Preregistration house officers and consent

Editor - General Medical Council guidance states that doctors must gain adequate informed consent from a patient before carrying out a procedure or treatment. ¹ The guidance is clear that the person providing the treatment or undertaking the procedure must obtain the consent. Only where this is not practicable can the task be delegated to another person provided that they are suitably trained and qualified and have sufficient knowledge of the proposed investigation or treatment.

Sadly, all too often the task of gaining consent from a patient is delegated to the most junior and inexperienced members of the team, including preregistration house officers (PRHOs). This is an inappropriate delegation of tasks in direct contravention of GMC guidelines. PRHOs are the least qualified and experienced of medical staff available to obtain consent from patients before a procedure.

In the era of clinical governance it is only a matter of time before an outside body or patient has good grounds to bring into question this consent process. With increasing national awareness of NHS activities the current risk management strategy that allows PRHOs to gain consent from a patient has not fully explored the issues surrounding this practice and the potential adverse outcomes to the trust, the patient, and the PRHOs involved.

NHS trusts should take a more active role in ensuring that employed medical staff comply with GMC guidance and in particular that consent for procedures is obtained by a senior member of the team who is capable of carrying out the procedure. Trusts should also ensure that PRHOs are required by their contract of employment to carry out tasks only in accordance with GMC guidelines.

It is totally inappropriate for a PRHO to be asked to gain consent from a patient for an operation. What might have been standard practice in the past is not acceptable now.

Andrew Rowland, preregistration house officer, Nottingham City hospital
Email: arowland@ncht.org.uk


studentBMJ 2001;09:171-216 June ISSN 0966-6494

1. General Medical Council. Seeking patients' consent: the ethical considerations. London: GMC, 1997.