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D HONEST


iii. changes to the structure of the service user’s body iv. the service user experiencing prolonged pain or prolonged psychological harm, (continuous period of 28 days) the shortening of the life expectancy of the service user; or


v.


(b) requires treatment by a healthcare professional in order to prevent—


i. the death of the service user, or


ii. any injury to the service user which, if left untreated, would lead to one or more of the outcomes mentioned in (a) above. This mirrors the CQC reporting requirements for GP practices in England. NHS bodies have slightly different disclosure requirements under the regulation, which include incidents which could result in, or appear to have resulted in the harms specified. This difference has been the subject of some debate. Examples of notifiable GP cases are provided by the CQC in a


“mythbuster” article on their website at tinyurl.com/ojm8bmn Ultimately, doctors must exercise judgement in terms of when to disclose a particular matter in the light of these requirements.


GMC guidance


The GMC has been issuing specific guidance in relation to being open and honest with patients when things go wrong since 1998, so there is no fundamental change in the regulatory position. However, expanded guidance has recently been produced (available at tinyurl.com/npxwpz6)


which provides more detail on expected behaviours and the steps doctors should take to honour their professional duty of candour. These include telling the patient (or where appropriate the patient’s


advocate, carer or family) when something has gone wrong; apologising to the patient; offering an appropriate remedy or support to put matters right, if possible, and explaining fully to the patient the short- and long-term effects of what has happened. In summary, for doctors who have already been complying with GMC


guidance on what to do when things go wrong, there i s little that has changed. The statutory duty placed on a general practice at an organisational level perhaps brings some clarity to the types of incidents that must be notified, but there remains an element of individual judgement that must be exercised depending on the circumstances of each case. The GMC guidance is more general than the statutory requirements, and simply emphasises that if something has gone wrong, the doctor has a duty to explain and apologise. It also includes guidance on reporting ‘near misses’ and encouraging a learning culture by reporting errors.


It can only be hoped that this new duty of candour brings positive


changes for patient care and that doctors, as the GMC states, receive the support of an “open and honest working environment where they are able to learn from mistakes and feel comfortable reporting incidents that have led to harm.”


Dr Barry Parker is a medical adviser at MDDUS


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