Service provision GP

Question 1

What are the 6+1 Caldicott principles?

Answer 1

Caldicott principles (1997)

1. Justify the purpose(s) for using confidential information
2. Don’t use personal confidential data unless it is absolutely necessary
3. Use the minimum necessary personal confidential data
4. Access to personal confidential data should be on a strict need-to-know basis
5. Everyone with access to personal confidential data should be aware of their responsibilities
6. Comply with the law
7. The duty to share information can be as important as the duty to protect patient confidentiality (added 2013)

(Information Governance Toolkit)

Question 2

What does the Data Protection Act (1998) regulate?

Answer 2

The Data Protection Act places obligations on those who process data and gives rights to those who are subject to that data, your patients.

In general the Act gives patients the right to access personal information about themselves, whether it be manual or computerised records, and whenever the record was compiled. Care should be taken to ensure that any third party information in the records, e.g. in relation to partner notification work, is not disclosed.

There are some exemptions to this access, including when the disclosure of information would be likely to result in serious harm to the mental or physical health of the data subject or any other person.

(e-LfH)

Question 3

What is a chaperone and when should we use them?

Answer 3

The GMC advises that when carrying out an intimate examination you should offer the option of an impartial observer (a chaperone) present wherever possible.

They suggest that this should be a health professional. A relative or friend is not an impartial observer, but you should comply with a reasonable request to have such a person present as well as a chaperone.

Failing to use chaperones appropriately is one of the most common reasons for referral to the GMC. This is often due to not having one present during an intimate examination.

An intimate exam is usually an examination of the breasts, genitalia or rectum but could include any examination where it is necessary to touch or even be close to the patient.

Consequently the offer of a chaperone and the patient’s response to the offer should be properly documented.

If a chaperone is present, their full name and position should also be documented.

(e-LfH)

Question 4

What kinds of support do you think a chaperone may be asked to provide?

Answer 4

• be present during intimate examination, assist with undressing if required
• provide reassurance, look for clues that patient is distressed
• act as interpreter
• be advocate for patient
• assist with procedures
• protect clinician from inappropriate behaviour from a patient or accusations of inappropriate behaviour by the clinician

(e-LfH)

Question 5

When is consent valid?

Answer 5

Consent is valid when the patient

• is competent i.e. has capacity
• has enough relevant information to make the decision
• is free from duress or undue influence from partners, family or friends
• is free from duress or undue influence from healtb professionals or other agencies

Question 6

Which of the following cases would you refer to child protection at social services, or to the police?

1. A 12-year-old boy who is having sex with a 15-year-old girl
2. A 17-year-old girl who has been having consensual sex with her youth worker who is 19
3. A 13-year-old girl who is having consensual sex with her 13-year-old boyfriend without her parents being aware
4. A 15-year-old girl who reports forced sexual touching by her uncle
5. A 14-year-old boy reporting consensual sex with a 16-year-old boy

Answer 6

A. Refer. You should usually share information about sexual activity involving children under 13, who are considered in law to be unable to consent. You should discuss a decision not to disclose with a named or designated doctor for child protection and record your decision and the reasons for it.

B. Refer, as her youth worker is in a position of trust.

C. No, unless other information that shows the young person is at risk is disclosed.

D. Refer.

E. No, unless other information that shows the young person is at risk is disclosed.

Question 7

Until when is a person legally a child?

Answer 7

A child is anyone under 18 years of age (England and Wales, under 16 in Scotland).