Your doctor's a secret agent

Harvey Jones on how GPs are selling information about patients to insurers

Most of us still have an old-fashioned relationship with our GP: we trust doctors and freely share details of our physical and emotional problems with them. But you might think twice if you knew how much of this personal stuff can end up in the files at insurance companies - and that GPs can make thousands of pounds a year from passing it on.

"The truth is, we are acting like secret agents for insurance companies," says Martin Breach, a GP in Lancashire. "Patients assume that what they say to their doctor is confidential. They don't realise that if they apply for private medical insurance, a mortgage or a loan, their doctor will read through the notes and identify health problems to the institution."

Consult your GP about a sexually transmitted disease and this information will be recorded. If you are a smoker, have had your cholesterol levels checked, consulted for depression or been tested to see if you are HIV positive, your risk status will increase and insurance costs rise. You may be refused cover altogether.

All this will be done with your consent. You sign away your right to privacy in a footnote on insurance forms. You can refuse, but without your permission the institution cannot see your notes and you can wave goodbye to the financial service you require.

"Every doctor probably completes a dozen of these forms a week," says Dr Breach. "The dilemma is that we want patients to consult and feel able to present worries about blood pressure, smoking, sexually transmitted diseases, alcohol use and other habits, but would every patient give honest information if they knew how it would be used?"

The other uncomfortable truth is that insurers pay GPs for this work. Dr Breach says: "This means that doctors have split loyalties. Most of the time they are acting on your behalf under the NHS, but for these reports they are working for the insurance company."

GPs receive pounds 29.25 for compiling a personal medical attendant's report from your notes, pounds 40.20 if they perform a medical as well. Dr Peter Holden is chairman of the British Medical Association committee, which oversees this payment system.

He defends the fees. "The NHS does not cover everything doctors do and it does not pay for completing insurance claim forms. Most of us are so busy in our normal working day that we do these in our own time. I am doing five reports this evening."

He says the fees are derisory for the effort involved. "A report takes half an hour for pounds 29, half of which goes on practice overheads. I then share the remainder with five GP partners and pay tax on what is left."

This explains why GPs can take weeks to complete a report, slowing up the processing of your application. Insurance companies also complain about the slapdash way many reports are completed.

Insurers claim to do all they can to maintain medical confidentiality. "There are strict checks on the procedures insurers must go through to get your permission to look at your records, and you can see any letter written to the insurer," says Suzanne Moore, at the Association of British Insurers.

"The laws on who can see the information are very strict. Each insurance company will have a chief medical officer who assesses the report; and the number of people who see it is kept to an absolute minimum."

She insists that insurance companies must seek medical information before processing an application. "Insurance companies want all relevant information when making a decision. If you have suffered an illness that will impact on your policy, the insurer will want to know about that."

Insurance companies may also use their own doctors to assess your health, particularly if you seek cover for large sums.

Dr Nicholas Norwell is medico-legal adviser with the Medical Defence Union, which advises GPs on legal and disciplinary issues. He says GPs don't have any choice about revealing personal details to insurers.

But mistakes and breaches of confidentiality can happen at any time. As Dr Norwell says: "The GMC frequently admonishes doctors or erases them from the register for breaching confidentiality. A doctor or receptionist might let slip in a social situation that somebody is pregnant or has had a stroke, and this could cause the patient distress."

Short of withholding information from your GP throughout your life, there is little you can do to get around the confidentiality dilemma. One option sometimes suggested is to consult with a private GP on particularly sensitive matters, to avoid information ending up on your NHS records. But this conflicts with the continuity of care that makes your GP so valuable.

Otherwise, make sure you know what you are consenting to when you sign an insurance company proposal form.

If you have a complaint about information released to an insurance company, contact the Insurance Ombudsman Bureau on 0845 600 6666.

YOUR RIGHT TO SEE YOUR MEDICAL RECORDS

n You must give your written consent before any institution can apply for a medical report from a doctor who has cared for you.

n Under the Access to Medical Reports Act 1988, you may see the report to an insurance company or employer. If you wish to see it, you should ask when the company makes its initial request. Your doctor cannot then send the report to the company for 21 days, to allow you time to see it.

n After the report has been sent, you still have six months to apply to see a copy.

n The Access to Health Records Act 1990 gives you the right to see your health records. Your GP can charge a pounds 10 fee for seeing information more than 40 days old, with extra charges for postage and copying.

n With both Acts, you have the right to request that inaccuracies are corrected, but the doctor is not obliged to accept your opinion. In that instance you can append a statement on the disputed information.