Recommendation 4: Reflection period for consent
From Report of the Independent Inquiry into the Issues raised by Paterson, published 4 February 2020.
Recommendation
We recommend that there should be a short period introduced into the process of patients giving consent for surgical procedures, to allow them time to reflect on their diagnosis and treatment options. The GMC should monitor this as part of Good Medical Practice.
In brief (written by this site)
In July 2026, Baroness Merron for the Department of Health and Social Care stated that NHS England has integrated decision support tools to facilitate two-stage decision-making that introduces a period of reflection before consent, alongside independent healthcare standards advising specific reflection time (Baroness Merron, Jul 2026). The Minister had affirmed in April 2026 that doctors are expected to follow General Medical Council guidance requiring that patients receive the time and support needed to make informed treatment decisions (Baroness Merron, Apr 2026). Earlier, the Thirlwall Inquiry legal team found in May 2024 that while guidance from the council and other bodies indicated patients should have sufficient time to consider options, no defined period was required (The Thirlwall Inquiry legal team, May 2024).
Sources
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026. The record below is the sources' own words.
About this summary
This recommendation asks for cultural or behavioural change, which is difficult to verify from published sources alone. The record reflects policy commitments rather than measured outcomes.
Government response
Accept in principle
Many key organisations, including the GMC, have taken steps to update their guidance, and to confirm that doctors should give patients sufficient time to consider their options before making a decision about their treatment and care. During annual appraisals, doctors must provide supporting information, including information to demonstrate they are continuing to meet the principles and values set out in ‘Good medical practice’. CQC also takes all GMC guidance into account during its assessments.
The government accepts this recommendation in principle, and agrees that patients, families and carers should be given enough time to consider relevant information before deciding to undergo treatment.
Delivery
Department of Health and Social Care says in progress (16 July 2026)
NHS England has integrated decision support tools into elective pathways of care. These tools support two stage shared decision making, which introduces a period of reflection for patients when deciding on treatment options and giving consent. This allows patients to take the time to fully understand the benefits and risks of treatment, talk with friends and family, and decide whether it is the most suitable option for them.
The Medical Practitioners Assurance Framework (MPAF) was developed by the Independent Healthcare Providers Network in response to reviews, including the Paterson Inquiry. The MPAF is designed to provide a basis from which all independent providers can work, giving confidence to patients and regulators, such as the Care Quality Commission, on what good looks like. The MPAF advises that policies need to provide for patients to be given specific time to reflect and make decisions.
From: Surgery (written question UIN HL1833)
Site note: The question follows up HL16570 on the period for reflection before consent. The recommendation is addressed to the General Medical Council; this is the Department of Health and Social Care's answer, not the GMC's.
DHSC and NHS England say in progress (27 February 2026)
The following guidance has been updated to indicate that doctors should give patients sufficient time to consider options before making a decision about their treatment and care:
• The GMC has revised guidance on decision making and consent that came into effect from 9 November 2020. The GMC sets/enforces the standards doctors must follow as part of “Good Medical Practice”. A serious or persistent failure to follow guidance that poses a risk to patient safety will put the doctor’s registration at risk. If a doctor’s practice regarding consent needs improvement, the GMC would require them to undertake professional development.
• In 2018, the Royal College of Surgeons (RCS) published guidance on consent and supported decision-making. As outlined in the RCS’ “Good surgical practice” patients should sign a consent form at the end of the discussion if they have decided to go ahead with treatment.
• The IHPN has updated the Medical Practitioners Assurance Framework (“MPAF”) with standards for patient consent. Compliance with consent standards is enforced by the medical regulators.
• Shared decision-making is a key element of NHS England’s Personalised Care programme. NHS England is implementing a 2-stage shared decision making process. This is supported by decision support tools which are being integrated into pathways of care as a core component of the delivery plan for tackling the covid-19 backlog of elective care. Two stage decision-making introduces a period of reflection for patients when deciding on treatment options and giving consent. This allows patients to take the time to fully understand the benefits and risks of treatment, talk with friends and family and decide whether it is the most suitable option for them. Integrating these tools into this decision-making process will support providers in meeting this requirement.
CQC considers GMC and RCS guidance and standards when conducting assessments. CQC can act if a provider is failing to ensure that consent is being obtained lawfully.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Implemented - Ongoing”. Table row: section 29.2 No. P2 / Action 2.1, PDF page 741.
DHSC states no delivery position (15 May 2024)
Action 2.1
Key organisations including the GMC and NHSE have updated their guidance, including to confirm that doctors should give patients sufficient time to consider options before making a decision about their treatment and care. NHSE is implementing a 2-stage shared decision making process, which includes a period of reflection for patients when deciding on treatment and giving consent. NHSE has published 11 decision support tools for patients on treatment options and continues to produce further decision support tools. The GMC has revised guidance on decision making and consent that came into effect from 9 November 2020. In 2018, the Royal College of Surgeons (RCS) published guidance on consent and supported decision-making. As outlined in the RCS’ “Good surgical practice” patients should sign a consent form at the end of the discussion if they have decided to go ahead with treatment. The IHPN has updated the Medical Practitioners Assurance Framework (“MPAF”) with standards for patient consent. Compliance with consent standards is enforced by the medical regulators. The GMC sets/enforces the standards doctors must follow as part of “Good Medical Practice”. A serious or persistent failure to follow guidance that poses a risk to patient safety will put the doctor’s registration at risk. If a doctor’s practice regarding consent needs improvement, the GMC would require them to undertake professional development. CQC takes into account GMC and RCS guidance and standards when conducting assessments. CQC can take action if a provider is failing to ensure that consent is being obtained lawfully.
From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024), The Department of Health and Social Care
Site note: DHSC's own comments on progress, supplied to the Thirlwall Inquiry in February 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). They are not a finding of the Inquiry. Table row: section 26.2 No. P2 / Action 2.1, PDF page 735-738.
Earlier statements on delivery (2)
Department of Health and Social Care (29 April 2026)
All doctors are expected to meet the standards set out in the General Medical Council’s (GMC’s) Good Medical Practice, which states that doctors must ensure patients are given the time and support they need to make informed decisions. Doctors must also follow the GMC’s guidance Decision making and consent, which came into effect in November 2020. The guidance sets out seven principles of decision making and consent, including giving patients the information they need to make a decision and the time and support they need to understand it.
The Care Quality Commission (CQC) considers GMC guidance and standards when conducting assessments. The CQC can act if a provider is failing to ensure that consent is being obtained lawfully.
NHS England has integrated decision support tools into elective pathways of care. These tools support two stage shared decision making, which introduces a period of reflection for patients when deciding on treatment options and giving consent. This allows patients to take the time to fully understand the benefits and risks of treatment, talk with friends and family, and decide whether it is the most suitable option for them.
From: Surgery (written question UIN HL16570)
Site note: The question asks, citing page 219 of the report, what steps are being taken to give patients a period to reflect before consenting to surgery. The recommendation is addressed to the General Medical Council; this is the Department of Health and Social Care's answer, not the GMC's.
Department of Health and Social Care (23 March 2021)
The General Medical Council (GMC) published its revised good practice guidance on consent on 30 September 2020. This came into effect on 9 November 2020 and sets out seven principles of decision making and consent, including giving patients the information they need to make a decision and the time and support they need to understand it. The GMC will work with organisations across the UK’s health services to support doctors to embed this into their everyday practice.
Site note: Written statement HCWS869 of 23 March 2021, made by Nadine Dorries, Minister of State for Patient Safety, Suicide Prevention and Mental Health, for the Department of Health and Social Care. It prints this recommendation and gives this passage under it. The recommendation is addressed to the General Medical Council; the passage is the Department's account of what the General Medical Council did, not the General Medical Council's own.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
Action 2.1:
Accepted in principle by the government.
There is no defined period required but key organisations such as the General Medical Council and the Care Quality Commission have indicated in their guidance that there should be sufficient time to consider options before making a treatment decision. Doctors must provide supporting information that they are continuing to meet the principles and values in ‘Good medical practice’ during annual appraisals.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 26.2 No. P2 / Action 2.1, PDF page 735-738.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - DHSC
Delivery statement - Thirlwall Inquiry legal team
Finding