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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.’

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