Duty of Candour

The General Medical Council (GMC) (with eight UK professional healthcare regulators) has underlined its commitment to a professional duty of candour for doctors in a statement issued in Oct 2014

Health professionals must be open and honest with patients when things go wrong. This is also known as ‘the duty of candour’.

Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.


This means that healthcare professionals must:


•tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong;

•apologise to the patient (or, where appropriate, the patient’s advocate, carer or family);

•offer an appropriate remedy or support to put matters right (if possible); and

•explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened.


Healthcare professionals must also be open and honest with their colleagues, employers and relevant organisations, and take part in reviews and investigations when requested. Health and care professionals must also be open and honest with their regulators, raising concerns where appropriate. They must support and encourage each other to be open and honest and not stop someone from raising concerns.

‘The awful reality that emerged from Mid Staffs and indeed other inquiries was that doctors knew about GMC guidance but were not empowered by it. They felt it was acceptable to ‘walk by the other side of the ward’ knowing that there was unsafe and unacceptable practice going on. We must all do what we can to make sure that does not happen again. The statement above is an important milestone and makes it clear that the professional duty of candour sits with every healthcare professional, regardless of their field of practice.


The government in Nov 2014 has introduced a further duty of candour on secondary care organisations registered with CQC – one required, and enforceable, by law.


This new statutory duty of candour will apply to all other care providers registered with CQC from 1 April 2015. The key principles are:


1. Care organisations have a general duty to act in an open and transparent way in relation to care provided to patients. This means that an open and honest culture must exist throughout an organisation.

2. The statutory duty applies to organisations, not individuals, though it is clear from CQC guidance that it is expected that an organisation’s staff cooperate with it to ensure the obligation is met.

3. As soon as is reasonably practicable after a notifiable patient safety incident occurs, the organisation must tell the patient (or their representative) about it in person.

4. The organisation has to give the patient a full explanation of what is known at the time, including what further enquiries will be carried out. Organisations must also provide an apology and keep a written record of the notification to the patient.

5. A notifiable patient safety incident has a specific statutory meaning: it applies to incidents where a patient suffered (or could have suffered) unintended harm that results in death, severe harm, moderate harm or prolonged psychological harm.

6. There is a statutory duty to provide reasonable support to the patient.

7. Once the patient has been told in person about the notifiable patient safety incident, the organisation must provide the patient with a written note of the discussion, and copies of correspondence must be kept.


Doctors are most likely to be the organisation’s representative under the statutory duty. It is important that you cooperate with your organisation’s policies and procedures, including the requirement to alert the organisation when a notifiable patient safety incident occurs.


An area of difficulty may be deciding whether an incident reaches the threshold for notification under the statutory duty. This may be confusing, as the threshold is low for the doctor’s ethical duty (any harm or distress caused to the patient) while the thresholds for the contractual and statutory duties are higher and slightly different (at least moderate harm).




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