General Medical Council/Nursing and Midwifery Council
Thursday, 11 December, 2014

We are consulting on draft guidance for doctors, nurses and midwives on their professional duty to be open and honest when things go wrong – known as the duty of candour.

Who is consulting?

The General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) are independent organisations that help to protect patients and improve medical, nursing and midwifery education and practice across the UK.

- We decide which doctors, nurses and midwives are qualified to work here and we oversee their education and training.

- We set the standards that doctors, nurses and midwives need to follow, and help to make sure that they continue to meet these standards throughout their careers.

- We take action when we believe a doctor, nurse or midwife may be putting the safety of patients, or the public’s confidence in the medical, nursing or midwifery profession, at risk.

Every patient should receive a high standard of care. Our role is to help achieve that by working closely with doctors, nurses and midwives, with their employers and with patients, to make sure that the trust patients have in their doctor, nurse or midwife is fully justified.

What is the consultation about?

One of the ways we protect patients is by setting out the professional values, knowledge, skills and behaviours required of all doctors, nurses and midwives working in the UK.

The core professional standards are set out in Good medical practice* for doctors and in The Code: Standards of conduct, performance and ethics for nurses and midwives for nurses and midwives.  Both Good medical practice and the Code cover fundamental aspects of a doctor’s, nurse’s or midwife’s role, including working in partnership with patients and treating them with respect.

Both Good medical practice and the Code say that doctors, nurses and midwives must:

  • be open and honest with patients if something goes wrong with their care
  • act immediately to put matters right if that is possible
  • promptly explain to patients what has gone wrong and the likely long-term and short-term effects.

This consultation is about providing more detailed guidance on these issues.

So why is more guidance necessary?

The Mid Staffordshire public inquiry identified the principles of openness, transparency and candour as the cornerstone of healthcare.

In his report,* Sir Robert Francis QC quoted from both Good medical practice and the Code, acknowledging that doctors and nurses are required by their regulators to be open with patients.

But he stated clearly that the current requirements for candour are not enough.

  • They do not adequately cover the necessary areas: ‘individual clinical and managerial professionals, provider organisations and their collective leadership, in the NHS and the private sector, commissioners, regulators and political leaders’.
  • The ways in which the requirement is currently recognised are ‘piecemeal and disjointed’.

The Department of Health (England), in response to the recommendations in the Francis report, stated that:

‘the General Medical Council and the Nursing and Midwifery Council will be working with the other regulators to agree consistent approaches to candour and reporting of errors, including a common responsibility across doctors and nurses and other health professions to be candid with patients whenbn mistakes occur whether serious or not’.

Eight regulators of healthcare professionals in the UK published a joint statement setting out the professional duty of candour on 13 October 2014.

This statement recognises that all healthcare professionals have a common responsibility to be open and honest with patients when something goes wrong with their care.

As well as working with the other healthcare regulators on the joint statement, the GMC and NMC have been jointly developing guidance that expands on the advice given in Good medical practice and the Code.

Why produce joint guidance?

This is the first time we have collaborated in this way to develop common guidance for all the professionals on both of our registers.

Healthcare is usually provided by multidisciplinary teams, and we think it makes sense for doctors, nurses and midwives to be working to the same standards, particularly for a fundamental ethical principle like being open and honest when things go wrong.

How can I help?

We are asking doctors, nurses and midwives, and all other people interested or involved in our work, if we have got the guidance right. The consultation is open to anyone who wants to comment on the issues in the new draft guidance – this is your chance to have your say.

We would like to know whether the guidance is clear enough: we don’t want it to be difficult to put into practice because the wording is ambiguous.

We want to know if the guidance covers everything that it should: whether we’ve missed anything out, or whether we’ve included irrelevant or unhelpful information that detracts from the main message.

We also want you to tell us your ideas for how we could show how the guidance should work in practice. In the past we’ve used case studies (such as those in Good medical practice in action* and the NMC’s Raising concerns toolkit†) and other learning materials. But we’re sure there are numerous ways to show how the guidance should be interpreted in different situations.

As well as these questions, we would like to know your thoughts on two specific issues: apologising to patients or those close to them, and informing patients about near misses (when something goes wrong with patient care that could have led to harm but didn’t).

You may be aware that the GMC has been running another consultation – Reviewing how we deal with concerns about doctors‡ – that also covers the issue of doctors apologising to patients.

Royal College of Physicians of Edinburgh General Medical Council and Nursing and Midwifery Council
Openness and honesty when things go wrong: the professional duty of candour - A public consultation on our draft guidance

The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the NMC and GMC call for views on Openness and honesty when things go wrong: the professional duty of candour.

Question 1: Is it helpful to have additional guidance on this issue?

Generally yes, to clarify what would be expected of a doctor in different situations and to remove dubiety.  It is not possible to provide detailed information on every possible scenario, and examples in the guidance will not necessarily capture the nuances of reality.  However, this guidance gives a clearer picture of what is expected through the professional duty of candour.

Question 2: How easy is this guidance to understand?

The guidance seems fairly straightforward.

Question 3: Do you think there is anything else that the guidance should cover?

No specific comment.

Question 4: Is there anything you think could be removed from the guidance?

No specific comment.

Question 5: Do you have any ideas about how we could illustrate how the guidance works in practice (eg case studies or decision tools)?

Decision tools would be likely to be more helpful as case studies can be very narrow and often exaggerated.  Decision tools could offer practical advice and support for a doctor who is querying how to proceed in a situation.

Question 6: Do you think there is anything else that doctors, nurses and midwives should consider when apologising to patients or those close to them?

To be genuine, apologies should be a sincere expression rather than something that is imposed by an external party.  The College would appreciate clarification on who would decide whether the apology is genuine, and what would happen if the apology was not deemed genuine?

Question 7: To what extent do you agree that patients should always be told about near misses?

As the guidance suggests, professional judgement and the individual circumstances of a situation will guide a clinician as to whether it is appropriate to tell a patient about a near miss. 

Question 8: Do you have any other comments or suggestions about the draft guidance?

It should be noted that all consultants are required to reflect on problems, errors and near misses routinely as part of revalidation.