Protecting Patient Confidentiality

GMC New Guidance on Confidentiality – in force 25 April 2017

Overview

Confidentiality and the circumstances in which confidential patient information may be disclosed is one of the most frequent sources of enquiry from practitioners, whether direct to the GMC or to their defence organisation. After an extensive consultation exercise over two years, the GMC has within the last few days published its new guidance in this area. Due to come into effect from 25 April 2017, the aim, according to the GMC’s new Chief Executive, is for this latest version to provide a “revised, refreshed and restructured” approach to the previous guidance, last updated in 2009. So far the document has been well-received, and this update looks at some of the background and key changes.

Review

Whilst the core principles of confidentiality remain the same, the new guidance takes a fresh look at the application of those core principles in the modern practice setting. The 2017 document focuses on the purpose behind the disclosure of confidential information and its practical application, rather than tying itself to the legal framework behind its disclosure, which was the 2009 guidance. The result is something far more user friendly and approachable.

The four key areas of development in the 2017 update are as follows:

Public protection responsibilities of practitioners, including when to make disclosure in the public interest;
the importance of sharing information in the context of direct patient care, recognising the multi-disciplinary and multi-agency dynamic of modern practice;
circumstances in which practitioners can rely on implied consent to share information for the purposes of direct care;
acknowledgement of the significant role that those close to the patient can play in providing support and care and the importance of recognising that role.

The new guidance is the product of an extensive consultation exercise involving hundreds of practitioners, patients, individuals, and institutions across the UK, overseen by a senior steering group chaired by Professor Jonathan Montgomery, Professor of Health Care Law at University College London.

One of the key differences in the approach taken, and reflected in the guidance, is that the consultation was informed in part by enquiries from practitioners and patients surrounding confidentiality and seeks to clarify and expand upon the issues regularly raised in relation to the 2009 guidance.

The 2017 perspective is designed to reflect the increasingly complex organisational contexts in which practitioners are operating in 2017. The consultation also took into account the significant advances in information technology since 2009, particularly in terms of the shift away from physical records and the use of electronic data, accessible by a variety of key individuals involved in direct care. A further helpful feature is the distinction drawn between disclosure in the context of direct patient care, as opposed to disclosure for some other reason.

Key features of the 2017 guidance:

Restructured to reflect more clearly how patient information is used in everyday practice.
Revised explanatory guidance on situations that can be hard to deal with – such as reporting concerns to the DVLA, and disclosing and reporting gunshot and knife wounds.
New decision making flowchart.
Expanded legal annex and key legislation factsheet.

A useful starting point is the flowchart from pages 19-21, which provides a practical step-by-step guide and which clearly reflects input from the profession and key organisations such as the three medical defence organisations who participated in the consultation, as well as the BMA and the Royal Colleges.

In parallel with the core document are a series of explanatory notes, available on the GMC website, which deal with real examples that practitioners may encounter in practice, such as the reporting of gunshot or knife wounds, reporting to the DVLA and disclosure of information about serious communicable diseases.

The guidance has also been added to new GMC app for practitioners, My GMP, which can be accessed on or offline.

Between now and the launch date of 25 April 2017, the GMC Standards team will be working on revised case studies and scenarios to bring these up to date with the 2017 guidance and refine the existing online materials, and the intention is for the process of review to continue over the months following inception in late April.

Summary

A timely and helpful update to this core area of good medical practice, following a comprehensive review, which so far has been well-received and should be a helpful reference point for healthcare professionals. The new guidance aims to cover most if not all of the scenarios routinely dealt with in practice based on the feedback received during the consultation. However, if practitioners have any queries surrounding the revised guidance or have a practice based scenario they wish to discuss, the starting point after familiarising yourself with the 2017 version should be to speak to your defence organisation in the first instance, and we will also be on hand and delighted to assist at any stage.