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Pharmaceutical Services Negotiating Committee

General News

Francis report makes patients the priority for all healthcare professionals

This week the final report of the public inquiry into the Mid Staffordshire NHS Foundation Trust, chaired by Robert Francis QC, was published.

The Francis report is an important document for the NHS.  It chronicles appalling failures in care and examines the causes.

The report calls for a shared culture in which patients’ needs are always put first and in which all healthcare professionals have a statutory duty to promote openness, transparency and candour. It identifies fundamental standards of care which all services should meet as a minimum, and sets out duties that should be put on all professionals.

In addition, the report sets out recommendations designed to ensure that healthcare professional groups are effectively regulated.

The report is an important reminder of the responsibilities of all those providing NHS care, and pharmacies can expect commissioners to have an increased focus on standards of delivery following its publication. 

The report is also clear that financial pressures and efficiency targets must not be prioritised at the expense of patient care.

Although the report centres on a secondary care Trust, its recommendations extend to discharge and the need to ensure appropriate care will be provided when a patient leaves hospital. This is relevant to community pharmacies, who are likely to be well-placed to check on patients and identify potential problems with their care. Post-discharge MURs can deliver real benefits.

Some of the recommendations that may be of interest to community pharmacy are detailed below.

Putting the patient first

Patients must be the first priority in all that the NHS does, with healthcare professionals doing everything in their power to protect patients from avoidable harm and being honest and open with patients regardless of the consequences for themselves. Contractors or outsourced services must also abide by these requirements, which could be included in the terms on which they are commissioned.

Openness, transparency and candour

Every healthcare organisation and everyone working for them must be honest, open and truthful in all their dealings with patients and the public, and organisational and personal interests must never be allowed to outweigh this duty. The following definitions are set out.

Openness: enabling concerns and complaints to be raised freely without fear, and questions asked to be answered

Transparency: allowing information about the truth about performance and outcomes to be shared with staff, patients, the public and regulators

Candour: any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked about it

Statutory obligations

There should be a statutory obligation to observe a duty of candour and it should be a criminal offence for any registered medical practitioner, nurse, or allied health professional or director of an authorised or registered healthcare organisation:

  • Knowingly to obstruct another in the performance of these statutory duties;
  • To provide information to a patient or nearest relative intending to mislead them about such an incident;
  • Dishonestly to make an untruthful statement to a commissioner or regulator knowing or believing that they are likely to rely on the statement in the performance of their duties.

It should be the job of the Care Quality Commission to ensure compliance with this duty.

Follow up of patients after discharge

GPs should undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services. A proactive system for following up patients shortly after discharge would not only be good “customer service”, it would probably provide a wider range of responses and feedback on their care.

Fundamental standards of service

Fundamental standards of minimum safety and quality should be set out, with zero tolerance of any services that do not comply with these. Enhanced quality standards could set requirements higher than these and should be performance managed by commissioners.


A wide range of recommendations about nursing were made, including that there should be an increased focus on training, education and professional development on the practical requirements of delivering compassionate care; that the Nursing and Midwifery Council and other bodies should work towards a common qualification/assessment; and that the Royal College of Nurses should consider splitting its Royal College functions and its employee representative/trade union functions between two bodies.

Department of Health

Department of Health officials need to connect more to the NHS by visits, and most importantly by personal contact with those who have suffered poor experiences.

Reporting incidents of concern

Reporting incidents of concern relevant to patient safety, compliance with fundamental standards or some higher requirement of the employer must be insisted upon.


It should be an offence for death or serious injury to be caused to a patient by breach of the regulatory requirements. Sharing of intelligence between regulators must go further and include all intelligence which when pieced together with that of partner organisations may raise the level of concern. And the Secretary of State should consider transferring the functions of regulating healthcare providers and the fitness of people to be directors or governors to the Care Quality Commission.


Patients raising concerns about their care should have the matter dealt with as a complaint if they wish and their expectations should be identified, with prompt and thorough processing of the complaint. Patients should also receive sensitive, responsive and accurate communication. Providers must promote to the public their desire to receive and learn from comments and complaints and commissioners should require access to complaints information.

Posted 8 February 2013

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