Professional standards In effect: 25 April 2017

Confidentiality:
disclosing information
about serious
communicable
diseases

Summary

This guidance gives advice about accessing, using and disclosing information about the infection
status of people who have serious communicable diseases, like HIV or tuberculosis.
It has advice on:

• talking to patients about the risk of transmission

• what to do if a healthcare colleague suffers a needlestick injury
• disease control and surveillance
• what to record on death certificates.

It explores the circumstances in which disclosure without consent may be necessary, helping you to
balance the risk of harm to others against the patient’s right to confidentiality.
Confidentiality: disclosing information
about serious communicable diseases
Professional standards: More detailed guidance

This guidance came into effect 25 April 2017.

You can find the latest version of all our professional standards at www.gmc-uk.org/guidance.

The GMC is a charity registered in

England and Wales (1089278)
and Scotland (SC037750).
Contents
Confidentiality: disclosing information about serious communicable diseases.................. 1
About this guidance................................................................................................. 4
Protecting information against improper disclosure.................................................... 4
Control and surveillance of serious communicable diseases........................................ 5
Protecting patients from risks posed by your health or your colleagues' health ............ 5
Disclosing information about patients who are diagnosed with a serious communicable
disease to those providing direct care ....................................................................... 5
Disclosing information in response to injuries to colleagues and others ....................... 6
Informing people at risk of infection from serious communicable disease.................... 7
Disclosing information when children and young people are at risk of a serious
communicable disease ............................................................................................. 7
Recording serious communicable diseases on death certificates ................................. 8
Endnotes ................................................................................................................ 9

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1. In our guidance Confidentiality: good practice in handling patient information we say:

1. Trust is an essential part of the doctor patient relationship and confidentiality is

central to this. Patients may avoid seeking medical help, or may under-report
symptoms, if they think their personal information will be disclosed by doctors without
consent, or without the chance to have some control over the timing or amount of
information shared.

17. You must disclose information if it is required by statute, or if you are ordered to do
so by a judge or presiding officer of a court.

18. You should satisfy yourself that the disclosure is required by law and you should only
disclose information that is relevant to the request. Wherever practicable, you

62.You should ask for a patient’s consent to disclose information for the protection of
others unless the information is required by law or it is not safe, appropriate or
practicable to do so1. You should consider any reasons given for refusal.

64. If it is not practicable or appropriate to seek consent, and in exceptional cases where
a patient has refused consent, disclosing personal information may be justified in the
public interest if failure to do so may expose others to a risk of death or serious harm.
The benefits to an individual or to society of the disclosure must outweigh both the
patient’s and the public interest in keeping the information confidential.

67. Before deciding whether disclosure would be justified in the public interest you
should consider whether it is practicable or appropriate to seek consent (see paragraph
14). You should not ask for consent if you have already decided to disclose information
in the public interest but you should tell the patient about your intention to disclose
personal information, unless it is not safe or practicable to do so. If the patient objects
to the disclosure you should consider any reasons they give for objecting.

68. When deciding whether the public interest in disclosing information outweighs the
patient’s and the public interest in keeping the information confidential, you must
consider:

a. the potential harm or distress to the patient arising from the disclosure – for
example, in terms of their future engagement with treatment and their
overall health
b. the potential harm to trust in doctors generally – for example, if it is widely
perceived that doctors will readily disclose information about patients
without consent
c. the potential harm to others (whether to a specific person or people, or to
the public more broadly) if the information is not disclosed

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 d. the potential benefits to an individual or to society arising from the release of
the information
e. the nature of the information to be disclosed, and any views expressed by the
patient
f. whether the harms can be avoided or benefits gained without breaching the
patient’s privacy or, if not, what is the minimum intrusion.

If you consider that failure to disclose the information would leave individuals or society exposed
to a risk so serious that it outweighs the patient’s and the public interest in maintaining
confidentiality, you should disclose relevant information promptly to an appropriate person or
authority.

About this guidance

2. Confidentiality is important to all patients and all patients are entitled to good standards of
care, regardless of what disease they might have, or how they acquired it. Those who have,
or may have, a serious communicable disease2 might be particularly concerned about their
privacy. This guidance, which forms part of the professional standards, sets out how the
general principles in our guidanceConfidentiality apply when doctors are accessing, using or
disclosing information about the infection status of patients who have serious communicable
diseases.
The professional standards describe good practice, and not every departure from them will
be considered serious. You must use your professional judgement to apply the standards to
your day-to-day practice. If you do this, act in good faith and in the interests of patients, you
will be able to explain and justify your decisions and actions. We say more about professional
judgement, and how the professional standards relate to our fitness to practise processes,
appraisal and revalidation, at the beginning of Good medical practice.

Protecting information against improper disclosure

3. You should make sure that information you hold or control about a patient’s infection status
is at all times effectively protected against improper disclosure. If you disclose information
about a patient’s infection status, you must keep disclosures to the minimum necessary for
the purpose.

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Control and surveillance of serious communicable
diseases
4. You must pass information about notifiable diseases to the relevant authorities for
communicable disease control and surveillance. Different diseases are notifiable in different
UK countries and the reporting arrangements differ. You should follow the arrangements
where you work.3 You should disclose anonymised information if practicable and as long as it
will serve the purpose.

Protecting patients from risks posed by your health or

your colleagues' health
5. Good medical practice4 says:
79. You must consult a suitably qualified professional and follow their advice about any
changes to your practice they consider necessary if:

a you know or suspect that you have a serious condition that you could pass on to
patients

b your judgement or performance could be affected by a condition or its

treatment.

You must not rely on your own assessment of the risk to patients.

80. You should be immunised against common serious communicable diseases (unless
contraindicated).

6. You should follow our guidance Raising and acting on concerns about patient safety if you
are concerned that a colleague who has a serious communicable disease is practising, or has
practised, in a way that puts patients at risk of infection5. You should inform your colleague
before passing the information on, as long as it is practicable and safe to do so.

Disclosing information about patients who are

diagnosed with a serious communicable disease to
those providing direct care
7. Most patients understand and expect that relevant information must be shared within the
direct care team to provide their care. If a patient objects to disclosure of personal

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 information that you are convinced is essential to provide them with safe care, you should
follow the guidance at paragraphs 30 - 31 of Confidentiality. If the patient does not have
capacity to make the decision, you can disclose information if it is in their overall benefit, in
line with the guidance at paragraphs 48 - 49 of Confidentiality.
8. If a patient who has been diagnosed with a serious communicable disease refuses to allow
you to tell others providing their care about their infection status, and you believe that
failing to disclose the information will put healthcare workers or other patients at risk of
infection, you should explain to the patient the potential consequences of their decision and
consider with the patient whether any compromise can be reached.
9. Like everyone else, healthcare workers are entitled to protection from risks of serious harm.
But disclosure of information about a patient’s infection status without consent is unlikely to
be justified if it would make no difference to the risk of transmission – for example, if the
risk is likely to be managed through the use of universal precautions that are already in
place.6 If the patient continues to refuse to allow you to tell other members of the
healthcare team about their infection status, you must abide by their wishes unless you
consider that disclosing the information is necessary to protect healthcare workers or other
patients from a risk of death or serious harm.

Disclosing information in response to injuries to

colleagues and others
10. If a colleague, police officer or anyone else suffers a needlestick or similar injury involving a
patient who has, or may have, a serious communicable disease, you should make sure that a
risk assessment is made urgently by an appropriately qualified colleague. Post-exposure
prophylaxis should be offered in accordance with that risk assessment, depending on the
type of body fluid or substance involved and the route and severity of the exposure.7
11. You should ask for the patient’s consent to disclose their infection status after other people
have been exposed to a serious communicable disease. If the patient cannot be
persuaded to consent to disclosure, or if it is not safe or practicable to ask for their consent,
you may disclose information if it is justified in the public interest. This could be, for example,
if the information is needed for decisions about the continued appropriateness of post-
exposure prophylaxis. You should follow the guidance on disclosing information in the public
interest at paragraphs 63 - 70 of Confidentiality.

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Informing people at risk of infection from serious
communicable disease
12. You should explain to patients who have serious communicable diseases how they can
protect others from infection, including from sexually transmitted diseases. This includes the
practical measures they can take to avoid transmission, and the importance of informing
people with whom they have sexual contact about the risk of sexual transmission of serious
communicable diseases.
13. You may disclose information to a person who has close contact with a patient who has a
serious communicable disease if you have reason to think that:

a. the person is at risk of infection that is likely to result in serious harm

b. the patient has not informed them and cannot be persuaded to do so.

14. If you believe that an adult who is at risk of infection lacks capacity to understand this
information, and is at risk of serious harm, you must give relevant information promptly to
an appropriate responsible person or authority, unless it is not of overall benefit to the
patient to do so (see paragraphs 55 - 56 of Confidentiality).

15. You should tell the patient before you disclose the information if it is practicable and safe to
do so. When you are tracing and notifying people, you should not disclose the identity of the
patient, if practicable. You must be prepared to justify a decision to disclose personal
information without consent.8

Disclosing information when children and young

people are at risk of a serious communicable disease
16. Most patients with a serious communicable disease who are parents of, or care for, children
will do all they can to protect the children from the risk of infection or the effects of the
disease. You should make sure the patient understands the information and advice you give
them, which you should tailor to their needs. You should do all you reasonably can to
support them in caring for themselves and in protecting their children.
17. You should explain to a patient with a serious communicable disease the importance of
testing any children who may already be infected, including children without symptoms and
young people who might have been vertically infected with a blood-borne virus.
18. If you are concerned that a child is at risk of serious harm because their parents cannot be
persuaded to protect them from the risk of infection, or because they refuse to allow the

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 child to be tested, you should treat it as a safeguarding concern and follow the advice in our
guidance Protecting children and young people: the responsibilities of all doctors.9

Recording serious communicable diseases on death

certificates
19. If a serious communicable disease has contributed to the cause of death, you must record
this on the patient’s death certificate.

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Endnotes
1. We give examples of when it might not be practicable to seek consent in paragraph 14 of
Confidentiality: good practice in handling patient information. You can find all of our guidance
online.

2. In this guidance, the term ‘serious communicable disease’ applies to any disease that can be
transmitted from human to human and that can result in death or serious illness. It
particularly applies to, but is not limited to, HIV, tuberculosis, and hepatitis B and C.

3. You can get advice from Public Health England, Public Health Wales, Communicable Disease
Surveillance Centre in Northern Ireland and Health Protection Scotland.

4. Good medical practice (General Medical Council, 2024). You can find all of our guidance
online.

5. See Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare
workers (Department of Health, 2007); Health Clearance for Tuberculosis, Hepatitis B,
Hepatitis C and HIV for new Healthcare Workers with direct clinical contact with patients
(Scottish Government, 2008); The Management of HIV infected Healthcare Workers who
perform exposure prone procedures: updated guidance (Department of Health, 2014); and
HIV Infected Health Care Workers: Guidance on Management and Patient Notification
(Scottish Government, 2005).

6. Universal precautions, otherwise known as standard infection control precautions, are the
basic infection prevention and control measures necessary to reduce the risk of transmitting
infectious agents. Guidance on infection control is provided by Health Protection Scotland,
NHS Wales, DHSSPS Northern Ireland and the Department of Health in England.

7. Guidance for clinical health care workers: protection against infection with blood-borne
viruses – Expert Advisory Group on AIDS and the Advisory Group on Hepatitis (Department of
Health, 1998); HIV post-exposure prophylaxis: guidance from the UK Chief Medical Officers’
Expert Advisory Group on AIDS (Department of Health, 2008).

8. The NHS (Venereal Diseases) Regulations 1974, The NHS Trusts (Venereal Diseases) Directions
1991 and The NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions
2000 state that various NHS bodies in England and Wales must ‘take all necessary steps to
secure that any information capable of identifying an individual… with respect to persons
examined or treated for any sexually transmitted disease shall not be disclosed except – (a) for
the purpose of communicating that information to a medical practitioner, or to a person
employed under the direction of a medical practitioner in connection with the treatment of

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 persons suffering from such disease or the prevention of the spread thereof, and (b) for the
purpose of such treatment and prevention’. There are different interpretations of the
regulations and directions, and concerns about their compatibility with the European
Convention on Human Rights. In particular, there have been concerns that a strict
interpretation of the regulations would prevent the disclosure of relevant information,
except to other doctors or those working under their supervision, even with the patient’s
consent. There have also been concerns that the regulations would prevent disclosure of
information to known sexual contacts in the public interest. Our view is that the regulations
and directions do not preclude disclosure if it would otherwise be lawful at common law, for
example with the patient’s consent or in the public interest without consent.

9. See also our case study about a parent who refuses to allow her daughter to be tested for
HIV.

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