When care goes wrong
Handle complaints, incidents and candour at consultant level
A safe answer protects the patient, communicates openly, supports those affected and creates proportionate learning. A complaint, a patient-safety incident, a conduct concern and a claim may overlap but do not use one automatic process.
Meet immediate clinical needs first
Stabilise the patient, preserve evidence where relevant, obtain appropriate senior or specialty help and ensure continuity. Do not let governance language displace urgent care.
Be open and compassionate
Explain known facts, apologise appropriately, avoid speculation and make a reliable plan for further communication. Professional and organisational duties of candour have related but distinct requirements.
Engage patients, families and staff
PSIRF emphasises compassionate engagement and learning. Ask what questions matter to those affected, provide a contact route and support staff without pre-judging blame.
Choose a proportionate response
Use local policy to decide reporting, review and escalation. Separate system learning from concerns that require conduct, capability, safeguarding, regulatory or legal routes.
Turn actions into assurance
Name owners, deadlines, measures, dissemination and review. An action list without evidence of implementation or effect does not close the learning loop.
In-depth consultant teaching · source review 11 October 2026
Apply the evidence to consultant practice
Keep immediate care, professional candour, statutory duties, patient engagement and proportionate systems learning conceptually distinct.
Scope: GMC professional candour is UK-wide; PSIRF is an England NHS patient-safety response framework.
The first task is care and communication, not the investigation
When harm or potential harm is identified, make the patient safe, seek the appropriate expertise, communicate with those directly affected and preserve accurate contemporaneous records. Do not delay urgent treatment while deciding whether a formal investigation threshold is met. A complaint may reveal a hazard that requires action now even before every historical fact is established.
The GMC professional duty of candour requires honesty and an apology when something has gone wrong and has caused or may cause harm or distress. Organisational statutory candour obligations have their own legal criteria and local processes; do not casually state that every near miss automatically meets the statutory notification threshold.
What to establish
- Identify the clinical lead for ongoing care and the person responsible for communicating with the patient.
- Keep explanations factual; acknowledge uncertainty without speculation or defensive attribution.
PSIRF is not 'investigate every incident'
NHS England's Patient Safety Incident Response Framework replaces the old Serious Incident classification with a proportionate, systems-oriented approach to learning and improvement. The response is informed by the organisation's safety incident response policy and plan, specific mandatory requirements and the potential for learning. Compassionate engagement with patients, families and affected staff remains important even when an individual formal investigation is not selected.
Patient-safety learning is separate from determining blame, professional fitness to practise or cause of death. Some events require parallel processes, including professional, employment, coronial or other statutory routes. Candidates should avoid promising to conduct a personal root-cause investigation of every event or conflating PSIRF learning with disciplinary action.
Closing the loop means evaluating safety controls
A recommendation such as 'provide more education' is rarely enough. Ask what conditions made the error more likely: unclear responsibility, staffing, task design, inaccessible prior results, interfaces between teams or alert fatigue. Prefer measurable system controls where appropriate and evaluate whether they work after implementation.
When a family asks what changed, a credible answer distinguishes an apology, factual explanation, review findings, implemented safety changes and their observed effectiveness. If the investigation is incomplete, give a clear route for further updates instead of claiming certainty prematurely.
A difficult disclosure needs ownership and ongoing contact
A patient may ask whether a specific individual caused the harm, how the consequences will be managed and whether the same thing could happen to someone else. An appropriate initial explanation gives known facts, expresses regret, addresses immediate care and arranges further communication. Avoid blame before the evidence is established, but do not use 'systems issues' as a way to avoid professional accountability where it may be relevant.
A consultant should know who coordinates clinical care and communication, who carries out any organisational review and how to support colleagues affected by the event. For example, a missed postoperative sepsis trigger, an unacknowledged urgent imaging result and an anaesthetic medication error may require different clinical responses but the same duties of candour, safe escalation and honest learning.
Apply the teaching
Delayed communication of an unexpected cancer finding
A clinically significant imaging finding was reported accurately, but the referring team did not act for six weeks because the result-alert pathway lacked a named owner.
Work through the decision, trade-offs and next steps using the source-led teaching above. The paid Consultant Core Preparation plan provides more structured answers and explained follow-ups. This public article remains a complete teaching guide.
Common failure: Treating the radiologist's accurate report as the end of organisational responsibility or blaming the referrer before testing the whole system.
Test your understanding
You discover a serious delay in acting on a clinical result. What do you do?
Try a concise answer using the evidence and safeguards covered in this article. Identify what you would need to verify locally.
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