Consider ethical issues of care record, MDU advises

GPs need to consider going beyond implied consent before allowing patient information to be uploaded to the spine, according to a medical defence body.

The Medical Defence Union has issued new guidance on the Summary Care Record which highlights GPs’ ethical duties. It points out that guidance to GPs from the Department of Health only covers the legal aspects of uploading information to the spine.

The MDU guidance highlights paragraph 10 of the General Medical Council’s guidance Confidentiality: Protecting and Providing Information which states that doctors must ensure that patients are aware about how information they provide will be shared.

The MDU states: “GPs will need to consider, therefore, whether they can rely on implied consent, or whether they need to seek express consent from their patients in order to upload their data onto the summary care record.

“GPs will need to consider a number of things. They will need, for example, to satisfy themselves that the CfH [Connecting for Health] publicity campaign had indeed reached all their patients, that all their patients had read and understood the leaflets and, if the GP had not heard from them, had decided not to seek an appointment with the GP to ask any questions, and not to ‘opt out’.”

Dr John Holden, medico-legal adviser to the MDU, said GPs need to consider whether they could rely on implied consent or whether they needed to seek express consent.

He told EHI Primary Care: “At the very least doctors need to give consideration to the need to go beyond pure simple implied consent.”

The MDU guidance also says that if patients approach GPs to ask for further information about the SCR, they will need to decide whether the information provided to them and their patients answers all the questions they or their patients may have about the scheme. The guidance adds: “If it does not, they will need to contact CfH to clarify any outstanding issues.”

Dr Holden said GPs should also consider their patients on an individual basis and if there were any patients for whom there might be particular difficulties, such as communication problems, they should seek advice from their medical defence organisation on a case by case basis.

The MDU issued its advice following the announcement earlier this month of the start of the SCR with trials at two GP practices in Bolton.

Dr Holden added: “The two pilots will be under intense surveillance and monitored very carefully and closely and as the system evolves things may change. In the meantime though doctors need to be aware that they have this ethical duty of confidentiality and any breach of that could lead to a serious complaint to the GMC.”

Concerns about consent and confidentiality have led some doctors to consider adding the Read code 93C3, refused consent for upload to national electronic shared record, to all patient records. Devon Local Medical Committee is encouraging its members to do so although blanket opting out is not recommended by the BMA.