Medicolegal & Employment Law

Gillick competence means a child under 16 has sufficient understanding and intelligence to consent to a specific medical treatment. It is assessed individually, for each decision, not globally.

Fraser Guidelines are specifically about contraception. A doctor may provide contraceptive advice or treatment to a young person under 16 without parental consent if:

• The young person understands the advice
• They cannot be persuaded to involve parents
• They are likely to begin or continue sexual activity with or without treatment
• Their physical or mental health would suffer without treatment
• It is in their best interests to provide contraception without parental knowledge

Young people aged 16 and 17 are presumed to have capacity to consent to medical treatment under the Family Law Reform Act 1969. However, unlike adults, their refusal can (in certain circumstances) be overridden by a parent or court if the decision would be seriously harmful.

If a patient lacks capacity, decisions must be made in their best interests under the Mental Capacity Act 2005. This means:

• Using the least restrictive option
• Consulting those close to the patient
• Respecting any advance decisions or LPA (Lasting Power of Attorney)
• Involving an IMCA (Independent Mental Capacity Advocate) if there is no one to consult

Note: relatives do not have the legal right to consent on behalf of an incapacitated adult unless they hold a valid LPA for health and welfare decisions.

Consent can be explicit (the patient actively agrees) or implied (for example, a patient who refers themselves to a specialist understands that relevant information will be shared). Sharing within a direct care team is generally covered by implied consent.

Some disclosures are legally required. You must disclose in these situations even without patient consent:

• Notifiable diseases (e.g. tuberculosis, measles, COVID-19) to the local authority
• Birth and death registration
• Court order or statutory demand from a regulatory body
• Road traffic accidents — police can request names and addresses of those involved
• Counter-terrorism legislation (Terrorism Acts)

You may disclose without consent if the public interest in disclosure clearly outweighs the patient's interest in confidentiality. This usually means:

• There is a serious, credible, and specific risk of harm to an identifiable person
• The harm cannot reasonably be prevented without disclosure
• The patient has refused consent and persuasion has not worked

The GMC guidance is clear: the potential harm to others must be serious. Minor risks do not justify breaking confidentiality.

Child safeguarding always takes priority over confidentiality. If you have a reasonable concern that a child is at risk of serious harm, you must share information with the appropriate agencies (children's social care, police) — even without parental consent or the patient's consent.

For vulnerable adults, the principles are similar. Disclosure may be justified to protect an adult who lacks capacity, or who is at risk of serious harm.

Confidentiality extends beyond death. You should not routinely disclose a deceased patient's records to family members. However, access may be granted to:

• Executors or administrators of the estate (under the Access to Health Records Act 1990)
• Those with a legitimate claim arising from the death (with access limited to directly relevant information)

Specific requests should be handled carefully — legal advice may be needed in complex cases.

Before writing any report for an employer, insurer, or solicitor about a patient, you must have the patient's explicit written consent. Under the Access to Medical Reports Act 1988, patients have the right to see any report you write about them for employment or insurance purposes before it is sent.

Key rules:

• Never disclose more information than is necessary for the specific purpose
• Correct factual errors if asked — but do not remove opinions you believe to be correct
• Insurers cannot use Subject Access Requests (SARs) under GDPR to access full medical records for insurance purposes

The MCCD must be completed by the attending practitioner — a medical practitioner who attended the deceased during their lifetime. From 9 September 2024, the previous requirement to have seen the patient within 28 days before death, or to have examined the body after death, was abolished. Any doctor who attended the patient during their lifetime may now complete the MCCD, provided they can certify the cause of death to the best of their knowledge and belief. In GP, this typically means the patient's own GP or a partner who has been involved in care.

The two-part structure:

• Part 1a: The direct cause of death (e.g. pneumonia)
• Part 1b: Conditions leading to 1a (e.g. COPD)
• Part 1c: Conditions leading to 1b
• Part 2: Other significant conditions that contributed to death but were not part of the main causal sequence

You must refer to the coroner when:

• The cause of death is unknown or cannot be certified
• The death was sudden, unexpected, or suspicious
• The death occurred during or shortly after an operation or anaesthetic
• The death was related to an accident, injury, or self-neglect
• The death may be related to industrial disease or poisoning
• The death occurred in custody or state detention
• Death in children — always consider referral if unexpected

If in doubt, ring the coroner's office. They are very approachable and would much rather be called than not.

In the UK, there is no legal duty to stop and help at an accident if you are off duty (unlike some other countries). However, there is a strong professional duty — the GMC in Good Medical Practice states you must offer assistance in an emergency. Your medical defence organisation provides indemnity for genuine Good Samaritan acts in good faith, even if the outcome is poor.

• Always act within your competence
• The standard expected is that of a doctor doing their best in the circumstances
• UK law provides protection from liability for first responders acting in good faith
• Inform your MDO if you were involved in a Good Samaritan act with an adverse outcome

Employees may be fairly dismissed for five potentially fair reasons:

• Misconduct — e.g. dishonesty, serious breach of policy
• Capability — either performance or health-related incapacity
• Redundancy — the role is no longer needed
• Illegality — e.g. a nurse loses their registration
• Some other substantial reason (SOSR) — a catch-all for unusual situations

Even with a potentially fair reason, the employer must follow a fair process. A failure of procedure can make an otherwise fair dismissal unfair.

Vicarious liability means an employer can be held legally responsible for the wrongful acts of their employee, if those acts were committed in the course of employment.

In general practice this means:

• The GP practice (as employer) may be liable if a member of staff negligently harms a patient during their normal duties
• This reinforces the importance of proper staff training, supervision, and policies
• It also applies to locums in many circumstances — check your practice indemnity arrangements

• All employees are entitled to 52 weeks of maternity leave regardless of length of service
• Statutory Maternity Pay (SMP) is paid for up to 39 weeks (to those who qualify)
• Dismissal during pregnancy or maternity leave is automatically unfair — there is no qualifying period
• Women on maternity leave have the right to return to the same job (ordinary maternity leave) or an equivalent job (additional maternity leave)
• Keeping in Touch (KIT) days: up to 10 days can be worked without ending maternity leave
• Employers must carry out a risk assessment for pregnant employees and make adjustments where needed

The Health and Safety at Work Act 1974 places a duty on employers to ensure, so far as is reasonably practicable, the health, safety, and welfare of their employees. In GP practices this includes:

• Risk assessments for all significant hazards
• Safe handling of sharps and clinical waste
• Infection control policies
• Management of lone working
• Workplace violence and patient aggression policies
• Employer liability insurance (mandatory)

Age is a protected characteristic under the Equality Act 2010. There is no longer a default retirement age. Employers cannot force an employee to retire simply because of age — this is direct age discrimination. Decisions about continued employment must be based on performance and capability, not age.

A GP registrar diagnoses a patient with a first unprovoked seizure. The patient is a delivery driver and says, "I need my licence for work — please don't report me." The registrar, not wanting to upset the patient, documents the seizure but says nothing about the DVLA.

A receptionist puts through a call from a patient's husband who is very worried about his wife. He says he thinks she is being abused by someone she met online and asks if she has been to the surgery recently. A GP registrar takes the call, feels bad for him, and confirms: "Yes, she has been in recently, but I can't say more."

A 72-year-old patient with a suspicious skin lesion says they do not want a biopsy. They understand the risk of missing a melanoma and say, "I've had a good life and I'm not going through all that." Their family contacts the surgery demanding the GP "make her have it done."

A GP registrar has a difficult consultation. Feeling overwhelmed at the end of a long day, they write a brief note: "Patient declined advice. Plan discussed." Six months later, the patient complains that they were not told about a risk that has materialised. The registrar's note provides no evidence of what was actually said.

Earlier than you think. MDOs (MDU, MPS, MDDUS) are there to help with: complaints, GMC referrals, inquest preparation, medicolegal advice, and ethical dilemmas. You do not need to wait until something is a formal complaint. If a consultation has left you uncertain, call. There is no shame in asking — in fact, it is what good doctors do.

Since April 2019, NHS clinical negligence claims in England are covered by the Clinical Negligence Scheme for General Practice (CNSGP). However, you still need MDO membership for GMC proceedings, complaints, inquests, and anything outside NHS contracted work. Most registrars will have this through their training scheme — check with your practice and deanery.

Presume capacity unless you have reason to believe otherwise (MCA Principle 1). If you have genuine concern, apply the two-stage capacity test. Consider referral to a psychiatrist or specialist if the decision is significant and your assessment is uncertain. Document your reasoning carefully. In complex cases, an Independent Mental Capacity Advocate (IMCA) can be appointed.

Not without the patient's consent. Being a worried relative does not override a patient's right to confidentiality. What you can do: listen to the relative's concerns (this does not breach confidentiality), encourage them to speak with the patient directly, or ask the patient for their consent to speak with the relative. If there is a genuine safeguarding concern, that changes the picture — apply the public interest test.

• Consent and the Montgomery standard
• Mental Capacity Act principles and the two-stage test
• Gillick competence and Fraser guidelines
• Confidentiality — when to share and when not to
• DVLA fitness to drive — specific conditions, Group 1 vs Group 2
• Bolam and Bolitho tests
• The three elements of clinical negligence
• Protected characteristics under the Equality Act 2010
• Death certification and coroner referral