Working with Relatives & Carers

SJT Textbook: Working with Relatives & Carers

Working with Relatives and Carers MSRA

This guide covers the delicate balance required in Working with Relatives and Carers MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate that you value the support network around a patient without ever compromising the patient’s confidentiality or autonomy.

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🎯 THE CORE PRINCIPLE

Relatives and unpaid carers are often essential to safe care, but the patient’s autonomy and confidentiality come first. Working well with relatives and carers means agreeing who the patient wants involved, what information can be shared, and by which routes, then revisiting this if capacity fluctuates or is lost.

In the SJT, high-scoring options balance kindness to relatives and carers with a clear structure: check the patient’s preferences, verify identity, share only the minimum necessary for direct care via secure channels, and document what you have done. When capacity is in doubt or absent, you must follow the Mental Capacity Act: assess capacity, make a best-interests decision that involves those close to the patient, choose the least restrictive option, and record your reasoning.

Low-scoring options either overshare (breaching confidentiality), refuse all communication (blocking supported care the patient wants), or ignore capacity, best-interests, and documentation.

In Working with Relatives and Carers MSRA questions, the decision to share information always hinges on one factor: Capacity. You must mentally toggle between “Consent” (if they have capacity) and “Best Interests” (if they don’t).

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Ask the patient who they want involved, what can be shared, and by which channels, and record this clearly.
2. Verify the identity and relationship of relatives or carers before sharing any information.
3. Share the minimum necessary information for direct care via secure, approved systems.
4. Reassess capacity when there is doubt, and if lacking, follow the MCA best-interests process with input from those close to the patient.
5. Consider safeguarding issues and escalate concerns appropriately if a relative or carer may be causing harm or coercion.
6. Recognise carer strain and signpost to carer assessment and support (for example, NICE NG150) when appropriate.
7. Summarise what has been discussed with relatives or carers, clarify next steps, and ensure the patient is kept informed if they have capacity.
8. Make a factual, contemporaneous record of who you spoke to, what was shared, why it was shared, and via which route.
9. In team settings, ensure that agreed communication preferences are visible and followed consistently.
10. Seek senior or specialist advice (for example, safeguarding or legal) when you are unsure about sharing or withholding information.

To score highly in Working with Relatives and Carers MSRA ranking questions, you must prioritise “Verification.” Never discuss a patient with a stranger on the phone without verifying their identity first.

Trap themes: assuming relatives always have a right to full information, or that you should never speak to them; ignoring capacity, consent, minimum necessary, and secure channels.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Before we discuss any details, I need to confirm who I am speaking to and your relationship to the patient.”
* “Because capacity is fluctuating today, we will make a best-interests decision with your partner’s input and I will record our reasoning.”
* “I can share the essentials needed for safe care, but I will not go through the full record. I will document what we have discussed.”

Consent and preferences • Assess capacity • Relevant minimum share • Engage carers appropriately • Record decisions

📋 QUICK FAQ

Can I speak to relatives if the patient has capacity?
Yes, if the patient agrees. Ask what they want shared and by which routes, then record their preferences. You can still listen to relatives even if you cannot share confidential details.

What if the patient lacks capacity?
Assess capacity for the specific decision. If they lack capacity, use the MCA best-interests process: consider the patient’s wishes and values, involve those close to them, choose the least restrictive option, and record your reasoning.

How much information should I share with carers?
Share the minimum necessary for safe care. Focus on practical information that supports treatment and safety, rather than full access to the record, unless legally justified.

What if I suspect abuse or coercion by a relative or carer?
Prioritise safety. Discuss concerns with a senior, follow safeguarding policies, and share relevant information with safeguarding teams as allowed under confidentiality guidance, documenting clearly.

Do I need to support carers too?
Yes. Identify carers, acknowledge their role, and signpost to carer assessment and support services (for example, under NICE NG150), especially when there is clear carer strain.

📚 GMC ANCHOR POINTS

• Work in partnership with patients, listen to what matters to them, and respect their rights and dignity (GMC Good Medical Practice 2024).
• Respect confidentiality while sharing information appropriately with those close to the patient, in line with the patient’s wishes and the law (GMC Confidentiality and “Sharing information with family members”).
• Follow the Mental Capacity Act and its Code of Practice when patients lack capacity, making and recording best-interests decisions.
• Support carers and recognise the impact of caring responsibilities on health, signposting to appropriate services and assessments.

💡 MINI PRACTICE SCENARIO

A ward patient with delirium has fluctuating capacity. Earlier, when lucid, they said: “I am happy for my partner to be involved, but please do not share my financial details.” Today they appear confused. Their partner asks you for a full copy of the notes and an explanation of the discharge plan.

Best action: Assess the patient’s capacity today for decisions about sharing information and discharge. If they lack capacity, make a best-interests decision with the partner’s input, share the minimum necessary clinical information for safe care via secure channels, respect the earlier wish not to share financial details, and document who you spoke to, what was shared, and why.
Why: This respects prior preferences, follows MCA best-interests requirements, shares proportionately, and creates a defensible record, rather than oversharing or blocking involvement.

🎯 KEY TAKEAWAYS

✓ Patient preferences come first: agree who to involve and what to share.
✓ Verify identity and use secure, approved channels for any disclosure.
✓ Share the minimum necessary for safe care and document the rationale.
✓ When capacity is lacking, follow the MCA best-interests pathway and record your reasoning.
✓ Recognise and support carers, and stay alert to safeguarding concerns.

🔗 RELATED TOPICS

* → Patient Confidentiality Principles
* → Capacity Assessment and Best Interests (MCA)
* → Sharing Information with Consent
* → Safeguarding Adults and Domestic Abuse
* → Dealing with Angry or Distressed Patients

📖 FULL PRACTICE QUESTIONS

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

A competent outpatient with heart failure says, “I would like my sister to know what is going on, but please just give her the basics. I do not want her to see the full letter.” They ask you to update her by phone today.

Options:
A. Ring the sister and read out the full clinic letter word for word.
B. Decline to speak to any relatives under any circumstances.
C. Confirm with the patient exactly what they mean by “the basics” and what they do not want shared.
D. Check the sister’s identity and relationship before sharing any details.
E. Share the agreed key points by phone, focusing on diagnosis, main treatment changes, and red flags, and document what was shared.
F. Email a copy of the full clinic letter to the sister’s personal email account.
G. Tell the patient that you cannot ever speak to relatives because of confidentiality.
H. Ask the patient if there is anyone else they would like involved and record this in the notes.

Example SJT — Rank 5 (best → worst)

A ward patient recovering from delirium has fluctuating capacity. Their partner has been the main carer at home and is visibly stressed. The patient previously said they wanted their partner involved but had not decided about full access to notes. The partner now asks for an explanation of medication changes and discharge plans.

Options:
A. Assess the patient’s capacity today; if lacking, hold a best-interests discussion with the partner and team, share the minimum necessary clinical information for safe care via secure channels, and document who you spoke to and why.
B. Refuse to speak with the partner at all because “confidentiality forbids it.”
C. Give the partner a copy of the full notes, including old clinic letters and non-clinical information.
D. Discuss everything in a busy bay where other patients and visitors can hear.
E. Offer to explain the key medication changes and discharge plan in a private space, verify identity, provide written information, and signpost the partner to carer support.