Manager


Practice


CALL LOG


A


The duty of confidentiality extends beyond a patient’s death and the presumption should be that personal information remains confidential unless there is a good reason for disclosure. The GMC provides guidance on the disclosure of records (Confidentiality) and paragraph 35 describes circumstances when you may disclose relevant information about a patient who has died. Such instances are when required by law or when necessary to meet a statutory duty of candour. In other circumstances, the extent of the personal information disclosed will depend on the facts of the case. A patient may have asked that certain information remains confidential and you should usually abide by those wishes. Otherwise, you should take into account whether disclosing the requested information is likely to cause distress to, or be of benefit to, the patient’s partner or family – and the purpose of the disclosure. A person with right of access to a deceased patient’s records under the Access to Health Records Act 1990 can include a personal representative or executor of the patient’s will – but the Act does not guarantee full unredacted access to the records should there be third-party or potentially harmful information. In this particular case, the practice will need to decide whether providing the husband with details of a previous termination would have been what the patient would have wanted. You should consider the nature and purpose of the request and avoid providing information which may cause serious harm. In this case, there may be an argument that, given the patient has not previously disclosed this sensitive information, she may have wished it to remain confidential after her death. If information is not disclosed, the decision can be challenged in court.


RUMOUR OF ILLEGALITY Q A


The practice has received an anonymous letter claiming that a patient has been selling on their prescription medication. A GP has discussed the matter with the patient who denies the allegation – however the doctor remains suspicious. How should we proceed?


This is a difficult situation as the claim is hearsay and cannot be substantiated.


You should consult GMC guidance on Confidentiality, which states: “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.” The guidance goes on to explain that there can be a public interest in disclosing information to protect individuals or society from risks of serious harm. “Such a situation might arise, for example, if a disclosure would be likely to be necessary for the prevention, detection or prosecution of serious crime, especially


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crimes against the person.” The practice should consider trying to seek consent to disclose the concern raised (although this is clearly unlikely to be given). The conversation will, however, prompt a discussion about this issue and may help clarify whether the patient is using the medication appropriately. If the practice considers that a serious crime may have occurred or might occur in the future, there could be a public interest to disclose the minimum information necessary to allow the police to initiate an investigation, The patient should be informed of this intention to disclose, unless doing so would increase risks to any individual or compromise the investigation. If the public interest is not outweighed by the patient’s duty of confidentiality and the information is not disclosed, this should be documented, along with the rationale.


PATIENT MEDICAL HISTORY Q


Our dental practice asks patients to complete a medical history form at every six-month check-up. At visits in between, our clinicians only ask if there have been any changes in the medical history. One of our dentists feels this is not sufficient and believes important information might be missed. He would prefer patients to fill in a new PMH form at every visit. What is most appropriate?


A


MDDUS advises


that patients should


complete a new


medical history every six months,


signing and dating it as


appropriate. The practice should have a system in place for checking patients attending in between the six- month timeframe. This should refer to the uploaded form and prompt the dentist or DCP to verify the information and ask about any changes, particularly in medication. Any changes should be noted, the form dated and initialled by the patient and the treating clinician (or by other means on an electronic form).


VOICEMAIL MESSAGES Q


Can you provide some clarification regarding the question of


confidentiality when leaving messages on patients’ voicemail? Some partners at our practice leave messages asking a patient to contact the surgery but others will leave no message at all. What is best practice?


A


It would be appropriate for your medical/nursing colleagues to use their


discretion regarding leaving a message. There may be consent in place to do so, or they may have significant concern for the patient’s health and wellbeing. Leaving a message on a patient’s voicemail in such circumstances could certainly be justifiable. If there is no clinical need to leave a message and doing so might disclose information to someone other than the patient, it is not usually appropriate nor necessary to record such a message.


CLINICAL IMAGES VIA SMARTPHONE Q A


Clinical staff in our practice are using mobile phones to photograph patient wounds in order to assist with ongoing care. These photographs are being emailed and then uploaded to the patient records. Concerns over data protection have been raised by some staff. Where do we stand?


The GMC provides guidance on Making and using visual and audio recordings


of patients which states that any recording made as part of the patient’s care forms part of the medical records and should be treated in the same way as written material in terms of security and disclosure. The patient must agree to this way of monitoring their condition (i.e. informed consent must have been obtained). Confidentiality must also be safeguarded, with digital photographs safely stored and secured. The Information Commissioner’s Office (ICO) provides


guidance in regard to the use of


personal devices by staff and the practice should consider which types of personal data may be


processed by staff on their own mobile phones. A mobile phone issued by the practice for general use would clearly be preferable, and you may find that your LMC has considered the practicalities of this issue. The NHS Information Governance Toolkit advises that data on portable devices should be encrypted and this may not be the case with a personal phone used to record patient images. How the images are relayed to the practice is also important, as using personal email might raise significant concerns with the GMC and the ICO. Any images of patients should be deleted from the portable device as soon as practical. They should also not be inadvertently uploaded to cloud storage and the information processing must meet GDPR requirements. Overall, it is probably more appropriate for a secure and practice- based system of clinical image capture and storage to be used.


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