Consent Policy
Code: A1.2-2
Date: 17/06/2014
Reviewed:
27/03/2020
27/06/2018
07/11/2017
Purpose:
To ensure that informed consent is obtained when patients are undergoing treatment that is potentially harmful, experimental, or for the purposes of research.
To ensure that informed consent is obtained when investigations or issues under discussion are contentious or have current disputed moral or ethical issues.
To ensure that everyone can have appropriate information given to them in a form that suits their needs.
Responsible Staff:
Implementation: Clinical Director
Action: All Clinical Staff, reception staff
Audit: Clinical Director, Practice Nurse.
Audit:
Clinical Director:
Code | Cycle (months) | Criterion | Standard |
A1.2-2.1 | 24 | A review of the currency and validity of consent documentation has been undertaken in the last 2 years including discussion with all clinical staff. | Yes |
A1.2-2.2 | 24 | Any nationally issued guidance has been incorporated into local consent documentation | Yes |
A1.2-2.3 | 24 | A list of current patient information resources has been created or reviewed within the last 2 years months. | Yes |
A1.2-2.4 | 12 | From a randomised sample of 20 procedures performed in the last 12 months, all patients undergoing treatments for which written consent is recommended have such consent recorded in their notes (or an acceptable exception has been recorded) | 90.00% |
Practice Nurse:
Code | Cycle (months) | Criterion | Standard |
A1.2-2.5 | 6 | Supplies of patient information resources have been checked and are sufficient to last 6 months (or replacements have been ordered) | Yes |
Practice Administrator:
Code | Cycle (months) | Criterion | Standard |
A1.2-2.6 | 24 | The practice has completed an appropriate patient satisfaction questionnaire including asking about consent in the last 24 months. | 2% |
Training Resources:
The Code of Health and Disability Services Consumers' Rights 1996
UK Medical Protection Society Guidelines
Linked Policies:
A1.1-1 Code of Health and Disability Services Consumers' Rights
Policy:
We recognise the right of patients to be fully involved in, and aware of the implications of any healthcare decisions which are made with their doctor.
Patients should be encouraged to ask questions about any investigation, diagnosis, procedure or medication.
In order for truly informed consent to occur, sufficient time must be allowed to permit a full and frank discussion of:
- risks
- benefits
- the null option (not undergoing treatment)
In order to ensure that sufficient time is available for discussion, consultations should generally be booked at no less than 15 minute intervals.
Where it would not otherwise compromise access to healthcare for patients, 2 empty appointment slots should generally be allocated per session. This permits flexibility in the amount of time made available for care and consent.
If more time may be needed, patients should be encouraged to return for additional consultation. This method is encouraged as it allows patients to assimilate information and formulate questions without pressure.
Where this is not possible, clinical staff should indicate to reception staff that they need more time, thus permitting more effective waiting time management and removing pressure from the clinician and the patients.
If a clinician feels that cost would be a barrier to the patient returning, then a free or reduced cost consultation may be offered. If possible, funding should be sought for this (eg ECAP, SIA) but if this is not available, We will waive costs.
Consent is not just about understanding the risks. True consent involves a weighing of the risks and benefits of one treatment agains another with as full information as is reasonably possible. The null option, where a patient understands the consequences of choosing no active treatment at all should also be discussed wherever possible.
Consent Forms
Written consent forms detailing the implications of appropriate procedures are made available on the Practice Management System.
Where a written consent form is available, it should be used though it is important to note that verbal consent is as valid as written consent.
Where patients are unable to read, it is acceptable for the consenting clinician to read the form to the patient, or to their representative and to record indication of consent appropriately. Patients able to mark the consent form should be asked to do so to acknowledge receipt of the information.
In every case, once scanned into the record, the patient should be given the original consent form as these usually contain useful aftercare advice.
We do not require written consent for immunisation as written consent marks immunisation as being a procedure with risks similar to surgery, which is clearly inappropriate.
Contentious Testing, Off-Label Prescribing and Alternative Perspectives.
Patients have a right to expect that in general the medical profession as a whole should stand behind and approve of the treatments being offered.
Where medication is prescribed in a dose or for an indication that is not approved in the data sheet, patients should be advised. This is best recorded by issuing an OLC outbox document which formally notifies the patient of their rights in this respect.
Where a practitioner has a perspective that may not be approved of by all, or at least the majority of the medical profession then it is important that patients are informed of this too. There is no practicable way to create an outbox document to cover these situations generally, so practitioners should consider creating resources to share with patients that include an explanation of how their perspective may differ from other practitioners and why they feel that following the alternative course might be more appropriate for the patient.
Contentious testing means testing where there is no widely recognised guideline or where there is dispute within the medical profession about the value or otherwise of the test. Such should be handled with as balanced a perspective as possible so that patients are able to appreciate the potential positive and negative outcomes that might be experienced as a result of choosing to have the test performed or not.
Where resources are given to patients, the resource should be recorded in the clinical record. Web resources should be referenced by copy/pasting the appropriate URL or other reference to the suggested site. This enables both a record of what was said to be maintained and also allows patients to review their records and retrieve the information if required at a later date.
Competence
Thorough information about competence is noted in the training resources however, in general:
Patients are competent when they are able to retain information, understand that information and believe that it is given in their best interests for a sufficient period of time such that they may weigh the consequences of a decision and react appropriately.
Lack of full capacity does not preclude the ability to express treatment preferences. In general, the more complex the matter, the higher the level of capacity required to make a judgement. Managing this is the duty of the consenting clinician, who should record their reasons for believing a patient to be sufficiently competent (or otherwise) to consent as appropriate.
Although the treatment of patients who lack competence is a clinical decision vested in the treating physician, It is good practice to seek the consent of an appropriate advocate for the patient before any procedure. If an Enduring Power of Attorney has been appointed, they would be the ideal person with whom to discuss consent.
Young Patients
For patients under 16 years, who satisfy the competency test, the practice may provide General Medical Services without the consent of a parent or Guardian, provided a valid and reasonable attempt is made to encourage the patient to seek such consent.
We will not perform operative procedures or other irreversible procedures on persons under 16 years of age without the consent of a parent, guardian or legally appropriate advocate, regardless of the client's competence.
Resource Availability and Updating
The Clinical Director shall discuss the content of consent and information resources with all clinical staff.
Staff are encouraged to propose or write new patient information resources which may then be shared. Ideas should be forwarded to the Clinical Director.
The primary resource repository is to be the practice website. Where possible, an easily prinatble version of the resources should be made available, in case patients do not have access to resources.
When practice resources are not available, patients may be directed to patient.co.uk or to specific pages of healthinfo.org.nz.
Change Log:
27/03/2020
Minor wording changes
Addition of comment about patients unable to read.
Checked and updated links
26/08/2018
Minor wording changes, removal of obsolete term Care Plus
07/11/2017
Added section on contentious testing, off-label prescribing and alternative perspectives.
17/06/14
Removed deprecated practice manager role.
Minor rewording.
Addition of further training resources