GPs are highly skilled professionals but they’re also human beings and that means mistakes in their jobs are possible.
As an MDO set up by GPs for GPs we understand and appreciate this as well as anyone – but we also know the importance of reacting appropriately when something has gone wrong.
In this guide, we’ll take a top-level look at the rules around duty of candour and what they say about the need to act after an error have been made.
What is duty of candour and why was it introduced?
Duty of candour is the legal requirement placed on GPs to be open and honest with patients and their families when something goes wrong that either does or could have caused significant harm. Under this, patients should be told of a ‘notifiable safety incident’ as soon as possible.
Duty of candour was introduced in November 2014 and then extended to GPs the following April and forms regulation 20 of the Health and Social Care Act 2008.
The new regulation came as a response to the Francis Inquiry, which looked into the care given by Mid Staffordshire NHS Foundation Trust. During the inquiry, it emerged that patients had not always been given a thorough explanation by the trust when their care had gone wrong.
The duty of candour was proposed by Sir Robert Francis and later accepted by then health secretary Jeremy Hunt. This is over and above a GP’s professional and ethical duty to be open and honest with a patient.
Duty of candour law: What you need to know
When considering duty of candour, it’s important to understand what is meant by a notifiable safety incident – and what the General Medical Council’s guidance says about reacting to this.
For GPs, a notifiable safety incident is something that, according to the ‘reasonable opinion of the health professional’ either did or could have caused:
• Death (outside of the natural course of an illness)
• Reduced sensory, motor or intellectual function (for 28 days or more)
• Amputation or other changes to the structure of the body
• Psychological harm (for 28 days or more)
• Shortened life expectancy
• Treatment to prevent death or any of the other above outcomes
In Scotland, the process is similar but the ‘reasonable opinion’ needs to come from a healthcare professional who isn’t involved in the incident. Scottish duty of candour comes under the Health (Tobacco, Nicotine and Care etc.) (Scotland) Act 2016.
In England, patients should be notified of the above as soon as possible. In Scotland, the government’s guidance suggests this should be within ten days.
GPs should arrange to meet in person with their patient to share any necessary information and, importantly, to apologise.
An apology is not an admission of guilt
At this point, it’s very important to stress that an apology is not the same as an admission of guilt. GPs should not feel as though they cannot apologise because it will end up costing them in future litigation. Indeed, the NHS Litigation authority states it ‘will never withhold cover for a claim because an apology or explanation has been given’.
GPs aren’t obliged to accept personal responsibility for things that were outside of their control such as a system error. However, the patient does have the right to an apology from the most appropriate team member, regardless of the source of responsibility.
The General Medical Council outlines three clear parts to an apology issued under duty of candour. It should outline:
• What has happened
• What can be done to deal with any immediate harm caused
• What will be done to prevent a repeat in the future
A GP’s apology should be genuine and relies on the individual to judge their own situation. However, the GMC suggests to bear the following in mind:
• Give patients information in a way they’ll understand
• Speak to patients at an appropriate time
• Be considerate with distressing details
• Be personal and properly apologise
• Tell the patient who to contact if they have further concerns
• Record details in a patient’s clinical record
Seek support with duty of candour matters
Hopefully this guide has filled you in on some of the key points to remember about duty of candour. However, if you do find yourself involved in a ‘notifiable safety incident’ then it’s important to remember that you should seek support.
With the Medical Defense Society you have access to our medico-legal advisory team and help with, for example, understanding how to handle an apology in one of the cases outlined above.
If you want to discuss duty of candour or if you wish to find out more about joining MDS, contact us today.
The Government has moved to clarify the rules over travel vaccinations – and has stressed that GPs do need separate indemnity cover for this work.
NHS Resolution’s website had originally stated that the administration of travel vaccines and immunisations in which the patient is charged were in the scope of the new state-backed indemnity scheme.
The NHS Resolution’s information about the clinical negligence scheme for GPs (CNSGP) has now been updated to clarify that this is not the case.
GPs and travel vaccines
The situation regarding travel vaccines and immunisations is as follows:
- Those listed as NHS-funded in the GMS Contract Guidance are covered by CNSGP
- Those not listed and that require the patient to pay, such as yellow fever or rabies, are classes as private services. The CNSGP does not cover private services offered by GPs so separate indemnity cover is needed for this.
- Advice on vaccinations – whether they are paid for or not – is covered by the CNSGP.
In recognition of the confusion, the Department of Health and Social Care has said it will provide assistance for any claim for clinical negligence made against anyone who administered travel vaccinations between 1st April 2019 and 31st July 2019. GPs should contact NHS Resolution for claims made within this specific period.
After this period – and in light of this clarification – GPs will need separate cover for this work.
Medical Defense Society CEO Rohan Simon said: “This is just one example of the importance of GPs retaining indemnity cover for the aspects of their role that fall outside of the state-backed scheme.
“We’re keen to ensure GPs have the support they need to do their jobs with peace of mind.”
If you have any queries about immunisations or any other aspects of GP work and indemnity, get in touch with us today.
Figures showing the alarming rate of surgery closures prove why it’s vital for the UK to look after its GPs, according to the Medical Defense Society.
A recent Pulse investigation showed that GP surgeries are shutting at a record rate, with further analysis of the data showing how coastal and rural areas are worst affected.
Pulse found that 138 GP practices closed their doors in 2018, affecting half a million patients. For context, there were just 18 closures in 2013. The rate of closures looks to have continued in 2019 too, with 12 in the first month alone, compared to eight at the same time in 2018.
The closures come on the back of a sustained fall in GP numbers as the profession faces challenges with recruitment and resourcing. Many practices are also merging, with smaller surgeries becoming part of larger practices.
‘It’s crucial that we look after our GPs’
MDS CEO Rohan Simon said: “These figures are alarming and should further serve to highlight how crucial it is that the UK looks after its existing GPs.
“No-one wants to see surgeries close, especially not in such high numbers, and one important way to do that is to ensure the skilled people employed in our profession have the support they need.
“MDS was set up in by GPs in order to cater for the specific needs of GPs and we’re acutely aware of the pressures they face and the support they need to be able to do their jobs.
“We’re constantly working with our members to ensure their needs are met and we’d support any efforts to reverse this trend. We’re also prepared to work with surgeries to help with their recruitment and retention challenges.”
Mergers contribute to GP closure figures
NHS England said there were fewer practice closures and patient dispersals in the 2017/18 financial year compared to 2016/17. It said it supports GPs through the resilience programme.
In 2017/18, 62% of GP contract closures were due to mergers and the rest due to practice closures. Smaller surgeries were the most likely to close in 2018 – with practices serving 5,000 or fewer patients accounting for 86% of closures.
Royal College of GPs chair Prof Helen Stokes-Lampard told The Guardian: “GPs and our teams are working to our absolute limits to provide safe, high-quality care, while general practice is under intense pressure, and this is resulting in some GPs leaving the profession, and in other cases forcing them to close their surgery doors.
“In some areas, practice closures are the result of surgeries merging or joining federations in order to pool their resources and provide additional services in the best interests of their patient population.”
GP issues in coastal and rural areas
Further analysis of the results suggests that coastal and rural communities have felt the impact of the loss of GP surgeries most keenly.
It emerged that 1,946 villages are now at least three miles away from their nearest GP practice. That’s 162 more than two years ago – with some patients now 14 miles away from a GP in rural areas.
The issues with recruitment are exacerbated in rural areas – with someone younger doctors less likely to want to relocate away from towns and cities.
Prof Stokes-Lampard explained: “Rural, coastal and deprived areas always struggle the most to attract GPs, but with a national shortage, they are being hardest hit. They are the canary in the mine for a problem across the country.”
Looking after the nation’s GPs
MDS is keen to hear from GPs who feel that their existing indemnity costs are prohibitively high. We can work with GP surgeries to see how we can support recruitment and retention in rural and coastal areas.
MDS is determined to look after the interests of all GPs and provides indemnity that has their specific needs in mind, with a clear mission statement to defend GPs’ interests.
If you wish to find out more about how we can provide the cover and support you need as a GP, contact us today.