The professional duty of candour means being open and honest with patients when something goes wrong: telling them, apologising, offering a remedy and explaining the effects. Dishonesty is deliberately misleading others. The NMC says dishonesty is always serious, and deliberately covering up when things go wrong is among the most serious forms. A mistake handled openly is usually far less serious.
Key takeaways
- Candour: tell the person, apologise, put things right where possible, explain.
- Organisations also have a statutory duty of candour in England, Scotland and Wales.
- The NMC treats deliberate cover-ups as one of the most serious forms of dishonesty.
- Not all dishonesty is equally serious; one-off, spontaneous acts with no personal gain are generally less serious.
Many Fitness to Practise cases start with an honest mistake. What happens next often matters more than the mistake itself. Being open protects patients and trust; concealing it can turn a clinical concern into a question about your honesty, which the NMC takes especially seriously.
What is the professional duty of candour?
The professional duty of candour is set out in the NMC Code (section 14) and in joint guidance from the NMC and the General Medical Council, first published in 2015 and refreshed in December 2024. When something goes wrong with a person's care that causes, or could cause, harm or distress, you should tell them, apologise, offer an appropriate remedy or support to put matters right if possible, and explain fully the short and long-term effects.
The duty also includes being open with your employer and colleagues, taking part in reviews and investigations, and reporting incidents and near misses. Saying sorry is not an admission of legal liability.
What is the statutory duty of candour?
Separately, health and care organisations have a statutory duty of candour. In England it is Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulated by the Care Quality Commission. Scotland and Wales have their own legislation. The statutory duty applies to organisations; the professional duty applies to you as an individual.
How does the NMC define dishonesty?
Panels apply the legal test from the Supreme Court case Ivey v Genting Casinos (2017). First, what did you actually know or believe about the facts at the time? Second, given that knowledge or belief, was your conduct dishonest by the standards of ordinary decent people? You do not need to have realised it was dishonest by those standards.
Honesty is of central importance to a nurse, midwife or nursing associate's practice.
Is dishonesty always serious?
Yes. The NMC's guidance says allegations of dishonesty will always be serious, and a registrant who has acted dishonestly will always be at some risk of being removed from the register. But not all dishonesty is equally serious, and the guidance sets out factors either way.
- More serious: deliberately breaching the duty of candour by covering up when things have gone wrong, especially if it could cause harm; misuse of power; vulnerable victims; personal financial gain from a breach of trust; direct risk to people receiving care; premeditated, systematic or longstanding deception.
- Generally less serious: one-off incidents; opportunistic or spontaneous conduct; no direct personal gain; incidents outside professional practice.
Why is covering up worse than the mistake?
A clinical error raises questions about skills and systems, which can often be addressed through learning and support. A cover-up raises questions about trust, which is much harder to put right. It can also put patients at further risk, because problems are not escalated or treated promptly.
What should I do if I realise I have made a mistake?
- Make sure the person is safe and get clinical help if needed.
- Tell the nurse in charge or your manager straight away.
- Follow local policy on telling the patient or their family, apologising and explaining what happened.
- Record what happened accurately and promptly. Never change or backdate earlier entries; add a new, dated entry.
- Complete an incident report and take part openly in any review.
Doing these things promptly is what the duty of candour looks like in practice. It also puts you in the strongest possible position if the matter is ever looked at by your employer or the NMC.
What are common dishonesty concerns in nursing?
- Falsifying records, such as observations, medication charts or signatures.
- Not disclosing information on job applications or to the NMC when required.
- Misrepresenting qualifications or experience.
- Timesheet or expenses fraud.
- Working elsewhere while on sick leave, where this involves deception.
Disclosure duties catch many people out: read telling your employer about an NMC referral and should I self-refer to the NMC?
How do I reflect on a dishonesty allegation?
Take legal advice first, particularly if facts are disputed. Reflection on dishonesty needs to go beyond the event to understanding why honesty matters so much in healthcare, what led you to act as you did, and what has changed in your values and decision-making, not just your processes.
The Dishonesty Explored course covers how regulators approach dishonesty and how to reflect meaningfully, and the dishonesty insight and reflection prompts guide you through it. See also how to demonstrate insight.
Frequently asked questions
It is the professional duty to be open and honest with patients when something goes wrong: tell them, apologise, offer a remedy and explain the effects. It is in the NMC Code and joint NMC and GMC guidance.
No. The NMC says dishonesty is always serious, but its guidance recognises less serious forms, such as one-off, spontaneous conduct without personal gain. Each case depends on its facts and on insight.
No. Saying sorry is part of the duty of candour and is not an admission of legal liability.
Panels apply the Ivey v Genting test: what you knew or believed at the time, and whether your conduct was dishonest by the standards of ordinary decent people.
Sources and further reading
- NMC: Making decisions on dishonesty charges and the professional duty of candour (FtP library)nmc.org.uk
- NMC: Guidance on the professional duty of candournmc.org.uk
- NMC: NMC and GMC refresh duty of candour guidancenmc.org.uk
- CQC: Regulation 20 – Duty of candourcqc.org.uk
- RCN: Duty of candour (advice guide)rcn.org.uk
