Chris Lancelot: Trust and confidentiality are at the heart of good medicine

Some NHS managers seem to believe confidentiality is for others to observe, not them.

Clinical information should remain confidential between patients and their healthcare advisers
Clinical information should remain confidential between patients and their healthcare advisers

We've been working on our quality and productivity indicators, analysing A&E attendance. Our PCT sent each practice details of their patients' A&E attendances - including their NHS numbers. Clearly, these managers don't see the need to comply with confidentiality rules or the Data Protection Act. The analysis of A&E attendance may demonstrate where NHS savings could be made, but patients' identity should never be available to PCT managers.

Each practice could have acquired this information legally, ethically and above all confidentially, from their own Secondary Uses Service data. There should be no exceptions to this rule - clinical information should remain confidential between patients and their healthcare advisers.

I wonder what these managers would have thought had they discovered one of these episodes related to their neighbour, boss or partner? Or themselves? Confidentiality isn't something to be ignored simply because it's convenient.

The Care Quality Commission (CQC) hasn't learnt this lesson, either, which is even more worrying. During practice visits it wants its non-medical inspectors to check practices' record-keeping by routinely accessing patients' notes, without their consent. The CQC says that GPs would be allowed to choose which records to display, as if that somehow made it less illegal.

Even when the CQC's error was pointed out, rather than acknowledging its mistake on a fundamental matter of medical ethics, it stubbornly insisted its actions were 'in the public interest'. How arrogant. You wouldn't think that its job was to monitor standards within the NHS, would you?

How many GPs will fail a CQC inspection because they refuse to reveal patients' records without consent? Yet if they do so, they risk being fined by the Information Commissioner and struck off by the GMC. A total Catch-22 and ethically insupportable.

How often do we have to say it? Patients share intimate details with healthcare professionals because they trust us. Confidentiality is at the heart of high-quality medicine and nothing should be allowed to threaten it.

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