Reflection period for consent

Accept in principle

Many key organisations, including the GMC, have taken steps to update their guidance, and to confirm that doctors should give patients sufficient time to consider their options before making a decision about their treatment and care. During annual appraisals, doctors must provide supporting information, including information to demonstrate they are continuing to meet the principles and values set out in ‘Good medical practice’. CQC also takes all GMC guidance into account during its assessments.

The government accepts this recommendation in principle, and agrees that patients, families and carers should be given enough time to consider relevant information before deciding to undergo treatment.

NHS England has integrated decision support tools into elective pathways of care. These tools support two stage shared decision making, which introduces a period of reflection for patients when deciding on treatment options and giving consent. This allows patients to take the time to fully understand the benefits and risks of treatment, talk with friends and family, and decide whether it is the most suitable option for them.

The Medical Practitioners Assurance Framework (MPAF) was developed by the Independent Healthcare Providers Network in response to reviews, including the Paterson Inquiry. The MPAF is designed to provide a basis from which all independent providers can work, giving confidence to patients and regulators, such as the Care Quality Commission, on what good looks like. The MPAF advises that policies need to provide for patients to be given specific time to reflect and make decisions.

The following guidance has been updated to indicate that doctors should give patients sufficient time to consider options before making a decision about their treatment and care:

• The GMC has revised guidance on decision making and consent that came into effect from 9 November 2020. The GMC sets/enforces the standards doctors must follow as part of “Good Medical Practice”. A serious or persistent failure to follow guidance that poses a risk to patient safety will put the doctor’s registration at risk. If a doctor’s practice regarding consent needs improvement, the GMC would require them to undertake professional development.

• In 2018, the Royal College of Surgeons (RCS) published guidance on consent and supported decision-making. As outlined in the RCS’ “Good surgical practice” patients should sign a consent form at the end of the discussion if they have decided to go ahead with treatment.

• The IHPN has updated the Medical Practitioners Assurance Framework (“MPAF”) with standards for patient consent. Compliance with consent standards is enforced by the medical regulators.

• Shared decision-making is a key element of NHS England’s Personalised Care programme. NHS England is implementing a 2-stage shared decision making process. This is supported by decision support tools which are being integrated into pathways of care as a core component of the delivery plan for tackling the covid-19 backlog of elective care. Two stage decision-making introduces a period of reflection for patients when deciding on treatment options and giving consent. This allows patients to take the time to fully understand the benefits and risks of treatment, talk with friends and family and decide whether it is the most suitable option for them. Integrating these tools into this decision-making process will support providers in meeting this requirement.

CQC considers GMC and RCS guidance and standards when conducting assessments. CQC can act if a provider is failing to ensure that consent is being obtained lawfully.

Action 2.1

Key organisations including the GMC and NHSE have updated their guidance, including to confirm that doctors should give patients sufficient time to consider options before making a decision about their treatment and care. NHSE is implementing a 2-stage shared decision making process, which includes a period of reflection for patients when deciding on treatment and giving consent. NHSE has published 11 decision support tools for patients on treatment options and continues to produce further decision support tools. The GMC has revised guidance on decision making and consent that came into effect from 9 November 2020. In 2018, the Royal College of Surgeons (RCS) published guidance on consent and supported decision-making. As outlined in the RCS’ “Good surgical practice” patients should sign a consent form at the end of the discussion if they have decided to go ahead with treatment. The IHPN has updated the Medical Practitioners Assurance Framework (“MPAF”) with standards for patient consent. Compliance with consent standards is enforced by the medical regulators. The GMC sets/enforces the standards doctors must follow as part of “Good Medical Practice”. A serious or persistent failure to follow guidance that poses a risk to patient safety will put the doctor’s registration at risk. If a doctor’s practice regarding consent needs improvement, the GMC would require them to undertake professional development. CQC takes into account GMC and RCS guidance and standards when conducting assessments. CQC can take action if a provider is failing to ensure that consent is being obtained lawfully.

Action 2.1:

Accepted in principle by the government.

There is no defined period required but key organisations such as the General Medical Council and the Care Quality Commission have indicated in their guidance that there should be sufficient time to consider options before making a treatment decision. Doctors must provide supporting information that they are continuing to meet the principles and values in ‘Good medical practice’ during annual appraisals.