Disclosure for local clinical audit

Background

Dr Khalid is a GP in a three-partner practice, and has a special interest in diabetes care. He would like to conduct a local clinical audit of Type 2 diabetes patients, with a view to increasing the number of patients who attend for regular assessment and ensuring that their other reviews (retinal screening, HbA1c) are up to date.

Scenario

The diabetes service is under pressure and Dr Khalid is considering bringing in a nurse on a short-term temporary contract, to assist with the clinics and to carry out the audit.

However, he is worried that patients would be unhappy if they discovered that a temporary member of staff had been given access to their confidential medical records.

The purpose of the audit is to assure and improve the care of a particular group of patients of the practice. But Dr Khalid reflects that, in his experience, most patients do not know very much, if anything, about local clinical audit.

While he thinks they would probably recognise the potential benefits for their own current and future health, they might nevertheless be uneasy about a use of their confidential medical information that they were not led to expect. Overall, he considers it unwise to proceed on the basis of too many assumptions.

What the doctor did

A few weeks prior to setting up the local clinical audit, Dr Khalid arranges for a poster to be placed in the practice waiting rooms – ‘Local clinical audit – what does it mean for you’?

The poster outlines the purpose and benefits of local clinical audit, makes clear that the audits are carried out by both temporary and permanent practice staff and that patient information will not be shared more widely.

The poster also explains that, if a patient has any questions or objections, they should speak to the practice manager, a nurse or a GP. Dr Khalid also asks the practice manager to update the ‘How we use your confidential information’ sections of the practice website and leaflet along the same lines. This results in a handful of questions but no formal objections.

Dr Khalid considers whether it might be possible to carry out the Type 2 diabetes audit using anonymised information, but concludes that this would be time consuming and impractical, and from the point of view of arranging follow-up with patients, undesirable. 

He is satisfied that the nurse brought in to do the work would be, for the period of their contract, working to support direct patient care and the confidentiality clause in their contract would provide assurance of probity, as would the fact that nurses are regulated professionals.

What the doctor had to consider

• All doctors in clinical practice have a duty to participate in clinical audit (paragraph 96).

• If an audit is to be carried out by the team that provided or are providing care, or those working to support them, such as clinical audit staff, doctors may disclose personal information about patients on the basis of their implied consent, provided that they:

• have ready access to information explaining how their information will be used, and that they have a right to object
•  have not objected (paragraph 88).

• Doctors are expected to satisfy themselves that any staff they manage (including administrative staff) are trained to understand their information governance responsibilities. Doctors with relevant responsibilities are also expected to make sure that employment contracts they are responsible for contain obligations to protect confidentiality (paragraph 123).