Criterion C2.2 – Presence of a third party during a consultation

Why this is important

Obtaining prior consent for the presence of a third party during a consultation means that the practice is complying with privacy laws and the patient’s confidentiality rights.

Documenting the presence of a third party in the patient’s health record also means that there is an accurate record of who was present during the consultation.

Meeting this Criterion

Prior consent to the presence of a third party arranged by the practice

Before the consultation commences, the practice must ask the patient if they consent to having a third party introduced by the practice present during the consultation. Third parties can be interpreters, registrars, chaperones/observers, and medical, allied health or nursing students on placement.

If a patient has previously given prior consent to have a third party present, you must still check that the consent remains valid at the beginning of the consultation.

If a student, nurse, or other health professional is to be present during the consultation (whether they are going to observe, interview or examine), the practice must seek the patient’s permission when the patient makes an appointment, or, failing that, when the patient arrives at reception.

It is not acceptable to ask permission in the consulting room, as some patients may not feel comfortable refusing consent in the presence of the third party, and therefore agree even if they would prefer not to. Practitioners must record in the consultation notes that the patient has consented to the presence of a third party.

It may be necessary to later identify any third parties that were present during a consultation. For this reason, details of the third party must be recorded so that they can be linked back to the consultation and subsequently identified if required. For example, you could identify the third party by reference to their role (eg nurse, medical student) or initials. Your medical defence organisation can provide advice on how your practice can develop a system for recording the presence of third parties in a consultation.

Chaperones and observers

In a general practice setting, there are a number of situations where a practitioner or a patient may wish, or need, to have a chaperone present during a consultation. The practice must clearly document the presence of a chaperone. If the practitioner requests the presence of a third party for this purpose, they must obtain and document prior consent from the patient. Details of the chaperone must be recorded so that they can be subsequently identified if required. If the patient declines the offer of a chaperone, it is a good idea to document this.

Patients not able to provide consent

If a patient is unable to provide consent (eg they have intellectual disability), the practice must seek consent from a legal guardian or advocate who has been appointed to oversee the interests of the patient.

Third parties who accompany the patient

When a patient is accompanied to the practice by a third person (such as a family member or carer), it may be appropriate to record the presence of the third party in the consultation notes.

In some circumstances, a patient might give consent to the presence of a third party during a consultation but it might not always be given freely (eg when a patient is in a violent relationship). The practitioner needs to consider whether it is appropriate for the third party to remain present for the consultation.

Meeting each Indicator

C2.2 A Our practice obtains and documents the prior consent of a patient when the practice introduces a third party to the consultation.

You must:

You could:

• maintain a policy about the presence of a third party during a consultation
• include information about the third-party policy in the induction manual for the practice team
• place signs in the waiting room when medical or nursing students are at the practice and observing consultations
• document the identity of a chaperone.