The purpose of this protocol is to set out the Practice’s approach to consent and the way in which the principles of consent will be put into practice.
Where possible, a clinician must be satisfied that a patient understands and consents to a proposed treatment, immunisation or investigation. This will include the nature, purpose, and risk of the procedure, if necessary by the use of drawings, interpreters, videos or other means to ensure that the patient understands, and has enough information to give ‘informed consent’.
Implied consent will be assumed for many routine physical contacts with patients. Where implied consent is to be assumed by the clinician, in all cases, the following will apply:
- An explanation will be given to the patient what he/she is about to do, and why.
- The explanation will be sufficient for the patient to understand the procedure
- In all cases where the patient is under 18 years of age a verbal confirmation of consent will be obtained and briefly entered into the medical record
- Where there is an increased risk to the patient because of the nature of the procedure an ‘Expressed Consent’ will be obtained. (see below)
Expressed consent (written or verbal) will be obtained for any procedure which carries a risk that the patient is likely to consider as substantial. A note will be made in the clinical record detailing the discussion about the consent and the risks. A consent form may be used for the patient to express consent.
Written consent will be obtained for:
- Incision or excision procedures
- The clinician will ensure that the patient is competent to provide a consent (16 years or over) or has ‘Fraser Competence’ if under 16 years. Consent will include the provision of all information relevant to the treatment. (see appendix 1)
- Questions posed by the patient will be answered honestly, and information necessary for the informed decision will not be withheld unless there is a specific reason to withhold. In all cases where information is withheld then the decision will be recorded in the clinical record.
- The person who obtains the consent will be the person who carries out the procedure (i.e. a nurse carrying out a procedure will not rely on a consent obtained by a nurse unless the nurse was present at the time of the consent)
- The practice acknowledges the right of the patient to refuse consent, delay the consent, seek further information, limit the consent, withdraw consent or ask for a chaperone
- The person obtaining consent will be fully qualified and will be knowledgeable about the procedure and the associated risks
- The practice will review consent in the light of changing patient circumstances and where appropriate re-visit the consent with the patient
- No alterations will be made to a consent form once it has been signed by a patient
- Clinicians will ensure that consents are freely given and not under duress (e.g. under pressure from other present family members etc.)
- If a patient is mentally competent to give consent but physically unable to sign the consent form, the clinician should sign the form as usual, and ask an independent witness to confirm that the patient has given consent orally or non-verbally
Other aspects which may be explained by the clinician include:
- Details of diagnosis, prognosis, and implications if the condition is left untreated
- Options for treatment including the option not to treat
- Details of any subsidiary treatments (e.g. pain relief)
- Patient experiences during and after the treatment, including common or potential side effects and the recovery process
- Probability of success and the possibility of further treatments
- The option of a second opinion
Informed consent must be obtained prior to an immunisation of a registered patient. There is no legal requirement for consent to immunisation to be in writing but patients not registered with the practice who attend for vaccinations privately will be asked to complete a consent form.
People with Parental Responsibility for Consent
There are only certain persons who are legally permitted to give consent for a child. (for e.g. vaccinations) This consent can be written or verbal.
These people are:
- Both the child’s parents if they were married to each other at the time of conception or birth AND are still married to each other at the time of consultation
- An unmarried genetic father who has acquired parental responsibility via a court order or parental responsibility order
- A genetic father who has married the mother after the birth of the child and is still married to her
- The child’s legal appointed guardian
- A person who has been given a residence order by a court regarding the child
- A local authority designated to have a care order for the child by a court
- A local authority or anyone having an emergency protection order in respect of a child
- Grandparents, foster parents and child minders cannot give consent unless they hold a legally binding court order as above
It is considered good practice for doctors and other health professionals to follow the criteria commonly known as the ‘Fraser Guidelines’:
- The young person understands the health professionals advice
- The health professional cannot persuade the young person to inform his or her parent to allow the doctor to inform the parents that he or she is seeking contraceptive advice
- The young person is very likely to begin or continue having intercourse with or without contraceptive treatment
- Unless he or she receives contraceptive advice or treatment, the young person’s physical or mental health or both are likely to suffer;
- The young person’s best interests require the health professional to give contraceptive advice, treatment or both without parental consent