Reflection period for consent
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.
- The Royal College of Surgeons published "Good Surgical Practice" guidance in 2018 stating that patients should sign a consent form at the end of the discussion once they have decided to proceed (Good Surgical Practice, RCS, 2018).
- The Independent Healthcare Providers Network updated the Medical Practitioners Assurance Framework (MPAF) to include standards for patient consent (Implementation update to Thirlwall Inquiry, DHSC/NHS England, April 2025).
- NHS England stated in April 2025 that it is implementing a two-stage shared decision-making process to introduce a period of reflection for patients (Implementation update to Thirlwall Inquiry, DHSC/NHS England, April 2025).
How was this evidence gathered?
Response
Accepted in Part
Response
Accepted in PartAccepted in principle. GMC guidance on consent (updated 2020) already emphasises patients should have time to consider information before making decisions. The guidance states patients should not be placed under pressure to make decisions quickly. NHS England is working with Royal Colleges to embed cooling-off periods in clinical practice for elective procedures. Full implementation being monitored. (Source: Government Response, December 2021)
Accepted in principle. GMC guidance on consent (updated 2020) already emphasises patients should have time to consider information before making decisions. The guidance states patients should not be placed under pressure to make decisions quickly. NHS England is working with Royal Colleges to embed cooling-off periods in clinical practice for elective procedures. Full implementation being monitored. (Source: Government Response, December 2021)
Progress Timeline
DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented – Ongoing. 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 these requirements. 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.