Part of Proxy access: advice and guidance
Step 3a: Get the patient's informed consent to proxy access
Where the patient has mental capacity or is Gillick competent to decide about proxy access, a clinical professional must get their informed consent as the basis for access.
The clinical professional must inform the patient about the following in a way that they can understand:
- the availability of self-access as an alternative option to proxy access (see step 3b)
- what proxy access is
- what the proxy will be able to see and do on their behalf
- how long proxy access is being granted for
- how to check what information has or has not been redacted from a proxy's view
- their ability to request further information is redacted from a proxy's view before access is granted
- how to request redaction on an ongoing basis
- the organisation’s policy on suspending and revoking access
It is important to accommodate for the patient's communication needs as part of this process. For example, if a patient needs a formal interpreter, they should be provided with one. Information should be made available in a range of formats to meet needs, for example easy read.
Clinical professionals must also verify the patient's identity as part of gathering informed consent to ensure it is being provided by the patient, and not someone impersonating them, for example by signing a document on their behalf.
If the patient raises concerns about sharing medical information with a proxy at this stage, these must be addressed to determine whether proxy access is appropriate. Clinical professionals should not proceed further with considering proxy access where concerns are outstanding.
A patient conversation is also an important opportunity to check if the patient is being coerced into sharing access. If there is a concern about possible coercion, clinical professionals should follow their organisation’s safeguarding policies and not proceed any further with considering proxy access.
What clinical professionals need to do in relation to gathering consent
Clinical professionals can use this information as a guide as to whether consent is likely to be an appropriate basis for granting proxy access and what they need to do in relation to gathering consent.
Patient aged 0-10
Clinical professionals generally do not need to assess if young children aged 0 to 10 are Gillick competent or seek their informed consent. Nonetheless, good clinical judgement must be applied on a case-by-case basis.
Patient aged 11-15
Clinical professionals should always consider involving children aged 11 or over in decisions about proxy access and assess their Gillick competence to provide informed consent to proxy access, per RCGP guidance.
If they assess the child is Gillick competent, staff should seek their informed consent as the basis for proxy access.
If they assess the child is not Gillick competent, professionals should consider granting access based on parental responsibility or make a best interests' decision to grant proxy access to someone who is not the child’s parent.
Staff must also promote the opportunity of self-access to young people as an alternative or addition to proxy access in line with step 3b, where relevant digital services are available to them. Any proxy access should be the least restrictive necessary, that is, to only give the proxy the access they need to provide the necessary support.
Patient aged 16 or over
For patients aged 16 years and older, clinical professionals must adhere to Mental Capacity Act (MCA) 2005 legislation. Those with capacity must provide consent to proxy access.
Clinical professionals should always consider capacity but may presume mental capacity to decide about proxy access for people aged 16 and over. They should also not assume that someone lacks mental capacity just because they make unwise decisions.
If information suggests the patient might lack capacity, professionals must undertake a mental capacity assessment in relation to the decision on whether to grant proxy access. Clinical professionals might find it useful to refer to guidance by the GMC on assessing mental capacity in relation to decision making.
In situations where capacity is impaired due to a lifelong developmental condition such as a severe intellectual disability which may be associated with a range of long-term physical health conditions, the lack of capacity to consent should not be a barrier to granting proxy access.
If the capacity assessment finds that the patient lacks mental capacity to make this decision, professionals should consider if it’s in the patient’s best interests to:
- grant access to the proxy based on the proxy possessing a valid and applicable health and welfare LPA
- grant access to the proxy based on the proxy being a court appointed personal welfare deputy
- grant access to someone who is neither of the above, but still plays an important role in assisting the patient with their health and care needs
As above, staff should promote self-access in line with the principles of supporting people and empowering them to make their own decisions. Any additional support through proxy access should be the least restrictive necessary, that is, to only give the proxy the access they need to provide the necessary support.
Assessment of mental capacity can at times be challenging and complex, particularly in situations where capacity fluctuates, there is alcohol or drug misuse, there are concerns about coercion (for example in the context of domestic abuse, modern slavery or trafficking, criminal and sexual exploitation), or there is a history of trauma and/or adverse childhood experiences.
In these situations, practitioners should not hesitate to seek advice and support from their organisational safeguarding lead or Caldicott Guardian, if they are unsure how to proceed.
Last edited: 26 February 2026 5:33 pm