Inferred or express consent
Verbal or written consent might be:
- express – when a patient signs or clearly expresses their agreement
- inferred (or ‘implied’) – where the circumstances imply the patient has consented.
Express consent should be sought wherever practical and/or where significant clinical risk is possible (eg before a procedure or surgery). A signed form is an example of express consent, but an informed and well-documented discussion with a patient might equally comply with this requirement.
Inferred consent should only be used when express consent cannot be obtained. GPs must not overestimate the scope of inferred consent. For example, it is reasonable to infer a patient’s consent to their records being collected and used during repeat consultations. However, this consent would not necessarily extend to the disclosure of that information to third parties; for example, sharing health summaries within referral letters to other medical professionals.
GPs should also be wary of taking silence or a lack of objection as an indicator of consent; if there is any doubt, GPs should obtain express consent.
It is recommended consent conversations are thoroughly documented, within a patient’s medical record. Problems might arise if a patient does not understand the potential uses of their health information. Where GPs must establish implied consent, comprehensive consultation notes are essential. These notes should include the information provided, the nature of the discussion and the patient’s response.
Consent in group practices
- In group practices that allocate GPs to see patients based on availability, a patient’s health information will be disclosed to and used by whichever GP sees the patient.
- New patients must be made aware of this rolling or rotating use of GPs. Patients should be made aware of the consulting GP when booking their appointment. It is reasonable to infer consent to the use and disclosure of the patient’s health information in this context if the patient does not otherwise object to seeing the allocated GP.