Recognising when candour is needed: harm, distress, and thresholds

Candour is not limited to major incidents. It applies whenever something goes wrong with treatment or care and that event has caused, or could have caused, harm or distress.

Pharmacy situations that commonly trigger candour

• Supplying the wrong medicine, strength, form, label, or quantity
• Missing or wrong advice: for example directions, warnings, referral advice, or follow-up information
• Clinical service problems: such as errors in vaccination, screening, consent, referral, or documentation processes
• Delays or omissions that affect treatment: for example a missed urgent supply, failed delivery, or overlooked prescription problem
• Confidentiality or privacy failures that cause distress or practical harm
• Service failures that do not injure the person physically but still cause distress, confusion, or loss of trust

Near misses still matter

A near miss that is corrected before the person is harmed still needs recording, reporting, and learning. Whether you disclose the error directly to the patient depends on whether they were exposed to risk, inconvenience, follow-up action, or distress. If you are unsure, escalate early and follow local policy and professional judgement rather than assuming silence is safer.

Keep the threshold difference clear.

• Professional candour is broader: it depends on judgement and may justify disclosure where the person experienced risk, disruption, inconvenience, follow-up action, or distress, even if direct harm was avoided.
• England statutory candour is narrower: CQC Regulation 20 applies to defined notifiable safety incidents; CQC says near misses are not brought into scope simply because harm could have occurred.

Nation note on organisational duties

If you are unsure whether candour is required, treat that as a reason to escalate early, not as a reason to stay quiet.