Third-party consultations, with the patient still at the centre

What a third-party case looks like

The RCGP's reasonable adjustments policy notes that while most SCA cases involve the patient, some use a role player as a carer, parent or other health or social care worker. In general practice this is everyday work: a mother with a toddler, a daughter ringing about her father's confusion, a husband worried about his wife's mood, a teenager who does not want a parent told.

Two questions run through every one of these cases. Who is my patient? And what can I share, with whom, and on what basis? The caller's worries are real and often part of the case, but they do not override the patient's right to confidentiality or, where they have capacity, to make their own decisions.

How the RCGP domains apply

These summaries are ours. The domain names are the RCGP's; read its own descriptors on the marking and results page and in the SCA consultation toolkit. See how the SCA is marked for the grades and pass mark.

Consent and confidentiality in practice

You can always listen. Sharing is a separate decision. The GMC's confidentiality guidance sets out the principles: use the minimum information necessary, share with consent where you can, and disclose without consent only where the law requires it or where the risk of serious harm justifies it. In an SCA case, that usually means:

• Ask the patient if they are there. If they are with the caller and able to talk, speak to them directly and ask what they are happy to share.
• If they are not there, take the history the caller can give, explain kindly that you cannot discuss details without the patient’s agreement, and plan how to reach the patient.
• Children and young people. Think about age and understanding. Young people who can understand a decision can consent to their own care and expect confidentiality, with limits where there is risk. Encourage them to involve a trusted adult.
• Adults who may lack capacity. Capacity is decision-specific. If someone holds a lasting power of attorney for health and welfare, check what it covers. Decisions should be in the person’s best interests and involve them as far as possible.

A practical structure

1. Who is there? Introduce yourself, confirm who you are speaking to and whether the patient is present, aware and happy to go ahead.
2. Hear the concern. Let the caller explain what they are worried about and why now. Ask what they have noticed.
3. Bring the patient in. Speak to the patient directly if possible, including children at an appropriate level. Ask their view.
4. Be clear about sharing. Say what you can and cannot discuss, and why, without sounding obstructive.
5. Plan for the patient. Agree whether they need to be seen, by whom and when. Consider the carer’s own needs and any safeguarding concern.
6. Safety-net both people. Make sure the caller and the patient know what to look out for and how to get help.

Common pitfalls

• Talking about the patient as if they were absent when they are sitting next to the caller.
• Sharing results or history with a relative without checking the patient agrees. This is a professionalism problem, not a communication slip.
• Shutting the caller out completely. “I can’t tell you anything” ends a useful conversation. You can still listen, give general information and explain how to help.
• Assuming a parent speaks for a teenager. Ask to speak to the young person alone where appropriate.
• Ignoring carer strain. An exhausted carer is often part of the risk.

Natural phrases

• “Before we start, can I check who I’m speaking to, and is your dad with you at the moment?”
• “I’m really glad you rang. Tell me what you’ve noticed.”
• “I can listen to everything you want to tell me. What I can share back depends on what your mum is happy with.”
• “Would it be all right if I had a word with Josh on his own for a few minutes?”
• “And how are you managing with all this yourself?”

Practice cases with a third party

Each of these cases involves a parent, carer, relative, professional or interpreter as well as, or instead of, the patient.

• Husband worried about wife's mood · Telephone
• The son who leaves on Friday · Telephone
• A "water infection" at 87 · Video
• The drip her brother wants · Telephone
• "I’ve been crushing Mum’s tablets into her tea — is that okay?" · Telephone
• "He’s lashed out at me again — I can’t cope, just sedate him" · Telephone
• "I found cannabis in my son’s room — fix him" · Telephone
• “She’s just not herself today — the dip was positive, so can you send some antibiotics over?” · Telephone
• "She’s suddenly confused and agitated — can you prescribe something to settle her?" · Telephone
• “I’ve got power of attorney for Mum — so can I say no to the hospital test?” · Telephone
• “Why does Dad’s certificate say heart failure — and why can’t we bury him yet?” · Telephone
• "My husband’s only 58 but he’s become rude, reckless with money and oddly uncaring — it’s like his personality’s changed" · Video
• “My son read me the letter — it says my sugar is high. Is it serious?” · Telephone
• The teacher’s phone call · Telephone
• "I thought he was dying in my arms" · Video

Each case page shows the candidate brief you would read in the 3-minute window. The learning points sit behind a spoiler, so read the brief, practise, then look. The full case, with the role-player script and examiner checkpoints, is in The Hot Seat.

How to practise

Read a case brief, set a 12-minute timer and run it with a partner, the AI patient or out loud on your own. The Hot Seat holds the full case bank with a scorecard for each case. The Consultation Conversation Lab drills the Relating to others skills (cues, ideas and concerns, shared plans), and Worked Example Consultations show what a passing consultation sounds like from start to finish. Many third-party cases are telephone calls; see SCA telephone consultations for the audio-only skills. Then put a few of these cases into your next mock exam.

Frequently asked questions

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