The purpose of the Policy is to set out the obligations for all working at Horizon Health Centre concerning the confidentiality of information held about patients and Horizon Health Centre.
This protocol is relevant to all employers and anyone who works at Horizon Health Centre including non-clinical staff. Individuals on training placements and visitors/observers on the premises must also adhere to this.
This protocol will be reviewed annually to ensure that it remains effective and relevant.
Importance of confidentiality
Confidentiality is a fundamental part of health care and crucial to the trust between doctors and patients. Patients entrust their practice with sensitive information relating to their health and other matters in order to receive the treatment and services they require. They should be able to expect that this information will remain confidential unless there is a compelling reason why it should not. All staff in the NHS have legal, ethical and contractual obligations of confidentiality and must ensure they act appropriately to protect patient information against improper disclosure.
Some patients may lack the capacity to give or withhold their consent to disclosure of confidential information but this does not diminish the duty of confidence. The duty of confidentiality applies to all patients regardless of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.
Information that can identify individual patients must not be used or disclosed for purposes other than healthcare unless the patient (or appointed representative) has given explicit consent, except where the law requires disclosure or there is an overriding public interest to disclose. All patient identifiable health information must be treated as confidential information, regardless of the format in which it is held. Information which is effectively anonymised can be used with fewer constraints.
The confidentiality of other sensitive information held about the practice and staff must also be respected.
We are working together with other local practices to offer patients access to more appointments in the early mornings, evenings and at weekends. To find out more about these services, please contact the practice.
Community Pharmacist Referral Pathway Pilot
All staff must:
It is expected that members of staff will comply with the law and guidance/codes of conduct laid down by their respective regulatory and professional bodies.
When a decision is taken to disclose information about a patient to a third party due to safeguarding concerns/public interest, the patient should always be told and asked for consent before the disclosure unless it would be unsafe or not practical to do so.
In the circumstances that consent cannot be sought, then there must be clear reasons and necessity for sharing the information.
Disclosures of confidential information about patients to a third party must be made to the appropriate person or organisation and in accordance with the principles of the Data Protection Act 1998 (Annex 1), the NHS Confidentiality Code of Practice (see below) and the GMC’s Good Medical Practice.
Obligations for employers
The employers at the practice must:
The purpose of this protocol is to set out the Horizon Health Centre’s approach to consent and the way in which the principles of consent will be put into practise. It is not a detailed legal or procedural resource due to the complexity and nature of the issues surrounding consent.
Where possible, a clinician must be satisfied that a patient understands and consents to a proposed treatment, immunisation or investigation. This will include the nature, purpose, and risks of the procedure, if necessary by the use of drawings, interpreters, videos or other means to ensure that the patient understands, and has enough information to give ‘Informed Consent’.
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Implied consent will be assumed for many routine physical contacts with patients. Where implied consent is to be assumed by the clinician, in all cases, the following will apply:
Expressed consent (written or verbal) will be obtained for any procedure which carries a risk that the patient is likely to consider as being substantial. A note will be made in the medical record detailing the discussion about the consent and the risks.
Other aspects which may be explained by the clinician include:
Informed consent must be obtained prior to giving an immunisation. There is no legal requirement for consent to immunisation to be in writing and a signature on a consent form is not conclusive proof that consent has been given, but serves to record the decision and discussions that have taken place with the patient, or the person giving consent on a child’s behalf.
Consent for children
Everyone aged 16 or more is presumed to be competent to give consent for themselves, unless the opposite is demonstrated. If a child under the age of 16 has “sufficient understanding and intelligence to enable him/her to understand fully what is proposed” (known as Fraser Guidelines), then he/she will be competent to give consent for him/herself.
When consent is not necessary
There are a few exceptions when treatment can go ahead without consent.
Where an adult patient does not have the capacity to give or withhold consent to a significant intervention, this fact should be documented in Mental Capacity Assessment Form (Appendix 1); why the health professional believes the treatment to be in the patent’s best interests, and the involvement of people close to the patient.
The standard consent forms should never be used for adult patients unable to consent for themselves. For more minor interventions, this information should be entered in patient notes.
An apparent lack of capacity to give or withhold consent may in fact be the result of communication difficulties rather than genuine incapacity. You should involve appropriate colleagues in making such assessments of incapacity, such as specialist learning disability teams and speech and language therapists, unless the urgency of the patient’s situation prevents this. If at all possible, the patient should be assisted to make and communicate their own decision, for example by providing information in non-verbal ways where appropriate.