Employers urged to create conditions which encourage doctors, nurses and midwives to admit mistakes

When things go wrong patients should expect a face-to-face explanation and apology from doctors, nurses and midwives, according to new guidance from the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC).

But the regulators have also made clear that professionals need to have 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.

The new guidance sets out the standards expected of all doctors, nurses and midwives practising in the UK. It also aims to help patients understand what to expect from healthcare professionals.

Under the new guidance doctors, nurses and midwives should:

• Speak to a patient, or those close to them, as soon as possible after they realise something has gone wrong with their care.
• Apologise to the patient – explain what happened, what can be done if they have suffered harm and what will be done to prevent someone else being harmed in the future.
• Use their professional judgement about whether to inform patients about near misses – incidents which have the potential to result in harm but do not.
• Report errors at an early stage so that lessons can be learned quickly, and patients are protected from harm in the future.
• Not try to prevent colleagues or former colleagues from raising concerns about patient safety. Managers must make sure that if people do raise concerns they are protected from unfair criticism, detriment or dismissal.

The guidance follows Sir Robert Francis QC’s call for a more open and transparent culture within healthcare following the failures in patient care at Mid Staffordshire NHS Foundation Trust. It has been jointly produced by the GMC and NMC to make sure that doctors, nurses and midwives are working together to a common professional standard and behaving in the same way – especially when mistakes are made. In England the professional duty of candour will sit alongside a legal obligation on organisations with similar measures being introduced in Scotland, Wales and Northern Ireland.

Niall Dickson, Chief Executive of the General Medical Council, said:

“We recognise that things can and do go wrong sometimes. It is what doctors, nurses and midwives do afterwards that matters. If they act in good faith, are open about what has happened and offer an apology this can make a huge difference to the patient and those close to them.

“We also want to send out a clear message to employers and clinical leaders – none of this will work without an open and honest learning culture, in which staff feel empowered to admit mistakes and raise concerns. We know from the Mid Staffordshire enquiry and from our own work with doctors that such a culture does not always prevail. It remains one of the biggest challenges facing our healthcare system and a major impediment to safe effective care.’

Jackie Smith, Chief Executive of the Nursing and Midwifery Council, said:

“We developed this joint guidance to help nurses, midwives and doctors to uphold a common duty of candour that is set out in their professional standards. They often work as part of a team and that should absolutely be our approach as regulators to ensure we are protecting the public.

“We believe that the public’s health is best protected when the healthcare professionals who look after them work in an environment that openly supports them to speak to patients, or those who care for them, when things have gone wrong. We can’t stop mistakes from happening entirely and we recognise that sometimes things go wrong. The test is how individuals and organisations respond to those instances, and the culture they build as a result.”

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Notes to editors

All healthcare professionals have a duty of candour, a professional responsibility to be honest with people in their care when things go wrong.

The overarching guidance for doctors is Good medical practice (GMP); for nurses and midwives it is The Code: Standards of conduct, performance and ethics for nurses and midwives. Both GMP and the Code cover fundamental aspects of a doctor’s, nurse’s or midwife’s role, including working in partnership with patients and treating them with respect. All doctors, nurses and midwives are required to be familiar with and follow GMP and the Code, and patients can use the guidance to find out what they can expect from their doctor, nurse or midwife.

The GMC has specific guidance – Raising and acting on concerns about patient safety (2012) – which highlights the duty of all doctors to raise concerns where they believe that patient safety, dignity or care is compromised by the practice of colleagues or the systems, policies and procedures in the places in which they work. The guidance also includes advice on acting on concerns, including where to go for help and principles for investigating concerns. 

The NMC has published specific guidance for nurses and midwives on Raising concerns, which is underpinned by its Code. 

About the GMC

The General Medical Council (GMC) is an independent organisation that helps to protect patients and improve medical education and practice across the UK.

• We decide which doctors are qualified to work in the UK and we oversee UK medical education and training.
• We set the standards that doctors need to follow, and make sure they continue to meet these standards throughout their careers.
• We take action when we believe a doctor may be putting the safety of patients, or the public's confidence in doctors, at risk.
• We are not here to protect doctors – their interests are protected by others. Our job is to protect the public.
• We are independent of government and the medical profession and accountable to Parliament. Our powers are given to us by Parliament through the Medical Act 1983.

We are a registered charity (number 1089278 with the Charity Commission for England and Wales, and number SC037750 with the Office of the Scottish Charity Regulator) and we have to show that our aims are for public benefit.

The GMC Media Relations office can be contacted on 020 7189 5454 or by email press@gmc-uk.org.

To find out more please visit www.gmc-uk.org.

About the NMC

The Nursing and Midwifery Council exists to protect the public. We do this by ensuring that only those who meet our requirements are allowed to practise as a nurse or midwife in the UK. We take action if concerns are raised about whether a nurse or midwife is fit to practise. 

Our powers derive from the Nursing and Midwifery Order 2001. It established the NMC, sets out our primary purpose of protecting the public, the structure of the organisation and our functions and activities. 

We are a registered charity in England and Wales [1091434] and in Scotland [SCO38362].