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1

define Professional duty of candour

All healthcare professionals have a professional responsibility, to be honest with patients when something goes wrong. This is set out in the professional duty of candour which introduces this guidance and which is part of a joint statement from eight regulators of healthcare professionals in the UK.

2

About this duty of candour guidance GDC

The GDC’s Standards for the Dental Team already require dentists and dental care professionals to:
• Put patients’ interests first (principle one);
• Be honest and act with integrity (standard 1.3); and
• Offer an apology and a practical solution if a patient makes a complaint (standard 5.3.8).
However, candour means being open and honest with all patients, whether they have made a complaint or not.

3

When something goes wrong health care 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.

4

In addition, when something goes wrong health care professionals must:

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.

5

Being open and honest- before treatment starts

Before treatment starts:
An important part of being open and honest with patients is having a thorough discussion before treatment starts (see principle three of the Standards – ‘obtain valid consent’). It is important that patients understand their options for treatment, including the potential benefits and any risks.
You must give patients sufficient information in a way they can understand, make sure that they understand the decision they are being asked to make and give them enough time to make the decision.

6

Being open and honest- when something goes wrong

When things go wrong: When something goes wrong4 with a patient’s care, you must:
• tell the patient; • apologise; • offer an appropriate remedy or support to put matters right (if possible); and • explain fully the short and long term effects of what has happened.

7

Being open and honest- telling the patient

Telling the patient:
As soon as you realise that something has gone wrong with a patient’s care which has caused them harm or distress, or which could do so in the future, you must tell them clearly, in a way that they can understand.
Most patients will want to know what has happened, what has been done or can be done to put matters right and what it means for them. You should answer any questions fully and honestly.
If the patient makes clear that they do not want to know the details, you should respect their decision. However, you should let them know that they can have further information later if they change their mind.
You should record your discussion with the patient (including their decision not to have further information, if applicable) in their notes.

8

Being open and honest- Apologising

Apologising:
When a patient in your care suffers harm or distress because something goes wrong with their care, you should apologise as soon as possible.
An apology is more likely to be meaningful to the patient if it is personal to them and relevant to what has happened, rather than being a general expression of regret.
You should explain:
• what happened, • what has been done or can be done to put matters right and, • what will be done to stop the same thing happening to someone else (if relevant).

9

Being open and honest- Apologising (continued)

Apologising to the patient is not the same as admitting legal liability for what happened. This is set out in legislation in parts of the UK and the NHS Litigation Authority also advises that saying sorry is the right thing to do. You should not withhold an apology because you think that it might cause problems later.
The most appropriate team member should make the apology and give the explanation to the patient. When apologising to the patient and explaining what happened, you do not have to take responsibility for something that went wrong which was not your fault (such as a mistake by another member of the team)
Make sure that the patient knows who to contact if they have further questions.
Depending on the wishes of the patient and your practice or workplace policy, you may need to follow up a verbal apology with a written one. If the incident is of sufficient seriousness to trigger the statutory duty (see paragraph on systems regulators above), a written apology must be given.
Record your apology in the patient’s notes.

10

Duty of candour staff

If you employ, manage or lead a team:
In the same way that you need to make sure that there is an effective procedure in place for staff to raise concerns, you also need to make sure your staff understand the need to be open and honest with patients and that the culture of the practice or workplace supports this. Training for the whole team in communication skills, including handling complaints, may be helpful.
You must not prevent or try to discourage staff from being open and honest with patients when something goes wrong.
Statutory duty of candour
In addition to the professional duty on individuals set out in this guidance, organisations which provide healthcare have a statutory duty of candour. As part of this, organisations have a duty to support their staff to be open and honest with patients when something goes wrong with their care. Following the publication of the Francis report6, the governments of each of the four UK countries are considering how to implement the duty of candour in relation to healthcare organisations.