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New guidance calls for practitioners to admit their mistakes

But BMA warns against ‘enforced apologies’

Jo Carlowe

Monday, 03 November 2014

Proposed new guidance from healthcare regulators will call for health professionals to be honest about their mistakes. 

The General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) have launched a public consultation on draft joint guidance which is designed to support doctors, nurses and midwives in fulfilling their professional duty to be open and honest.

The proposals cover the need to learn from ‘near misses’ as well as when something goes wrong and a patient is harmed. There is also advice on apologising to patients and those close to them.

The draft guidance calls on clinical leaders and employers to support doctors, nurses and midwives by creating cultures in the workplace that are open, honest, and where people learn from mistakes so that future patients are protected from harm.

Niall Dickson, Chief Executive of the GMC, said: “Patients deserve a clear and honest explanation if something has gone wrong with their care. This is why, for the first time, we are collaborating on this new joint guidance. It will ensure that doctors, nurses and midwives are working to a common standard and will know exactly what their responsibilities are. But it will only be of any use if it makes sense in day-to-day practice and that is why we are now going to consult with patients and with doctors, nurses and midwives who deal with these issues on the clinical front line. We want to know if it is clear enough, covers everything it should and we would welcome ideas on how best to illustrate the guidance working in practice.”

Mr Dickson added: “We also want to send out a very clear message to employers and clinical leaders - none of this will work without an open and honest learning culture and we know from the Mid Staffordshire enquiry and from our own work with healthcare professionals that too often such a culture does not prevail. It remains one of the biggest challenges facing our healthcare system and a major impediment towards safe effective care.”

However, responding to the consultation, the British Medical Council points out that most poor outcomes are caused by failings within the system rather than with the individual and warns against ‘enforced apologies’.

Dr Mark Porter, Chair of BMA Council, said: "The BMA strongly believes that patients should always be treated with the utmost respect and in a culture of openness and transparency. We need NHS leaders to commit to making this a practical reality and look forward to Sir Robert Francis' report on his review of 'Freedom to Speak up’.

“When things go wrong the vast majority of doctors already apologise at the earliest opportunity as this is a key professional duty. The General Medical Council proposals to support that duty may well be helpful in this process, however any suggestion of an enforced apology where there is a dispute over where fault lies would be inappropriate. Research shows that most poor outcomes are due to system rather than individual failures. Apologies in these circumstances should be couched in those terms if we are to have a process that is truthful and appropriate."

Commenting on the launch of the join consultation, Secretary of State for Health, Jeremy Hunt said: “Transparency and honesty when things go wrong are powerful tools to improve patient safety, and part of the continued culture change we are determined to see in the NHS. These new guidelines will complement the statutory duty of candour on organisations and help make the NHS safer than ever before.”

The new draft guidance follows Sir Robert Francis QC’s call for a more open and transparent culture within healthcare following the failures in patient care at Mid Staffordshire NHS Foundation Trust.

The consultation is open until 5 January 2015. The GMC and NMC aim to publish their new joint guidance in March 2015.

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