Consent Policy

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’. The Practice will allow sufficient time for the patient to consider whether to give consent and if required consult others, or ask for a second opinion.

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, 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 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 (see below).

Obtaining Consent

• 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.
• 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, withdraw consent or ask for a chaperone.
• The Practice will review consent in the light of changing patient circumstances and where appropriate revisit the consent with the patient.
• 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.
• 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 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 has 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 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

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.

People with Parental Responsibility for Consent

There are only certain persons who are legally permitted to give consent for a child (for example for vaccination) This consent can be written or verbal.
These people are;

• The child’s birth mother.
• Both the child’s parents IF they were married to eachother at the time of conception or birth AND are still married to eachother at time of consultation.
• An unmarried genetic father who is present at the child’s registration and who’s name is on the birth certificate (from 1st December 2003 only, before that date this does not apply)
• An unmarried genetic father who has acquired parental responsibility via a court order or a 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 legally 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, fosterparents and childminders can not give consent unless they hold a legally binding court order as above.

NB A child’s father who is not married to the mother at the time of birth or conception and who has not married her subsequently can not in law give legally binding consent for the child unless he has obtained a parental responsibility order via the court system (or unless his name is on the birth certificate from 1/12/2003)
If a person who can give legally binding consent is unable to accompany a child to an appointment they may write a letter giving consent for the named procedure/immunisation for the child and send this, signed, with the child and carer to the appointment.