Duty of Candour

1. What is the Duty of Candour

1.1. The professional Duty of Candour arose following the response to the findings and recommendations from the Mid-Staffordshire NHS Foundation Trust Public Inquiry into poor patient care at Mid Staffordshire NHS Foundation Trust (‘the Francis Inquiry’) and the UK Government’s response to this Inquiry entitled ‘Hard Truths: The Journey to Putting Patients First’ in January 2014.

1.2. The Duty of Candour applies throughout the patient relationship, from beginning to the end of treatment. However, the Duty of Candour is particularly relevant when things go wrong during the therapeutic relationship.

2. BPC’s Standards of Conduct, Practice and Ethics

2.1. The relevant parts of the Standards are as follows:

Standard 1 – Make the care of patients your primary concern.

Standard 1.6 – Before you and a patient agree to work together, clearly explain, either orally or in writing:

• the fee, including any cancellation policy which affects fees;
• the frequency of proposed sessions including day and time where this has been agreed; and
• the limits on confidentiality.

Standard 1.8 – Unless there are exceptional circumstances, notify a patient of any proposed changes to the therapeutic process, the practicalities of the treatment offered and/or the terms and conditions of treatment, and provide the patient with a reasonable amount of time to understand and accept the proposed changes.

Standard 1.9 – Unless there are exceptional circumstances, give patients appropriate and sufficient notice of the ending of treatment to permit a thoughtful ending phase of appropriate duration, having regard to the length and complexity of the relationship and the continuing clinical needs of the patient.

Standard 3 – Raise concerns if patients or others are at risk.

Standard 3.1 – Comply with legal obligations in relation to the safeguarding of children, young people and adults at risk.

Standard 10 – Maintain public confidence in the profession.

Standard 10.1 – Act with honesty and integrity.

Standard 10.3 – Ensure that your conduct, whether or not connected to professional practice, does not undermine public confidence in you or the profession.

Standard 11 – Maintain professional candour.

Standard 11.1 – Be open and honest with patients when things go wrong, taking into consideration the impact on the patient’s treatment.

Standard 11.4 – Inform the BPC if you are aware of concerns relating to a colleague that may be harming their patients or other colleagues.

Paragraph 13 – Registrants must carry out their duties in a professional and ethical way and maintain appropriate and professional boundaries with patients at all times, so that they are not exploited in any way.

3. What could go wrong during the therapeutic relationship?

3.1. As BPC Registrants will be aware, not all therapeutic relationships with patients are straightforward and sometimes the therapeutic relationship can break down.

3.2. Given the specific nature of the therapeutic relationship, it is possible that registrants may:

• Misunderstand or mis-hear something a patient says during a session which is not corrected in dialogue;
• Overrunning a session or making a mistake about the date or time of a session;
• Sending the wrong invoice to a patient or an incorrect amount in an invoice.

4. What if things do go wrong?

4.1. If something goes wrong with a patient, you must act in accordance with BPC’s Standards.

4.2. Being candid with a patient should not be misunderstood as admitting liability or wrongdoing nor should it be confused with complaint handling. The Duty of Candour applies irrespective of whether a complaint or concern has been raised by a patient and any action taken should always be in the best interests of the patient.

5. Is the Duty of Candour just limited to patients?

5.1. The Duty of Candour is not just limited to patient interactions.

5.2. All Healthcare professionals must be open and honest with their colleagues, employers, and relevant organisations and take part in reviews and investigations when requested.

5.3. Healthcare professionals must also be open and honest with their regulator, raising concerns where appropriate. This is emphasised within the BPC Standard 11.4.

6. Duty of Candour & Whistleblowing

6.1. The Duty of Candour applies to any concerns a BPC Registrant may have regarding fellow practitioners; BPC Registrants or other regulated professionals and/or any concerns regarding a patient’s safety and welfare.

6.2. If a BPC Registrant holds concern(s) regarding a patient’s treatment or safety, or a particular clinician’s treatment of a patient, they must communicate these concerns to the relevant person or organisation as patient safety is paramount. This could include discussing concerns with a Supervisor during supervision or with a senior colleague. Alternatively, a Registrant can contact the Ethics Committee of their Member Institution for further assistance.

6.3. Should a Registrant wish to raise concern(s) regarding a fellow BPC Registrant, please contact the BPC accordingly on FtPO@bpc.org.uk. If your concerns arise in connection with another regulated Healthcare practitioner, please contact the relevant regulatory body.