Communications with primary care trusts: another challenge

Bourke and Wessely are to be commended for their useful summary of medical confidentiality.¹ However, there is a new challenge in this area—communication with primary care trusts and other organisations that control funding of clinical care. A secretary in my NHS trust was ordered by an administrator from a nearby primary care trust to forward a clinic letter on a patient whom I had assessed in my neuropsychiatry clinic, so that the trust could decide whether a follow-up appointment was to be “authorised.” We were told that failure to forward the letter would prevent the patient from being seen again. No account was taken of the sensitivity of information contained in the letter. There was no reference to obtaining the patient’s consent. The primary care trust representative was not a clinician and was not writing on behalf of a clinician. Neither she nor the primary care trust formed part of the clinical team, and the decision they were making was not necessarily in the patient’s interest—it was purely about funding.

It is ironic that in these times where legitimate access to patient information for research purposes is becoming ever more difficult, ostensibly to protect patient confidentiality, flagrant breaches are being made in the service of financial control.