Probity · Duty of candour

Duty of Candour and Probity: Being Open When Things Go Wrong

The two duties of candour, what every regulator expects of you personally, how to have the conversation and what to say, how the organisational duty works in England, Scotland, Wales and Northern Ireland, what enforcement and the evidence show, and how candour affects fitness to practise.

Reviewed October 2026 against GMC, NMC, HCPC, GDC, GPhC and CQC guidance, UK legislation, Bills before Parliament and the Northern Ireland Assembly, and government findings

Professional vs statutory What to say All four UK nations

Short answer: the duty of candour means being open and honest with patients when something goes wrong with their care. There are two versions. The professional duty applies to every registered health and care professional through their regulator's standards: tell the patient, apologise, offer to put things right and explain the likely effects, as soon as possible. The statutory duty applies to care organisations, with legal requirements that differ across England, Scotland and Wales, and no statutory duty yet in Northern Ireland. Candour is part of probity: being open after a mistake protects patients and protects you, while concealing one turns a clinical error into a question of honesty.

Key takeaways

Every regulator requires candour. The GMC and NMC share joint guidance, and the HCPC, GDC and GPhC each set it in their standards.
You should speak to the patient as soon as possible, before an investigation is complete.
A personal apology, such as "I am sorry", is expected, and it is not an admission of legal liability.
The statutory duty in England has led to a criminal prosecution of an NHS trust, but government findings in 2024 showed only 23% of respondents thought it was correctly complied with.
A failure of candour can be treated as seriously as dishonesty in fitness to practise.

Candour is closely linked to probity, explained in our guide to probity in healthcare. This guide covers the duty itself: what it requires, how to fulfil it, and what happens when it is not met.

Two duties of candour

	Professional duty	Statutory duty
Who it applies to	You, as a registered professional	Care organisations registered with the CQC in England, care providers in Scotland and NHS bodies in Wales (Northern Ireland has no statutory duty yet)
Where it comes from	Your regulator's standards and guidance	Legislation in each nation
When it applies	When something goes wrong with a patient's care that causes, or has the potential to cause, harm or distress	When a defined level of harm occurs, for example a "notifiable safety incident" in England
What it requires	Tell the patient, apologise, offer to put things right, explain the effects	A set process: notification, apology, written follow-up and records
Enforced by	Your regulator, through fitness to practise	The CQC in England, by fixed penalty notices or prosecution; other regulators elsewhere

Both can apply to the same event. The organisation must meet its legal process, and you must still be personally open with the patient.

What each regulator expects of you

Regulator	Where candour sits	What it says
GMC and NMC	Joint guidance, Openness and honesty when things go wrong: the professional duty of candour (updated 2024)	"All health and care professionals have a duty of candour – a professional responsibility to be honest with patients when things go wrong."
NMC	The Code, section 14: be open and candid	"Explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers" (14.2), and "document all these events formally" (14.3).
HCPC	Standard 8: be open when things go wrong	"You must be open, honest and candid when something has gone wrong with the care, treatment or other services that you provide" (8.1), including telling service users, explaining the likely impact and correcting the mistake where possible. "You must apologise" (8.2).
GDC	Guidance, Being open and honest with patients when something goes wrong (in effect from 1 July 2016)	Acknowledge the problem quickly, apologise appropriately and offer a remedy or support. "Saying sorry is not the same as admitting liability."
GPhC	Standard 8: speak up when they have concerns or when things go wrong	Pharmacy professionals "are open and honest when things go wrong" and "say sorry, provide an explanation and put things right when things go wrong".

The candour conversation: what to do and say

The GMC and NMC guidance sets out what patients need to hear. You "should speak to the patient as soon as possible after you realise something has gone wrong with their care" (para 11), and "share all you know and believe to be true about what went wrong and why, and what the consequences are likely to be" (para 12).

Tell them

What happened, in plain language, as far as you know it now. Do not wait for the investigation to finish.

Apologise

Personally. The guidance says patients "are likely to find it more meaningful if you offer a personalised apology – for example 'I am sorry…'" (para 17).

Explain the effects

What it means for them now and in the future, and what will be done to look into it.

Put it right

Offer treatment, support or a remedy, and tell them who to contact and what will happen next.

Choose a private place and an appropriate time
Say "I am sorry" and mean it
Be honest about what you do not yet know
Offer a follow-up conversation
Record the conversation accurately, the same day

Don't

Speculate about causes you have not established
Blame colleagues or the system in the moment
Use technical language to soften what happened
Delay because you are worried about a complaint
Alter or add to records afterwards without marking the change

Near misses The guidance asks you to use your judgement about near misses: tell patients where they need or want the information, for example where it helps them understand their care or their recovery (paras 21 to 22). Near misses should always be reported internally so others can learn.

An apology is not an admission of liability

The GMC and NMC guidance says "apologising to a patient does not mean that you are admitting legal liability for what has happened" (para 15). In England and Wales, section 2 of the Compensation Act 2006 supports this, as explained in our guide to writing your response. In Scotland, the Apologies (Scotland) Act 2016 says an apology "is not admissible as evidence of anything relevant to the determination of liability" in most civil proceedings.

The organisational duty across the UK

Nation	Law	Key points
England	Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 20	Providers must act "in an open and transparent way". After a notifiable safety incident, they must notify the person "as soon as reasonably practicable", in person, with "an account, which to the best of the registered person's knowledge is true", and "include an apology", followed by written notification and records.
Scotland	Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 and Duty of Candour Procedure (Scotland) Regulations 2018	In force from 1 April 2018. Organisations must notify the person, apologise and offer a meeting after an unexpected or unintended incident resulting in harm or death. Each provider must prepare an annual report on the duty of candour (section 24).
Wales	Health and Social Care (Quality and Engagement) (Wales) Act 2020	In force from 1 April 2023. NHS bodies in Wales must be open and honest when a patient suffers unexpected or unintended harm that is "more than minimal". Health boards and NHS trusts must report each year how often the duty applied and what they did to prevent a repeat (section 7).
Northern Ireland	No statutory duty yet	After a 2021 consultation and a second consultation on a "Being Open" framework (December 2024 to March 2025), the Health Minister announced on 18 September 2025 that officials are developing a Bill to "place a legal obligation on health and social care organisations to act with honesty and transparency when things go wrong". The professional duty already applies to every registrant.

In England, a notifiable safety incident for an NHS body is an unintended or unexpected incident that could result in, or appears to have resulted in, death, severe harm, moderate harm or prolonged psychological harm. Other providers have a slightly different definition based on the type and duration of harm.

Coming next: the Hillsborough Law The Public Office (Accountability) Bill, introduced on 16 September 2025 and at committee stage in the House of Lords in October 2026, would create a separate statutory "duty of candour and assistance" for public authorities and officials, including those delivering public functions. It applies to inquiries, inquests and investigations, not to the conversation with a patient, and would be backed by criminal offences. It is not yet law. If passed, it sits alongside the patient-facing duties on this page rather than replacing them.

Enforcement and what the evidence shows

Real case · Plymouth Magistrates' Court · 2020

CQC prosecution of University Hospitals Plymouth NHS Trust

What happened. After a patient died following an unsuccessful endoscopy that caused a perforated oesophagus, the trust failed to share details of what happened with her family and did not apologise within a reasonable time.

The outcome. The trust admitted the breach on 23 September 2020 and was fined £1,600, with a £120 victim surcharge and £10,845.43 costs. The CQC said it was "the first time CQC has prosecuted an NHS trust for failure to comply with the regulation concerning duty of candour".

The lesson: the statutory duty is enforceable in the criminal courts. The sum was modest, but the public record of a failure to apologise was not.

In November 2024, the Department of Health and Social Care published the findings of its call for evidence on the statutory duty of candour, based on 261 responses.

40%thought the purpose of the duty is clear and well understood

25%thought staff know of and understand its requirements

23%thought it is correctly complied with when an incident occurs

0%of family members who responded thought it is correctly complied with

Source: Department of Health and Social Care, findings of the call for evidence on the statutory duty of candour (26 November 2024). Respondents were self-selecting, so the figures show views, not measured compliance.

Candour and fitness to practise

Being open

Shows insight

The GMC and NMC guidance notes that a fitness to practise panel may see an apology as evidence of insight. Prompt, honest disclosure is one of the strongest signs that a mistake will not be repeated.

Covering up

Changes the case

A clinical error that is concealed, or a record that is altered to hide it, becomes a probity case. NMC guidance treats a breach of the duty of candour as among the most serious concerns, even without a dishonesty finding, as explained in our guide to dishonesty allegations.

Candour skills can be learned, and training can support CPD or remediation where candour has been raised as a concern. For records made after an incident, see our guide to medical records and probity.

Frequently asked questions

What is the duty of candour in healthcare?

The duty to be open and honest with patients when something goes wrong with their care. There is a professional duty for every registrant and a statutory duty for care organisations.

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

The professional duty applies to you personally through your regulator's standards. The statutory duty applies to care organisations through legislation, with set processes and legal enforcement.

Does apologising mean admitting liability?

No. GMC and NMC guidance says an apology does not mean admitting legal liability. The Compensation Act 2006 in England and Wales and the Apologies (Scotland) Act 2016 support this.

How quickly should I tell a patient something has gone wrong?

As soon as possible after you realise it, according to GMC and NMC guidance, even before an investigation is complete. The statutory duty in England requires notification as soon as reasonably practicable.

Do I have to tell patients about near misses?

Use your judgement. The guidance says to tell patients where they need or want the information. Near misses should always be reported internally.

Is there a duty of candour in Northern Ireland?

Not yet. In September 2025 the Health Minister announced that a Bill is being developed to create a statutory organisational duty. The professional duty already applies to every registrant across the UK.

Does the Hillsborough Law change the duty of candour?

Not yet. The Public Office (Accountability) Bill is still going through Parliament. It would add a duty of candour and assistance for public authorities and officials in inquiries, inquests and investigations. It would not replace the professional or statutory duties to be open with patients.

Can a failure of candour lead to a fitness to practise case?

Yes. Concealing a mistake or failing to be open can turn a clinical error into a probity concern, and regulators treat it seriously even without a finding of dishonesty.

Primary sources

17 official documents and laws