I’m worried about my patient. When must I report my concerns?

All healthcare professionals are in a position of trust and responsibility. But in some circumstances our own duty to report may override other obligations that we owe our patients

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Healthcare professionals may witness concerning situations or disclosures of unexpected information. Health and Care Professions Council (HCPC) standards require physiotherapists to recognise and respond appropriately where there is a duty to report information without patient consent, which can include where the law requires it or when necessary to protect public safety or prevent harm. 

This is a balance which can lead to dilemmas in practice.

When reporting, you must hold an honest belief and evidence to support your concerns; for example, what you observe, are told or other forms of documentary evidence such as emails or letters. You should be able to justify your decision, take a reasonable and proportionate approach to escalating your concern through appropriate channels and keep clear records to show how you came to your decision.  

The HCPC advises that even where it is considered to be in the public interest to disclose confidential information, you should still take appropriate steps to get the service user’s consent (if possible) before you do so. You should keep them informed about the situation as much as you can. However, this might not be possible or appropriate in some circumstances, such as when you disclose information to prevent or report a serious crime.

In this article we consider some scenarios that might give rise to a duty to report. 

A patient discloses they are continuing to claim Jobseeker’s Allowance even though they’ve returned to work

Circumstances such as alleged benefit fraud raise questions about whether there is a moral duty to report activities perceived to be against the public interest. However, a moral obligation does not outweigh a professional duty. Therefore, your duty to maintain patient confidentiality outweighs your duty to report suspected benefit fraud and therefore you would not be required to report your suspicions.   

You suspect that a patient is at risk of radicalisation

The ‘Prevent’ training programme is part of the UK government’s counter- terrorism strategy and all staff should be alert to potential signs of radicalisation and know how to seek support and report concerns though your employer or local systems.

You can access free Prevent awareness training here.

You are concerned that a patient is no longer safe to drive

Drivers have a legal responsibility to self-report if their health is affecting their ability to drive safely. The DVLA advises healthcare professionals should remind patients of this and encourage them to self-report. Where a patient will not self-report physiotherapists have a duty to report driver safety concerns and should notify DVLA directly. 

The DVLA has resources to support patient conversations, a comprehensive list of national medical guidelines on fitness to drive and reporting concerns, plus access to DVLA medical advisers for further advice. 

The HCPC also has essential resources to help you weigh up your decision (see resources box).

My patient has disclosed they plan to harm themselves

You have a regulatory duty to report concerns promptly and appropriately if you have an honestly held belief that a person (adult or child), is suffering, or is at risk of harm. 

Wherever possible you should involve patients, and appropriate carers, in discussions about safeguarding concerns and encourage them to seek support via the GP, crisis teams or other appropriate healthcare professionals. 

Work in an organisation? 

Escalate your concerns via organisational safeguarding procedures. Your line manager should guide and support you through this. 

Work in private practice? 

All local authorities have designated safeguarding leads. You should know who this is and how to raise concerns to them. 

Worried about reporting? 

Remember you are not alone. Seek support from colleagues/line managers as appropriate. Many workplaces have CSP health and safety reps who can help you. The CSP has resources to help you build your resilience and look after your wellbeing.

Professional Advice team

The CSP’s Professional Advice Service gives advice and support to members on complex and specialist enquiries about physiotherapy practice, including professional practice issues, standards, values and behaviours, international working, service design and commissioning, and policy in practice.

Sara Glanville-Taylor and Clare Aldridge are CSP professional advisers

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