Proxy Access

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Proxy Access is where someone is given access to another person’s medical record. For example:

• A parent or guardian for a patient aged under 13.
• A parent or guardian who has legal responsibility for a patient between 13 and 16 where the GP has assessed that the patient is not capable of making their own decisions.
• A carer for a patient over the age of 16 – we would need permission from the patient.

The proxy does not have to be a registered patient at the practice, but must be registered for online services on the GP system and always use their login credentials.

To be given proxy access, a patient’s representative must have the informed consent of the patient or, in cases where the patient does not have capacity to consent, the GP has decided that it is in the best interests of the patient for them to have proxy access.

Patients aged 16 or above are assumed to have the capacity to consent unless there is an indication that they are not. Young patients between the ages of 13 and 16 who are judged as having capacity to consent by their GP may also consent to give proxy access to someone else.

Legitimate reasons for the practice to authorise proxy access without the patient’s consent include:

• The patient has been assessed as lacking capacity to make a decision on granting access and the applicant has a lasting power of attorney for health and welfare, the applicant is acting a court appointed deputy on behalf of the patient or the GP considers it to be in the patient’s interest in accordance with the Mental Capacity Act 2005.
• The patient is a child who has been assessed as not competent to make a decision on granting proxy access.

The practice may refuse or withdraw proxy access, if they judge that it is in the patient’s best interests to do so.

When a child reaches 13, we will send letters to the child and their parent/legal guardian to explain that all proxy access has now been switched off. If the child wants proxy access re-instated, they will need to give us permission and this may be assessed by a GP.

Gillick competence

The ‘Gillick Test’ helps clinicians to identify children aged under 16 who have the legal capacity to consent to medical examination and treatment. They must be able to demonstrate sufficient maturity and intelligence to understand the nature and implications of the proposed treatment, including the risks and alternative courses of actions.

In 1983, a judgement in the High Court laid down criteria for establishing whether a child had the capacity to provide valid consent to treatment in specified circumstances, irrespective of their age. Two years later, these criteria were approved in the House of Lords and became widely acknowledged as the Gillick test. The Gillick Test was named after a mother who had challenged health service guidance that would have allowed her daughters aged under 16 to receive confidential contraceptive advice without her knowledge.

Fraser guidelines

As one of the Law Lords responsible for the Gillick judgement, Lord Fraser specifically addressed the dilemma of providing contraceptive advice to girls without the knowledge of their parents. He was particularly concerned with the welfare of girls who would not abstain from intercourse whether they were given contraception advice or not. The summary of his judgement referring to the provision of contraceptive advice was presented as the ‘Fraser Guidelines’. Fraser guidelines are narrower than Gillick competencies and relate specifically to contraception.

Please contact the practice for more information.