01Principles and purposeThe professional or clinical skill and the decisions it supports.
Candour is a continuing clinical relationship, not a single scripted disclosure. When something has gone wrong, establish safety, recognise the patient’s likely information needs and speak as soon as there is enough information to be useful. State the facts in plain language, distinguish observation from inference, acknowledge uncertainty and invite questions. If the full effect is not yet known, say so and arrange a named follow-up. Waiting for root-cause analysis can compound harm through silence; guessing can create a different harm through misinformation.
The GMC professional duty is personal and UK-wide: doctors must be open and honest with patients when something has gone wrong with treatment or care that causes, or has the potential to cause, harm or distress. They should apologise, explain fully and promptly what happened and the likely short- and long-term effects. They must also be candid with employers, participate in reviews and raise concerns about systems. The organisational duty is separate. In England, Regulation 20 imposes requirements on registered providers for a notifiable safety incident, including notification, a true account, reasonable support and a written follow-up. Wales introduced its statutory NHS duty under the Health and Social Care (Quality and Engagement) (Wales) Act regime. Scotland’s Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 establishes an organisational procedure, with revised national guidance published in 2025. Do not transplant one nation’s numerical trigger or notification form into another.
A good apology is direct, specific enough to be meaningful and free from defensive qualifiers. It can be given before fault is allocated: “I am sorry this happened and for the harm and worry it has caused.” Explain current care and support, how the event will be reviewed, how the patient can contribute and when they will hear more. Consider communication needs, independent advocacy, interpreters and the needs of families or representatives, while preserving the patient’s confidentiality. A patient’s death does not extinguish the duty, but who may receive information depends on authority, confidentiality after death and the applicable procedure.
Key points
- Put the patient’s immediate clinical needs first, then explain what is known, what remains uncertain and what will happen next. Candour is not delayed until an investigation proves fault.
- Give a sincere apology. An apology acknowledges the patient’s experience and regret; it is not, by itself, an admission of legal liability.
- Tell a senior clinician and activate the local incident and candour process, but do not delegate away your own professional responsibility to be honest with the patient.
- Record the conversation, facts available, questions, apology, support offered and follow-up plan. Correct the record transparently if later evidence changes the account.
- Professional candour applies to individual doctors throughout the UK. Organisational statutory triggers and procedures differ in England, Wales and Scotland; Northern Ireland’s Being Open Framework is non-statutory as at September 2026.
- Support involved staff without centring them over the harmed person. Participate honestly in learning, preserve evidence and avoid blame, speculation or promises about an outcome you cannot control.
02Situations and prioritiesThe context, relevant information and actions that matter most.
Deterioration, wrong treatment, missed escalation or a delayed diagnosis may require urgent clinical rescue before a detailed conversation. Stabilisation and candour proceed in parallel; concern about blame must never obstruct corrective care.
Professional candour can apply when an error had the potential to cause harm or distress even if serious injury did not materialise. Organisational statutory notification thresholds are narrower and jurisdiction-specific.
Complexity is not a reason for silence. Explain verified facts and uncertainty, avoid naming a culpable individual, and schedule an update after review. Correct earlier information explicitly if it changes.
A complaint, portal result or another clinician may reveal the event first. Acknowledge the resulting loss of trust, apologise for the delay, address immediate questions and activate the same review and follow-up process.
The provider may lead formal notification while the treating doctor retains a personal duty to be honest, contribute evidence and escalate if the organisation is not responding appropriately.
03Assessment and interpretationHow to gather information, assess the situation and recognise uncertainty.
Consider the information, its meaning and its limitations before deciding what follows.
- 01
Immediate harm assessment - Why
- Identify treatment, monitoring and support required because of the event.
- Interpretation and limitations
- Assess the patient clinically and mitigate continuing risk before reconstructing causation. State what is attributable, possible or not yet known without minimising symptoms.
- 02
Verified chronology - Why
- Create a reliable factual basis for the first conversation and review.
- Interpretation and limitations
- Use contemporaneous records, results and direct accounts; preserve the original record and add dated corrections rather than rewriting history. Separate facts from provisional interpretation.
- 03
Jurisdiction and threshold check - Why
- Identify the correct organisational procedure alongside professional candour.
- Interpretation and limitations
- Confirm nation, provider type and local policy. A conclusion that the statutory trigger is not met does not cancel the broader GMC duty to be open.
- 04
Communication-needs assessment - Why
- Make disclosure understandable and psychologically safe.
- Interpretation and limitations
- Arrange an independent interpreter, accessible format, advocate or appropriate representative. Check understanding and offer time rather than delivering a dense technical monologue.
- 05
Learning and recurrence review - Why
- Move from explanation to safer care.
- Interpretation and limitations
- Report through the incident system, preserve evidence and participate candidly in proportionate review. Focus on contributory systems and reliable actions, not premature individual blame.
04Worked approachesCases with ordered reasoning, an action and a check of the outcome.
01Worked caseDelayed recognition after an abnormal resultA clinician discovers that an abnormal result was filed without action six weeks earlier. The patient is clinically stable but now needs urgent further assessment.+
- 1Contact the patient promptly using a safe method, arrange the needed clinical assessment and alert an appropriate senior. Verify the result, chronology and immediate management without waiting for the incident investigation.
- 2Explain in plain language that the result was not acted on when it should have been, what is known about possible consequences and what remains uncertain. Give a sincere apology and invite questions.
- 3Activate the provider’s incident and organisational candour route under the correct national framework. Offer practical and emotional support, communication adjustment and a clear way to contribute to the review.
- 4Final action: agree a named clinical plan and written follow-up, including who will communicate investigation findings. Do not speculate about individual blame or imply the patient must complain to obtain answers.
- 5Verification: document the disclosure and apology, confirm that urgent assessment and incident notification were received, update the patient when evidence changes and escalate if either clinical care or organisational response stalls.
02Practical approachNear miss with potential for harmA wrong infusion is prepared but intercepted before administration; the patient witnessed alarm among staff and is distressed.+
- 1Confirm that no medicine was administered and assess for any residual clinical risk.
- 2Explain honestly what was prepared, how it was intercepted and why review is still needed; apologise for distress without claiming that no harm matters.
- 3Report the event, preserve relevant evidence and apply the organisation’s threshold process.
- 4Tell the patient what safety actions and follow-up will occur, record the conversation and check understanding.
03Escalation approachOrganisation discourages disclosureA manager tells a trainee to wait indefinitely because the event might attract litigation.+
- 1Protect the patient and establish verified facts.
- 2Seek senior clinical, governance or medico-legal advice promptly and refer to the GMC professional duty.
- 3Escalate through the organisation and raising-concerns route if necessary; legal anxiety does not justify misleading silence.
- 4Maintain an accurate record and ensure the patient receives timely information and continuing support.
05Feedback, follow-up and evidenceReview outcomes, seek feedback and identify what to improve.
- Name the person responsible for clinical follow-up and for the organisational update; record dates, contact preferences and unanswered questions.
- Review for delayed physical or psychological effects and adjust care. Candour includes explaining newly recognised consequences, not merely the initial event.
- Check whether promised investigation findings, written notification and support were actually delivered, escalating delay or inconsistency.
- Translate learning into a specific action with an owner and evidence of reliability, then feed that back to the patient where appropriate.
- For WPBA, reflect on clarity, empathy, uncertainty and systems learning; anonymise the account and avoid presenting candour as an admission-of-liability exercise.
06Special situationsVariants, exceptions and circumstances that change the usual approach.
Professional and organisational duties are parallel
A provider’s statutory notification process does not replace the doctor’s own conversation, and a statutory threshold decision does not define the whole professional duty.
Apology is clinically meaningful
A clear apology can validate harm and preserve trust. Defensive phrases such as “sorry if you feel” shift responsibility and should be avoided.
Facts can be disclosed before causation is settled
Say what happened operationally, the present clinical effect and the uncertainty. Formal analysis can later explain why; it should not become a precondition for basic honesty.
Candour protects the record
Never alter an earlier note to make care appear better. Add a dated correction or supplementary entry that preserves the audit trail and records the new understanding.
Staff support and accountability can coexist
A just culture recognises human and system factors while requiring honest evidence and proportionate action. Support must not become secrecy or pressure on the patient.
07Common pitfallsFrequent interpretation and management errors.
- 01
Waiting for a complaint, proof of negligence or a completed investigation before speaking to the patient.
- 02
Using the England Regulation 20 definition or procedure as though it applied unchanged throughout the UK.
- 03
Giving a vague conditional apology, blaming an absent colleague or speculating about causation during the first conversation.
- 04
Assuming an electronic incident report completes professional candour or patient follow-up.
- 05
Rewriting or deleting the original clinical record rather than making a transparent dated correction.