Exceptions to Confidentiality (e.g., safeguarding, public health)

SJT Textbook: Exceptions to Confidentiality (Safeguarding, Public Interest, Statutory Duties)

Exceptions to Confidentiality MSRA

This guide covers the critical topic of Exceptions to Confidentiality MSRA scenarios. While privacy is the default, the Professional Dilemmas paper tests your ability to recognise exactly when safety trumps secrecy.

🎥 Video Lesson (YouTube)

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🎯 THE CORE PRINCIPLE

Confidentiality is the default. However, UK practice recognises specific, tightly defined situations where you may or must disclose information without the patient’s consent. These sit in three broad categories:

* Safeguarding children and adults at risk.
* Public-interest disclosures to prevent serious harm or serious crime.
* Statutory or legal duties such as notifiable diseases, DVLA fitness to drive, gunshot or knife wounds, court orders and coroner requests.

The SJT is not asking you to memorise every statute but to apply a clear, structured approach: identify whether there is a legal duty or strong public interest, choose the right authority (for example safeguarding team, UKHSA, DVLA, police, coroner), share only what is necessary on a need-to-know basis, use secure channels, and document your decision and rationale. Where it is safe and does not prejudice prevention or detection of serious crime, you should inform the patient.

High-scoring options show you are willing to override confidentiality where required to protect patients and the public, but you do so proportionately, lawfully, and transparently. Low-scoring options either hide behind confidentiality and allow serious harm to continue, or disclose excessively and indiscriminately.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Actively assess risk of serious harm or serious crime, and whether any statutory duty applies.
2. In safeguarding scenarios, recognise that consent is not required if safety is at risk; choose a more appropriate lawful basis.
3. For notifiable infections, notify UKHSA promptly with the minimum necessary details and record what you have done.
4. In ongoing unsafe driving (for example uncontrolled seizures), warn the patient clearly, encourage them to notify DVLA, and if they refuse, consider proportionate disclosure in the public interest.
5. Inform police promptly in cases of gunshot or knife wounds and follow GMC guidance on how much identifying information to share.
6. Comply with court orders and coroner requests by disclosing relevant information, not entire records where unnecessary.
7. Always share on a need-to-know basis with the correct authority (safeguarding team, MASH, social services, UKHSA, DVLA, police, coroner).
8. Use secure, approved communication routes rather than informal messaging or personal email.
9. Document facts, risk assessment, legal/ethical basis, what you shared, with whom, how, and who made the decision.
10. Inform the patient about the disclosure where it is safe and does not increase risk or prejudice prevention or detection of serious crime.

These options either hide behind confidentiality when the law or public interest requires action, or disclose far more than is needed. Safe answers recognise that confidentiality can and must be overridden in defined circumstances but still apply minimum necessary, correct authority, secure channels and careful documentation.

💬 MODEL PHRASES (Use These in SJT Logic)

* “UK law requires me to notify suspected notifiable diseases to UKHSA; I will share only what is necessary and document why.”
* “If you choose to continue driving while it is unsafe, I may have to tell DVLA in the public interest to protect others, but I would like to work with you on this first.”
* “I need to follow this court order and provide the relevant information, but I will limit it to what is necessary and record what I have disclosed.”
* “I will discuss this with our safeguarding team and information governance lead so we can act lawfully and minimise any risk to you and others.”
* “Where it is safe I will let you know what information has been shared, why, and with whom.”

Safeguard risk • Act on statutes (NOIDs, DVLA, court, coroner, gunshot/knife) • Focus on minimum • Explain if safe • Log decisions • Approved channels • Who/when recorded

Use SAFE-LAW to check you have: considered safeguarding, followed statutory duties, limited disclosure, been transparent where safe, documented thoroughly, chosen secure routes and recorded who you contacted and when.

📋 QUICK FAQ

Do I need consent to share information for safeguarding?
No. In most safeguarding situations consent is not required. You should choose an appropriate lawful basis (for example vital interests, public task) and share the minimum necessary with safeguarding services on a need-to-know basis, documenting your rationale.

Are notifiable diseases compulsory to report?
Yes. Registered medical practitioners must notify suspected notifiable diseases to UKHSA. You should notify promptly, share only relevant details, and document that you have done so, even if parents or patients would prefer you not to.

When can I disclose to DVLA without consent?
If a patient is unfit to drive, you should explain the risks and ask them to stop driving and to inform DVLA. If they continue to drive against advice and refuse to notify DVLA, you may disclose relevant information in the public interest to protect others, sharing the minimum necessary and recording your reasoning.

What should I do about gunshot or knife wounds?
You should inform the police promptly that such a case has presented. GMC guidance sets out how much identifying information to give initially and emphasises balancing public safety with the patient’s safety and confidentiality. You should also document what you have done.

How do court orders and coroner requests affect confidentiality?
If there is a court order or coroner request, you must disclose the information required by law. You should still limit the disclosure to relevant information, use secure channels, and document what you have shared.

Should I always tell the patient about a disclosure without consent?
Yes, where it is safe and practical, and it will not increase risk or prejudice the prevention or detection of serious crime. If informing them would escalate risk, delay if necessary and record your reasoning.

In Exceptions to Confidentiality MSRA questions, you are often acting as a judge. You must weigh the patient’s right to privacy against the public’s right to safety.

📚 GMC ANCHOR POINTS

* GMC Confidentiality: disclosing information for the protection of patients and others.
* GMC guidance on managing and protecting personal information, including when disclosures are required by law.
* GMC and NHS safeguarding guidance on sharing information where a child or adult is at risk.
* GMC guidance and DVLA standards on fitness to drive and public-interest disclosure.
* GMC guidance on reporting gunshot and knife wounds to the police.
* Professional duty to keep clear, accurate, contemporaneous records of high-risk decisions.

To score highly in Exceptions to Confidentiality MSRA ranking questions, you must be decisive. Hesitating when a child is at risk or a driver is dangerous will lose you points.

💡 MINI PRACTICE SCENARIO

A woman in her 30s tells you during a GP consultation that her partner has been “losing his temper” and hitting her. She has bruising. She begs you not to tell anyone because “it will only make things worse”. She also mentions that their 5-year-old child is often at home when this happens.

Best action: Explain that because a child may be at risk and there is serious ongoing harm, you cannot keep this entirely confidential. Tell her you will share limited information with the safeguarding team to protect her and the child, involve her as much as possible in the process, use secure channels, and document what you have shared and why.

Why: Safeguarding duties override confidentiality where a child or adult at risk may come to serious harm. You should share the minimum necessary with appropriate services, be transparent where safe, and record your decision.

🎯 KEY TAKEAWAYS

✓ Confidentiality is not absolute; law and public interest can justify disclosure without consent.
✓ Safeguarding, serious harm and serious crime are key triggers for public-interest disclosure.
✓ Some disclosures are mandatory (for example notifiable diseases, court orders, coroner requests).
✓ DVLA may be informed in the public interest if a patient continues to drive while unfit and refuses to notify.
✓ Always share the minimum necessary information with the correct authority via secure channels.
✓ Document your assessment, legal/ethical basis, what you shared, and whether the patient was informed.
✓ Where it is safe, explain the disclosure to the patient and maintain a transparent, supportive approach.

🔗 RELATED TOPICS

* → Confidentiality and Information Governance
* → Sharing Information with Consent
* → Safeguarding Children and Adults at Risk
* → Public-Interest Disclosures and Duty of Candour
* → Fitness to Drive (DVLA)
* → Social Media and Digital Professionalism

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

You are an ST1 GP trainee. A woman attends with bruising to her arms and ribs. She says her partner has been hitting her for several months and sometimes throws objects around the house. She tearfully tells you not to tell anyone, saying “If social services get involved he will go mad”. She discloses that their 5-year-old child is usually at home when this happens. She appears frightened but is reluctant to make a formal statement.

Which THREE of the following actions are the most appropriate?

Options:
A. Agree to keep the disclosure confidential and record nothing in the notes to avoid making things worse.
B. Reassure her that you take this seriously, record the injuries and history factually, and explain you will need to share limited information with safeguarding services because a child may be at risk.
C. Immediately phone the police in front of her without any explanation, regardless of her wishes.
D. Seek advice from your practice safeguarding lead or named safeguarding GP the same day.
E. Arrange a routine follow-up in three months and advise her to return if things worsen.
F. Make a safeguarding referral, sharing the minimum necessary information with the local safeguarding team via secure channels, and document your rationale and discussions.
G. Post the details in the practice WhatsApp group so colleagues are aware.
H. Tell her that GDPR prevents you from sharing anything without her explicit written consent.

Example SJT — Rank 5 (best → worst)

You are a hospital consultant. A competent patient with recurrent generalised seizures continues to drive despite clear advice to stop and inform DVLA. At a recent review, the patient tells you they are still driving and refuses to inform DVLA, stating “I cannot afford to lose my licence”. You are very concerned about the risk to the public.

Rank the following actions in order of appropriateness (best to worst):

Options:
A. Explain that if they will not inform DVLA and stop driving, you may have to disclose relevant information to DVLA in the public interest, make a proportionate disclosure via secure channels if they still refuse, and document the decision.
B. Do nothing further because confidentiality always overrides public safety and the conversation has already happened.
C. Post a warning message about the patient’s driving in the practice WhatsApp group to “spread the word”.
D. Tell the patient you will send their entire medical record to DVLA to teach them a lesson.
E. Ask the patient’s neighbour to remove their car keys without telling the patient.