Core Revision
Revision aid, not clinical advice. This page is educational material written for exam preparation. It is not a substitute for the current guideline or for clinical judgement, and must not be relied on for the care of any individual. Always check up-to-date national guidance and verify independently before acting on anything here.
Chapter 6 of 11 · Ethics, Law & Safeguarding
Must, may, must not: statutory and public-interest disclosure
Some disclosures the law compels. Some it permits. Sorting one from the other is most of what disclosure questions are testing.
MUST: disclosures required by law
| Duty | Trigger | To whom, and when |
|---|---|---|
| Notifiable diseases Health Protection (Notification) Regulations 2010 England — Scotland, Wales and Northern Ireland have their own lists and routes | Clinical suspicion of a notifiable disease. Do not wait for laboratory confirmation. | UKHSA health protection team. Urgent cases: by telephone within 24 hours. All cases: online within 3 days. |
| FGM mandatory reporting FGM Act 2003 s5B (England & Wales) | A girl under 18 tells you FGM has been carried out on her, or you observe physical signs appearing to show it. Suspicion and risk do not trigger it. | Police, on 101, as soon as possible. Close of the next working day is the Home Office’s best-practice expectation; one month is the absolute outer limit. Not social services. |
| Terrorism Act 2000 s19 | Belief or suspicion of a terrorist financing offence, arising in the course of your work. | A constable. (s38B is the separate general duty on anyone to disclose information about acts of terrorism. The National Crime Agency suspicious-activity route is the regulated-sector mechanism, not the s19 route for a doctor.) |
| Road Traffic Act 1988 s172 | Police request the identity of a driver alleged to have committed a traffic offence. | Identity only — never clinical information. |
| Court order or coroner | A judge or coroner orders disclosure. | As ordered. Object to the judge if you believe the material is irrelevant. |
| Deaths | Any death meeting the Notification of Deaths Regulations 2019 criteria. | The coroner. All other deaths go to the medical examiner for scrutiny before registration. |
Three of these are misremembered constantly. FGM reporting is under-18s only, and only where she tells you or you see it — a girl you believe to be at risk is ordinary safeguarding, not s5B, and an adult who was cut as a child is not covered at all. Prevent is a duty to have “due regard” (Counter-Terrorism and Security Act 2015 s26), not a duty to disclose, and Channel is voluntary — the person must consent to support. And s172 gets you the driver’s name, nothing else.
The notifiable disease list has grown. Since 6 April 2025 it includes chickenpox (varicella), MERS, influenza of zoonotic origin, congenital syphilis, neonatal herpes, acute flaccid paralysis, disseminated gonococcal infection and CJD; hantavirus disease was added on 19 May 2026. The old exam answer “chickenpox is not notifiable” is now wrong. HIV remains not notifiable, and only zoonotic influenza is — not seasonal flu.
A 4-year-old presents with a classic chickenpox rash. Mum mentions in passing that an older cousin, aged 15, recently came back from abroad and “had something done” that the family will not discuss.
What are your notification duties here?
Chickenpox is notifiable in England (since 6 April 2025) — notify UKHSA online within 3 days, on clinical suspicion, without waiting for confirmation.
The cousin is a safeguarding concern, not a s5B mandatory report: nobody has told you FGM was performed and you have not observed physical signs. Discuss with your safeguarding lead and refer to children’s social care on the basis of risk.
The mandatory duty is narrow: she tells you, or you see it. A vague family remark is neither. Report as a safeguarding concern instead — which may well end up with the police, but through the right route and with the right threshold.
It was not, until 6 April 2025. It is now.
A 15-year-old, recent travel, and a family unwilling to discuss a procedure is a recognised FGM risk pattern. It does not meet the mandatory reporting trigger, but it plainly meets the threshold for a safeguarding discussion.
Pick an option to see the answer.
MAY: disclosure in the public interest
The GMC permits disclosure without consent where failure to disclose may expose others to a risk of death or serious harm, or for the prevention, detection or prosecution of serious crime.
Before you disclose:
- Seek consent first, unless that is impracticable or would undermine the purpose or put someone at risk
- Tell the patient what you intend to do and why — unless it is unsafe or impracticable to do so
- Disclose only what is necessary, to the person who needs it
- Record your reasoning, whether or not you disclose
Where the only person at risk is the patient themselves and they have capacity, you should usually respect their refusal. The public-interest gateway opens when other people are at risk.
The DVLA: the most examined example
The driver has the legal duty to notify the DVLA (or the DVA in Northern Ireland), not you. Your job is to advise, and to document that you did.
- Tell the patient they must not drive and must notify the DVLA. Record it.
- If they cannot understand the advice — dementia, severe learning disability — tell the DVLA as soon as practicable.
- If they continue to drive against advice, make every reasonable effort to persuade them; consider telling a relative or carer if that will help. If they still drive, contact the DVLA promptly and disclose to the medical adviser.
- Tell the patient in writing once you have done so.
A 71-year-old with early Alzheimer’s disease is still driving. You have twice advised him to notify the DVLA and to stop driving. His wife tells you he drove to the shops yesterday and got lost. He has capacity and refuses to stop.
What is your next step?
Capacity protects his right to decide about his own treatment. It does not entitle him to put other road users at risk. Others are at risk, so the public-interest gateway is open.
You have advised, he has continued against advice, so you contact the DVLA medical adviser promptly. Tell him first if it is safe and practicable, and confirm in writing once you have done it. Consider whether involving his wife would help persuade him — but do not let that become a substitute for acting.
The DVLA holds the licensing function and has a medical adviser for exactly this. Police involvement is not the route.
Practical measures can help and are worth suggesting — but they do not discharge your duty, and they place an unfair burden on a family member. Notify the DVLA.
Pick an option to see the answer.
Serious communicable diseases
You may disclose to a person at risk of infection likely to result in serious harm where the patient has not told them and cannot be persuaded to. Tell the patient first if it is practicable and safe. Disclose the minimum necessary — the fact of a risk, not necessarily the diagnosis or the source.
Gunshot and knife wounds
- Gunshot wound: the police should usually be informed, including where it appears accidental. The GMC allows a narrow exception where no one other than the patient is at risk and contact would cause the patient harm or distress or damage their trust.
- Knife or sharp-instrument wound: inform the police, unless the injury appears accidental or the result of self-harm.
- The initial call should not usually carry identifying details — you are telling them an incident has occurred so they can assess public risk.
- Then ask the patient whether they will speak to the police. Abide by a refusal unless there is a public-interest justification to disclose more.
The two-stage structure is what is examined. Doctors routinely get it wrong in both directions — refusing to call at all, or handing over the patient’s name and address in the first breath. Call, without identifying details; then have the conversation with the patient.
Self-testA patient discloses that he has been driving a lorry despite untreated obstructive sleep apnoea with excessive daytime sleepiness. He asks you not to tell anyone. What do you do?
Advise him that he must stop driving and notify the DVLA, and that Group 2 (lorry) licensing standards are stricter than Group 1. Document the advice.
If he continues to drive, disclose to the DVLA. The risk to other road users from a sleepy HGV driver is exactly the “risk of death or serious harm to others” the GMC contemplates, and the vehicle class raises it. Tell him before you do it if you safely can, and confirm in writing afterwards.
Self-testWhat is the difference between the Prevent duty and a Channel referral?
Prevent is a statutory duty (Counter-Terrorism and Security Act 2015 s26) on specified authorities to have “due regard to the need to prevent people being drawn into terrorism”. It is a duty of attention and process — training, awareness, escalation routes — not a duty to disclose.
Channel is the multi-agency support programme people can be referred into. It is voluntary and requires consent — from a parent, guardian, or the agency responsible for their care if the person is under 18. Raising a Prevent concern does not require consent; accepting Channel support does.
Written and checked by NHS GPs. Last reviewed 24 August 2026. UK law and guidance change — always follow current local policy and your defence organisation’s advice in a real case.
Fitness to drive comes up constantly
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