What is the role of informed consent in private medical practice?

The legal basis

For consent to be valid it must be voluntary, informed and given by someone with capacity to make that decision. Treating a patient without valid consent can be a battery in law, a negligence claim, a GMC matter and a breach of CQC registration requirements, all at once.

The key case is Montgomery v Lanarkshire Health Board, decided by the Supreme Court in 2015. It replaced the old test of what a responsible body of doctors would disclose. You must now take reasonable care to make sure the patient knows about any material risks of the recommended treatment and about reasonable alternatives. A risk is material if a reasonable person in the patient’s position would be likely to attach significance to it, or if you are, or should be, aware that this particular patient would.

For CQC-registered providers in England, regulation 11 of the 2014 Regulations says care and treatment must only be provided with the consent of the relevant person. CQC guidance expects information about risks, complications and alternatives to be given in a way the person can understand, by someone who knows the treatment well enough to answer questions. Consent is also one of the policies every new provider must send with a CQC application.

GMC guidance

The GMC’s Decision making and consent, in effect since 9 November 2020 and last updated in August 2026, sets out seven principles. In summary:

1. All patients have the right to be involved in decisions about their treatment and care, and to be supported to make informed decisions if they are able.
2. Decision making is an ongoing process built on meaningful dialogue, sharing information relevant to the individual patient.
3. All patients have the right to be listened to, and to be given the information they need, and the time and support to understand it.
4. You must try to find out what matters to the patient, so you can share relevant information about the benefits and harms of the options and reasonable alternatives, including taking no action.
5. You must start from the presumption that all adult patients have capacity. A patient can only be judged to lack capacity for a specific decision at a specific time, after an assessment in line with the law.
6. Care for a patient who lacks capacity must be of overall benefit to them, and decisions should be made in consultation with those close to them or advocating for them.
7. Patients whose right to consent is affected by law should be supported to take part in decisions and to exercise choice where possible.

The depth of the discussion should be proportionate to the decision. A routine blood test needs a brief explanation. A procedure, a long-term medicine or an unlicensed treatment needs a fuller one, and time for the patient to think.

What needs extra care in private practice

Consent to costs

A patient cannot give properly informed consent to a plan whose cost they do not understand. Before you start, explain the fee for the consultation and what is likely to follow, such as tests, follow-up, prescriptions and referrals. Say what is not included. Consumer law and GMC standards on honesty in financial dealings point the same way. See how much to charge and charging for tests.

The patient as customer

Private patients sometimes arrive expecting a particular test, prescription or referral. Consent means the patient decides whether to accept what you offer. It does not oblige you to provide treatment you believe is not in their clinical interest. Explain your reasoning and record it. Mention options available on the NHS where relevant, because a reasonable alternative can include getting the same care free. See managing patient expectations.

Financial interests

If you have a financial interest in a recommendation, for example in a screening package, a laboratory or a product, tell the patient. See handling conflicts of interest.

Sharing information with the NHS GP

Ask at registration or at the first consultation whether the patient agrees to you sharing information with their NHS GP, and explain why it matters for their safety. Record the answer, and revisit it if circumstances change. See sending notes to the NHS GP.

Remote consultations

Consent to a video or phone consultation should include its limits, for example that you cannot examine the patient and may need to see them in person. If you record consultations or use an AI scribe, tell patients and explain how the recording or transcript is used and stored.

Cosmetic and elective treatments

Where treatment is elective, allow time between the discussion and the procedure, and avoid anything that feels like pressure to decide on the day. The GMC’s separate guidance on cosmetic interventions sets out specific expectations on consent for those procedures.

Capacity and children

• Adults. Presume capacity. If you doubt it, assess it for the specific decision under the Mental Capacity Act 2005 in England and Wales. Scotland has the Adults with Incapacity (Scotland) Act 2000, and Northern Ireland has its own mental capacity legislation.
• Young people aged 16 and 17 are presumed able to consent to their own treatment.
• Under 16s can consent if they have enough understanding and intelligence to fully understand what is proposed, known as Gillick competence. Otherwise someone with parental responsibility consents. Scotland has its own statutory rule, with a similar effect.

Private services that see children should have a clear policy on checking parental responsibility and on seeing young people alone. See who can I see as a private GP?

Recording consent

• Record the key points discussed, including material risks, alternatives and the patient’s questions, not just “consent obtained”.
• Use written consent forms for procedures, but treat the form as evidence of the conversation, not the conversation itself.
• Give written information where it helps, and note what you gave.
• Record refusals and withdrawals of consent, and the information you gave about the consequences.
• Offer a chaperone for intimate examinations, and record the offer and the response.

Consent records are a common focus of audit and CQC assessment. See how to run a clinical audit.