MPS Director of Policy and Communications, Dr Stephanie Bown, fears that a duty of candour proposed for GPs will not inspire the cultural change the NHS requires
In the wake of the Francis report, we wholly agree with those areas for action, which create a culture of openness, transparency and candour, but strongly disagree that a legislated duty is the way of achieving this. A statutory duty might seem like a ‘quick win’, but this blunt instrument approach would cut across the whole idea of building a supportive and open environment to raise concerns and could instead invite ‘gaming’ and only doing the minimum necessary.
In the US there are certain states that have introduced mandatory disclosure (to communicate details of adverse events with affected patients and their families), but whether transparency with patients has been achieved, is still highly questionable. We believe that you cannot legislate to create a culture of openness; only fearful behaviour is created in this way.
We strongly agree with the focus on training and education for health professionals, but would go further by saying that an understanding of errors and high quality communication skills should be embedded as a core part of medical training.
"An understanding of errors and high quality communication skills should be embedded as a core part of medical training"
There also needs to be more done to eliminate the barriers that doctors face in being open. In a survey of MPS members, 91% of doctors identified that time was a key barrier to them being open with patients, and 70% identified a lack of support as a barrier. GPs might well be concerned by the reference to them playing a ‘monitoring role’ on behalf of their patients when it comes to outcomes of secondary services.
For those involved in commissioning, this might be a natural fit, and having greater transparency of performance information could be useful to inform their commissioning decisions. For the day-to-day GP however, we will be watching closely to see how the government responds to this recommendation – GPs have an ever-increasing number of expectations placed upon them, but we need to ensure they have the tools and support to meet these expectations.
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