Duty of candour system for GPs too crude, says GPC

GPs are now legally obliged to be open and honest with patients after statutory duty of candour regulations took effect on 1 April, in a move the GPC described as a 'crude' tickbox approach.

Dr Chaand Nagpaul: duty of candour concern (Photo: JH Lancy)
Dr Chaand Nagpaul: duty of candour concern (Photo: JH Lancy)

Changes to the Health and Social Care Act mean GPs now have a duty to inform patients if they have caused them harm, and to issue an apology. This has has long been a professional GMC requirement, but is now legally enforceable following the update to regulations.

The duty of candour was introduced in response to the Francis Report, published in 2013.

GPs have previously raised concerns that a legal obligation to be open to patients could ‘undermine professionalism’. The BMA has also warned that GPs should not be forced to apologise if it is unclear where the fault lies.

Crude process

GPC chairman Dr Chaand Nagpaul told GP that doctors already have a professional duty to patients if they cause them harm, but the government needs to improve ‘working environments that compromise safe care’.

‘It’s unfortunate that issuing an apology is now a tickbox exercise – what patients want is an understanding of the concerns they have,’ Dr Nagpaul said.

‘GPs should have discussions with patients with concerns or complaints, and in most cases, it will result in an apology. But the simplistic emphasis on the apology in its own right is a very crude way of looking at a broader process of dealing with patients.’

The statutory duty of candour applies if a patient has ‘suffered (or required treatment to prevent) unintended harm resulting in death or specified conditions, such as impairment of sensory, motor or neurological functions or prolonged pain or psychological suffering’, according to the Medical Defence Union (MDU).

New duty

Dr Michael Devlin, from the MDU, said: ‘While the duty applies to organisations rather than individuals, CQC guidance makes it clear that all staff must cooperate in order to ensure that the duty is met.

‘Organisations are expected to tell patients about a notifiable patient safety incident as soon as is reasonably practicable, providing a full explanation of the incident, an apology and explaining what further action will be taken.’

The MDU advises that GPs should take careful notes and notify CQC ‘without delay’ when things go wrong.

‘This is because the new duty of candour in primary care and independent practice mirrors existing requirements to tell CQC if patients suffer certain specified types of unintended harm,’ Dr Devlin said.

Draft GMC guidance on duty of candour is available, and final guidance is due to be published in the summer.

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