Appendix 1: complex scenarios in relation to granting and managing parental access

One parent indicates that another parent should not have access, or it should be limited (either when requesting proxy access, or at any time)

Consider suspending access if there are safeguarding concerns

Check whether the other parent has proxy access and consider suspending it if the parent asking for the other parent’s access to be limited surfaces significant safeguarding concerns. The organisation’s safeguarding lead and a responsible clinical professional should be involved.

Ask if there are any relevant court orders which prevent the other parent having access to the child or their records or removes parental responsibility, though the latter is rare. If there are, staff should request to see copies of these.

Evaluate proxy access for both parents separately, based on an individualised assessment of necessity and the risk of each parent having access

Evaluate whether either or both parents should have proxy access on a case-by-case basis. The granting of proxy access should be linked directly at all times with what is necessary for the child or young person, and what is in their best interest.

Expect to find that the needs and risks are not always symmetrical and therefore not expect to provide both parents with the same level of access under a policy of “treating both parents the same.” As in Step 1, it is important to consider each parent’s role in supporting the child with their health, care, and support needs.

Assessment of needs and risks should also consider the risk of harm to any of the parents resulting from proxy access. For example, a perpetrator of domestic abuse using proxy access to a child’s records to find out a victim’s address and perpetrate further abuse.

Provided that decisions on access are justified on the basis of necessity and risk, the decision is likely to be considered in the best interests of the child / young person and patient safety.

Communicate the outcome of the decision with the parent(s)

While it is in the best interests of the child / young person that clinical professionals and staff maintain good relationships with both parents, their priority must be to the child or young person’s needs, and this may require them to have a difficult discussion with any parent. Consider the GMC’s guidance as to what information they should disclose or withhold to each parent, noting that they are not required to disclose information they consider may increase the risks to the child / young person.

The risks of disclosure to the proxy (which are also unlikely to be symmetrical) should also influence what is disclosed to whom. For example, the risk of not counselling a victim of domestic abuse that they have or have not provided any access to the other parent may be that the parent may feel less able to access care on behalf of their child, which may favour disclosure.

A stepparent requests proxy access on behalf of their stepchild

A parental responsibility agreement may grant parental responsibility to a stepparent, which may give them an equivalent legal basis for proxy access.

Where legal step-parental responsibility is not in place by virtue of an order, the consent of a person with parental responsibility / legal guardian is required. Clinical professionals and staff should always establish whether all those with parental responsibility / legal guardianship are aware of an application and whether they do or do not support the application.

Any provision of access should be evaluated on a case-by-case basis as per the guidance on parents in conflict above.

The child is under the care of the local authority as part of a care order or child protection plan 

If a child is on a child protection plan or a Looked After Child, clinical professionals and staff should discuss any requests for proxy access with their organisational safeguarding lead and, if needed, the social worker involved. It may also be appropriate to consult with anyone else with parental responsibility.