Medico-Legal - Duty to notify specified diseases

The MDU's Dr Mike Devlin provides updated advice on how to deal with notifiable diseases.

GPs should disclose details about notifiable diseases, such as measles (Photograph: SPL)
GPs should disclose details about notifiable diseases, such as measles (Photograph: SPL)

GPs in England have a duty to disclose information about patients with notifiable diseases, such as measles, to the local authority. The Health Protection (Notification) Regulations 2010 are intended to allow prompt investigation and response to diseases and other hazards posing a threat to public health.

Infectious diseases and contamination (such as chemicals or radiation) can threaten health in circumstances that range from small-scale incidents to national emergencies.

Although the obligation to notify has been established for more than 100 years, the 2010 regulations require more, to include diseases which although not notifiable, may represent a significant risk to human health, and to include toxic risks to human health.

DH guidance sets out the duties of medical practitioners and patient details that must be included in a notification (see boxes below). It also explains the health protection powers available to local authorities and justices of the peace. The DH advises that its guidance is no substitute for consulting the legislation or taking legal advice.

GPs' notification duties

GPs are required to notify the proper officer of the local authority in which the patient resides when they have 'reasonable grounds for suspecting' that the patient:

  • Has a notifiable disease as listed in Schedule 1 of the notification regulations; these include acute meningitis, food poisoning, malaria, measles, mumps, rubella and TB.1
  • Has an infection not included in Schedule 1, which presents, or could present, significant harm to human health (for example, emerging or new infections).
  • Is contaminated (for example: by chemicals or radiation) in a manner which presents, or could present, significant harm to others.
  • Has died with, but not necessarily because of, a notifiable disease, or other infectious disease or contamination that presents or could present, or that presented or could have presented significant harm to human health.

 

Patient details to be included in a notification
  • Name, birth date and gender.
  • Home address or current residence (if different) and telephone number.
  • NHS number.
  • Occupation and name and address of place of work (if relevant).
  • Relevant overseas travel history.
  • Ethnicity.
  • Parents' contact details (if patient is a child).
  • Details of the disease, infection or contamination suspected and date symptoms began.
  • The date of the doctor's diagnosis and his or her name, address and telephone number.

Confidentiality concerns
When dealing with a patient with a notifiable disease, GPs are required by law to disclose certain patient information, so it is not strictly necessary to obtain the patient's consent.

However, your ethical obligation to inform the patient still applies unless it is not practicable to do so or would undermine the purpose of the disclosure.

The DH guidance states that doctors should not delay notifying the local authority because diagnostic tests are awaited, because this may impair the effectiveness of public health protection. There is also provision for urgent oral reporting.

The guidance also states that notification of infection not included in Schedule 1 of the 2010 Regulations (the classical notifiable diseases) and of toxic contamination are anticipated to be exceptional occurrences.

Once notified, the local authority officer is expected to pass the information to the Health Protection Agency (HPA) or their local counterpart and if appropriate, the officer of the port health authority or local authority where the patient disembarked in the UK.

Diagnostic laboratories must notify the HPA if they identify a causative agent (listed in Schedule 2) in a human sample. But GPs who have requested tests should be aware that the HPA has the legal right to approach them for specific information not provided by the laboratory, which may include the patient's home address.

Where known, this information must be provided in writing within three days from the date of request, or 'orally, as soon as reasonably practical'.

GPs with concerns about notifiable diseases or their responsibilities to disclose patient information should contact their medical defence organisation for specific advice.

Case study
A GP saw a patient who had acute hepatitis C. The GP explained that she had a statutory duty to notify the health authority. The patient was happy for the GP to do this, but did not want their name or address to appear on the notification.

The GP rang the Medical Defence Union (MDU) to ask if she could justify breaching the patient's confidentiality because in her opinion notification would not afford the public additional protection.

MDU advice was that as acute infectious hepatitis was included in the statutory list of notifiable diseases, there was a specific duty to provide the information. She was also advised that the GMC's confidentiality guidance states: 'You must disclose information to satisfy a specific statutory requirement, such as notification of a known or suspected case of certain infectious diseases' (paragraph 17).

The MDU adviser suggested the GP explain to the patient that she had both a legal and an ethical duty to provide identifiable details in the notification.

  • Dr Devlin is head of advisory services at the MDU

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

    CPD IMPACT: EARN MORE CREDITS

    These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

    • Review the regulations and the DH guidance to ensure you know your obligations.
    • Check on the Health Protection Agency website for the most up-to-date list of diseases listed in Schedule 1 (www.hpa.org.uk).
    • Ensure that all GPs and practice staff are aware of their own responsibilities in terms of notification of diseases. Update your locum induction folder with the relevant information.

    Reference
    1. The Health Protection (Notification) Regulations 2010. www.opsi.gov.uk/si/si2010/uksi_20100659_en_1

    Resources
    1. Health Protection Legislation (England) Guidance 2010. DH, 25 March 2010.

    2. Paragraph 19, Confidentiality, GMC, 2009.

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