What Is the Duty of Candour in Healthcare?
The duty of candour in healthcare operates at two levels, and understanding the distinction is essential:
- Professional duty of candour — this applies to you as an individual practitioner. It is set out in your regulator's professional standards and requires you to be open and honest with patients when something goes wrong. Breaching it is a fitness to practise matter
- Statutory (organisational) duty of candour — this applies to healthcare organisations (NHS trusts, GP practices, care homes, dental practices) registered with the Care Quality Commission (CQC). It requires the organisation to notify patients of notifiable safety incidents — those that result in moderate or severe harm, or death
Both duties exist to ensure that patients are told the truth when their care goes wrong. But they operate differently: the professional duty is broader and applies to any situation where something has gone wrong, regardless of the severity. The statutory duty has a specific legal threshold and applies only to notifiable safety incidents.
When something goes wrong with a patient's care, they have a right to know. They have a right to an honest explanation of what happened, why it happened, and what is being done to prevent it happening again. That is the duty of candour in its simplest form.
What the Duty of Candour Requires You to Do
In 2014 (updated in 2024), the GMC and NMC published joint guidance on the professional duty of candour. The principles apply across all UK healthcare regulators and require you to:
- Tell the patient — inform the patient (or their family/carer) as soon as possible when something has gone wrong with their care
- Explain what happened — provide an honest and clear account of what went wrong, in language the patient can understand
- Apologise — offer a sincere apology. An apology is not an admission of legal liability
- Offer a remedy — explain what is being done to put things right and to prevent the same thing from happening again
- Support the patient — offer emotional and practical support, including signposting to independent advice or complaints procedures
- Report the incident — ensure the incident is reported through the appropriate internal channels and, where required, to external bodies
How Each Regulator Enforces the Duty of Candour
Good Medical Practice 2024 requires doctors to be open and honest with patients when things go wrong. The GMC treats a failure to be candid as a serious departure from professional standards. In fitness to practise cases, panels frequently distinguish between the original clinical failing and the subsequent failure to be open — and the dishonesty is often treated more seriously.
The NMC Code requires nurses, midwives, and nursing associates to act with honesty and integrity, to be open and candid with patients, and to raise concerns immediately if patient safety is at risk. The NMC's fitness to practise guidance explicitly identifies a failure to be candid as evidence of potential impairment.
The GDC Standards for the Dental Team include a specific requirement to be open and honest with patients when something goes wrong. The GDC's fitness to practise process treats dishonesty and a failure to be candid as among the most serious categories of concern.
The GPhC Standards for Pharmacy Professionals require pharmacists to be open, honest, and transparent. When dispensing errors or other incidents occur, pharmacists are expected to disclose them to the patient promptly and honestly.
The HCPC Standards of Conduct, Performance and Ethics (revised September 2024) explicitly require registrants to be open when things go wrong (Standard 8). The revised standards provide clearer guidance on the process to follow, including informing the service user, offering an apology, and reporting the incident.
What Happens When You Breach the Duty of Candour
Breaching the duty of candour in healthcare can have severe consequences for your registration:
- Fitness to practise investigation — your regulator may open a formal investigation into your conduct
- Aggravating factor — regulators treat a failure to be candid as an aggravating factor that increases the seriousness of the original concern and makes a more serious sanction more likely
- Dishonesty finding — if the failure to be candid involved active concealment or misleading the patient, it may be characterised as dishonesty — one of the most serious categories of fitness to practise concern
- Sanctions — depending on the severity, sanctions can range from a warning through to conditions, suspension, or removal from the register
In practice, regulators consistently find that a professional who makes a clinical error and is immediately open about it faces a fundamentally better outcome than one who makes the same error and conceals it. The cover-up is almost always worse than the original mistake.
Common Situations Where the Duty of Candour Applies
- Clinical errors — wrong medication, missed diagnosis, procedural errors, failure to escalate a deteriorating patient
- Communication failures — results not communicated to the patient, referrals not made, important information not documented or shared
- Near misses — even if no harm resulted, the professional duty of candour may still apply if the patient was at risk
- Systemic failures — staffing issues, equipment failures, or organisational problems that compromise patient care
- Complaints — when a patient raises a concern, responding openly and honestly is part of the duty of candour, not separate from it
Duty of Candour and the Apology: Understanding the Legal Position
One of the most common reasons professionals fail to meet the duty of candour is fear that an apology will be treated as an admission of legal liability. This fear is understandable but largely unfounded.
In England and Wales, the Compensation Act 2006 provides that an apology, an offer of treatment, or other redress does not by itself amount to an admission of negligence or breach of statutory duty. In Scotland, the Apologies (Scotland) Act 2016 provides similar protection. An apology is a professional obligation, not a legal concession.
Your regulator expects you to apologise sincerely when something goes wrong. Your legal position is not weakened by doing so. In fact, failing to apologise can make your position worse — both with your regulator and in any subsequent legal proceedings.
How to Demonstrate the Duty of Candour in Fitness to Practise Proceedings
If you are facing a fitness to practise investigation, demonstrating that you understand and are committed to the duty of candour is a critical part of evidencing insight and remediation:
- Complete CPD on the duty of candour — structured learning demonstrates that you have engaged with the principle and understand your obligations
- Address it in your reflective statement — your reflective statement should explicitly address what you have learned about the duty of candour and how it applies to the concerns in your case
- Evidence practice changes — describe what you now do differently to ensure openness and transparency in your practice
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A Practical Checklist for the Duty of Candour
Use this checklist whenever something goes wrong with a patient's care:
- Has the patient been told? — as soon as reasonably practicable after the incident is identified
- Have you explained what happened? — in clear, honest, jargon-free language
- Have you apologised? — a sincere, personal apology that acknowledges the patient's experience
- Have you explained the next steps? — what is being done to investigate, remedy, and prevent recurrence
- Has the incident been reported? — through your organisation's incident reporting system and, where required, to your regulator
- Is it documented? — a clear, contemporaneous record of the conversation, including what was said and what was offered
- Has the patient been offered support? — including information about complaints procedures and independent advice
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See Which Course Fits Your Case →Frequently Asked Questions
What is the duty of candour in healthcare?
The duty of candour requires healthcare professionals and organisations to be open and honest with patients when something goes wrong with their care. It has two forms: a professional duty that applies to individual practitioners through their regulator, and a statutory organisational duty that applies to healthcare providers registered with CQC.
When does the duty of candour apply?
The professional duty of candour applies whenever something goes wrong with a patient's care that causes, or has the potential to cause, harm or distress. The statutory organisational duty applies specifically to notifiable safety incidents — those that result in moderate or severe harm, or death.
What happens if I breach the duty of candour?
Breaching the duty of candour can trigger a fitness to practise investigation by your regulator. Regulators treat a failure to be open and honest as a serious concern — in some cases more serious than the original clinical error. It can lead to conditions, suspension, or removal from the register.
Does the duty of candour mean I have to admit liability?
No. The duty of candour requires you to tell the patient what happened and offer an apology. An apology is not an admission of legal liability. Legislation in England, Wales, and Scotland provides that an apology does not by itself constitute an admission of negligence.
Does the duty of candour apply to all healthcare professionals?
Yes. Every healthcare professional registered with the GMC, NMC, GDC, GPhC, HCPC, GOC, GCC, or GOsC has a professional duty of candour. It applies regardless of your profession, seniority, or clinical setting.
This article is for general informational purposes only and does not constitute legal or professional regulatory advice. If you are facing a fitness to practise investigation, seek independent legal advice from a specialist regulatory solicitor and contact your medical defence organisation or professional indemnity provider without delay.