A quick guide to the duty of candour
Leo Briggs explains how understanding both the ethical and legal duty of candour helps dental professionals respond appropriately and maintain patient trust.
Most patients accept that mistakes can happen but they won’t forgive any attempt to cover them up. The duty of candour is key to retaining their trust.
The ethical duty of candour
The GDC says dental professionals have a duty of candour ‘when something goes wrong which causes, or has the potential to cause, harm or distress’ (GDC, 2019).
It expects Professional Conduct Committees to ‘take very seriously a finding that a dental professional took deliberate steps to avoid being candid with a patient or to prevent someone else from being so’.
The legal duty of candour
Alongside this individual duty is a legal duty of candour about ‘notifiable patient safety incidents’, which applies to NHS and private dental practices in England and Scotland and to practices providing NHS services in Wales (Northern Ireland plans similar legislation).
This requires practices to notify patients about patient safety incidents that meet the relevant threshold.
For example, in England, this is something unintended or unexpected which already has, or might lead to death, severe or moderate harm.
There is specific guidance about the legal duty of candour threshold and process for England, Scotland and Wales.
- Foster an open practice culture: ensure the duty of candour is embedded within the practice and everyone cooperates. Have a clear practice process that includes immediate actions, the process for reporting and investigating and the relevant legal threshold for notifying incidents. This should also be covered in inductions and training
- It’s better to be honest: it’s usually a good idea to be upfront with patients about issues as soon as reasonably practical, even if they don’t meet the threshold. However, do seek advice from your dental defence organisation if you’re unsure how to proceed
- Explain what happened: provide a full explanation of what is known at the time, what happens next and the outcome of further enquiries. The treating clinician is usually best placed to represent the practice
- Say sorry: a sincere apology is the right thing to do and can help avoid a complaint. It isn’t an admission of legal liability
- Support patients: give them time to ask questions and access to appropriate support or a suitable remedy. Ensure you have their contact details
- Keep records: follow up discussions in writing, including details of further enquiries and outcomes. This is a legal requirement under the duty of candour but it’s sensible in any case. Keep copies of all correspondence for reference
- Learn from errors: patients will be reassured to know incidents have been investigated and lessons learned. It’s about trying to identify areas that need attention such as better systems, training or equipment, along with a plan to change.
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