Children over 16
Children 16 and over are deemed capable of consenting to medical treatment, and in the same way are usually considered able to agree to the release of their confidential information.
Children under 16
Professional judgement is required when considering disclosure of information about a child under 16 years of age. The overriding consideration for the healthcare professional must always be the best interests of the child.
A child under 16 may be mature enough to understand what is involved in their proposed treatment (that is, the child is Gillick competent). If so, they are also likely to be able to make a decision about the extent to which information relating to that treatment can be provided to others, who may include their parents.
You should ordinarily respect their wishes if they do not want their parents to know. However, you should make every reasonable effort to persuade the child to involve his or her parents or guardians.
Should you decide to disclose information to a Gillick-competent child's parents or guardians against his or her wishes, you should generally tell the child before disclosing the information. This applies in all but very rare cases. Any decision to disclose must be in the child's best interests and you must be prepared to justify your decision.
Children who are not competent
In the case of a child who is not Gilllick competent, the parents or those with parental responsibility should authorise treatment and any disclosure of information on the child's behalf.
The biological mother of a child will automatically hold parental responsibility for the child, as will the father if he was married to the child's mother at the time of the child's birth.
Unmarried fathers named on the birth certificate of children born after 1 December 2003 in England and Wales (15 April 2002 in Northern Ireland and 4 May 2006 in Scotland) will hold parental responsibility. There are other circumstances in which fathers can gain parental responsibility and members may wish to discuss more unusual cases with the MDU.
If you believe a child is the victim of abuse or neglect, you must promptly inform an appropriate person or statutory body, in order to prevent further harm. The information you share should be restricted to what is reasonably necessary to achieve the object of child protection.
Ideally, you should seek the consent of the child or young person (or in the case of children lacking competence, the authority of someone with parental responsibility) unless that would be detrimental to the purpose of the disclosure, or increase the risk of harm to the child, in which case the minimum relevant information should be disclosed without delay.
If you believe disclosure is not in the child's best interests, or are uncertain as to the risk that might exist, you should discuss it with an experienced colleague, such as a designated doctor for child protection.
Local Safeguarding Children Boards
Local Safeguarding Children Boards (LSCBs) are responsible for coordinating the effective safeguarding and welfare of children locally. If a child dies unexpectedly, the LSCB may call you to a meeting to discuss the case. The MDU can advise you on how best you can contribute to the process.
The death of a child in suspicious circumstances may result in a serious case review under Chapter 5 of Working Together to Safeguard Children. The MDU can assist you if you are involved in an investigation after the death of a child in such circumstances.
In either case, you may need to disclose the deceased child's records, but care should be taken not to disclose the notes of other family members without their consent. In some circumstances, you may be justified in disclosing limited information about other family members.
Schools may ask for confirmation that a pupil has attended an appointment at your surgery but this information can only be disclosed with the child's consent or the parent/guardian's authority. You could suggest to the school that the child takes an appointment card with him when he attends an appointment, for his GP to sign.
Your obligation to respect a patient's right to confidentiality, and their express wishes, extends beyond death.
You may disclose limited information to help identify a dead person, or fuller details in certain circumstances, for example, where the information is already a matter of public record.
When a child under 16 dies, you must explain the cause and circumstances of the death to those with parental responsibility seeking information.
Questions and answers
A 14-year old girl presented with an ectopic pregnancy. She had been given the contraceptive pill by the family planning clinic. Two months ago, I prescribed an antibiotic without knowing she was on the pill. She doesn't want her parents to know about either the pregnancy or the treatment. What should I do?
Children under 16 can consent to treatment without parental agreement if they are Gillick-competent. If the patient has the intelligence and maturity to understand the nature, purpose, benefits and risks of the treatment as well as the risk of going untreated, and any alternatives, her consent alone may be valid.
If she has capacity to consent, she very probably has the capacity to give or withhold consent to disclosure of confidential information about the treatment. However, you should take every reasonable step to persuade her to involve her parents. If she refuses, then you may accept her refusal as valid. If the patient wants to involve her parents, you are able to give them a full explanation. If she does not give an indication either way, you must ask for her permission before disclosing any information to the parents.
My patient brought her six-month old son to see me with an infected burn on his leg. He is small for his age and has a worrying collection of bruises over his chest wall which look suspiciously like fingertip bruising. She is unable to account for these marks or for the delay in bringing this to our attention any earlier. I am concerned that she or her partner is abusing this little boy. Am I allowed to breach confidentiality by passing this information on?
If you have reasonable grounds to suspect that a child is being abused then your duty of care to the child means that you should tell the appropriate authorities without delay, so that the child can be protected. You should take care that any disclosure is made to the appropriate responsible person or statutory agency and that the information provided is the minimum necessary.
This guidance was correct at publication 10/11/2017. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.