Duty of candour could undermine open and honest GP culture

Patients could be less likely to receive an explanation and an apology when doctors make a mistake under NHS regulations that take effect from October, medico-legal experts fear.

GP: most doctors already apologise for any mistake (Photo: JH Lancy)
GP: most doctors already apologise for any mistake (Photo: JH Lancy)

A poll by the Medical Defence Union (MDU) found that of 245 GPs, 108 had been involved recently in an incident in which something had gone wrong with a patient’s care.

Of these GPs, 105 said the patient had been provided with an explanation, and 101 said the patient had been offered an apology.

In 105 of the cases, the GPs said there had been no repercussions to their actions.

MDU medico-legal adviser Dr Michael Devlin said the poll showed that ‘doctors overwhelmingly understand their duty to be open and honest’.

Legal duty of candour

From October 2014 the government plans to introduce a legal duty of candour that will apply to organisations including GP practices.

The duty, which will become part of the requirements for registration with the CQC for all health and social care providers, will apply to any incident over a certain threshold.

Dr Devlin said that the threshold at which the duty would apply is ‘significant harm’.

He said: ‘If doctors clearly understand the obligation to be open with patients when things go wrong and routinely carry out that duty, is a statutory duty of candour really necessary?

‘We believe this will lead to an unnecessary administrative burden for medical staff and it is bound to lead to confusion about the types of incidents covered.’

GPs and other doctors may delay giving patients explanations or apologies while they determine whether the incident was over the duty of candour threshold, he warned.

Opposite of intended effect

‘This is obviously the opposite of what is intended,’ added Dr Devlin. ‘What is needed is for NHS organisations to ensure there is full and unqualified support for clinical staff who follow their ethical responsibility and are open and honest with patients.’

One doctor who responded to the poll said a duty of candour would undermine doctors’ professionalism, because a genuine apology when something goes wrong is the ‘hallmark of a professional’.

A DH spokesman said: ‘Robert Francis was clear about the need for a duty of candour.

‘We have consulted widely to make sure that the threshold will be clearly defined, based on existing reporting categories wherever possible.

‘GPs should already be reporting incidents so the new duty will not be creating extra layers of bureaucracy. We would always expect GPs to explain and apologise when things go wrong.’

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