The importance of medical confidentiality is well known. It’s mentioned in the Hippocratic oath and emphasised throughout medical school. A confidential relationship enables patients to trust and confide in doctors, so we can provide the best care for them. However in the UK medical confidentiality is not absolute (though in some other countries there are tighter restrictions on what is disclosed).
The GMC provides guidance in its booklet, Confidentiality: good practice in handling patient information. This covers a broad range of situations when doctors may need to consider whether their duty of confidentiality to the patient is outweighed by other factors. Let’s look specifically at the situations where you will be expected to disclose patient information to the police, and how to go about doing that.
Under section 38B of the Terrorism Act 2000, all citizens (including doctors) must tell the police if they become aware of information that they believe would help prevent a terrorist act, or secure the arrest or prosecution of someone involved in terrorism. It is a criminal offence not to tell the police 'as soon as is reasonably practicable' in these circumstances, and conviction could result in a fine or up to five years in prison.
Requests for patient information should always be considered carefully.
Knife and gunshot wounds
The GMC advises that a gunshot wound or injury sustained from an attack with a knife, blade or sharp instrument, must be reported to the police whenever a victim arrives at hospital. Accidental injury from, or self-harm with, a knife or blade will not usually require notification. Identifying details such as name and address should usually only be disclosed with the patient's consent. If the patient refuses, the information may only be disclosed if you consider it is in the public interest, or you are required to by court order.
Either of these scenarios might need urgent police attendance in which case use of the 999 service may be appropriate. The treating doctor will need to ensure the police are contacted, but it may be reasonable to delegate this task to another member of staff while the doctor attends to the patient.
Female genital mutilation (FGM)
FGM has been a crime in the UK since 1985 and it’s also an offence to take a child out of the country to have the procedure done. Since 31 October 2015, healthcare professionals in England and Wales who 'discover' an act of FGM appears to have been carried out on a girl under the age of 18 have a legal duty to notify the police.
'Discovery' in this context arises if a girl tells you she has been subjected to FGM, or if you observe physical signs indicating FGM has taken place, not arising from surgery necessary for her physical or mental health, or arising from labour or childbirth.
Find out more about FGM guidance for doctors.
The Home Office recommends using the 101 non-emergency police number (although the report can be made in writing). Provide your name, contact details, role and place of work, the girl's name, age and address, and why the report is being made. You should also tell the police what safeguarding action has been undertaken, or will be undertaken, and check your safeguarding lead is updated. Best practice would be for this to be done by the end of the next working day, but the act requires that the notification is made within 28 days of the discovery.
If you're told by a third party that a girl has undergone FGM, the mandatory obligation to report doesn't apply. You should, however, ensure you follow local safeguarding procedures.
Road traffic accidents
Section 172 of the Road Traffic Act 1988 allows the police, under certain circumstances, to require information from anyone, including doctors, which may lead to the identification of a driver alleged to have committed a road traffic offence. It is an offence to fail to comply with such a request. You are only required to give information to allow identification of the driver, and this would not normally involve disclosure of any clinical details.
In some circumstances the police can require disclosure of information via court order or production order. As its unlikely you will have seen such a document before, you may wish to seek advice to check the document is valid and applicable to you before disclosing.
It’s not always straightforward
Requests for patient information should always be considered carefully. Beyond these few situations where you are obliged to give information to the police, there are other scenarios where disclosure may be in the public interest so seek advice if you are not sure. These decisions can be complex and subtle. For example, in our experience the police often quote data protection legislation which permits disclosure of patient information for the purposes of the detection, prevention and prosecution of crime but the law does not require it.
In NHS Trusts, there will be a Caldicott Guardian who can guide you. In primary care, every practice will have a data protection officer who may able to help. As an MDU member you can always seek advice from us on our 24 hour helpline where our experienced team will assist you with your specific query.