What is the duty of candour?
The duty of candour means being open and honest with patients when something goes wrong with their care. In the UK there are two linked duties, and it helps to keep them separate.
| Professional duty of candour | Statutory (organisational) duty of candour | |
|---|---|---|
| Who it applies to | Individual registered professionals | Care providers and organisations |
| Where it comes from | Your regulator's standards and joint regulator guidance | Law in each UK nation, for example Regulation 20 in England |
| When it applies | When something goes wrong that causes, or could cause, harm or distress | When a defined notifiable safety incident occurs |
| Who enforces it | Your regulator, through fitness to practise | In England, the Care Quality Commission |
In 2014, eight UK healthcare regulators, including the GMC, NMC and GPhC, published a joint statement on the professional duty of candour. The GMC and NMC later published shared guidance, Openness and honesty when things go wrong. The HCPC includes a similar duty in its standards of conduct, performance and ethics, under being open when things go wrong.
What exactly must you do when something goes wrong?
The joint regulator statement sets out four things you must do for the patient, or their advocate, carer or family where appropriate:
- Tell them: Explain that something has gone wrong. Do this as soon as you reasonably can, once the patient is safe and any urgent treatment is under way.
- Apologise: Say sorry, sincerely and in plain words. An apology is about acknowledging what happened and how it affects them.
- Offer a remedy or support: Where possible, offer something to put matters right, such as further treatment, a referral, or support with the effects.
- Explain the effects: Fully explain the likely short-term and long-term effects of what happened, as far as they are known.
In a team, it is not always clear who should speak to the patient. The guidance expects someone to take responsibility for this, usually the most senior person involved or the clinician leading care, and expects others to support them. If you made the error but someone else leads the conversation, make sure they have accurate information, and offer to be present if that would help the patient.
You must also be open and honest with colleagues, employers and relevant organisations, take part in reviews and investigations when asked, and be open with your regulator. You must support colleagues to do the same and must not prevent anyone from raising a concern.
Does saying sorry mean admitting liability?
No. This is one of the most common worries, and it stops people apologising when they should. The GMC and NMC guidance is clear that apologising is not the same as admitting legal liability. The law in England and Wales and in Scotland also provides that an apology is not, by itself, an admission of legal liability.
A good apology acknowledges what happened and its impact. It does not need to speculate about fault or blame, especially before the facts are known.
I'm sorry if you feel upset, but these things happen. The wrong dose was probably a pharmacy error, so it wasn't really anything to do with me. Hopefully there'll be no problem.
I'm very sorry. Your mother was given a higher dose of her blood thinner this morning than was prescribed. We have checked her, she is stable, and we are monitoring her blood closely for the next 24 hours. The main risk is bleeding, so we will watch for that and tell you straight away if anything changes. We are looking into how it happened and will share what we find with you. Here is how to contact me or the ward manager with any questions.
The weaker version minimises, deflects blame and leaves the family without information. The stronger one is honest, specific, explains effects and next steps, and offers ongoing contact.
What is a notifiable safety incident?
In England, the statutory duty under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 applies to notifiable safety incidents. CQC guidance says an incident must meet three criteria:
- it was unintended or unexpected,
- it occurred while providing a regulated activity, and
- in the reasonable opinion of a healthcare professional, it has caused, or might cause, death or harm at the level set for that type of provider.
For NHS trusts and foundation trusts, the harm threshold covers death, severe harm, moderate harm or prolonged psychological harm. Other providers, such as GP practices, independent hospitals and care homes, use a different set of harm definitions. The same incident can meet the threshold for one type of provider but not another, so check the definition for your setting.
Fault does not matter for this test. A patient's consent to a procedure does not rule out a notifiable incident. A near miss is not a notifiable safety incident under the regulation, although the professional duty still asks you to be open about it.
Scotland and Wales have their own statutory duties of candour with different rules and thresholds. Arrangements in Northern Ireland differ again. If you work outside England, check the guidance for your nation and your employer's policy.
What does the organisation have to do?
Under Regulation 20, the registered provider is responsible for meeting the statutory duty, although it can delegate tasks to staff. CQC guidance says that, as soon as reasonably practicable after becoming aware of a notifiable safety incident, the provider must:
- tell the relevant person in person that the incident has happened,
- apologise,
- give a truthful account of what is known so far and explain what further enquiries will take place,
- follow this up in writing, including an update on enquiries,
- keep a secure written record of all meetings and communications, and
- provide reasonable support, such as an interpreter or signposting to services.
In practice, this often means the clinician involved, a senior colleague, or both, meet the patient or family. Your trust will have a policy on who leads. Know where to find it before you need it.
What should you do about near misses?
A near miss is something that could have caused harm but did not, often because it was caught in time. The professional guidance asks you to report near misses as well as incidents that cause harm, so that your organisation can learn from them.
Whether to tell the patient about a near miss is a judgement. The GMC and NMC guidance has a section on this. In general, consider whether the patient would want to know, and whether telling them would help them understand their care. If you are unsure, discuss it with a senior colleague.
Daniel noticed during a final check that a prescription had been labelled with the wrong strength of a medicine. He corrected it before it was handed out. He recorded it as a near miss, discussed it with his team, and changed the labelling check so a second person confirms strength on high-risk medicines. The patient was not affected, so there was no need to tell them in this case. Daniel's openness meant the team learned from the error rather than hiding it. (Fictional example.)
Why does candour matter so much to regulators?
Regulators see a clear difference between making a mistake and covering one up. Most honest errors, handled openly, do not lead to serious regulatory action on their own. Hiding a mistake, altering records, or pressuring a colleague to stay quiet can turn a clinical issue into a question of honesty.
NMC sanctions guidance, for example, lists covering up mistakes, especially where patients could be harmed, as something that makes dishonesty more serious. Concerns about honesty are generally harder to address than an isolated clinical error.
- Report the incident through your local system as soon as you can.
- Write an accurate, factual and contemporaneous record. Never change an existing entry; add a dated, signed note instead.
- Tell your line manager or a senior colleague.
- Contact your defence organisation or trade union if there may be a complaint, an investigation or a referral.
Learning more about candour and incident learning
Being candid is a skill, not just a rule. It takes practice to tell someone bad news clearly and kindly, and to stay honest under pressure.
Our Duty of Candour Training covers the professional and statutory duties, with practical examples of conversations and records. Communication, Attitude and Responding to Complaints helps with the conversations that often follow an incident. Human Factors and Learning from Incidents looks at why errors happen and how to reflect on them in a way that leads to change. These courses support your professional development and are not a substitute for your employer's policy or advice from your representative.
Frequently asked questions
Who does the duty of candour apply to?
The professional duty applies to every registered healthcare professional, including doctors, nurses, midwives, pharmacists, paramedics and allied health professionals. The statutory duty applies to care organisations. In England it covers providers registered with the CQC. In practice you share responsibility: your organisation must meet the legal duty, and you must meet your own professional duty.
How soon should I tell a patient something has gone wrong?
As soon as reasonably practicable, once the patient is safe. CQC guidance on the statutory duty uses this phrase rather than a fixed number of hours. Your local policy may give more detail on timescales for the formal written notification. Do not delay an honest first conversation while waiting for an investigation to finish.
Is an apology an admission of guilt?
No. Regulator guidance confirms that apologising is not the same as admitting legal liability, and the law in England and Wales and in Scotland supports this. A sincere apology acknowledges what happened and its impact on the patient. It does not need to assign blame. Withholding an apology out of fear can itself be seen as a failure of candour.
What if the mistake was made by a colleague?
You still have a duty to be open. Make sure the patient is safe, and raise the issue with the colleague and your manager or the person leading care. In a team, someone should take responsibility for speaking to the patient, and others should support them. If you have concerns that an error is being hidden, use your organisation's speaking up route.
Do I have to tell the patient about a near miss?
Not always. You must report near misses so your organisation can learn. Whether to tell the patient depends on the circumstances, including whether they would want to know and whether it affects their care. GMC and NMC guidance covers this. If you are unsure, discuss it with a senior colleague and record your decision.
What happens if I do not follow the duty of candour?
Failing to be open can be raised with your regulator as a fitness to practise concern. Covering up a mistake, or changing records, may be treated as dishonesty, which regulators take very seriously. Organisations in England that breach Regulation 20 can face CQC enforcement action. If you are worried about a past incident, speak to your defence organisation or union.
Related courses
Duty of Candour Training
This course explains the two duties of candour that apply in UK healthcare: the professional duty that applies to every registered professional, and…
Communication, Attitude and Responding to Complaints
This course looks at why concerns about communication and attitude arise, how patients and colleagues experience a rude, dismissive or rushed manner,…
Human Factors and Learning from Incidents
This course explains why skilled and caring professionals make errors, using the science of human factors, the Swiss cheese model and the idea of a…
Sources and further reading
- Openness and honesty when things go wrong: the professional duty of candour. General Medical Council and Nursing and Midwifery Council.
- Joint statement on the professional duty of candour. UK healthcare professional regulators.
- Regulation 20: Duty of candour. Care Quality Commission.
- Notifiable safety incidents. Care Quality Commission.
- What you must do when you discover a notifiable safety incident. Care Quality Commission.
- Standards of conduct, performance and ethics. Health and Care Professions Council.
- Sanctions for the highest risk cases. Nursing and Midwifery Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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