Being open and honest with patients when something goes wrong is a 'fundamental part of pharmacy professional practice,' the General Pharmaceutical Council (GPhC) has reminded pharmacists and pharmacy technicians in new resources published last week to help them fulfil 'duty of candour'. 

The GPhC said these resources, Keeping Patients Safe - Being Open and Honest, and Pharmacy Team Toolkit - Learning from Incidents, 'bring together relevant existing policy, standards and previous statements on the professional obligations of pharmacists and pharmacy technicians, with respect to candour.' 

They emphasise that duty of candour - the professional responsibility to be open and honest with patients when something goes wrong - 'is not an add on - it’s a fundamental part of pharmacy professional practice,' the regulator explained. 

The responsibility to be open and honest applies 'even in difficult or challenging times,' it said, and 'it’s essential that professionals do the right thing for patients, their families and carers. 

'Saying sorry meaningfully when things go wrong is vital for everyone involved.' 

The Keeping Patients Safe document highlights how healthcare professionals must tell the patient when something has gone wrong, apologise, offer an appropriate remedy or support to put matters right - if possible, and explain fully to the patient the short and long-term effects of what has happened. 

'When apologising to patients and explaining what has happened, we do not expect pharmacists or pharmacy technicians to take personal responsibility for something going wrong that was not their fault,' the GPhC explained, 'but the patient has the right to receive an apology from the most appropriate team member regardless of who or what may be responsible for what has happened.' 

Pharmacists and pharmacy technicians 'being open and honest with everyone involved in patient care' will 'help demonstrate that they are open to learning from mistakes - a basic part of professionalism,' the GPhC said. 

It warned that its fitness to practise committees 'will take very seriously a finding that a pharmacist or pharmacy technician took deliberate steps to avoid being candid with a patient.' 

Given the link with issues around liability and indemnity, the National Pharmacy Association (NPA) and the Pharmacists’ Defence Association (PDA) – as leading providers of professional indemnity - have contributed to the new resources and highlighted the importance of openness and transparency in this context. 

PDA chair Mark Koziol said 'taking a frank and honest approach is crucial,' and the organisation has assured its members it 'would never refuse to cover a claim because an apology has been offered.' 

Jasmine Shah, head of advice and support services for the NPA, said: 'We are striving to move away from a blame culture towards a learning culture. It is important to acknowledge when something goes wrong and to help the patient understand what happened. What we aim for is a resolution that is supportive both of the patients and professionals involved.' 

The toolkit resource for pharmacy teams includes case studies and examples of 'notable practice’ about how pharmacy teams have learned from incidents to improve patient safety outcomes and minimise the risk of these happening again, the GPhC explained. 'All pharmacy teams are urged to use the new toolkit to prompt learning and reflection during pharmacy team meetings or other discussions,’ the regulator said. ‘Whilst the toolkit examples are drawn from the GPhC’s inspections of community pharmacies, the professional duty to be candid applies in all sectors of pharmacy practice.' 

Duncan Rudkin, chief executive of the GPhC, acknowledged that pharmacists and pharmacy technicians 'work hard to provide person-centred, safe and effective care to patients, but sometimes things go wrong.’ He said the way professionals respond to these situations is 'key' to supporting the people affected and improving patient safety. 

'Our new resources highlight the importance of saying sorry,’ he said. ‘Apologising to a patient does not mean that a professional is admitting legal liability for what has happened. It’s an acknowledgement that something could have gone better, and gives an opportunity for learning to improve patient safety outcomes and minimise the risk of the same thing happening again.' 

Chair of the GPhC, Gisela Abbam, hosted a roundtable meeting on the duty of candour on 13 June, attended by the chief pharmaceutical officers and organisations representing pharmacy professionals, employers and students, patients and the public and other regulators. 

The purpose of the roundtable was to seek feedback on the new resources and 'discuss further actions that we can all take to make sure everyone working in pharmacy understands their responsibilities to be open and honest when things go wrong, and to improve patient safety,' Ms Abbam explained. 

Pharmacist and patient voice champion, Sarah Seddon, spoke at the roundtable and welcomed the initiative. 'It’s not just about looking forwards to improve overall safety in an abstract way for theoretical patients,' she said. 'It’s about looking after that patient to the best of your ability to restore their trust, to prevent compounded harm and to help them feel safe again.' 

She said 'good application of duty of candour' allows you to know you've done your 'absolute best' for that patient.  

'A professional must have the skills, knowledge, self-awareness and humanity to accept what has happened, to own any mistakes and obtain appropriate, timely support for everyone involved,' she said. 

Chief pharmaceutical officer for England, David Webb, said duty of candour is an 'essential part' of being a pharmacy professional and 'the way forward' in terms of learning from errors and improving systems. 

The GPhC encourages pharmacy professionals to: 

  • promote and encourage a culture of learning and improvement
  • challenge poor practice and behaviours
  • raise a concern, even when it is not easy to do so
  • support people who raise concerns and provide feedback
  • be open and honest when things go wrong
  • say sorry, provide an explanation and put things right when things go wrong
  • reflect on feedback or concerns, taking action as appropriate and thinking about what can be done to prevent the same thing happening again
  • improve the quality of care and pharmacy practice by learning from feedback and when things go wrong