Each case needs its own consideration.
Record fully any decision to share information in your patient's notes. Be prepared to explain and justify your decisions and actions.
Relatives and carers
- You may share information with those helping to care for a patient, with the patient's permission.
- If the patient is unable to give permission, then you may share such information as is necessary – provided it is in the patient's best interests.
Other healthcare workers
- Patients should understand why and when information about them might be shared with others involved in their clinical care.
- You should only share information on a 'need-to-know' basis, and you must respect a patient's objections to disclosure.
- Primary care organisations or the NHS Business Services Authority (Dental Practice Board in Scotland; Central Services Agency in Northern Ireland) have certain rights to see NHS General Dental Services records for purposes such as verification and audit.
- Dentists should comply with their lawful requests, but only subject to patient consent.
- Some NHS claim forms include an authority to disclosure of records to the relevant NHS authorities.
You may be required to disclose information to organisations such as the GDC, CQC, the Parliamentary and Health Service Ombudsman (PHSO), NHS Protect and Accountable Officers (controlled drugs).
- The GDC may require a dental professional to produce patient records as part of its fitness to practise procedures. However, patient consent to such disclosure should still be sought.
- The Care Quality Commission (CQC) in England and the Welsh Assembly Government have legal powers to require NHS healthcare professionals to provide relevant information, including personal records. Anyone not complying may face a fine. The PHSO has the power to require disclosure to help it fulfil its statutory duties.
CQC, NHS Protect and Accountable Officers say that requests for information should be proportionate and the minimum necessary. It may be possible to provide anonymised information, so seek DDU advice.
Insurance companies and private dental funding schemes
- When asked to submit reports to employers or insurers, you should seek permission and check if the patient wishes to see the report before it is sent.
- You should explain to the patient the extent of the information to be disclosed and the fact that relevant information cannot be concealed or omitted.
- Consent is usually required before disclosing information to social services.
- There may be occasions when it is necessary to disclose information about a patient without consent, either because the patient lacks capacity and it is in the patient's best interests, or is otherwise in the public interest.
- You should do everything you can to inform your patient when information about them is shared.
- The police do not have an automatic right to information about patients.
- However, there are specific provisions which require disclosure, such as S172 of the Road Traffic Act 1988 and S38B of the Terrorism Act 2000.
When the police have obtained a valid court order compelling you to disclose information:
- Information may be released to the police if it is in the public interest; you should be prepared to justify a disclosure made on this basis, so contact the DDU for advice.
- If you have information that a patient is or could be at risk of significant harm, or you suspect they are a victim of abuse, you should ordinarily inform the appropriate social care agencies or the police.
- Disclosure to solicitors, other than those acting for the patient, requires the patient's specific consent, unless the solicitors provide proof of a court order requiring disclosure.
Courts, tribunals and coroners/procurators fiscal
- A judge and presiding officers at tribunals can make an order to produce confidential documents.
- The coroner (or procurator fiscal in Scotland) has a right of access to a deceased patient's records.
HM Revenue & Customs
- Tax inspectors have legal powers to obtain documents under the Finance Act 2008.
- They may request any information or documents it is reasonable for them to have to assist them in checking a taxpayer's position.
- They must give notice in writing of the information they require.
- When disclosing information for this purpose you would need to be satisfied that it is reasonably required, as the Act places limits on the disclosure of personal (ie. medical) information.
Publication, research and audit
- Personal information cannot be published without a patient's consent.
- Data for research must be anonymised, unless a patient has given consent.
- Documents for financial audit and administration should be anonymised and kept separate from clinical records.
Appointment books and diaries
- Disclosure of information contained in appointment books and diaries risks breaching the confidentiality of patients.
Before disclosing any confidential patient information to third parties, consider the following:
- Are you clear about the legal, clinical and ethical grounds of information-sharing where a request to release information has been made?
- Where a decision to release information has been agreed or made, have you made sure that only the minimum information necessary is disclosed?
- Are the names of other patients blanked out when diaries and appointment books are being disclosed?
- Have all documents for your financial audit and administration been anonymised?
This guidance was correct at publication 19/01/2018. 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.