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NHS trusts must create conditions which encourage doctors and nurses to admit mistakes

Doctors and nurses need 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.

This is the key finding of new guidance from the GMC and the Nursing and Midwifery Council (NMC), which urges NHS employers to develop a more positive, learning culture for healthcare professionals.

The new guidance sets out the standards expected of all doctors, nurses and midwives practising in the UK, and emphasises that when things go wrong patients should expect a face to face explanation and apology from doctors, nurses and midwives.

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, CEO of the GMC, 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.”

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.

Jackie Smith, chief executive of the Nursing and Midwifery Council, added: “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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