A family (mother, father and two teenage children) attend for vaccinations before they go on holiday. Their adult son comes in for an appointment the next day requesting the same vaccinations, and explains that they are travelling to Iraq. If you have suspicions about the purpose of their trip what should you do?
There has recently been considerable political and media interest around children, adults and entire families travelling to countries in the Middle East. This has led some GPs with suspicions about their patients' travel plans to contact Medical Protection for advice about how to approach similar situations and their professional and legal obligations.
Although media coverage has highlighted the issue of individuals going abroad to take part in terrorist-related activity, this does not necessarily mean that this is the case in the above situation.
Establish the purpose of the trip
GPs are particularly adept and skilled at dealing with ‘non-medical’ issues in consultations, such as social issues, child protection and counselling. In this situation however, you may understandably feel apprehensive about exploring such potentially sensitive and complex issues and causing upset to the family.
If you do have concerns about this family's trip to Iraq, I suggest you make further enquiries to establish the purpose of the visit, as any concerns may be entirely benign. You may therefore like to begin with open questions, such as specifically where they are travelling to and how long they will be away for.
It is difficult to be armed with a definitive list of questions, as inevitably they will depend on how the conversation develops. The information you receive can then be considered in the context of your existing knowledge of the family’s social situation.
If you have concerns that the purpose of the travel may potentially be linked to terrorist activity, you are required to take further action.
When GPs are required to act
In 2011 the Government revised the UK’s anti-terrorism ‘Prevent’ strategy, and the Department of Health (DH) published ‘Building Partnerships, Staying Safe – The health sector contribution to HM Government’s Prevent strategy: guidance for healthcare organisations’.
This guidance recognises that healthcare organisations are key partners in helping prevent vulnerable individuals from being drawn into terrorist-related activities, whilst stressing that doctors are not required to take on surveillance or enforcement roles. This means that you do not need to be certain of the purpose of travel or interrogate the family in order to act on your concerns.
Section 38B of the Terrorism Act 2000 requires all individuals to, as soon as reasonably practicable, inform the police if they have information that may be of material assistance in preventing the commission, preparation or instigation of an act of terrorism. It is a criminal offence not to disclose such information, punishable by up to five years imprisonment and/or a fine. Foreign travel potentially linked to terrorism falls under this.
It is a defence not to disclose information if you have a 'reasonable excuse'. However, your duty of patient confidentiality is unlikely to be a reasonable excuse not to disclose information that may help prevent terrorism.
The GMC’s Confidentiality guidance recognises that doctors may be justified in disclosing confidential patient information - even where patients have withheld consent - if it is in the public interest to do so, such as assisting in the prevention, detection or prosecution of serious crime.
You would therefore need to consider whether it is appropriate to seek permission to disclose information about your patients to the police. It may not be safe or practicable to seek their consent in the usual way as there may be, for example, a risk of the family absconding.
In addition to informing the police, I suggest that you discuss the situation with local child safeguarding team, and also the adult team if you are concerned that anyone is travelling under duress. In this case, it is important that you inform the safeguarding team(s) of the police involvement as this may influence when they approach the family to avoid the risk of jeopardising the police investigation.
In addition and in view of the complex and case-specific nature of such a scenario, it is strongly recommended that you contact your medical defence organisation for advice at your earliest possible opportunity.
All GPs should ensure they are familiar with the DH’s guidance, as it describes factors that may make individuals susceptible to exploitation. Some CCGs also provide local guidance and offer training through online modules and training days.
- Dr Harpreet Sarna is a medico-legal adviser at Medical Protection