The scene

A GP called the MDU advice line. A six-year-old patient from her practice was being treated in hospital for acute leukaemia. The child had responded well to treatment, and the hospital team was planning to discharge her.

During the child's hospital stay, staff on the ward had expressed concern regarding her father's behaviour, which they felt was erratic and occasionally concerning. As part of the discharge planning, the GP was asked to contribute any information she believed might be relevant in the context of child safeguarding.

He said that he would formally complain if any information was shared without his consent.

The GP was aware that the child's father, who was also a patient at her practice, had a history of a significant psychotic illness, which had been stable for many years on medication. She could see from her records that the father had not been ordering medication regularly since the child had become unwell. 

She contacted the father who said that he had been too busy looking after his child to order medication. He refused to attend for assessment, or to allow any disclosure of his medical history to the safeguarding team. He said that he would formally complain if any information was shared without his consent. The GP asked what she should do in this situation.

MDU advice

The adviser reminded the doctor that she should always act in the best interests of children and young people1. At times, this might require a doctor to share relevant information about the child's parent. It is preferable that the parent gives consent if such information is to be shared, but there may be circumstances when consent is withheld, and in which the benefit to the child outweighs the parent's interest in keeping that information confidential2. It appeared that this was the position here.

The doctor was advised to discuss the specifics of the case, while paying due regard to confidentiality, with her local child safeguarding lead and her Caldicott Guardian, and to carefully document their advice. Both agreed that it would be appropriate to disclose information regarding the father's health to the safeguarding team.

The doctor contacted the MDU medico-legal helpline again to discuss the next steps. The adviser suggested that the GP could now justify disclosing information regarding the father's history. He suggested that the GP make a further attempt to obtain consent, and if it was still withheld, that she advise the father that she intended to disclose the information to the safeguarding team, in keeping with GMC guidance3,4. She was advised to disclose the minimum amount of confidential information necessary for the purpose, and to carefully document her reasons for disclosing the information in the patient's notes.

Outcome

The doctor followed the advice. The father was initially unhappy that information regarding his health had been disclosed, but subsequently restarted his medication and his mental health improved. He later expressed his gratitude to the doctor for her frankness and support.

FOOTNOTES

1GMC: 0-18 Years: guidance for all doctors; paragraph 8

2GMC: Protecting children and young people, The responsibilities of all doctors; para 36

3Ibid; paragraph 38

4GMC: Confidentiality, paragraph 37-39


This page was correct at publication on 01/12/2015. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Dr Edward Farnan

Medico-legal adviser

MB BCh BAO LLM FRCGP DGM DCH DRCOG

Dr Farnan graduated from Queen's University, Belfast, in 1995 and completed his GP training in Northern Ireland, practising as a principal in general practice in Armagh for 11 years. He also sat on a research ethics committee, and had a particular interest in clinical governance.

See more by Dr Edward Farnan