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Government drops plans for doctors to have legal duty of candour to report poor care

The Government has dropped plans to impose a statutory duty of candour that would have legally obliged GPs to report treatment or care that they believed had caused death or serious injury.

In his response to the Francis Report on failures of care at the Mid Staffordshire NHS Foundation Trust, health secretary Jeremy Hunt today said doctors would have a professional duty to report any failures of care or ‘near misses’ they come across, but this would be not be a legal obligation, despite this being a recommendation by Robert Francis.

But the Department of Health did state it would aim to introduce a criminal sanction for ‘wilful neglect’ by medical staff, which it said was ‘designed for those guilty of the most extreme types of poor care’.

The BMA has welcomed the Government’s decision to shelve the plans for a statutory duty of candour but warned that the new criminal sanction will not have the desired effects.

The health secretary’s response to the Francis Report said that existing professional guidance and codes would be reviewed to ‘strengthen’ the professional duty of candour, a process that will be carried out by the GMC and will be monitored by the Professional Standards Authority

The Government said: ‘The professional values of individual clinicians are critical in ensuring an open culture in which mistakes are reported, whether or not they cause actual harm.’

‘The General Medical Council, the Nursing and Midwifery Council and the other professional regulators will be working to agree consistent approaches to candour and reporting of errors, including a common responsibility across doctors and nurses, and other health professions to be candid with patients when mistakes occur whether serious or not, and clear guidance that professionals who seek to obstruct others in raising concerns or being candid would be in breach of their professional responsibilities.’

It added: ‘The professional regulators will develop new guidance to make it clear professionals’ responsibility to report “near misses” for errors that could have led to death or serious injury, as well as actual harm, at the earliest available opportunity and will review their professional codes of conduct to bring them into line with this guidance.’

‘The professional regulators will also review their guidance to panels taking decisions on professional misconduct to ensure they take proper account of whether or not professionals have raised concerns promptly.’

The BMA welcomed the Government’s announcement. Dr Mark Porter, chair of BMA Council, said: ‘We are… pleased that the Government has heeded the BMA’s warnings over the introduction of a statutory duty of candour for individuals, instead strengthening the professional duty that already exists. It is vital that organisations actively listen to their staff and take on their concerns.’

However, he added: ‘While extending wilful neglect as a criminal offence may go some way towards reassuring the public, it is unlikely to bring around the change in culture we need, and how this will work in practice is something that we will continue to discuss with the Government as there are already criminal sanctions in place in order to hold healthcare workers, including doctors, to account.’

Niall Dickson, chief executive of the GMC, said: ‘Through our guidance, we have already done a great deal to encourage a duty of candour among doctors, but we are not complacent. We know there is more to do. We must strengthen the link between our guidance and doctors’ practice on the frontline, the words on the page and actions on the ward. We look forward to working with doctors and others to make that happen.’

The Government also put forward plans to pilot ‘Schwartz rounds’ in GP practices.

The initiative, developed in the US but promoted in the UK by the King’s Fund through its ‘Point of Care’ programme, are described by the think-tank as: ‘A forum for clinical and non-clinical staff from all backgrounds and levels of an organisation to come together once a month, for one hour, eat lunch or breakfast together, and explore the impact that their job has on their feelings and emotions.’

The Department of Health’s response today said: ‘Supporting staff wellbeing means recognising the impact of the work that they do. The pioneering work on Schwartz rounds is one example of how staff can be supported to deal with the realities of care for staff. The Government has already signalled its support for this work…. For the first time ever, they will also be piloted with GP practices, district nurses and in the community.’

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