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Nigel's surgery 49: Consent for minor surgery in GP surgeries
This issue has been updated in light of a legal update from the British Medical Association.
It is vital in all cases that people understand what treatment involves and that they give their consent.
GP practices can offer a range of minor surgery procedures. These range from joint and soft tissue injections to complex procedures involving excisions. When we inspect, we look for evidence that consent to care and treatment always sought in line with legislation and guidance (key line of enquiry E6).
Key principles for consent
The British Medical Association has provided a legal update that summarises the landmark case of Montgomery v Lanarkshire Health Board (2015). This marks a shift in the principles underlying consent, placing greater emphasis on the perspective of the patient. Historically, the consent process was guided by what a group of medical practitioners considered to be reasonable, in accordance with the Bolam principle. Judges in the Montgomery v Lanarkshire case stated that doctors must:
- not make assumptions about what a patient needed to know; but must provide information about all material risks.
- make patients aware of alternative treatments.
The Royal College of Surgeons (RCS) and the General Medical Council (GMC) have produced guidance around documenting the consent process and obtaining written consent from patients.
The RCS has described key principles for consent.The discussion about consent should:
- aim to give the patient the information they need to make a decision about what treatment or procedure (if any) they want
- be tailored to the individual patient - this needs time to get to know the patient well enough to understand their views and values.
- explain all reasonable treatment options, along with their implications,
- include all material risks for each option. This ‘test of materiality’ includes whether
- in this particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or
- the doctor is or should reasonably be aware that the particular patient would likely attach significance to it.
GMC guidance on consent highlights the importance of providing information in language the patient can understand. Before beginning treatment, the doctor or a member of the healthcare team should check the patient still wants to go ahead.
The responsibility for consent sits with the doctor undertaking the procedure. If this is not practical, responsibility may be delegated to someone else, provided they:
- are suitably trained and qualified
- have sufficient knowledge and understanding of the procedure including the risks, and
- understand GMC guidance around consent.
Obtaining a patient’s written consent
The GMC guidance states “in cases that involve higher risk, it is important that you get the patient’s written consent. This is so that everyone understands what was explained and what was agreed.”
GMC also recommends obtaining written consent from a patient “if the investigation or treatment is complex or involves significant risks; or there may be significant consequences for the patient’s employment, or social or personal life.”
Written consent may not be necessary for relatively minor procedures such as joint injections, but would be required for more invasive procedures such as skin excision and vasectomy.
Documenting the consent process
RCS recommends recording the discussion around consent. This includes:
- contemporaneous documentation of key points in the discussion
- hard copies or web links of any further information provided to the patient
- the patient’s decision.
This is also important for patients choosing not to undergo treatment. The GMC recommends documenting any specific requests by the patient.
Obtaining written consent from a patient is not sufficient documentation of the consent process. A ‘consent form’ or designated record could be used as a checklist to make sure everything is covered and to record that consent was sought.
The consent is only valid if it is given voluntarily and appropriate information and capacity have been satisfied.
Minor surgery in GP practices: CQC registration
GP practices are required to register with CQC for certain regulated activities.
The regulated activity of surgical procedures does not include minor surgical procedures if they are:
- undertaken by a medical practitioner
- limited to curettage, cautery or cryocautery of warts, verrucae or other skin lesions
- carried out using local anaesthesia, or no anaesthesia
Practices providing these minor surgical procedures, for example joint injections do not need to register for the surgical procedures regulated activity.
Always refer to our guidance The scope of registration when considering what regulated activities to register for.
- Last updated:
- 22 June 2018