the prevention, detection or prosecution of serious crime. 62 You should ask for a patient’s consent to disclose information for the protection of others unless the information is required by law or it is not safe, appropriate or 1 practicable to do so . You should consider any reasons given for refusal. 64 If it is not practicable or appropriate to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justifed in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefts to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confdential. 67 Before deciding whether disclosure would be justifed in the public interest you should consider whether it is practicable or appropriate to seek consent (see paragraph 14). You should not ask for consent if you have already decided to disclose information in the public interest but you should tell the patient about your intention to disclose personal information, unless it is not safe or practicable to do so. If the patient objects to the disclosure you should consider any reasons they give for objecting. 68 When deciding whether the public interest in disclosing information outweighs the patient’s and the public interest in keeping the information confdential, you must consider: a the potential harm or distress to the patient arising from the disclosure – for example, in terms of their future engagement with treatment and their overall health b the potential harm to trust in doctors generally – for example, if it is widely perceived that doctors will readily disclose information about patients without consent 01 Confdentiality: disclosing information about serious communicable diseases c the potential harm to others (whether to a specifc person or people, or to the public more broadly) if the information is not disclosed d the potential benefts to an individual or to society arising from the release of the information e the nature of the information to be disclosed, and any views expressed by the patient f whether the harms can be avoided or benefts gained without breaching the patient’s privacy or, if not, what is the minimum intrusion. If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining confdentiality, you should disclose relevant information promptly to an appropriate person or authority. Control and surveillance of serious communicable diseases 4 Protecting patients from risks posed by your health or your colleagues’ health 5 Confdentiality is important to all patients and all patients are entitled to good standards of care, regardless of what disease they might have, or how they acquired it. Those who have, or may 2 have, a serious communicable disease might be particularly concerned about their privacy. This explanatory guidance sets out how the general principles in our guidance Confdentiality apply when doctors are accessing, using or disclosing information about the infection status of patients who have serious communicable diseases. Protecting information against improper disclosure 3 You should make sure that information you hold or control about a patient’s infection status is at all times effectively protected against improper disclosure. If you disclose information about a patient’s infection status, you must keep disclosures to the minimum necessary for the purpose. 4 Good medical practice says: 28 If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualifed colleague. You must follow their advice about any changes to your practice they consider necessary. You must not rely on your own assessment of the risk to patients. About this guidance 2 You must pass information about notifable diseases to the relevant authorities for communicable disease control and surveillance. Different diseases are notifable in different UK countries and the reporting arrangements differ. You should follow the arrangements where 3 you work. You should disclose anonymised information if practicable and as long as it will serve the purpose. 29 You should be immunised against common serious communicable diseases (unless otherwise contraindicated). 6 You should follow our guidance Raising and acting on concerns about patient safety if you are concerned that a colleague who has a serious communicable disease is practising, or has practised, in a way that puts patients at risk of 5 infection. You should inform your colleague before passing the information on, as long as it is practicable and safe to do so. 02 Confdentiality: disclosing information about serious communicable diseases Disclosing information about patients who are diagnosed with a serious communicable disease to those providing direct care 7 Most patients understand and expect that relevant information must be shared within the direct care team to provide their care. If a patient objects to disclosure of personal information that you are convinced is essential to provide them with safe care, you should follow the guidance at paragraphs 30 and 31 of Confdentiality. If the patient does not have capacity to make the decision, you can disclose information if it is in their overall beneft, in line with the guidance at paragraphs 48 and 49 of Confdentiality. 8 If a patient who has been diagnosed with a serious communicable disease refuses to allow you to tell others providing their care about their infection status, and you believe that failing to disclose the information will put healthcare workers or other patients at risk of infection, you should explain to the patient the potential consequences of their decision and consider with the patient whether any compromise can be reached. 9 Like everyone else, healthcare workers are entitled to protection from risks of serious harm. But disclosure of information about a patient’s infection status without consent is unlikely to be justifed if it would make no difference to the risk of transmission – for example, if the risk is likely to be managed through the use of 6 universal precautions that are already in place. If the patient continues to refuse to allow you to tell other members of the healthcare team about their infection status, you must abide by their wishes unless you consider that disclosing the information is necessary to protect healthcare workers or other patients from a risk of death or serious harm. Disclosing information in response to injuries to colleagues and others 10 If a colleague, police offcer or anyone else suffers a needlestick or similar injury involving a patient who has, or may have, a serious communicable disease, you should make sure that a risk assessment is made urgently by an appropriately qualifed colleague. Post-exposure prophylaxis should be offered in accordance with that risk assessment, depending on the type of body fuid or substance involved and the route 7 and severity of the exposure. 11 You should ask for the patient’s consent to disclose their infection status after other people have been exposed to a serious communicable disease. If the patient cannot be persuaded to consent to disclosure, or if it is not safe or practicable to ask for their consent, you may disclose information if it is justifed in the public interest. This could be, for example, if the information is needed for decisions about the continued appropriateness of post-exposure prophylaxis. You should follow the guidance on disclosing information in the public interest at paragraphs 63–70 of Confdentiality: good practice in handling patient information. Informing people at risk of infection from serious communicable disease 12 You should explain to patients who have serious communicable diseases how they can protect others from infection, including from sexually transmitted diseases. This includes the practical measures they can take to avoid transmission, and the importance of informing people with whom they have sexual contact about the risk of sexual transmission of serious communicable diseases. 13 You may disclose information to a person who has close contact with a patient who has a serious communicable disease if you have reason to think that: a the person is at risk of infection that is likely to result in serious harm 03 Confdentiality: disclosing information about serious communicable diseases b the patient has not informed them and cannot be persuaded to do so. 14 If you believe that an adult who is at risk of infection lacks capacity to understand this information, and is at risk of serious harm, you must give relevant information promptly to an appropriate responsible person or authority, unless it is not of overall beneft to the patient to do so (see paragraphs 55 and 56 of Confdentiality). 15 You should tell the patient before you disclose the information if it is practicable and safe to do so. When you are tracing and notifying people, you should not disclose the identity of the patient, if practicable. You must be prepared to justify a decision to disclose personal 8 information without consent. Disclosing information when children and young people are at risk of a serious communicable disease 16 Most patients with a serious communicable disease who are parents of, or care for, children will do all they can to protect the children from the risk of infection or the effects of the disease. You should make sure the patient understands the information and advice you give them, which you should tailor to their needs. You should do all you reasonably can to support them in caring for themselves and in protecting their children. 17 You should explain to a patient with a serious communicable disease the importance of testing any children who may already be infected, including children without symptoms and young people who might have been vertically infected with a blood-borne virus. 18 If you are concerned that a child is at risk of serious harm because their parents cannot be persuaded to protect them from the risk of infection, or because they refuse to allow the child to be tested, you should treat it as a safeguarding concern and follow the advice in our guidance Protecting children and young 9 people: the responsibilities of all doctors. Recording serious communicable diseases on death certifcates 19 If a serious communicable disease has contributed to the cause of death, you must record this on the patient’s death certifcate. Endnotes 1 We give examples of when it might not be practicable to seek consent in paragraph 14 of Confdentiality: good practice in handling patient information. You can fnd all of our guidance online at www.gmc-uk.org/guidance. 2 In this guidance, the term ‘serious communicable disease’ applies to any disease that can be transmitted from human to human and that can result in death or serious illness. It particularly applies to, but is not limited to, HIV, tuberculosis, and hepatitis B and C. 3 You can get advice from Public Health England, Public Health Wales, Communicable Disease Surveillance Centre in Northern Ireland and Health Protection Scotland. 4 Good medical practice (General Medical Council, 2013). You can fnd all of our guidance online at www.gmc-uk.org/ guidance. 5 See Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers (Department of Health, 2007); Health Clearance for Tuberculosis, Hepatitis B, Hepatitis C and HIV for new Healthcare Workers with direct clinical contact with patients (Scottish Government, 2008); The Management of HIV infected Healthcare Workers who perform exposure prone procedures: updated guidance (Department of Health, 2014); and HIV Infected Health Care Workers: Guidance on Management and Patient Notifcation (Scottish Government, 2005). 04 You can fnd the latest version of this guidance on our website at www.gmc-uk.org/guidance. Confdentiality: disclosing information for education and training purposes 1 In our guidance Confdentiality: good practice in handling patient information we say: c The disclosure is approved through a statutory process that sets aside the common law duty of confdentiality (see paragraphs 103–105). 77 Many important uses of patient information contribute to the overall delivery of health and social care. Examples include health services management, research, epidemiology, public health surveillance, and education and training. Without information about patients the health and social care system would be unable to plan, develop, innovate, conduct research or be publicly accountable for the services it provides. 79 Anonymised information will usually be suffcient for purposes other than the direct care of the patient and you must use it in preference to identifable information wherever possible. If you disclose identifable information, you must be satisfed that there is a legal basis for breaching confdentiality. 80 You may disclose personal information without breaching duties of confdentiality when any of the following circumstances apply. d The disclosure can, exceptionally, be justifed in the public interest (see paragraphs 106–112). You must also be satisfed that the other relevant requirements for disclosing information are met (see paragraph 10).1 About this guidance 2 The use of information about patients is essential to the education and training of medical students, doctors in training and other healthcare students and trainees. This explanatory guidance sets out how the general principles in our guidance Confdentiality apply in the particular context of education and training. a The disclosure is required by law, including by the courts (see paragraphs 87–94). b The patient has given explicit consent (see paragraph 95). 01 Confdentiality: disclosing information for education and training purposes General principles 3 For most education and training uses, anonymised information will be suffcient and must be used whenever practicable. If it is necessary to use identifable information about a patient, or it is not practicable to anonymise information, you should usually ask for the patient’s explicit consent before disclosing it to anyone who is not part of the team that is providing or supporting the patient’s direct care. You should make sure that the patient is under no pressure to consent. In particular, you should avoid any impression that their care depends on giving consent.2 Teaching and training of medical students, doctors in training and other healthcare students and trainees 4 Most patients understand and accept that the education and training of medical students, doctors in training and other healthcare students and doctors in training relies on them having access to information about patients. If doctors in training or medical or healthcare students are part of the team providing or supporting a patient’s direct care,3 they can have access to the patient’s personal information, just as other team members do, unless the patient objects.4 5 If the doctor or student is not providing or supporting the patient’s care, anonymised information should be used for education and training purposes whenever practicable. This may not be achievable, for example, on ward rounds, but it will then usually be possible to seek the patient’s explicit consent to disclosure. 6 In some cases it might be necessary to disclose personal information, or it might not be practicable to anonymise it or to ask for a patient’s consent. In such cases you may disclose relevant personal information to medical students, doctors in training and other healthcare students and trainees, as long as you are satisfed that information has been made readily available to the patient about the disclosure and of their right to object, and they have not objected. You must also be satisfed that they understand that the information is given in confdence, which they must respect. Patients who lack capacity 7 You should not disclose personal information for education and training purposes about patients who lack capacity if you can use information about other patients instead. 8 If you wish to disclose personal information about a patient who currently lacks capacity (for example, because they are acutely unwell), but who is likely to regain capacity, you should wait and ask for their consent later if you can. 9 If you are asked, or want, to disclose information about a patient who lacks capacity, you should seek the views of anyone the patient asks you to consult, or who has legal authority to make decisions on their behalf,5 or who has a close personal relationship with the patient. They may be able to give you an indication of the patient’s previously expressed preferences, views and beliefs. 10 In the absence of any indication about the preferences of a patient who lacks capacity, you should not publish information that could identify that patient. In exceptional cases, however, you may disclose relevant personal information to medical students, doctors in training and other healthcare students and trainees if it is necessary for their education and training. You must be satisfed there is no reasonably practicable alternative to using personal information, and you should have no reason to believe that it is contrary to the interests of the patient to do so. 02 Confdentiality: disclosing information for education and training purposes Disclosing information to secondary school and college students 11 Doctors are sometimes asked to provide work experience for secondary school or further education college students, which may include allowing them to be present during consultations with patients. 12 You should ask for the patient’s explicit consent to a student observing their care. You should also satisfy yourself that the student’s presence does not adversely affect the patient’s care, for example by inhibiting frank discussion. 13 You should satisfy yourself that the student understands the importance of respecting confdentiality and that their school or college takes seriously its responsibilities for its students’ conduct.6 Training records and case studies 14 You must anonymise patient information in training records and case studies as far as it is possible to do so. The anonymisation code of practice published by the Information Commissioner’s Offce considers data to be anonymised if it does not itself identify any individual, and if it is unlikely to allow any individual to be identifed through its combination with other data.7 Simply removing the patient’s name, age, address or other personal identifers is unlikely to be enough to anonymise information to this standard.8 15 If it is diffcult to anonymise information about patients while retaining enough detail to make a training record useful, or if it is necessary to include potential identifers to allow the record to be audited, you should ask for the patient’s consent to use their information if you can. If it is not practicable to seek the patient’s consent, you may use potentially identifable information in a training record as long as you are satisfed that the record will be kept securely and will be managed in accordance with other data protection requirements. You must still remove as many identifers as you can.9 16 If the information is likely to be more widely accessible (for example, in discussion at a seminar or conference, or published in a journal), and you consider that the patient could be identifed, you should usually use the information only when you have the patient’s explicit consent. 17 When asking for the patient’s consent, you must give the patient enough information about the nature and purpose of the disclosure to enable them to make an informed decision. This should include a description of the information to be disclosed and an indication of who will have access to it and how it will be used. 18 You may disclose information only for the purposes for which the patient has given consent, and you must remove as many identifers as you can. You must respect a patient’s refusal to consent to the publication of their identifable information. 19 If for any reason you cannot get a patient’s consent – for example, because the information you want to disclose is so old that efforts to trace the patient have been or are likely to be unsuccessful – you will need to consider whether disclosing potentially identifable information can be justifed in the public interest. You should seek advice from a Caldicott or data guardian or a legal adviser, who is not directly connected with the use for which the disclosure is being considered, before disclosing personal information without consent. 03 Confdentiality: disclosing information for education and training purposes Endnotes 1 All paragraph numbers in this section refer to our guidance Confdentiality: good practice in handling patient information. You can fnd all of our guidance online at www.gmc-uk.org/ guidance. 2 See our guidance Decision making and consent paragraph 13 which states that you must give patients the information they want or need about their right to refuse to take part in teaching. 3 In this guidance, ‘direct care’ refers to activities that directly contribute to the diagnosis, care and treatment of an individual. The direct care team is made up of those health and social care professionals, who provide direct care to the patient and others, such as administrative staff, who directly support that care. 4 See paragraphs 28–29 of Confdentiality for advice on implied consent. 5 Welfare attorneys, court-appointed guardians and courtappointed deputies have legal authority to make some decisions on a patient’s behalf. For disclosure in the public interest, you will be seeking their views about the patient’s preferences, rather than their consent to disclose. 6 Practical guides on arranging work experience have been published in Wales, Enabling work experience in the health sector in Wales (Careers Wales, 2012), and in England, More than photocopying: Work experience - a toolkit for the NHS (Health Education England Careers, 2015). 7 You can fnd the Information Commissioner’s Offce (ICO) anonymisation code of practice on the ICO website at www.ico.org.uk. 8 Other potential identifers include the patient’s initials, postcode, NHS or CHC number, local identifers (such as hospital numbers), national insurance number, and key dates (such as birthdate, date of diagnosis or date of death). 9 The Academy of Medical Royal Colleges has published guidance on entering information in e-portfolios, which you can fnd on their website at www.aomrc.org.uk/publications/ reports-guidance/academy-guidance-e-portfolios. 04 You can fnd the latest version of this guidance on our website at www.gmc-uk.org/guidance. Confdentiality: disclosing information for employment, insurance and similar purposes 1 In our guidance Confdentiality: good practice in handling patient information we say: it may be relevant to some benefts paid by government departments and to other assessments of a patient’s entitlement to pensions or other healthrelated benefts 115 Third parties, such as a patient’s insurer or employer, or a government department, or an agency assessing a claimant’s entitlement to benefts, may ask you for personal information about a patient, either following an examination or from existing records. In these cases, you should: d offer to show your patient, or give them a copy of, any report you write about them for employment or insurance purposes before it is sent, unless: i they have already indicated they do not wish to see it a be satisfed that the patient has suffcient information about the scope, purpose and likely consequences of the examination and disclosure, and the fact that relevant information cannot be concealed or withheld b obtain or have seen written consent to the disclosure from the patient or a person properly authorised to act on the patient’s behalf. You may accept an assurance from an offcer of a government department or agency, or a registered health professional acting on their behalf, that the patient or a person properly authorised to act on their behalf has consented c only disclose factual information you can substantiate, presented in an unbiased manner, which is relevant to the request. You should not usually disclose the whole record, although ii disclosure would be likely to cause serious harm to the patient or anyone else iii disclosure would be likely to reveal information about another person who does not consent.1 About this guidance 2 One of the core duties of a doctor is to make the care of your patient2 your frst concern. There are, however, many circumstances in which you might be asked to disclose information from existing records or after examining a patient, and in which you face dual obligations. By this we mean that you have obligations both to the patient and to the person or organisation that has requested the information. 01 Confdentiality: disclosing information for employment, insurance and similar purposes 3 This explanatory guidance sets out how the general principles in our guidance Confdentiality apply when patient information is being disclosed in these circumstances. The guidance applies to disclosure of information obtained directly from a patient, or from a patient’s medical record, or from another health professional. It does not apply if your opinions are based solely on information provided by the person or body that is commissioning the opinion. How much information should you disclose? 6 You should only disclose information that is relevant to the request, which means you should not usually disclose a patient’s whole record.4 There are two exceptions to this general rule. n n When do dual obligations arise? 4 Usually, dual obligations arise when a doctor works for, is contracted by, or otherwise provides services to: n n n 5 a patient’s employer (as an occupational health doctor) an insurance company an agency assessing a claimant’s entitlement to benefts n the police (as a police surgeon) n the armed forces n the prison service n a sports team or association.3 Alternatively, a person or organisation you have previously had no direct relationship with, such as your patient’s employer or insurance company, might ask you to provide a medical report or information about a patient. You might be offered payment for your own or your staff’s time and effort, giving rise to an obligation in addition to the one you have to your patient. Beneft claims: the patient’s whole record may be relevant to some benefts paid by government departments or agencies.5 Legal processes: a solicitor may need to see their client’s whole record to assess which parts are relevant, for example, to personal injury claims. If the claim goes ahead, the person against whom the claim is made may ask for copies of important documents, which could include records containing the patient’s medical history. Under court rules in England and Wales, they can see the patient’s whole record and the solicitor should explain this to the patient. In Northern Ireland and Scotland, you should disclose your patient’s record in accordance with their wishes or as ordered by a court.6 Writing reports 7 When writing a report 7 you must: a make sure it is not false or misleading – you must take reasonable steps to check the information in the report is correct, and you must not deliberately leave out relevant information b restrict the report to areas in which you have direct experience or relevant knowledge c make sure any opinion you include is balanced, and be able to state the facts or assumptions on which it is based. 02 Confdentiality: disclosing information for employment, insurance and similar purposes Disclosing a report about a patient Disclosures required by law 8 You do not need to ask for separate consent to release a report following an examination as long as you are satisfed that the patient has given informed consent both for the examination and for the release of any subsequent reports (see paragraph 115 of Confdentiality, which is reproduced at the top of this explanatory guidance). 14 You must disclose information if it is required by law or by the courts. If a disclosure is required by law, you should follow the guidance at paragraphs 87–94 of Confdentiality. If you are not sure whether a disclosure is required by law, you should ask the person or body requesting the information to identify the legal basis, or seek independent legal advice. 9 You should, however, usually offer to show your patient or give them a copy of any report you write about them for employment or insurance purposes before it is sent.8 Disclosures in the public interest 10 If a patient asks you to amend a report, you should correct any errors of fact and any opinion that is based on errors of fact. You should not remove information, opinion or advice if you believe the report would be false or misleading as a result. 11 If a patient withdraws consent for the report to be disclosed, it may be appropriate for you to tell the patient that their decision may lead to adverse consequences for them. For example, the absence of occupational health information could disadvantage the patient in negotiations with their employer. You must, however, abide by the patient’s wishes unless the disclosure is required by law (see paragraph 14) or can be justifed in the public interest (see paragraph 15). 15 Disclosing personal information about a patient without consent may be justifed in the public interest if failure to do so may expose others to a risk of death or serious harm. This could arise, for example, if a patient may pose a serious risk to others through being unft for work or if conditions at work are unsafe.9 If you think that a disclosure may be justifed in the public interest, you should follow the guidance at paragraphs 63–70 of Confdentiality. 12 If a patient withdraws consent for a report to be disclosed, or fails to attend an appointment, you can let the report commissioner know but you should not disclose any further information. 13 When you are satisfed that a report should be disclosed, you should complete and send the report without unreasonable delay. 03 Confdentiality: disclosing information for employment, insurance and similar purposes Endnotes 1 You can fnd Confdentiality: good practice in handling patient information, and the rest of our guidance, online at www.gmc-uk.org/guidance. 2 The term ‘patient’ in this guidance refers to employees, clients, claimants, athletes and anyone else whose personal information you hold or have access to, whether or not you care for them in a traditional therapeutic relationship. 3 Doctors might provide their services to professional sports clubs (where the dual obligation is to both the patient and the club, which is very similar to the dual obligation of an occupational health doctor) or to associations (where the dual obligation is both to the patient and to a governing body or team of selectors). 4 Disclosure of the whole record may breach the principles of data protection law, as the full record may contain information that is excessive and not relevant for the purpose. The Information Commissioner’s Offce (ICO) has advised that it is not appropriate for insurance companies to obtain medical records using patients’ subject access requests. The Access to Medical Reports Act 1988 gives insurance companies a clear and established legal route to access medical information, while safeguarding patients’ rights. You can fnd the ICO statement at https://ico.org.uk/ about-the-ico/news-and-events/news-and-blogs/2015/07/ insurers-using-subject-access-requests-to-see-medicalinformation/. 5 The Department for Work and Pensions publishes advice about reports for benefts purposes. See www.gov.uk/ government/collections/healthcare-practitioners-guidanceand-information-from-dwp. 6 The Law Society and the British Medical Association jointly publish model consent forms authorising the release of health records to solicitors under data protection law. The forms include notes for clients, solicitors and medical records controllers. You can fnd them at www.bma.org.uk/ support-at-work/ethics/confdentiality-and-health-records. 7 See Good medical practice, paragraphs 71–74, which you can fnd at www.gmc-uk.org/guidance. 8 Under the Access to Medical Reports Act 1988, patients are entitled to see a report that has been written about them for employment or insurance purposes by a doctor who is or has been responsible for the clinical care of the individual before it is sent, unless exceptions apply. Patients have the right to ask the doctor to amend any part of the report that the patient considers to be incorrect or misleading, and to attach their disagreement to the report, or to withdraw their consent for the release of the information. These provisions do not apply to reports for benefts purposes. If the patient has no legal right to see the report before it is sent, you should follow the guidance in paragraph 115(d) of Confdentiality, which is reproduced at the start of this explanatory guidance. If any of the exceptions set out in paragraph 115(d) apply, you should still disclose as much of the report as you can. 9 The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 and the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (Northern Ireland) 1997 place duties on employers, the self-employed and people in control of work premises to report certain serious workplace accidents, occupational diseases and specifed dangerous occurrences (near misses). You can fnd out more about these regulations on the website of the Health and Safety Executive (HSE) for England, Wales and Scotland: www.hse.gov.uk, and the website of the Health and Safety Executive for Northern Ireland (HSENI): www.hseni.gov.uk. 04 You can find the latest version of this guidance on our website at www.gmc-uk.org/guidance. Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA 1 In our guidance Confidentiality: good practice in handling patient information we say: 1  Trust is an essential part of the doctorpatient relationship and confidentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think that their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared. 60 Doctors owe a duty of confidentiality to their patients, but they also have a wider duty to protect and promote the health of patients and the public. 62 You should ask for a patient’s consent to disclose information for the protection of others unless the information is required by law or it is not safe, appropriate or 1 practicable to do so. You should consider any reasons given for refusal. 64 If it is not practicable or appropriate to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confidential. 67 Before deciding whether disclosure would be justified in the public interest you should consider whether it is practicable or 1 appropriate to seek consent. You should not ask for consent if you have already decided to disclose information in the public interest but you should tell the patient about your intention to disclose personal information, unless it is not safe or practicable to do so. If the patient objects to the disclosure you should consider any reasons they give for objecting. 68 When deciding whether the public interest in disclosing information outweighs the patient’s and the public interest in keeping the information confidential, you must consider: a the potential harm or distress to the patient arising from the disclosure – for example, in terms of their future engagement with treatment and their overall health b the potential harm to trust in doctors generally – for example, if it is widely perceived that doctors will readily disclose information about patients without consent c the potential harm to others (whether to a specific person or people, or to the public more broadly) if the information is not disclosed d the potential benefits to an individual or to society arising from the release of the information 01 Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA e the nature of the information to be disclosed, and any views expressed by the patient f whether the harms can be avoided or benefits gained without breaching the patient’s privacy or, if not, what is the minimum intrusion. If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining confidentiality, you should disclose relevant information promptly to an appropriate person or authority. information without consent to the DVLA or DVA in the public interest if a patient is unfit to drive but continues to do so. Assessing a patient’s fitness to drive 5 n refer to the DVLA’s guidance Assessing fitness to drive – a guide for medical professionals,4 which includes information about disorders and conditions that can impair a patient’s fitness to drive About this guidance 2 When diagnosing a patient’s condition, or providing or arranging treatment, you should consider whether the condition or treatment may affect their ability to drive safely. You should: Doctors owe a duty of confidentiality to their patients, but they also have a wider duty to protect and promote the health of patients and the public.2 This explanatory guidance sets out the steps doctors should take if a patient’s failure or refusal to stop driving exposes others to a risk of death or serious harm.3 n seek the advice of an experienced colleague or the DVLA’s or DVA’s medical adviser if you are not sure whether a condition or treatment might affect a patient’s fitness to drive.5 Reporting concerns to the DVLA or DVA Fitness to drive: doctors’ and patients’ responsibilities 3 4 6 The Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales and the Driver and Vehicle Agency (DVA) in Northern Ireland are legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a person holding a driving licence has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver. The driver is legally responsible for telling the DVLA or DVA about any such condition or treatment. Doctors should therefore alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency. Doctors may, however, need to make a decision about whether to disclose relevant If a patient has a condition or is undergoing treatment that could impair their fitness to drive, you should: a explain this to the patient and tell them that they have a legal duty to inform the DVLA or DVA b tell the patient that you may be obliged to disclose relevant medical information about them, in confidence, to the DVLA or DVA if they continue to drive when they are not fit to do so c make a note of any advice you have given to a patient about their fitness to drive in their medical record. 7 If a patient is incapable of understanding this advice – for example, because of dementia – you should inform the DVLA or DVA as soon as practicable. 02 Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA 8 9 If a patient refuses to accept the diagnosis, or the effect of the condition or treatment on their ability to drive, you can suggest that they seek a second opinion, and help arrange for them to do so. You should advise the patient not to drive in the meantime. As long as the patient agrees, you may discuss your concerns with their relatives, friends or carers. Endnotes If you become aware that a patient is continuing to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop. If you do not manage to persuade the patient to stop driving, or you discover that they are continuing to drive against your advice, you should consider whether the patient’s refusal to stop driving leaves others exposed to a risk of death or serious harm. If you believe that it does, you should contact the DVLA or DVA promptly and disclose any relevant medical information, in confidence, to the medical adviser. 10 Before contacting the DVLA or DVA, you should try to inform the patient of your intention to disclose personal information. If the patient objects to the disclosure, you should consider any reasons they give for objecting. If you decide to contact the DVLA or DVA, you should tell your patient in writing once you have done so, and make a note on the patient’s record. 1 We give examples of when it might not be practicable to seek consent in paragraph 14 of Confidentiality: good practice in handling patient information. You can find all of our guidance online at www.gmc-uk.org/guidance. 2 See ‘The duties of a doctor registered with the General Medical Council’ in Good medical practice, which you can find at www.gmc-uk.org/guidance. 3 The principles in this guidance also apply to drivers and pilots of other kinds of regulated transport, including rail, water and air, although such individuals are likely to undergo medical assessment as part of the relevant licensing or certificating process. If you are concerned that a patient who holds a private or commercial pilot’s licence may be medically unfit to fly an aircraft, you can contact the UK Civil Aviation Authority’s medical department on 0330 022 1972 for confidential advice or, out of hours, either contact the CAA’s main reception on 0330 022 1500 or email [email protected]. For advice about a seafarer, you can contact the Maritime and Coastguard Agency health and safety branch for advice at seafarers.h&[email protected]. If you are concerned that a train driver’s medical condition or treatment may make them unfit to drive a train, the advice from the Office of Rail and Road (ORR) is to make contact with their employer’s HR department in the first instance. The ORR can provide contact details for train operators in Great Britain if you know the name of the employer. You can contact the ORR by email at [email protected]. 4 You can find this at www.gov.uk/government/publications/ assessing-fitness-to-drive-a-guide-for-medicalprofessionals. 5 You can contact the DVLA’s medical advisers on 01792 782 337 or at [email protected], and the DVA on 0800 200 7861. Responding to requests for information from the DVLA or the DVA 11 If you agree to prepare a report or complete or sign a document to assist the DVLA’s or the DVA’s assessment of a patient’s fitness to drive, you should do so without unreasonable delay. 03 You can fnd the latest version of this guidance on our website at www.gmc-uk.org/guidance. Confdentiality: reporting gunshot and knife wounds 1 In our guidance Confdentiality: good practice in handling patient information we say: 1 Trust is an essential part of the doctorpatient relationship and confdentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think that their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared. 60 Doctors owe a duty of confdentiality to their patients, but they also have a wider duty to protect and promote the health of patients and the public. 62 You should ask for a patient’s consent to disclose information for the protection of others unless the information is required by law or it is not safe, appropriate or 1 practicable to do so. You should consider any reasons given for refusal. 64 If it is not practicable or appropriate to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justifed in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefts to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confdential. 67 Before deciding whether disclosure would be justifed in the public interest you should consider whether it is practicable or 1 appropriate to seek consent. You should not ask for consent if you have already decided to disclose information in the public interest but you should tell the patient about your intention to disclose personal information, unless it is not safe or practicable to do so. If the patient objects to the disclosure you should consider any reasons they give for objecting. 68 When deciding whether the public interest in disclosing information outweighs the patient’s and the public interest in keeping the information confdential, you must consider: a the potential harm or distress to the patient arising from the disclosure – for example, in terms of their future engagement with treatment and their overall health b the potential harm to trust in doctors generally – for example, if it is widely perceived that doctors will readily disclose information about patients without consent c the potential harm to others (whether to a specifc person or people, or to the public more broadly) if the information is not disclosed 01 Confdentiality: reporting gunshot and knife wounds d the potential benefts to an individual or to society arising from the release of the information e the nature of the information to be disclosed, and any views expressed by the patient f whether the harms can be avoided or benefts gained without breaching the patient’s privacy or, if not, what is the minimum intrusion. If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining confdentiality, you should disclose relevant information promptly to an appropriate person or authority. The police also need statistical information about the number of gunshot and knife injuries, and when and where they occur, to inform their own and their crime reduction partners’ operational and strategic priorities. 5 For these reasons, the police should usually be informed whenever a person presents with a gunshot wound. Even accidental shootings involving lawfully held guns raise serious issues for the police about, for example, frearms 2 licensing. The police should also usually be informed when a person presents with a wound from an attack with a knife, blade or other sharp instrument. 6 The police should not usually be informed if a knife or blade injury appears to be accidental, or a result of self-harm. There may also be other circumstances in which you consider that contacting the police is not proportionate. For example, this might be the case if you consider that no one other than the patient is at risk of harm, and that contacting the police might cause the patient harm or distress, or might damage their trust in you or in doctors generally. 7 If you are in doubt about the cause of an injury, you should if possible consult an experienced colleague. About this guidance 2 This explanatory guidance sets out how the principles in our guidance Confdentiality apply when a patient presents with a gunshot wound or a knife wound that is not self-inficted. 3 The principles in Confdentiality and this guidance apply to all violent injuries, but gunshot and knife wounds raise issues that warrant special consideration, given the potential immediacy of risk to others. Reporting gunshot and knife wounds 4 The police are responsible for assessing the risk posed by a member of the public who is armed with, and has used, a gun or knife in a violent attack. They need to consider: „ the risk of a further attack on the patient „ the risk to staff, patients and visitors in the emergency department or hospital „ the risk of another attack near to, or at, the site of the original incident. Making the report 8 If you are responsible for the patient, you should make sure that the police are contacted where appropriate, but you can delegate this task to another member of staff. 9 Personal information, such as the patient’s name and address, should not usually be disclosed in the initial contact with the police. The police will respond even if the patient’s identity is not disclosed. 02 Confdentiality: reporting gunshot and knife wounds Make the care of the patient your frst concern 10 When the police arrive, you should not allow them access to the patient if this will delay or hamper treatment or compromise the patient’s recovery. 11 If the patient’s treatment and condition allow them to speak to the police, you or another member of the healthcare team should ask the patient whether they are willing to do so. If they are not, you, the rest of the healthcare team, and the police must abide by the patient’s decision. Disclosing personal information without consent 12 If it is probable that a crime has been committed, the police will ask for more information. If practicable or appropriate, you should ask for the patient’s consent before disclosing personal information unless, for example, doing so: „ may put you or others at risk of serious harm „ would be likely to undermine the purpose of the disclosure, by prejudicing the prevention, detection or prosecution of a serious crime „ you have already decided to disclose information in the public interest (see Confdentiality: good practice in handling patient information, paragraph 67 on page 1 of this guidance). 13 If the patient refuses consent or cannot give it (eg because they are unconscious), you can still disclose information if it is required by law or if you believe disclosure is justifed in the public interest. 14 Disclosures in the public interest may be justifed when: „ failure to disclose information may put someone other than the patient at risk of death or serious harm (you should not usually disclose information against the wishes of an adult patient who has capacity if they are the only person at risk of harm)3 „ disclosure is likely to help in the prevention, detection or prosecution of a serious crime. 15 If there is any doubt about whether disclosure without consent is justifed, the decision should be made by, or with the agreement of, the consultant in charge or the healthcare organisation’s Caldicott or data guardian. 16 You must document in the patient’s record your reasons for disclosing information with or without consent. You must also document any steps you have taken to seek their consent or inform them about the disclosure, or your reasons for not doing so. 17 Unless it is not practicable or safe to do so, you should tell the patient about any disclosures that have been made as soon as possible after the disclosure. 18 If there is no immediate reason for disclosing personal information in the public interest, no further information should be given to the police. The police may seek an order from a judge or a warrant for the disclosure of 4 confdential information. Children and young people 19 Any child or young person under age 18 years arriving with a gunshot wound or a wound from an attack with a knife, blade or other sharp instrument is likely to raise child protection concerns. Knife or blade injuries from domestic or occupational accidents, or from possible selfharm, might also raise serious concerns about the safety of children and young people. 20 You should follow the advice in Protecting children and young people: The responsibilities of all doctors whenever you are concerned that a child or young person has experienced, or is at risk of, serious harm. 03 Confdentiality: reporting gunshot and knife wounds Endnotes 1 We give examples of when it might not be practicable to seek consent in paragraph 14 of Confdentiality: good practice in handling patient information. You can fnd all of our guidance online at www.gmc-uk.org/guidance. 2 The police are responsible for deciding whether an individual is ft to hold a shotgun or frearms licence. Disclosure of information to the police may be justifed in the public interest to inform this decision if failure to disclose the information may expose others to a risk of death or serious harm. 3 See Confdentiality: good practice in handling patient information, paragraphs 57–59, for further guidance. 4 See schedule 1 to the Police and Criminal Evidence Act 1984, schedule 1 of The Police and Criminal Evidence (Northern Ireland) Order 1989 and section 135 of the Criminal Procedure (Scotland) Act 1995. The police can also use powers to seize evidence, such as clothing, that may help in detecting or prosecuting crime. 04 You can fnd the latest version of this guidance on our website at www.gmc-uk.org/guidance. Confdentiality: responding to criticism in the media 1 In our guidance Confdentiality: good practice in handling patient information we say: 1 Trust is an essential part of the doctor-patient relationship and confdentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think that their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared. About this guidance 2 Doctors are sometimes criticised in print or broadcast media or on social media1 by their patients2 or by someone who is close to, or who represents, a patient. The criticism can include inaccurate or misleading details of the doctor’s diagnosis, treatment or behaviour. 3 Although this can be frustrating or distressing, it does not relieve you of your duty to respect your patient’s confdentiality. This explanatory guidance sets out how the general principles in our guidance Confdentiality apply when doctors are considering how to respond to criticism in the media. in the profession, even if they do not involve the disclosure of personal information without consent. 5 You must not put information you have learned in confdence about a patient in the public domain without that patient’s explicit consent. You should usually limit your public response to an explanation of your legal and professional duty of confdentiality. 6 However, from time to time, media reports or social media discussions might cause patients to be concerned about your practice, or that of a health service you are associated with. In such cases it may be appropriate to give general information about your normal practice. You must be careful not to reveal personal information about a patient, or to give an account of their care, without their consent. If you deny allegations that appear in public media, you must be careful not to reveal, directly or by omission or inference, any more personal information about the patient than a simple denial demands. 7 You should seek advice from your professional or defence body, or from a solicitor, on how to respond to criticism in the media and, if appropriate, any legal redress available to you. Responding to criticism 4 Disclosures of patient information without consent can undermine the public’s trust in the profession as well as your patient’s trust in you. Disputes between patients and doctors conducted in public can also prolong or intensify confict and may undermine public confdence Endnotes 1 See also our guidance Doctors’ use of social media. You can fnd all of our guidance online at www.gmc-uk.org/guidance. 2 In this guidance, ‘patient’ refers to both current and former patients. 01