There are days you will never forget as a GP. The time a patient brought a gun into the surgery, the time a patient told me that he intended to harm his wife and, sadly, the more frequent cases of child abuse that my colleagues and I see.
Shocking as these occurrences are, there are robust, tried and tested procedures in place that I have always felt able to call upon. Yet, one of the few times I was completely stopped in my tracks when dealing with a patient followed the implementation of the government’s Prevent strategy.
Although Prevent has been running since 2003, last year the government created additional legislation which compels medics to tell the authorities of anyone they believe is at risk of being drawn into terrorism — including not just violent but also non-violent “extremism”. This is an “assessment” that is based on what the patient tells you in the consulting room.
In one case, when I was seeking to understand the broader stresses of a patient, I found myself not pursuing a line of questioning I wanted to ask about their experience of Islamophobia. I know this is a distressing experience for many of my patients of Muslim faith. And yet I was afraid that these questions would lead to mistrust, and that the patient might feel constrained in giving honest answers. Worse still, I worried that I might be required to report on the patient, given the scheme’s sweeping definition of “extremism” as “vocal or active opposition to fundamental British values”. Prevent had completely changed my relationship with my patients. I found myself, an experienced GP, unable to explore my patient’s needs.
The current statutory duty to compel health professionals to report on patients risks turning doctors into counter-terrorism agents. Doctors have tremendous power over their patients, and the cornerstone of the doctor-patient relationship is trust. Prevent risks destroying that trust, particularly with respect to Muslim patients. We risk being seen by our patients as agents of the state, ready to act under Prevent on our conscious or unconscious biases, and report our patients for “extremism” to the authorities.
Prior to Prevent, we as doctors already knew what to do when faced with serious concerns, and acted accordingly under the General Medical Council’s confidentiality guidance. This guidance permits disclosures “in the public interest” of personal information about a patient shared in a confidential setting , for example, “if failure to disclose may expose others to a risk of death or serious harm”.
These guidelines have always been more than robust enough to deal with the most difficult of circumstances I have faced. At the same time, they have allowed me to maintain integrity and retain trust from patients who come to their GP expecting the highest levels of confidence.
The General Medical Council must clarify the professional standards relating to confidentiality applicable in Prevent settings. The standard for disclosure of confidential information under Prevent appears to be much lower than that warranted by the common law duty of confidentiality and the General Medical Council guidance. I can no longer assure my patients of confidentiality anymore.
I feel that we have been corrupted because we are abusing our position as doctors, I am not a judge, and I am not in a position to detect “pre-criminal” behavior. Although many people are aware that Prevent is operational in schools, I think it may surprise some to know that health professionals are also being co-opted in this way. It harks back to a time when doctors were called upon to report on girls requesting contraception. Not only does it feel deceitful, but there is a very real risk of causing more harm. This is not the reason why we chose to become doctors.
There are also concerns that Prevent will deter patients from across Muslim communities, who are already likely to be disadvantaged and face higher risks of ill health, from accessing healthcare at all. We cannot afford to erode trust in the medical profession in this way. The National Police Chiefs’ Council’s own data reveals that the initiative is flawed, with 80 per cent of all Channel referrals being set-aside, implying thousands of individuals were wrongly referred.
I endorse the findings of the recent Open Society Justice Initiative’s Eroding Trust report, which calls for the policy of statutory reporting to Prevent by teachers and doctors to be abandoned. Teachers and doctors should be free to do their jobs, to respond with professional judgement and common sense, without becoming “agents of the state”. And law enforcement agencies should do their job and use the criminal law to prosecute terrorists.
Prevent risks creating a state-sanctioned vigilante society that inherently perpetuates bias against Muslim communities in Britain. Alienating Muslims from the rest of society is plainly counterproductive, and will only hinder the government’s efforts to counter terrorism. No doctor should be made complicit in that alienation.
Dr. Clare Gerada is a general practitioner since 1992, a Member of BMA council and former Chair of the Council of the Royal College of General Practitioners.