Why Duty of Candour matters
A practical guide to Duty of Candour for NHS trusts, providers, commissioners and families. Learn the governance, evidence and delivery steps that improve outcomes and reduce risk. Strong investigations combine independence, systems thinking, meaningful engagement and practical recommendations that improve safety rather than assign blame.
Understanding Advanced Techniques for Duty of Candour across the NHS
The Provider Selection Regime (PSR) replaced the previous NHS procurement rules in January 2024, introducing new decision-making processes for awarding healthcare contracts. Unlike the previous Procurement, Patient Choice and Competition Regulations, the PSR provides commissioners with greater flexibility — including direct award options where continuity of care, patient safety or service integration justify it. However, the regime also requires commissioners to demonstrate transparent decision-making and to consider whether competitive tendering would better serve patients.
Providers need to understand the three PSR decision-making processes: Direct Award Process A (for services where there is only one capable provider), Direct Award Process B (for services meeting specific criteria around continuity and integration), and the Most Suitable Provider process which involves competitive evaluation. Each route has different evidence requirements and timelines.
The PSR also introduces new requirements around stakeholder engagement. Commissioners must demonstrate that they have considered patient views, provider feedback and clinical input when making award decisions. Providers who engage proactively with commissioners — sharing outcome data, innovation proposals and partnership plans — are better positioned regardless of which award route is used.
The current landscape
The quality of an investigation report is measured not by its length, but by the clarity and actionability of its recommendations. Each recommendation should specify what needs to change, who is responsible, what the deadline is, and how progress will be measured. Vague recommendations like 'improve communication' are unhelpful and unlikely to drive real change.
Multi-agency investigations present particular challenges around information sharing, governance and coordination. When multiple organisations are involved, agreeing a shared terms of reference, establishing clear lines of accountability, and managing parallel processes (such as criminal investigations or inquests) requires experienced independent oversight.
What organisations need to know
This article focuses on Advanced Techniques for Duty of Candour across the NHS and the wider priorities around Duty of Candour, Independent Investigations, NHS, healthcare strategy, best practice. The strongest organisations do not treat this as a stand-alone exercise — they connect governance, workforce, communication and evidence so leaders can make decisions quickly and confidently.
NHS trusts, providers, commissioners and families should consider these questions before proceeding:
- What are the key learning questions this investigation should answer?
- How will family and patient perspectives be incorporated throughout?
- What governance structure will oversee the investigation and receive findings?
Practical checklist
Getting Duty of Candour right requires structured preparation and disciplined follow-through:
- Set clear terms of reference, governance routes and expectations for family involvement early
- Gather evidence from records, interviews, policies and contextual operational factors
- Translate findings into recommendations with named owners, deadlines and measurable follow-through
- Translate Duty of Candour into named actions, owners and realistic deadlines
- Keep evidence, decisions and outcomes in one place so future assurance, inspection or procurement activity is easier to manage
Evidence you should have ready
Organisations with strong evidence bases consistently perform better in independent investigations activities. Key evidence includes:
- Clinical records, incident reports and policy documentation relevant to the event
- Staff interviews conducted in a supportive, non-punitive environment
- Contextual operational data (staffing levels, workload, system pressures at the time)
Governance considerations
Strong governance underpins successful delivery. For Duty of Candour, this means:
- A defined timeline with milestones for evidence gathering, analysis and draft reporting
- Quality assurance of the final report by an independent reviewer before publication
Common mistakes to avoid
Based on our experience working with NHS trusts, providers, commissioners and families, these are the most frequent errors:
- Over-scoping the investigation and losing focus on the most important learning questions
- Treating family engagement as a communication task rather than a core part of the methodology
- Writing recommendations that are too vague to track or implement
Avoiding these pitfalls requires leadership commitment, clear accountability and a willingness to seek independent review when internal perspectives may be limited.
How CPGB Ltd can help
We support NHS trusts, providers, commissioners and families with independent investigations, PSIRF support, family engagement and complex multi-agency reviews. Our team combines frontline health and social care experience with practical consultancy so recommendations are proportionate, evidence-led and built for real delivery.
With over 100 years of combined NHS experience and a track record that includes contracts worth over £200 million, investigations across 50+ NHS trusts and 40+ CQC improvements achieved, we bring both credibility and practical expertise to every engagement.
Contact us to discuss Duty of Candour and the wider priorities around Independent Investigations, NHS, healthcare strategy, best practice.