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Independents' Day

GPs to be given legal 'duty of candour' to highlight bad patient care

GPs face a new statutory ‘duty of candour’ to report treatment or care that they believe has caused death or serious injury, says the Department of Health in its official response to the public inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust.

The duty will apply to all all providers registered with the CQC, but the Department of Health said it would look at how how broadly the duty should apply.

Health secretary Jeremy Hunt also said they would explore whether to introduce a new ‘chief inspector of primary care’ to sit alongside chief inspectors for hospitals and care homes, which would act as ‘whistleblower in chief’ for the NHS.

But it stopped short of recommending an Ofsted-style quality rating for indivividual GPs - with ratings of ’inadequate’ to ‘outstanding’ - but the measure will be intrdoduced for hospitals and care homes. Mr Hunt said the ratings could not be entirely ruled out for GPs in the future.

The DH document said: ‘A spirit of candour will be critical to ensuring that problems are identified quickly and dealt with promptly. Openness is a key element of healthy organisational cultures in health.’

It added that while such a contractual duty already exists, it intends to go further and make this a statutory duty.

The document added: ‘We intend to go further and introduce a statutory duty of candour on health and care providers to inform people if they believe treatment or care has caused death or serious injury, and to provide an explanation. We will need to carefully consider the scope of this duty on all providers.’

It comes as the DH also published its revised version of the NHS Constitution today but it said further changes are likely to be consulted on in light of Francis later in the year.

Other actions that may come to be of relevance to GP practices include making nurses subject to revalidation; the CQC adopting a new peer-review model for assessments that will take into account whether patients are being listened to and are treated with dignity and respect; as well as the DH asking the GMC to tighten and speed up its procedures dealing with breaches of conduct.

Mr Hunt said: ‘The health and care system must change. We cannot merely tinker around the edges - we need a radical overhaul with high quality care and compassion at its heart.

‘Today I am setting out an initial response to Robert Francis’ recommendations. But this is just the start to a fundamental change to the system.’

GPC deputy chair Dr Richard Vautrey said that the development was ‘concerning’ as GPs already had a professional responsibility to be open and honest and engage their patients.

He said: ‘To actually impose a statutory responsibility actually risks, paradoxically, the situation being made less transparent because of a fear of litigation affecting your livelihood. It may actually make it harder rather than making it easier.

‘So there is the potential for a lot of unintended consequences as a result of this and we are not really sure this is the best way to proceed. We want a change in culture of the NHS without a fear of criminalisation in the process.’

He also cautioned against the prospect of a chief inspector of primary care: ‘We already have significant regulation with GMC, CQC looking at quality of primary care. I think we are yet to be convinced that it would do anything other than duplicate what is already there.’

Dr Michael Devlin, head of advisory services at the Medical Defence Union, said: ‘We note that the Government is planning to introduce a statutory duty of candour for providers of care to NHS patients and that it would apply only in cases where there is serious injury or death. At the moment, there are too many unanswered questions such as whether/how it would apply to primary care and how serious injury would be defined.’

‘We see no need for a statutory duty of candour because GPs are already under an ethical duty to tell patients as soon as anything goes wrong, irrespective of whether it is ‘serious’ or not. So far as we know GPs are already fully aware of and comply with that professional duty to be open and honest if something goes wrong.’

Dr Stephanie Bown, director of policy and communications at the Medical Protection Society, added: ‘MPS has long held the view that while you can mandate disclosure, legislation cannot deliver the attributes of high quality and open communication such as empathy, sincerity, and comprehensiveness. A culture change is what is needed.’

‘We will be further highlighting to Government that despite the understandable appeal of a legislated duty, this will not achieve the objective of effective open communication. The risk of any legislation is creating a ‘tick-box’ mentality, which does not support the intensely sensitive, personalised and patient-centred conversations that should happen with patients and their families when something has gone wrong.’

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Put your questions on how to avoid a career-ending complaint to our panel of experts at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.


Readers' comments (15)

  • Could someone please tell Mr Hunt putting in more regulation will only over burden the already stretched health care and compromise care.

    I am at the point where I can't remember all the new regulations coming in on daily basis. Apparantly we now must not prescribe for our selves, should have sex with ex-patients (not joking, GMC said so!), comply of all CQC protocols, legal frame work of duty to reprort patient care. This is before any clinical guideline (which also changes frequently, did the Pulse not report 7 new guidance introduced to GP each day?)

    Does anyone wonder why GPs haven't got the time to actually improve their clinical care??

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  • Is it really restricting this duty to "has caused death or serious injury"? That is, no forward looking "will cause death or serious injury unless some action is avoided or something else is done"? Or is this simply how the text reads in the story and the real duty will include that?

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  • For give me but what happened to the professional regulatory body for NHS Mangers?
    A "blacklist" does not meet the same professional and performance standard monitoring as the medical staff currently perform.
    A five year revalidation by a very senior manager from another reigion seems a suitable mechanism for preventing incestous internal appraisal and falling standards in Nhs managers.
    It is odd so little is said about the historical personal patronage of career development for very senior NHS management.
    Perhaps more will follow on this topic from the government when someone develops their gardening interest and retires in the summer?

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  • Vinci Ho

    Agent Hung has to show to the public he is to do 'something '. What is the easiest way? Put more bureaucrats into the system .What else does he know otherwise ?
    So the duty of candour (I spelt condour the other day , ha ,ha,ha) is based on an idea of more political scrutiny from top to bottom. But what about the top is harming our patients . Where do we report without being punished? Afterall , when was the last time you heard a bureaucrat or politician wholeheartedly admitted that he or she was wrong? (Please do not say Mr Clegg )

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  • This all gets back to the competing forces of vocation and money!

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  • I retire in less than 2 weeks and I cannot wait.

    In recent years I have been increasingly aware that there is pressure on me to chose the correct coding when I see a patient so I can do audits on the most ridiculous things. This distracts me from concentrating on the most important thing. THE PATIENTS PROBLEM.

    More legislation will make this worse and we will be in the situation where any doctor in their 50's will be counting down the days to retirement .

    I cannot wait to be an ex GP and I would advise any young doctor reading Pulse NOT TO CHOOSE GENERAL PRACTICE IN THE UK. Work overseas, choose hospital medicine, study botany. ANYTHING BUT GENERAL PRACTICE.

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  • Does this mean that GPs will finally have to start reporting on their concerns about other GPs?

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  • It leads to bad patient care when the government do all kinds of things.

    1. Low GP morale by imposing contracts on them.

    2. Distracting from patient care by sending Cant Quite Cope around to check the carpets and toilets every year or so.

    3. Understaffing OOH rotas so one doctor covers too many patients. IT IS DANGEROUS MR HEREMY JUNT

    4. Creating reams of boxes to tick which take time away from seeing patients.

    No end of other examples. Will Heremy Junt listen?

    Not a snowball in hells chance.

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  • We can candour all day long but if the likes of David Nicholson and Barbara Hakin arent listening what is the point. Perhaps I should be sending all my concerns direct to Mr Hunt, I have quite a few already

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  • Ameer Khan

    Why is everyone anonymous?? I guess this is the real problem with GPs, were afraid to speak out and as a result we get shafted by the government!!

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