The GMC has published explanatory guidance setting out what to do when a patient presents with a gunshot or knife wound
Earlier this month, the BBC reported that some knife crime victims are reluctant to go to hospital to get their wounds stitched as they fear the police will get involved. Some victims are worried that they may be implicated if the police pursue the person who attacked them. Frontline workers who deal with gang violence report that they know people who have paid a vet to treat a stab wound rather than go to their local accident and emergency department.
According to police recorded crime figures, violent crime in England and Wales has risen by 24%, including a 9% rise in knife crime and a 7% rise in gun crime in the 12 months from June 2015 – June 2016. Understanding what has driven this rise in crime is complex – a wide range of factors including improvements in recording as well as an actual rise in knife and gun crime are likely to have contributed. A knife or blade was used in a crime every 16 minutes on average last year.
The General Medical Council (GMC) has published revised guidance on confidentiality for all doctors practising in the UK which comes into effect on 25 April 2017. Until that time existing guidance should be followed. The GMC have also published revised explanatory guidance which sets out how the principles apply when a patient presents with a gunshot wound or knife wound. In addition, this revised explanatory guidance now clarifies that the decision whether or not to call the police when a patient presents with a gunshot or knife wound is a professional judgement and is not mandatory in all cases. This was always the intention, but emergency doctors had expressed concern that the previous guidance could be applied in a way that was disproportionate and harmful to patients’ trust. It also clarifies that the principles set out could apply to other kinds of violent injury.
Police should normally be informed if a person comes to hospital with a gunshot wound or wound from a knife or other sharp instrument.
The police are responsible for assessing the risk posed by someone who is armed/has used a gun or a knife. The police need this information to consider:-
The ‘Cardiff Model’ developed by the Violence and Society Research Group is a mechanism of sharing and using anonymous data collected from violence related Accident & Emergency admissions about the precise locations and times of violent incidents and weapon used to help support effective policing, such as tackling crime hotspots and informing violence prevention strategies. In areas where it has been implemented it has led to a significant reduction in admissions as a result of violent crime. A study in 2012 found that an effective information-sharing partnership between health services, police and local government in Cardiff led to substantial cost savings for the health service.
The decision as to whether there can be disclosure in the public interest should be made by/with the agreement of the:-
Disclosure may be justified if:-
A note should be made in the patients record stating:-
Child protection concerns must be considered and the guidance in Protecting children and young people: The responsibilities of all doctors should be followed.
Making decisions about when to share confidential information can often be difficult and stressful. In relation to any decision, the issues and grounds of disclosure need to be considered, if appropriate debated with a senior colleague and then clearly documented in the notes.
Bevan Brittan has substantial experience in advising healthcare professionals in connection with the disclosure of confidential information. If you would like to discuss any of the issues raised please contact us.