The guidance is split into two sections:
- the professional's duty to be open and honest with the patient in their care (and those close to them), if something goes wrong; and
- the professional's duty to be open and honest with their employer and to encourage a culture that reports adverse incidences as well as near misses.
It seeks to give practical information to professionals on how to implement the core principles as set out in Good Medical Practice and The Code: Professional standards of practice and behaviour for nurses and midwives in accordance with their duty of candour.
The guidance also provides comfort that apologising does not mean the professional is admitting to legal liability for an incident and that the NHS Litigation Authority will not withhold cover for a claim because an apology or explanation had been given. For professionals that are concerned in case the incident progresses to a complaint before a Fitness to Practise Panel, the guidance states that an apology may be viewed as evidence of insight and further, that a Fitness to Practise Panel could consider a more serious sanction if there is evidence of failure to raise a concern or an attempt to cover up an adverse incident. Although, as noted at the recent IBC Legal's Disciplinary Tribunals conference on 14 July, issues may arise if professionals and their employers disagree about the implications under the duty of candour in a particular case.
To complement the guidance the NMC have produced a series of case studies developed with practicing midwives and nurses to reflect a range of situations and to help the registrants understand how to integrate the duty of candour in their practice.
In respect of the new guidance, the chief executives of both regulators have made the following statements:
Niall Dickson, Chief Executive of the General Medical Council has said:
"We recognise that things can and do go wrong sometimes. It is what doctors, nurses and midwives do afterwards that matters. If they act in good faith, are open about what has happened and offer an apology this can make a huge difference to the patient and those close to them.
We also want to send out a clear message to employers and clinical leaders – none of this will work without an open and honest learning culture, in which staff feel empowered to admit mistakes and raise concerns. We know from the Mid Staffordshire enquiry and from our own work with doctors that such a culture does not always prevail. It remains one of the biggest challenges facing our healthcare system and a major impediment to safe effective care".
Jackie Smith, Chief Executive of the Nursing & Midwifery Council has said:
"We developed this joint guidance to help nurses, midwives and doctors to uphold a common duty of candour that is set out in their professional standards. We often work as part of a team and that should absolutely be our approach as regulators to ensure that we are protecting the public.
We believe that the public's health is best protected when the healthcare professionals who look after them work in an environment that openly supports them to speak to patients or those that care for them, when things have gone wrong. We can't stop mistakes from happening entirely and we recognise that sometimes things go wrong. The test of how individuals and organisations respond to those incidences, and the culture they build as a result."