The four principles

Beauchamp and Childress: autonomy, beneficence, non-maleficence, justice. They are prima facie binding — none automatically outranks another, and conflicts are resolved by specification and balancing rather than by a hierarchy.

Know the standard criticisms too, because they are what turns a recital into an answer: principlism gives no decision procedure when principles conflict; it is culturally individualist and under-weights family and community; it neglects virtue and care ethics; and “justice” is left substantively empty.

Consent: Montgomery, Bolam and McCulloch

Good Medical Practice 2024

In effect from 30 January 2024, replacing the 2013 edition. Four domains:

1. Knowledge, skills and development
2. Patients, partnership and communication
3. Colleagues, culture and safety
4. Trust and professionalism

New in the 2024 edition: explicit duties on tackling bullying, harassment and discrimination; duties for those in leadership and management roles; and clearer provisions on sexual boundaries.

Duty of candour

Two duties, often confused. One is professional and applies to you; the other is statutory and applies to the organisation.

The GP practice threshold

GP practices are not “health service bodies” for these purposes, so regulation 20(9) applies. A notifiable safety incident is an unintended or unexpected incident that, in the reasonable opinion of a healthcare professional, appears to have resulted in:

• death directly related to the incident;
• impairment of sensory, motor or intellectual function lasting or likely to last 28 days or more;
• changes to the structure of the body;
• prolonged pain or prolonged psychological harm (28 days or more); or
• shortened life expectancy;

— or that requires treatment to prevent any of those outcomes.

What you must actually do

1. Tell the patient (or their representative) in person, as soon as reasonably practicable
2. Apologise
3. Give a true account of all the facts you know at that point
4. Explain what further enquiries will be made
5. Follow up in writing with that account, the apology and the results of enquiries
6. Keep a secure written record of it all

Complaints in England

• Two stages: local resolution by the provider or commissioner, then the Parliamentary and Health Service Ombudsman. There is no independent second stage in between — that was abolished in 2009.
• Time limit: 12 months from the incident, or from when the complainant knew of it, with discretion to extend.
• Acknowledge within 3 working days.
• There is no fixed statutory response deadline — respond as soon as reasonably practicable after investigating, and keep the complainant informed if it will take longer than agreed.
• Anyone affected may complain, or a representative may complain for a child, someone lacking capacity, or someone who has died.
• Since 1 July 2023, complaints about primary care in England are handled by ICBs, not NHS England.

Clinical negligence

Four elements: duty of care, breach, causation, damage. Breach is Bolam as qualified by Bolitho. Causation is the “but for” test.

Limitation: 3 years from the cause of action or the later date of knowledge. For children, time runs from their 18th birthday, so a claim can be brought until 21. For people who lack capacity, time does not run at all while incapacity persists. The court has a discretion to disapply the limit.

Fitness to practise

The threshold is whether there is a current risk to public protection requiring action. Stages: triage → investigation → case examiners (no action, warning, undertakings, or referral to the MPTS) → MPTS hearing.

The standard of proof is the civil standard — the balance of probabilities — and has been since 2008. Interim orders (conditions or suspension for up to 18 months) are not sanctions and are not a finding of impairment; they hold the position while the case is investigated.

MPTS sanctions: no action, undertakings, conditions up to 3 years, suspension up to 12 months, or erasure — with restoration not possible for 5 years. A warning can be issued even where fitness to practise is not impaired.

Learning from things that go wrong

• Significant event analysis remains the core primary care tool and an appraisal expectation.
• PSIRF replaced the Serious Incident Framework in NHS trusts by autumn 2023. It is not mandatory in general practice, though its concepts are being introduced through the Primary Care Patient Safety Strategy.
• All practices report incidents to LFPSE, which replaced the NRLS.
• Reflective notes are not legally privileged. The GMC does not ask for them when investigating a doctor, but a court can compel them. Write reflections about learning, and keep the factual account of events in the record and the SEA.

Death certification since September 2024

Martha’s Rule

Named after Martha Mills, who died of sepsis in 2021 after her family’s concerns about her deterioration were not acted on. Three components: staff can request an urgent second-opinion or critical care review from a different team; patients and families have the same escalation route via an advertised 24/7 number; and there is structured daily enquiry of the patient about their condition.

Rollout: 143 sites from May 2024, with phase 2 extending it across acute trusts from April 2025. NHS England expects implementation across acute inpatient services to be complete during 2026/27, and is currently testing it in a small number of maternity, neonatal, emergency, community and mental health services rather than operating it there routinely.

Self-testA patient asks you to apologise in writing for a delayed cancer diagnosis. Your practice manager says not to, in case it is used against you. Who is right?

You are. The Compensation Act 2006 s2 provides that an apology, an offer of treatment or other redress does not of itself amount to an admission of negligence. Both the GMC and NHS Resolution actively encourage early, meaningful apologies — and failure to apologise is one of the most consistent drivers of complaints escalating into claims.

Apologise for what happened and its effect on her. That is different from conceding a legal breach of duty, which is a matter for your defence organisation and the facts.

Self-testWhat is the difference between the professional and the statutory duty of candour in one sentence each?

Professional: a duty on you personally, from the GMC, to be open and honest with a patient whenever something goes wrong — with no harm threshold.

Statutory: a duty on the organisation, under CQC regulation 20, triggered by a notifiable safety incident, with prescribed steps and a written follow-up, breach of which is a criminal offence.

And a point worth keeping straight: there is currently no statutory individual duty of candour on doctors. The Public Office (Accountability) Bill would create a separate duty for public authorities and officials, but it is not yet law.

Written and checked by NHS GPs. Last reviewed 24 August 2026. UK law and guidance change — always follow current local policy and your defence organisation’s advice in a real case.