Dental professionals have long been expected to be open and honest with patients if something goes wrong with their care. Now the GDC has produced more detailed guidance on this subject which addresses communicating with patients, managing staff and the implications for Professional Conduct Committee hearings.
'Being open and honest with patients when something goes wrong', which came into effect on 1 July 2016, follows the introduction of a legal duty of candour for dental practices, adult social care organisations, NHS (medical) and independent sector organisations registered with the CQC in England.
Similar legislation has been passed in Scotland (but the duty of candour provisions are not yet in force) and is proposed in Northern Ireland while the Welsh Government has conducted a consultation on the issue.
Although the specific obligations of the statutory duty of candour apply to organisations, much of the practical responsibility for compliance falls to dental professionals. You will often be best placed to alert the organisation when a notifiable patient safety incident occurs and be its representative in meetings with the patient and their family.
Legal duty vs professional duty
Whereas the statutory duty of candour has complex thresholds at which it applies, the professional, ethical duty does not. It arises where something has gone wrong with a patient's care which has caused them harm or distress, or which could do so in the future. This threshold is lower than the statutory one - the harm does not need to be moderate, severe or prolonged.
The duty of candour guidance supports the GDC's existing Standards for the Dental Team, which explains the professional obligations that may arise when things go wrong with a patient's treatment, whether or not they complain.
Clinical governance procedures, which aim to ensure patient safety incidents are reported, investigated and the results acted on complement the professional duty of candour. The guidance reminds dental professionals they have a duty to raise concerns personally and support their staff in doing so.
The key points from the GDC's duty of candour guidance are set out below.
- Be honest and open from the outset. Give patients all the information they need about the benefits and risks of different treatment options in a way they understand, as well as time to make a decision.
- Inform patients as soon as you realise that something has gone wrong with their care. You must tell them in a way they can understand, explain what it means for them in the short and long-term, apologise and offer support or an appropriate remedy. The GDC suggests this could apply in a range of situations from a patient suffering actual harm during a procedure, to a problem with a service that causes distress. Bear in mind that the duty of candour can arise even though the patient has not complained about their care.
- The most appropriate member of the dental team should apologise. It isn't necessary to take responsibility for something that wasn't your fault, but the GDC says it is more meaningful if the apology is personal and relevant to what happened rather than a general expression of regret. It stresses that an apology is not an admission of legal liability and should not be withheld because you believe it might cause problems. A written apology from the organisation will also be required if the incident meets the threshold for the statutory duty of candour.
An apology is not an admission of legal liability and should not be withheld because you believe it might cause problems.
- Leave the door open: ensure patients know who to contact if they have further questions. If a patient does not want to know the details of what happened, respect their decision but make it clear they are welcome to this information should they change their mind.
- Keep a record. Document discussions with the patient, including your apology and (if applicable) their decision not to have further information.
- Instill an open and honest culture in the workplace. Employers and others in a leadership role should ensure staff understand the need for openness and are supported in this. It may also be helpful to provide training in communication skills and complaint-handling. There should also be an effective procedure for staff to raise concerns.
- Evidence of candour will be considered by Professional Conduct Committee hearings. If a dental professional's practice is found to be impaired, the GDC's latest Indicative Sanctions Guidance states: 'a panel should take very seriously a finding that a dental professional took deliberate steps to avoid being candid with a patient or to prevent someone else from being so.'
The DDU is happy to offer dental professionals advice on how to make an effective apology and on how the duty of candour applies in every day practice. You can phone one of our dento-legal advisers for support on 0800 374 626.
Deputy head of the DDU
Leo Briggs qualified from University College Hospital, London, in 1989. He has worked extensively in the community dental service including a brief period overseas. He has also worked in general dental practice.
Leo gained a masters degree in periodontology from the Eastman in 1995 and is on the GDC specialist register for periodontics. From 1995-2017 he provided specialist periodontal treatment in both the salaried dental services and private practice. He started working for the DDU in 2005. Between 2007 and 2009 he worked part time at the DDU and part time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth. In 2009 Leo went full time with the DDU. In January 2016 he became deputy head of the DDU.
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