Avoid unwarranted disclosure in referrals

There is much to digest in the new revised GMC guidance on patient confidentiality (link below), and MDDUS encourages members to read the document carefully. One common pitfall in this area was highlighted in a recent call to our advice line.

A patient had attended a member’s practice seeking referral for elective surgery. The GP wrote the letter and forwarded medical records to the specialist but in doing so disclosed an unrelated medical condition. This prompted a complaint from the patient.

The GMC confirms in its new guidance on confidentiality that appropriate information sharing is essential to the efficient provision of safe, effective care, both for the individual patient and for the wider community of patients. But it also states: "When disclosing information about a patient, you must… keep disclosures to the minimum necessary".

In providing patient referrals doctors should only include personal information relevant to the medical condition being treated. Be aware that inadvertent inclusion of personal details that a patient may not want disclosed in a referral is a much greater risk today with most patient information now being held in easily transmissible electronic form.

Ensure that your practice systems for referrals take account of this risk. Disclosure of confidential information unnecessarily or improperly can expose practitioners to possible civil actions or disciplinary proceedings, or prosecution under the Data Protection Act.

ACTION Ensure that patient referral letters provide only details relevant to the specific medical condition being treated. Including other unrelated details may be judged as a breach of patient confidentiality.

Link: GMC guidance for doctors: Confidentiality