What is the duty of candour?

It is the duty to be open and honest with patients when something goes wrong with their care. The GMC and NMC joint guidance requires you to tell the person, apologise, offer an appropriate remedy or support to put matters right if possible, and explain fully the short and long term effects.

Does apologising admit legal liability?

No. GMC Good medical practice 2024 paragraph 45 says apologising does not, of itself, mean that you are admitting legal liability. The joint candour guidance adds that this is set out in legislation in parts of the UK, and that NHS Resolution advises saying sorry is the right thing to do.

What should an apology contain?

The joint GMC and NMC guidance says patients expect to be told three things: what happened, what can be done to deal with any harm caused, and what will be done to prevent someone else being harmed. It asks for a personalised apology rather than a general expression of regret.

Do you have to wait for the investigation before telling the patient?

No. Paragraph 11 says you should speak to the patient as soon as possible after you realise something has gone wrong and do not have to wait for the outcome of an investigation, but you should be clear about what has and has not yet been established.

Do you have to tell a patient about a near miss?

Not always. Paragraphs 21 and 22 ask you to use professional judgement. Sometimes the patient needs or would want to know, and telling them may help their recovery. In other cases, telling them about an incident that has not caused and will not cause harm may distress them unnecessarily. Seek advice if unsure.

Duty of Candour — IMT Interview Ethics Station Answer

Q: What is the difference between the professional and statutory duty of candour?

The professional duty falls on you as a registrant and is triggered by harm or distress. The statutory duty in Regulation 20 falls on the registered person, meaning the organisation, and is triggered by a notifiable safety incident as defined in the regulation.

Q: What is a notifiable safety incident?

For a health service body, Regulation 20(8) defines it as any unintended or unexpected incident during a regulated activity that, in the reasonable opinion of a health care professional, could result in or appears to have resulted in the death of the service user relating directly to the incident, or severe harm, moderate harm or prolonged psychological harm.

A duty of candour scenario at the IMT interview asks one thing: when something goes wrong, do you tell the patient, and how? The answer is that there are two duties, one on you and one on your organisation, and you can name both.

Key takeaways

The professional duty of candour is set out in the joint GMC and NMC guidance Openness and honesty when things go wrong: the professional duty of candour, published 29 June 2015 and updated on 15 March 2022 and 13 December 2024.
That guidance says every health and care professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress.
It requires four things: tell the person, apologise to them, offer an appropriate remedy or support to put matters right if possible, and explain fully the short and long term effects of what has happened.
The statutory duty of candour sits on the organisation, not on you. Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires registered persons to act in an open and transparent way and to notify the relevant person of a notifiable safety incident as soon as reasonably practicable.
Regulation 20(7) defines an apology as an expression of sorrow or regret in respect of a notifiable safety incident, and GMC Good medical practice 2024 paragraph 45 says apologising does not, of itself, mean that you are admitting legal liability.

What is the principle behind the duty of candour?

The principle behind the duty of candour is that a patient harmed by their care is owed the truth about it, promptly, from the people who provided that care.

The GMC and NMC joint guidance puts it as a duty on every health and care professional to be open and honest with patients and people in their care when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress.

It extends the duty sideways as well. Professionals must be open and honest with colleagues, employers and relevant organisations, take part in reviews and investigations when requested, and be open and honest with their regulators.

What is the difference between the professional and statutory duties?

The difference is who the duty falls on. The professional duty of candour falls on you as a registrant; the statutory duty of candour in Regulation 20 falls on the registered person, meaning the organisation providing the regulated activity.

Regulation 20 also sets a threshold that the professional duty does not. It is triggered by a notifiable safety incident, which Regulation 20(8) defines for a health service body.

That definition is any unintended or unexpected incident that occurred in respect of a service user during the provision of a regulated activity that, in the reasonable opinion of a health care professional, could result in or appears to have resulted in the death of the service user, where the death relates directly to the incident rather than to the natural course of their illness or underlying condition, or severe harm, moderate harm or prolonged psychological harm.

Regulation 20(7) defines prolonged psychological harm as psychological harm which a service user has experienced, or is likely to experience, for a continuous period of at least 28 days, and prolonged pain in the same 28-day terms.
It defines severe harm as a permanent lessening of bodily, sensory, motor, physiologic or intellectual functions related directly to the incident and not to the natural course of the illness.

The professional duty has no such threshold. It is engaged by harm or distress, and the GMC and NMC guidance paragraph 9 says it also applies where a patient may yet suffer harm or distress.

What does Regulation 20 require the organisation to do?

Regulation 20 requires the organisation to tell the relevant person in person, in writing, and with an apology, and to keep the records.

Regulation 20(1) requires registered persons to act in an open and transparent way with relevant persons in relation to care and treatment provided.
Regulation 20(2) requires notification as soon as reasonably practicable after becoming aware that a notifiable safety incident has occurred, together with reasonable support to the relevant person.
Regulation 20(3) requires that the notification is given in person by one or more representatives, provides a true account of all the facts known at that date, advises what further enquiries are believed appropriate, includes an apology, and is recorded in a written record kept securely.
Regulation 20(4) requires a written notification to follow, containing that account, the details of any enquiries to be undertaken, the results of any further enquiries, and an apology.

Saying that the statutory duty of candour is the organisation's duty, and that yours is professional and unconditional, is the sentence that separates a prepared candidate from one who has heard the phrase.

What do you actually say to the patient?

The GMC and NMC guidance tells you what a patient expects from an apology after a duty of candour incident, and it is three things, not one.

What happened.
What can be done to deal with any harm caused.
What will be done to prevent someone else being harmed.

Paragraph 11 says to speak to the patient as soon as possible after you realise something has gone wrong, with someone available to support them, and that you do not have to wait for the outcome of an investigation.

Paragraph 12 says to share all you know and believe to be true about what went wrong and why, and what the consequences are likely to be, explaining what is still uncertain and responding honestly to any questions.

Paragraph 17 asks for a personalised apology, for example 'I am sorry', rather than a general expression of regret on the organisation's behalf, and asks you to record the details of the apology in the patient's clinical record.

What is the worked scenario, answered aloud?

A patient on your ward has been given a dose of the wrong antibiotic overnight. She is well, but has had an avoidable extra day of treatment, and nobody has told her. Said aloud, here is the answer.

I would first do what I can to put matters right: review her, check she has come to no harm, correct the prescription and take advice from pharmacy and my registrar. Paragraph 10 puts that step before the conversation.

I would then make sure the conversation happens. Paragraph 10 says that after doing what you can to put matters right, you or someone from the healthcare team must speak to the patient, usually the lead or accountable clinician.

In that conversation I would tell her what happened, apologise personally, explain the likely short and long term effects, and say what is still being looked into. I would answer her questions honestly, including where I do not yet know the answer.

I would record the conversation and the apology in her notes, and I would report the incident through the trust's incident reporting system, which paragraph 45 of Good medical practice 2024 requires so that it can be reviewed and lessons learnt.

I would tell my consultant, because whether this meets Regulation 20's definition of a notifiable safety incident, and therefore triggers the organisation's statutory duty, is not my decision alone.

What does the panel listen for in a duty of candour answer?

The panel listens for whether your duty of candour answer contains an actual apology. Candidates describe the framework fluently and then never say the words they would say to the patient.

That you put matters right before you have the conversation, and say what that means concretely.
That you apologise personally rather than expressing institutional regret.
That you know apologising does not, of itself, admit legal liability, which GMC Good medical practice 2024 paragraph 45 states outright.
That you separate the professional duty on you from the statutory duty on the organisation.
That you report the incident as well as disclosing it, because those are two different obligations.
That you document the conversation and the apology in the record.

The ethics, professionalism and governance area is weighted 1.2 and scored 1 to 5 by each of two interviewers, inside a station whose communication mark is weighted 1.6, so how the apology sounds is worth more than how the regulation is quoted.

What is the trap in a duty of candour scenario?

The trap in a duty of candour scenario is waiting for the investigation. Paragraph 11 of the GMC and NMC guidance says you do not have to wait for the outcome, but you should be clear about what has and has not yet been established.

The second trap is the fear of liability. Paragraph 15 records that apologising does not mean admitting legal liability, that this is set out in legislation in parts of the UK, that NHS Resolution advises saying sorry is the right thing to do, and that a fitness to practise panel may view an apology as evidence of insight.

A third trap is taking the blame for something that was not yours. Paragraph 16 says you are not expected to take personal responsibility for system errors or a colleague's mistake, but the patient still has the right to an apology from the most appropriate team member.

How do you escalate a candour incident?

Escalation after a candour incident runs to the clinician with lead responsibility, then to the organisation's own incident process, then to the statutory duty if the threshold is met.

Your consultant or the accountable clinician, who paragraph 10 identifies as usually the most appropriate person to speak to the patient.
The trust's incident reporting system, because Good medical practice 2024 paragraph 45 requires you to report the incident in line with your organisation's policy so it can be reviewed or investigated.
The patient safety or governance team, who decide whether Regulation 20's notifiable safety incident threshold is met and run the organisation's statutory duty.
Your defence body, if you are unsure what to say or are worried about your own position.

How this comes up at the IMT interview

At the IMT interview, duty of candour is a station 1 ethics, professionalism and governance scenario of up to five minutes, following the six-minute exploration of your application that opens with a two-minute presentation.

It also appears inside station 2, where the clinical scenario contains an error made overnight and the one-minute handover has to say plainly what happened and what the patient has been told.

internalmedicineinterview's bank of 361 IMT questions across 56 scenarios includes ethics-station scenarios with AI-marked spoken practice, so you can hear whether you actually apologised or only described apologising.

Duty of Candour