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Consultation Guide: Confidentiality in Primary Care.

For IMG GP Trainees.

This SCA-focused consultation guide on Confidentiality in Primary Care is specifically tailored to support IMG GP trainees new to the UK or actively preparing for the RCGP SCA exam. It includes contextual explanations, consultation phrases with breakdowns, regional considerations, learning resources, pitfalls, and portfolio tips. While this guide provides a strong foundation, confidentiality laws and GMC guidance are subject to change, we recommend the reader make it a habit to review annual updates, attend webinars, and flag key changes in your CPD log or portfolio reflections.


Introduction: Why Confidentiality Matters in UK Primary Care

Confidentiality is a cornerstone of medical ethics and legal practice in the UK. In general practice, where clinicians often develop longstanding relationships with patients, preserving trust is essential. The General Medical Council (GMC) and other professional bodies, such as the Medical Defence Union (MDU), place strong emphasis on maintaining confidentiality unless a clear public interest or legal obligation justifies disclosure.

In clinical consultations, patients often disclose sensitive and personal information. Knowing when and how to share that information safely and legally, especially without consent, is both a clinical and communication skill that’s tested explicitly in the SCA exam.


Bridging The Gap.

Many IMG doctors trained abroad may not have had in-depth exposure to UK-specific confidentiality legislation and ethical expectations. UK graduates are introduced to complex confidentiality topics from early medical school and are well-drilled in the complex communication styles expected during discussions involving disclosure.


IMGs may unintentionally:

  • Under-communicate their legal duties to the patient.

  • Fail to document the rationale behind sharing information.

  • Miss opportunities to show reflective understanding in consultations.

  • Struggle to pass RCGP SCA cases with significant ethical considerations about confidentiality, disclosures, ethics and duty of care.

A strong grasp of confidentiality scenarios, combined with culturally competent communication, is therefore essential—not just for passing the SCA, but for safe daily practice.


Cultural Competency Note:

Many IMGs may come from countries where there is no legal obligation to disclose driving risks or where the family may expect the doctor to “handle it quietly.” In the UK, however, this is a legal duty placed on the patient, and explaining the rationale (safety, legal protection, public risk) in a calm and non-judgemental way is both culturally appropriate and exam-relevant.


Common Scenario: Advising a Patient to Inform the DVLA (Patient Agrees)

Clinical Context:

You’re consulting with a 54-year-old man who has recently had a first unprovoked seizure. He's currently well, medically stable, and back at work within the same month. He mentions he still drives occasionally and has not informed the DVLA.

🩺 Your Consultation Strategy:

  1. Empathise and Acknowledge the Impact

Use a patient-centred approach before introducing legal duties.

Phrase & Explanation:

  • “I can imagine this seizure and everything since must have felt overwhelming. It is understandable that you would want to return to your normal routine. Driving often feels like part of our independence, doesn’t it?”

➡️ This builds rapport and recognises the potential emotional impact of losing driving privileges.


2. Introduce Legal Obligation Clearly but Supportively

Phrase & Explanation:

  • “In situations like yours, where someone’s had a seizure, the DVLA does require you to stop driving for [X duration] and inform them. This is part of UK law and is meant to keep both you and other road users safe.”

➡️ This frames the issue as a public safety concern, not a personal judgment, using inclusive language like “someone” and “meant to keep you safe.”

3. Encourage Shared Responsibility

Phrase & Explanation:

  • “It’s your legal duty to inform the DVLA directly, but I’m happy to support you in understanding how to do that or where to find the information.”

➡️ This reinforces patient autonomy but shows ongoing support. It also makes clear that the GP does not do the notifying (primarily) but helps facilitate it.


4. Confirm Understanding and Agreement

Phrase & Explanation:

  • “Does that sound okay to you?”

  • "What are your thoughts on informing DVLA as soon as possible?"

  • “Just to confirm—you’re happy to inform the DVLA yourself today?”

➡️ Clarifies consent and makes your documentation clearer. It’s also an examiner-friendly check of patient understanding and safety.


5. Document Clearly and Offer Written Resources

Phrase & Explanation:

  • "I will document all we have discussed in your medical records. It is important I record all we have discussed about your decision today".

Signposting Tip:

  • “You can visit the uk.gov website to make a declaration – the guidance is quite clear and easy to follow.”

  • "It can be a lot to give up your driving licence for a while, and I think we need to speak to the right support to get you through this. There is a website called Diabetes UK with loads on information on diabetes and driving when you are on insulin. They also have a hotline to speak to specialist advisors who can guide you with the right information about informing DVLA. Would you like me to share their details with you so you give them a call?"

🛑 Common Pitfalls to Avoid:

  • ❌ Failing to document that the patient accepted the advice

  • ❌ Saying “I will tell the DVLA for you” – this removes responsibility from the patient (exceptions exist if the patient refuses)

  • ❌ Delaying the conversation – always address driving early in any condition that could impair consciousness or judgement, no matter how simple e.g leg pain that impairs driving and applying emergency manoeuvres.


Consultation Phrases Explained – Complex Scenarios

Below are common confidentiality dilemmas you may encounter in primary care, with example phrases you can use in the consultation, followed by an explanation of what each phrase achieves and why it is effective for the SCA.


Scenario 1: Disclosure to DVLA or Police

📌 Context:

You're seeing a patient with a condition such as stroke, epilepsy or substance misuse that may impair their ability to drive. Or you may encounter a lorry or truck driver who holds a Group 2 driving license and refuses to contact the DVLA following severe hypoglycaemic episodes. How do you manage and communicate your decisions when the patient refuses to inform the DVLA, and you have a legal duty to do so if they continue to drive?

Suggested Phrases:

  • “I understand this is sensitive (....a difficult position, challenging situation), but where there’s a risk to public safety—for example, having severe low sugar that is affecting your ability to drive—I’m obliged to inform the DVLA, even if you choose not to.”

  • “I always prefer to do this with your involvement, but if necessary, I am professionally obliged to disclose without your consent.”

💡 Why this works:

  • Shows empathy (“I understand this is sensitive”)

  • Clearly and concisely outline your professional duty, with long narration or schooling the patient.

  • Frames the disclosure as non-negotiable, but respectful and involving the patient as much as you can.

  • Demonstrates legal awareness, transparency and clinical ownership in deciding to disclose to the DVLA.


Scenario 2: Safeguarding a Child

📌 Context:

A parent discloses domestic violence or concerning behaviours but resists any external involvement. The child may be at risk.

Suggested Phrases:

  • “When children are involved, our duty to protect them sometimes means we must share information with social services. We’ll always try to involve you in the process and explain what’s happening.”

  • “You don’t have to go through this alone—we’re here to help—but I need to make sure your child is safe, and that means I may need to speak to safeguarding professionals.”

💡 Why this works:

  • Frames safeguarding as supportive, not punitive

  • Emphasises collaboration (“We’ll involve you”)

  • Shows patient-centred concern for both parent and child


Scenario 3: Third-Party Requests or Relatives Involved in Care

📌 Context:

A family member wants to discuss a patient’s care or is present in the consultation. For example, a teenager above 16 years or young adult who presents with a friend or relative.

Suggested Phrases:

  • “Before we discuss anything further, may I confirm: do you permit me to speak to your [spouse/relative/carer] today?”

  • “I can appreciate they’re concerned, but I would to have your consent to discuss your symptoms unless there’s a significant risk of harm.”

  • “Even if a relative is helping with care, I need your formal consent to share your health information.”

💡 Why this works:

  • Clarifies legal duty before assumptions are made, even in teenagers and young adults.

  • Avoids accidental breaches and disclosures.

  • Maintains professionalism and patient trust


Scenario 4: Declining to Share Information with a Relative Without Consent

Clinical Context:

You’re in a GP surgery. A patient’s adult daughter calls in. She’s worried about her father (your patient), who she says has seemed low and has been missing his diabetes check-ups. She asks you to confirm if he’s been seen recently and what’s going on with his care. You check and find that her father hasn’t given any consent for information sharing. Suggested Phrases:

  • “Thank you for reaching out—I understand you’re concerned. But I’m unable to share any information without your [father’s/mother’s/relative’s] consent.”

  • “Confidentiality rules mean I can’t confirm or deny any details unless we have permission from your [X].”

  • “What I can suggest is encouraging your [X] to contact us directly, and we’d be happy to support them.”


💡 Why this works:

  • Reinforces ethical and legal boundaries while showing empathy

  • Avoids accidental breaches when relatives call

  • Offers a constructive next step without giving away confidential information


Common Pitfalls to Avoid in SCA and Practice

  1. Assuming implied consent – Always check explicitly.

  2. Being vague about your duty – Be confident and clear.

  3. Not documenting the rationale for breaching confidentiality.

  4. Using jargon (e.g., “safeguarding escalation”) without lay explanation or using a conversational communication style.

  5. Failing to reflect cultural awareness – For example, not recognising that in some cultures, family involvement is assumed unless told otherwise.


UK Regional Variations Matter

The legal thresholds and safeguarding protocols can differ across:

  • England

  • Wales

  • Scotland

  • Northern Ireland

Always consult local safeguarding boards and professional indemnity providers for location-specific guidance.


Stay Current – Build it into Your CPD

Confidentiality principles can change as case law evolves. You are expected to remain up-to-date through CPD. Suggested Learning Resources:


ePortfolio Tip: Reflect Like a GP, Not an FY1

A common challenge for IMGs is low-level reflection in the portfolio. Avoid entries like:

“I learnt about confidentiality and why it’s important.”


Instead, reflect on how you navigated complexity, showed leadership or escalated safely.

Strong Example:

"In some cultures, family involvement in adult medical care is expected. GP may feel pressured to "just tell the family," especially if the caller is the patient's spouse or eldest child. In the UK, however, patient confidentiality is strict, regardless of family hierarchy or concern, even in teenagers and young adults (within the right context, for example, where there is no risk to harm or safety)".


Reflect on this scenario in your ePortfolio as a demonstration of navigating ethical complexity, rather than simply stating “I understand confidentiality.” Focus on managing distress from relatives, using appropriate consultation phrases, and upholding GMC principles under pressure.


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