Good practice guidance

The following summarises existing guidance in relation to confidentiality, consent and services for young people including sexual health provision and termination of pregnancy.

 

Department of Health, Best Practice Guidance For Doctors And Other Health Professionals On The Provision Of Advice And Treatment To Young People Under 16 On Contraception, Sexual And Reproductive Health

This guidance from the Department of Health clearly states that the duty of confidentiality owed to a person under 16, in any setting, is the same as that owed to any other person.   Services are asked to produce confidentiality policies which reflect this guidance.

It advises that where a health professional believes that there is a risk to the health, safety or welfare of a young person or others which is so serious as to outweigh the young person’s right to privacy, they should follow locally agreed child protection protocols, as outlined in Working Together to Safeguard Children.

In these circumstances, the over-riding objective must be to safeguard the young person. If considering any disclosure of information to other agencies, including the police, staff should weigh up against the young person’s right to privacy the degree of current or likely harm, what any such disclosure is intended to achieve and what the potential benefits are to the young person’s well-being.   Except in the most exceptional of circumstances, disclosure should only take place after consulting the young person and offering to support a voluntary disclosure.

The guidance also states that a doctor or health professional is able to provide contraception, sexual and reproductive health advice and treatment, without parental knowledge or consent, to a young person aged under 16, as long as the young person understands the advice provided and its implications and their physical or mental health would otherwise be likely to suffer and so provision of advice or treatment is in their best interest. Doctors who are not prepared to offer a confidential contraceptive service to young people must make alternative arrangements for the young person to be seen by another professional.


Department of Health, National Service Framework for Children, Young People and Maternity Services

This requires that:

  • All health services develop policies which take account of the needs of young people, and include addressing issues of confidentiality, copying young people in to clinical correspondence or writing to the young person; and wherever possible, by the holding of personal health records by young people.
  • Health, education, social care and other services develop policies and good practice guidelines to be followed by all practitioners, on young people’s rights and professionals’ responsibilities for consent and confidentiality.
  • Health, education, social care and other services for young people produce, and clearly display, a confidentiality policy which makes clear the duty of confidentiality and care to young people, including those under 16, as set out in the Royal College of General Practitioners’ Confidentiality and Young People Toolkit. Staff are able to explain the implications of these policies to young people.
  • Young people have rapid access to emergency contraception, for example, through community pharmacy schemes, and walk-in centres.
  • Young women have early and easy access to free pregnancy testing, unbiased advice and speedy referral for NHS funded abortion or ante-natal care.
  • Primary care services, particularly general practice, deliver a comprehensive sexual health programme.
  • Young people have access to age appropriate services as they make the transition to adulthood.  

Department of Health, You’re Welcome Quality Criteria

The You’re Welcome quality criteria lay out principles to help health services become young people friendly. The criteria include the following topic areas:

  • Accessibility, including opportunities for young people to make an appointment and attend consultations without the involvement of a parent or carer and provision of services at times and in locations that are accessible to young people.
  • Publicity, including that service publicity should make clear young people’s entitlement to a confidential service, any limitations of confidentiality for young people and the rights of parents or carers regarding their level of influence on their child’s care.
  • Confidentiality and consent, including that confidentiality and consent policies are on display and are routinely explained to young people by staff who have received multi-disciplinary training in this area.
  • Monitoring and evaluation, including that young people should be involved in service development and that all clients should be invited to give their opinion of the service offered and whether it meets their needs.

You’re Welcome also incorporates specific quality criteria for sexual health services that include the need for comprehensive, integrated services and arrangements for young women with unplanned pregnancies to be seen immediately by another practitioner for impartial discussion if their first contact is with a member of staff who is ethically opposed to abortion.


Teenage Pregnancy Unit, Best Practice Guidance on the Provision of Effective Contraception and Advice Services for Young People

This guidance recommends that:

  • Services should be planned in consultation with young people.
  • All services should have an explicit confidentiality policy which young people are made aware of.
  • A non-judgemental attitude to young people is an essential criterion in recruitment.
  • Services should be provided in non-clinical and comfortable environments, in a location that is easily accessible to young people.
  • Services should be open at times that are convenient to young people, eg after school and weekends.
  • At a minimum services should be able to provide: condoms; hormonal contraception; including emergency contraception; pregnancy testing and non-judgemental advice; referral for NHS abortion services and antenatal care; and staff trained in counselling skills.

The Medical Foundation for AIDS and Sexual Health, Recommended Standards for Sexual Health Services

Confidentiality is a guiding principle of these standards which have been endorsed by the Department of Health. It is reiterated that young people under 16 have the same rights as adults. Services are encouraged to develop and display a confidentiality policy as this is likely to encourage service uptake, especially by young people.

NHS Code of Conduct:  Confidentiality

The NHS Code of Conduct says that young people under 16 who have the capacity and understanding to take decisions about their own treatment are entitled to decide whether personal information may be passed on and generally to have their confidence respected.


General Medical Council Ethical Guidance

Section 18 of Good Medical Practice, which sets out the duties of doctors registered with the GMC, states: ‘You must treat information about patients as confidential. If in exceptional circumstances there are good reasons why you should pass on information without a patient's consent, or against a patient's wishes, you must follow our guidance on Confidentiality: Protecting and Providing Information and be prepared to justify your decision to the patient, if appropriate, and to the GMC and the courts, if called on to do so.’


Nursing and Midwifery Council Code of Professional Conduct

Section 5 of the code of professional conduct for nurses and midwives states that ‘as a nurse or midwife you must protect confidential information’. Section 5.3 of the code states that ‘if you are required to disclose information outside the team that will have personal consequences for patients or clients, you must obtain their consent. If the patient or client withholds consent, or if consent cannot be obtained for any reason, disclosures may be made only where:

  • They can be justified in the public interest (usually where disclosure is essential to protect the patient or client or someone else from the risk of significant harm)
  • They are required by law or by order of a court.


General Medical Services Contract

The new GMS Contract states that a GP must ‘provide all necessary maternity medical services to female patients whose pregnancy has terminated as a result of miscarriage or abortion or, where the Contractor has a conscientious objection to the termination of pregnancy, prompt referral to another provider of primary medical services, who does not have such conscientious objections.’


BMA guidance

The British Medical Association says that doctors with a conscientious objection to abortion should make their views known to the patient and enable the patient to see another doctor without delay if that is the patient's wish. Although they may not impose their views on others who do not share them doctors with a conscientious objection may explain their views to the patient if invited to do so.

Royal College of Obstetricians and Gynaecologists

In its clinical guideline The Care of Women Requesting Induced Abortion the RCOG states that:

  • Ideally, all women requesting abortion are offered an assessment appointment within 5 days of referral.
  • As a minimum standard, all women requesting abortion are offered an assessment appointment within 2 weeks of referral.
  • Ideally, all women can undergo the abortion within 7 days of the decision to proceed being agreed
  • As a minimum standard, all women can undergo the abortion within 2 weeks of the decision to proceed being agreed.
  • As a minimum standard, no woman need wait longer than 3 weeks from her initial referral to the time of her abortion.