What Triggers the Duty of Candour?

Candour is generally triggered when a patient experiences - or was exposed to a clear risk of - harm, distress, or loss arising from care, dispensing, the environment, administration, or data handling. Intent is not required; unintended consequences still call for openness. ^[2][1]

Recognising triggers in optical settings

Clinical triggers include missed or delayed referrals, erroneous prescriptions, incorrect measurements, failure to act on red flags, or mis-instilled drops. For example, a delayed glaucoma referral that allowed vision to deteriorate would be a clear trigger.

Dispensing triggers can involve wrong lenses or PD/height errors that lead to falls or prolonged symptoms.

Environmental triggers include trips, chemical exposures, or faulty equipment that affects diagnosis - for instance, a fall caused by a loose carpet edge in the waiting room.

Data triggers may involve emails sent to the wrong recipient, visible screens, or misfiled records; for example, a letter accidentally addressed to another patient. ^[1][4]

Distinguishing dissatisfaction from harm

Distinguishing dissatisfaction from harm helps without minimising feelings. Even when an outcome sits within tolerance, candour often applies if risk or distress occurred. For example, glasses within prescription tolerance that still caused dizziness leading to a fall would trigger candour. Thresholds for distress may be lower, and support needs higher, for older adults, children, and people with learning disabilities. ^[2][6]

• Screening questions: Did our action or inaction cause or risk harm or significant distress? Would a reasonable clinician inform the patient to preserve trust? Would you want to know if roles were reversed? ^[3][1]
• Evidence to check quickly: records and timestamps; device outputs; referral logs; dispensing measurements; communications sent; environmental checks. ^[3][4]

Timing, content, and uncertainty

Once a trigger is recognised, notification should usually happen as soon as practicable - even if facts are incomplete. ^[2][5]

Information commonly covers what is known, what is being investigated, and immediate steps to keep the person safe.

Alongside who will follow up and when, practical supports should also be clarified:^[3][5]

• transport to urgent care
• replacing broken spectacles the same day
• scheduling an expedited review

Where uncertainty remains, stating that plainly can help. Speculation, blame, and complex causal language tend to obscure rather than clarify. Simple explanations - "the OCT image quality was degraded because the device faulted; we did not realise this at the time" - invite questions and preferences for updates. ^[3][4]

Recording the decision

Recording the decision to treat an event under candour, who approved it, and the risk grading used supports transparency. When candour is not triggered, notes typically explain the reasons and any service apology or explanation offered, so the rationale is clear if reviewed later. ^[2][1]

References (numbered in text) Why we include references

1. The professional duty of candour — General Optical Council Find (opens in a new tab)
2. Regulation 20: Duty of candour — Care Quality Commission Find (opens in a new tab)
3. Openness and honesty when things go wrong: The professional duty of candour — General Medical Council (joint guidance with the Nursing and Midwifery Council) Find (opens in a new tab)
4. Elaine O'Connor; Hilary M Coates; Iain E Yardley; Albert W Wu. Disclosure of patient safety incidents: a comprehensive review. Int J Qual Health Care (2010) Find (opens in a new tab)
5. Saying sorry — NHS Resolution Find (opens in a new tab)
6. Hanzla Naeem; Erin J Demoulin; James Allen; Adrian Andronic; Anthony Howard. Duty of candour: encouraging a culture of openness and honesty. British Journal of Hospital Medicine (2023) Find (opens in a new tab)