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Consent Policy

THE NEW HALL LANE PRACTICE

 

CONSENT PROTOCOL

 

Introduction

 

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 practise.  It is not a detailed legal or procedural resource due to the complexity and nature of the issues surrounding consent.

 

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 risks 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

 

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, any 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 a significant risk to the patient an “Expressed Consent” will be obtained in all cases (see below).

 

Expressed Consent

 

Expressed consent (written or verbal) will be obtained for any procedure, which carries a risk that the patient is likely to consider as being substantial.  A note will be made in the medical record detailing the discussion about the consent and the risks.  A Consent Form may be used for the patient to express consent and is always used by the Practice when carrying out any minor surgery.

 

Obtaining Consent

 

·         Consent (Implied or Expressed) will be obtained prior to the procedure, and prior to any form of sedation.

 

·         The clinician will ensure that the patient is competent to provide a consent (16 years or over) or has “Gillick Competence” if under 16 years.  Further information about Gillick Competence and obtaining consent for children is set out below.

 

·         Consent will include the provision of all information relevant to the treatment.

 

·         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 doctor unless the nurse was present at the time of the consent).

 

·         The person obtaining consent will be fully qualified and will be knowledgeable about the procedure and the associated risks.

 

·         The practice acknowledges the right of the patient to refuse consent delay the consent, seek further information. Limit the consent, or ask for a chaperone.

 

·         Clinicians will use a Consent Form where procedures carry a degree of risk or where, for other reasons, they consider it appropriate to do so (e.g. malicious patients).

 

·         No alterations will be made to a Consent Form once a patient has signed it.

 

·         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 is physically unable to sign the Consent Form, the clinician should complete the Form as usual, and ask an independent witness to confirm that the patient have given consent orally or non-verbally.

 

Other aspects which may be explained by the clinician include:

 

·         Details of the diagnosis, prognosis, and implications if the condition is left untreated

 

·         Options for treatment, including the option not to treat.

 

·         Details of any subsidiary treatment (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.

 

Immunisations

 

Informed consent must be obtained prior to giving an immunisation.  There is no legal requirement for consent to immunisation to be in writing and a signature on a consent form is not conclusive proof that consent has been given, but serves to record the decision and discussions that have taken place with the patient, or the person giving consent on a child’s behalf.

 

Consent for children

 

Everyone aged 16 or more is presumed to be competent to give consent for himself or herself, unless the opposite is demonstrated.  If a child under the age of 16 has “sufficient understanding and intelligence to enable him/her to understand fully what is proposed” (known as Gillick Competence), then he/she will be competent to give consent for him/herself.  Young people aged 16 and 17, and legally ‘competent’ younger children, may therefore sign a Consent Form for themselves, but may like a parent to countersign as well.

 

For children under 16 (except for those who have Gillick Competence as noted above), someone with parental responsibility should give consent on the child’s behalf by signing accordingly on the Consent Form.

 

The Gillick Judgement (Fraser Guideline)

 

This concluded that a doctor would be justified in proceeding without the parents’ consent or knowledge to give contraceptive advice, prescribe the contraceptive pill or fit a contraceptive device to a girl under the age of 16 if:

 

·         The young person understands the health professional’s advice

·         The health professional cannot persuade the young person to inform his or her parents or 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, is likely to suffer.

·         The young person’s best interests require the health professional to give contraceptive advice, treatment, or both, without parental consent.

 

Gillick Competence

 

This concept regards the consent of a child under 16 being regarded as valid where the above criteria are met.  Children under 16 can consent to treatment only if they understand its nature, purpose and hazards.   To be able to consent the child should fully understand and appreciate the consequences of the treatment and equally failure to treat.

 

Parental responsibility

 

Under the Children Act 1989, parents have a parental responsibility for their children which is defined as:

“…all rights, duties, powers, responsibilities and authority which by law a parent has in relation to the child and his property…”

 

N.B. The natural father of a child, who was not married to the mother at the time of the child’s birth, will not have parental responsibility unless this is acquired under section 4 of the Children Act, either by agreement with the mother or court, or by marrying the mother.

 

In the absence of the parents, another relative or other person in loco parentis should be consulted, if possible.  But essential treatment should not be delayed if their authority is not obtained.

 

If a child under 16 is capable of consenting to treatment and does so, treatment may proceed.  If a competent child under the age of 16 refuses treatment, it will not necessarily override authorisation given by someone who has parental responsibility for the child or the court.  In such circumstances consider the age and emotional development of the child, the nature of the condition and the consequences to the child of the proposed treatment, and the effect on the child of the imposition of treatment against the child’s wishes.

 

If a failure to treat would result in death or permanent injury, it is concluded that in spite of the child’s refusal, treatment is justified in their best interests.

 

Parental refusal of treatment

 

When a child is not considered “Gillick competent” it may be unlawful for a doctor to continue with treatment against the wishes of the child’s parent or guardian.  It is important to ensure parental authority is obtained before giving immunisations.

 

There are cases where the parents’ wishes conflict with reasonable medical practice and are not in the best interests of the child.  Consider carefully whether the treatment should be given against the parents’ wishes – a second opinion is strongly advised.  Consider how appropriate and available alternative measures are and make a record of the assessment and decision in the patient’s clinical notes.  The views of the parents will be an important factor in the decision.

 

Termination of pregnancy

 

The MDU has been advised that when a girl is under 16, her parents should be consulted unless the girl forbids you to do so.  You should obtain the patient’s consent and the written authority of the parents.  But their refusal should not prevent a lawful termination to which the patient herself consent, if the doctor is satisfied that the patient is mature enough to understand the nature of the operation, common complications and the issues involved.

 

Children in care

 

When a child is the subject of a care order, the local authority has parental responsibility under the Children Act, and can authorise treatment on the child’s behalf.  But the order does not deprive parents of their parental responsibility or their ability to authorise or refuse treatment.  The act makes it clear that the local authority has the power to decide the extent to which a parent or guardian may meet his responsibility

 

 

 

   

CONSENT FORM

 

PATIENT’S DETAILS

 

Name ………………………………………………………....

 

NHS NUMBER ………………………………………………

 

 

THIS SECTION FOR COMPLETION BY THE GP

 

This form has been prepared for the treatment, investigation or operation details below:

 

…………………………………………………………………………………………….

 

…………………………………………………………………………………………….

I confirm that I have explained the above treatment, investigation or operation to the patient, and such options as are appropriate, e.g. the type of anaesthetic (if any) proposed, in terms that in my judgement are suited to their understanding – and/or these have been explained to the parent or guardian of the patient.

 

Signature ………………………………………….  Date ………………………………..

 

Name of GP completing the procedure Dr ………………………………………………..

 

 

THIS SECTION FOR COMPLETION BY THE PATIENT/PARENT/GUARDIAN

 

1.       I am the patient / parent / guardian  (delete as necessary)

 

2.       I agree to the procedure(s) proposed on this form and the doctor named on this form has explained this to me.

 

3.       I agree to have the type of anaesthetic (local / sedation) that has been explained to me.

 

4.       I understand that any procedure, in addition to that described on this form, will only be carried out if it proves to be necessary, in my best interests and can be justified for medical reasons.

 

5.       I have notified the doctor of the following allergies which may be relevant to my treatment.

 

       …………………………………………………………………………

 

Signature of Patient/Parent/Guardian: …………………………………………………………………………………………………………..

 

Full Name of Patient/Parent/Guardian ………………………………………………………………….

 

Address (if not the patient) ……………………………………………………………………………..

 

…………………………………………………………………………………………………………..

 

Note to GP: A patient has the legal right to grant or withhold consent prior to this procedure.  Patients should be given sufficient information in a way they can understand, about the proposed treatment and the possible alternatives.  The patient’s consent to the procedure should be recorded on this form.

 

Note to Patient: The doctor should explain the proposed treatment and any alternatives.  You can ask questions and seek further information.  You have the right to refuse this treatment.  You may ask for a relative, friend or nurse to be present.

 

 
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