Sharing without consent: public interest, serious harm and safeguarding

Use proportional, documented reasoning when confidentiality may need to be breached to protect patients or others, including safeguarding and serious-harm scenarios.

• Identify when public-interest disclosure may be considered.
• Apply a proportionality balance between confidentiality and prevention of serious harm.
• Use safeguarding information-sharing principles without treating safeguarding as a blanket exception.
• Disclose only relevant information to an appropriate recipient.
• Record reasoning and seek advice where thresholds or authority are uncertain.

Confidentiality can be overridden where disclosure is required by law or justified in the public interest. Public-interest disclosure requires a real balancing exercise; it is not a general label for anything that seems useful.

Where there is a risk of serious harm, the clinician should consider the nature and likelihood of harm, the potential benefit of disclosure, the harms caused by disclosure, the recipient’s ability to act, and whether a less intrusive route can achieve the purpose.

Safeguarding does not mean consent is irrelevant. GMC guidance encourages seeking consent unless doing so would create risk, cause harmful delay, or disclosure has already been judged necessary in the public interest.

Information shared without consent should be relevant and limited. Whole-record disclosure is rarely justified simply because a safeguarding concern exists.

When a difficult disclosure is made or withheld, document the decision, information shared, recipient, rationale, advice sought and whether the patient was informed.

Use CLEAR consistently across information decisions.

1. Clarify the purpose and recipient.
2. Locate the professional and legal authority.
3. Evaluate necessity, proportionality and the minimum information needed.
4. Ask about consent, objections, capacity, statutory duties or powers, and public-interest factors.
5. Record the reasoning, disclosure, advice and safeguards.

CLEAR is an educational scaffold, not a statutory legal test.

Scenario 1. A child discloses abuse and asks the doctor not to tell anyone.

Reasoning prompt: clarify purpose and recipient; locate authority; evaluate necessity and minimum information; ask about consent, objections, capacity and risk; record and escalate proportionately.

Scenario 2. A patient makes a credible threat of serious violence towards an identifiable person.

Reasoning prompt: clarify purpose and recipient; locate authority; evaluate necessity and minimum information; ask about consent, objections, capacity and risk; record and escalate proportionately.

Scenario 3. An adult at risk refuses a referral, but there is concern about coercive control and serious ongoing harm.

Reasoning prompt: clarify purpose and recipient; locate authority; evaluate necessity and minimum information; ask about consent, objections, capacity and risk; record and escalate proportionately.

• Safeguarding means consent never matters.
• Public interest means anything beneficial to society.
• Share the entire record to be safe.
• If uncertain, delay until absolute proof exists.

• What exactly is the purpose of using or disclosing the information?
• Who is asking, and have I verified identity and role?
• What professional, common-law, statutory and data-protection authority applies?
• Can the purpose be achieved with less or anonymised information?
• Does the patient expect this use, have they consented or objected, and does that matter in this context?
• Is there a nation-specific rule, local policy or specialist route I need to check?
• What should I document, and who should I consult if uncertain?

Optional reflection: Do not enter identifiable patient, colleague or employer information. Identify one situation in your practice where confidentiality, data protection and local governance could easily be conflated. How would CLEAR improve the reasoning?

• Confidentiality is not absolute.
• Public-interest disclosure requires proportionality.
• Serious risk can justify disclosure without consent.
• Safeguarding does not erase the need for careful reasoning.
• Seeking consent may be inappropriate if it increases risk.
• Share with an appropriate agency able to act.
• Only relevant information should normally be shared.
• Do not wait for certainty where serious safeguarding risk requires action.
• Explain unexpected disclosures where safe and practicable.
• Document the balance and advice obtained.

Check current versions for time-sensitive decisions.

• R2 - GMC: Disclosing patients’ personal information: a frameworkOpen official source
• R3 - GMC: Disclosures for the protection of patients and othersOpen official source
• R6 - ICO: Data sharing: a code of practiceOpen official source
• R14 - GMC: Protecting children and young people: confidentiality and sharing informationOpen official source