New guidance on duty of candour

DOCTORS should admit mistakes and apologise to patients, according to new duty of candour guidance from the General Medical Council.

Patients should also expect a face-to-face explanation when things go wrong.

But the regulator made it clear that clinicians must have the support of an "open and honest working environment where they are able to learn from mistakes and feel comfortable reporting incidents that have led to harm."

Rules came into force in England at the end of last year placing a legal duty on hospital, community and mental health trusts to inform and apologise to patients where mistakes have led to significant harm. Now these new guidelines from the GMC place a professional obligation on individual doctors.

The guidance, jointly produced by the Nursing and Midwifery Council (NMC), also applies to nurses and midwives.

Similar measures are being introduced in Scotland, Wales and Northern Ireland.

Under the new guidance, doctors, nurses and midwives should:

  • Speak to a patient, or those close to them, as soon as possible after they realise something has gone wrong with their care.
  • Apologise to the patient - explain what happened, what can be done if they have suffered harm and what will be done to prevent someone else being harmed in the future.
  • Use professional judgement about whether to inform patients about near misses – incidents which have the potential to result in harm but do not.
  • Report errors at an early stage so that lessons can be learned quickly, and patients are protected from harm in the future.
  • Not try to prevent colleagues or former colleagues from raising concerns about patient safety. Managers must make sure that if people do raise concerns they are protected from unfair criticism, detriment or dismissal.

The GMC guidance comes in the wake of Sir Robert Francis QC’s call for a more open and transparent culture within healthcare following patient care failings at Mid Staffordshire NHS Foundation Trust.

GMC Chief Executive Niall Dickson said: “We recognise that things can and do go wrong sometimes. It is what doctors, nurses and midwives do afterwards that matters.

“If they act in good faith, are open about what has happened and offer an apology this can make a huge difference to the patient and those close to them.”

He also had a strong message for employers and clinical leaders, saying: “None of this will work without an open and honest learning culture, in which staff feel empowered to admit mistakes and raise concerns.

“We know from the Mid Staffordshire enquiry and from our own work with doctors that such a culture does not always prevail. It remains one of the biggest challenges facing our healthcare system and a major impediment to safe, effective care.”

A professional duty to raise concerns is already set out in the GMC’s core guidance, Good Medical Practice, and its additional 2012 guidance Raising and acting on concerns about patient safety.

There is similar guidance in the NMC’s The Code: Standards of conduct, performance and ethics for nurses and midwives and in Raising concerns: Guidance for nurses and midwives.

Read the new guidance in full on the GMC website: http://www.gmc-uk.org/guidance/news_consultation/27274.asp