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MDU advises doctors on their new duty of candour

Duty of candour written into hospital contracts from 1 April

Louise Prime

Monday, 18 March 2013

If things go badly wrong in a patient’s care doctors will soon be contractually bound to take particular actions, separate from their existing ethical obligations. The Medical Defence Union has today published guidance for hospital doctors on how they will be affected by the new rules regarding a duty of candour.

Doctors already have an ethical duty to be open and honest with patients when things go wrong during their care, offering an explanation and apology, under the General Medical Council’s Good Medical Practice.

From 1 April, the new standard NHS contracts will mean that hospital doctors are additionally subject to a contractual duty of candour if a “reportable patient safety incident occurs or is suspected to have occurred”. This is an event that results in moderate or severe harm or death.

Under the new rules, within 10 days of a reportable incident – sooner if possible – the provider must investigate what happened and the patient (or other relevant person) must be verbally informed of all known facts, preferably by the clinician involved in the incident, and given an apology. A written record must also be kept.

If there is a breach of this contract, the commissioning body will be able to recover up to £10,000 from the provider.

The contractual duty of candour does not apply to primary care doctors.

The MDU’s head of advisory services Dr Michael Devlin said: “For very many years we have advised our members to let patients know as soon as something goes wrong and to apologise if appropriate, explaining what has happened and what they are going to do to put it right. More recently doctors have had an ethical duty to behave in this way so it is nothing new in itself. But it is in the interests of all providers to ensure they have guidance in place for members of staff about the contractual duty of candour and set out how the organisation will comply.

“Doctors will remain at the heart of ensuring patients are told when something goes wrong. But they need to know that, unlike their ethical duty which is unrestricted, the contractual duty of candour only applies to incidents that result in moderate or severe harm or death.

“There may be some confusion within organisations and among patients, carers and relatives about the sort of incident that will be covered by the contractual duty and even dispute about the extent of that duty.

“Doctors will need to continue to inform patients in the usual way any time anything goes wrong. From 1 April they will also need to be aware of their own organisation’s duty of candour guidance and make sure they follow their organisation’s procedures. It is very likely that careful note-taking will become even more important, not just in documenting discussions and explanations for the patient’s record, but also in ensuring that, when an incident occurs that invokes the duty, all the appropriate paperwork is completed.”

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