Last week’s thrilling episode ended with Ken Clarke bringing in his ‘New Contract’ for GPs. This involved GPs undertaking additional tasks for which they could claim payment – which resulted in an overdose of bureaucracy.

As a result of the way in which it had been implemented (despite GPs voting to reject it) a feeling of mutual distrust had intensified. It was a nadir for the profession. Doctors didn’t trust the politicians and vice versa. There followed years that were, according to Dr Theodore Dalrymple, increasingly “ones of drudgery, servitude and subordination to politicians and their henchmen, the managers, who utter Pecksniffian pieties as they secure the advancement of their own inglorious careers.”

Accordingly, a particularly obnoxious local NHS manager decreed that members of his staff should go round to GP practices, take patients private medical records off the shelves without their knowledge and consent, and read through them. The excuse was that this was to ensure that GPs were doing the work they’d been claiming for under the ‘new contract.’

I thought that this was clearly a breach of the principle of confidentiality. This may seem like a dull topic … indeed, some would go as far as arguing that it makes watching paint dry seem like a breathtaking spectator sport. That said, it is of paramount importance – and has been from the time of Hippocrates. The Hippocratic Oath explicitly states: “Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not which ought not to be spoken of outside, I will keep secret, as considering all such things to be private“.

Would you be happy if somebody with no role in your clinical care was allowed to browse through your private medical records – records which may contain personal and potentially embarrassing details? As with Vegas, the understanding has always been that “What happens in general practice, stays in your GP surgery.” Confidentiality is the cornerstone of General Practice – patients won’t confide in a GP if they think what they say is going to be shared with every nosey Tom, Dick and Harry. Likewise, there is the fear that GPs will be deterred from writing comprehensive notes if they think they are likely to be seen by the prying eyes of those who play no part in a patient’s care.

I put out a press release which began as follows: 

“When it comes to confidentiality and there are two schools of thought: on the one hand there is the new breed of NHS managers who think it doesn’t matter at all and, on the other, there is the public. Research carried out on behalf of the Data Protection Registrar shows that “the public consider privacy to be surpassed in importance only by concern about the crime of the streets and standards of education – ranking more highly than unemployment and inflation.”

It wouldn’t matter what the NHS managers think providing we doctors are prepared to stand up for the rights of our patients. Unfortunately, however, the medical profession has gone soft on confidentiality … for some time some very nice, well intentioned people have been looking through patient’s records – and have been doing so for all the right reasons. Unfortunately, a lot of not-so-nice people have been watching from the wings and now they want to get in on the act. Their motives are suspect and, if doctors are willing to hand them this right without a word of dissent, we are on a very slippery slope.”

By “very nice, well intentioned people” I meant, for example, doctors involved in research etc. The medical records are a treasure trove of data which can aid medical advances. The problem was that those less well intentioned (e.g. insurance companies, NHS managers whose moral compasses were malfunctioning – etc) thought: “If they can do it why can’t we?

There followed a long battle. This involved taking on the establishment with the aid of an exceptionally talented local lawyer (who shouldered much of the burden and did so with great skill). We were supported by a variety of individuals/journalists, and organisations – most notably the Community Health Councils (CHCs). As you can see from the enclosures, the CHCs constituted an effective body for championing patients rights. For this reason they were unpopular with politicians and NHS managers and it came as no surprise that they were abolished in 2003 in England without any discussion.

With her help, and following correspondence/meetings with politicians of the time (e.g. Robin Cook, Peter Bottomley, and Stephen Dorrell), the scheme was stamped out. We won! Hurrah!!! Thereafter, anyone who wanted to read your records had (a) to let you know and (b) get your permission …which is as it should be.

The price was that, what with this campaign and the attempt to get the ‘New Contract proposals judicially reviewed, I became very unpopular with local NHS managers (and one in particular). His opportunity to show his displeasure came later … but more of that shortly.

Dr John Cormack

THE CONFIDENTIALITY CAMPAIGN WHICH FOLLOWED THE IMPOSITION OF THE  ‘NEW CONTRACT’

A small selection of the correspondence that took place and some of the newspaper articles can be found at: https://mega.nz/folder/XN81mCyA#c4OkMRIIH35i__xxw_yurw