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NMC issues guidance on duty to be 'open' about errors

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Nurse, midwives and doctors have for the first time been issued joint guidance on their professional duty to be open with patients and to apologise when something has gone wrong.

The professional “duty of candour” guidance should also send out a “clear message” to employers and clinical leaders about their responsibility to support transparency, according to the Nursing and Midwifery Council and General Medical Council, which launched the guideline today.

panel management 

The joint guidance requires registrants to explain what has happened and apologise when a patient has already suffered, or may be harmed in the future, due to a mistake.

Professional judgement must be used to decide whether to inform patients of so-called “near misses” – an adverse incident that had the potential to result in harm but did not.

However, apologising does not mean a registrant is taking personal responsibility for an error that was not their fault, states the guidance – called Openness and honesty when things go wrong: the professional duty of candour.

“But the patient has the right to receive an apology from the most appropriate team member, regardless of who or what may be responsible,” it says.

Following consultation of draft guidance last year, an extra section has been included in the final version clarifying that saying sorry does also not mean the healthcare professional is admitting legal liability for what has happened.

“In addition, a fitness to practise panel may view an apology as evidence of insight,” adds the guidance.

Registrants are told in the guidance they should be supported by employers to report adverse incidents and near misses routinely and should raise a concern if this is not the case.

They should also not prevent colleagues or former colleagues from raising concerns about patient safety.

“If you are in a management role, you must make sure that individuals who raise concerns are protected from unfair criticism or action, including any detriment or dismissal,” adds the guideline.

“None of this will work without an open and honest learning culture, in which staff feel empowered to admit mistakes”

Niall Dickson

Niall Dickson, chief executive of the GMC, said the regulators wanted to send out a “clear message” to organisations about their responsibility to individual employees.

“None of this will work without an open and honest learning culture, in which staff feel empowered to admit mistakes and raise concerns,” he said.

He said it remained “one of the biggest challenges” facing the healthcare system and a “major impediment to safe, effective care” that an open culture did not exist across the board.

Jackie Smith

Jackie Smith

NMC chief executive Jackie Smith said: “We can’t stop mistakes from happening entirely and we recognise that sometimes things go wrong. The test is how individuals and organisations respond to those instances, and the culture they build as a result.”

The new guidance builds on previous requirements for nurses and doctors to be honest with patients.

It follows a recommendation made by Sir Robert Francis following his inquiry into care failings at Mid Staffordshire NHS Foundation Trust that there should be a legal “duty of candour” on both organisations and individual clinicians.

However, in its response, the government only introduced a legal duty on organisations, not for individuals. It instead asked professional regulators to strengthen their guidance for individuals.

  • 1 Comment

Readers' comments (1)

  • michael stone

    I had a quick scan of this guidance yesterday - I am about to send the following comments to the GMC:

    Section 16f says:

    ‘f You should record the details of your
    apology in the patient’s clinical record.18, 19 A verbal apology may need to be followed up by a written apology, depending on the patient’s wishes and on your workplace policy.*

    If the DETAILS OF a VERBAL apology are to be noted anywhere - and in particular within any type of 'official record' - there are very strong arguments that the record should be 'signed off' by whichever party to the conversation did not write the record. The argument is obvious, and in the context of conversations during end-of-life care, I have presented it at:

    You do not seem to be requiring this 'confirmation that both sides agree the record of a conversation is correct' - I consider that you should require this.

    I also take issue with section 9. While MDTs are prevalent in the NHS, and some mistakes might be 'the result of team behaviour', other parts of your guidance - and also something I heard Niall Dickson say on BBC Radio 4 yesterday - make me think that you understand that 'patients want to receive a face-to-face apology and explanation, from whomever made the mistake, because what most patients want, is to be convinced that the same mistake isn't likely to be made again' (my phrase).

    So only for 'systemic mistakes' is it appropriate for the 'team leader' to apologise - for INDIVIDUAL MISTAKES, it should be an apology directly from the clinician whose mistake it was.

    I had personal experience of how annoying, this type of thing is, some years ago when I was tangled up with my PCT, trying to find out why something had happened: I had letters signed by the CE of the PCT (that stems from the complaints regulations), and at other times I was told I could speak to somebody who had written a report when at the time I wanted to speak to some district nurses, and later when I wanted to speak to the author of the report I was offered instead a district nurse. 'Who I wanted to speak to' was determined by 'what I had managed to disentangle and understand at any particular time', so I knew who I thought could best answer my questions: the people who were 'offered up' to speak to me, were almost never the ones who I actually wanted to talk to.

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