Abstract
In a report published by Imperial College London in 2023, the UK ranked 21st out of 38 of the Organisation for Economic Co-operation and Development (OCED) member countries for patient safety. Dr Hana Patel will discuss how the duty of candour may help form a more streamlined approach to reducing harms in the NHS in England.
Professional obligations and duty of candour
Most health and care professionals will be governed by a regulatory body, that should state the professional duty, and ethical obligation for individual practitioners, to be honest and apologise.
As a doctor, our professional obligation, as stated by the General Medical Council (GMC), with regards to duty of candour relates to any incident occurring, with potential for harm or distress, not just notifiable ones.
In its Good Medical Practice guidance, the GMC state that: When you realise that something has gone wrong, and after doing what you can to put matters right, you or someone from the healthcare team must speak to the patient
As doctors, we should be open and honest, by telling our patients when something has gone wrong. The GMC advises that we should apologise for any harm caused, explaining the effects of the error and offer our patients a resolution or support. Again, the purpose of this is to build upon a building of trust, transparency and to foster learning from our mistakes.
What is an example of duty of candour that I may encounter?
A typical example that a GP registrar may encounter for a professional duty of candour might be failing to review a blood test result in a timely manner (owing to annual leave or forgetting to check your pathology results), leading to a delayed diagnosis.
Another example may be prescribing the incorrect dose of medication for a patient, leading them to take their medication at the wrong dose, strength or frequency.
Once a mistake has been recognised and established, the GMC advises offering patients a timely and sincere apology, providing a full explanation of what happened, and documenting the incident in the patient’s medical records.
Clinicians tend to be anxious to use the word ‘sorry’ as it may be an indication of liability, however the GMC states regarding this: 14. Patients expect to be told three things as part of an apology: what happened what can be done to deal with any harm caused what will be done to prevent someone else being harmed. 15. Apologising to a patient does not mean that you are admitting legal liability for what has happened. This is set out in legislation in parts of the UK and NHS Resolution also advises that saying sorry is the right thing to do. In addition, a fitness to practise panel may view an apology as evidence of insight.
Final thoughts?
With statistics sharing that one in 20 GP consultations involve an error, it is important to think about how we approach mistakes and errors, the language we use when speaking to patients and their relatives about this, open and honestly, while building on a culture of learning and improvement.
Using the trainee portfolio to reflect on adverse incidents can help to show insight and aid in life-long learning, as capturing duty of candour is incorporated into the GP NHS England yearly appraisal post Certification of Completion of Training (CCT).
