Duty of Candour from 1 April 2018

When any new legislation is proposed part of my role is to see if there are any implications for the pharmacy profession. This can mean responding to consultations, engaging with members to gauge opinion, participating in advisory or short life working groups and working with civil servants and politicians to influence the proposals.

The new Duty of Candour regulations, which come into force on April 1st   this year, was one such area where we were invited to participate in a Scottish Government working group.The group consisted of a wide range of stakeholders and explored the issues that the new legislation would raise. This proved more challenging than originally anticipated and the changes were delayed to accommodate this.

The new legislation is targeted at organisations rather than individuals but that inevitably means that individuals will need to be aware of changes in process and organisations must appoint a responsible person to carry out the Duty of Candour procedure. As regulated professionals however we are already individually bound by the GPhC regulatory standards which cover most of the principles embedded in the duty of candour regulations.

I am thinking particularly of the need to be open and honest and apologise when mistakes occur, as they inevitably do from time to time.  Apologising does not implicate you as being at fault but shows regret that the incident happened, and can go a long way to smoothing oil on troubled waters. The Duty of Candour legislation is designed to address any unexpected event or incident that has resulted in death or harm that is not related to the course of the condition for which the person is receiving care.

There is of course a close parallel here with inadvertent dispensing errors and the changes in legislation which will come into effect on 16th April to protect community pharmacists from criminal prosecution.* The focus on a culture of learning from mistakes rather than blaming is key to the success of both pieces of legislation. Everyone needs to feel safe in reporting errors so that the learning from incidents can be taken on board and patient safety improved overall.

The recent Quality Improvement Roadshows, led by the RPS across the country, were very successful in highlighting the importance of embedding this learning culture into the workplace from both actual errors and near misses so that we are continually striving to improve our processes to keep patients safe. Duty of Candour changes fit very well with our professional obligations and should not present any problems to the pharmacy profession. The RPS professional standards for error reporting have lots of information on best practice to support members.

Information on the details of the new legislation is readily accessible by e-learning from the links below.

The Knowledge Network Scotland: http://www.knowledge.scot.nhs.uk/scormplayer.aspx?pkgurl=%2fecomscormplayer%2fdutyofcandour

NES (Turas) e-Learning module: https://learn.nes.nhs.scot/2654/elearning-nmahp/duty-of-candour%2f

For more information, see also the Scottish Government’s Organisational Duty of Candour guidance.

* The RPS remains absolutely committed to working with Government to find a solution for hospital.

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