1. Purpose
A single-handed independent specialist makes decisions with patients who are often paying privately and who may feel a procedure is expected once they have come this far. Good consent means a genuine, shared decision based on the patient's own goals, with the material risks and the alternatives, including doing nothing, set out honestly, and free from any pressure created by the doctor's financial interest in proceeding. This policy sets out how the practice takes consent and shares decisions.
The practice must verify this policy against current GMC consent guidance and the Montgomery standard of material risk before adoption.
2. Sources to verify before adoption
- GMC, Decision making and consent: https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/decision-making-and-consent
- GMC, Good medical practice (including managing conflicts of interest and financial interests): https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-medical-practice
- The Montgomery v Lanarkshire standard of material risk (verify the current legal position)
- Mental Capacity Act 2005: https://www.legislation.gov.uk/ukpga/2005/9/contents
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 11 (consent): https://www.legislation.gov.uk/uksi/2014/2936/regulation/11
3. Scope
This policy applies to:
- every treatment, procedure and investigation the practice offers
- the doctor and any staff who support the consent process
- adults with capacity, adults who may lack capacity, and (where in scope) young people
4. A shared decision
Consent is a conversation, not a form. For each decision the doctor:
- finds out what matters to the patient: their goals, concerns and the things that would affect their choice
- explains the condition, the options (including doing nothing), and the likely outcome of each
- sets out the material risks, meaning those a reasonable patient in this person's position would want to know, and any that matter to this particular patient
- gives the patient time and space to ask questions and to decide
5. Honesty about benefit and alternatives
- the doctor is honest about how likely the treatment is to help, and does not overstate it
- the realistic alternatives, including more conservative options and doing nothing, are offered fairly
- the patient is never given the impression that a procedure is the only option when it is not
6. Financial interest and no pressure
Because the practice has a financial interest in providing treatment, the practice is careful that this never influences the advice:
- the doctor's financial interest in proceeding is recognised, and the patient is not pressured toward a paid procedure
- fees are explained clearly and in advance, so cost is not a surprise
- where the patient would be as well or better served by a less costly option, or by care the practice does not provide, the doctor says so
7. Time to decide for elective treatment
For elective treatment the patient is given time between the discussion and the procedure to reflect, is told they can change their mind at any point, and is not booked for an irreversible elective procedure on the same day as the first consultation unless there is a clinical reason.
8. Capacity
Where a patient may lack the capacity to make a decision, the practice follows the Mental Capacity Act: capacity is assessed for that decision, the patient is given all practicable help to decide, and where they cannot, a best-interests decision is made and recorded, involving those close to the patient and an advocate where the patient has no one to represent them.
9. Recording
The consent discussion, the options and risks covered, the patient's questions, the fee information given, and the patient's decision are recorded. The signed form is part of the record, not the whole of it.
10. Audit cadence
The practice checks, on a stated cadence, that:
- consent records show a real, person-specific discussion of options, risks and alternatives, not a generic form
- elective procedures had time to reflect and were free from pressure
- fees were explained in advance and conflicts of interest managed
- capacity assessments and best-interests records are present where needed
The doctor and the Registered Manager review the results and record the improvement actions that follow.