Review Urges GMC to Mend Damaged Relationship With Doctors

Peter Russell

June 06, 2019

The General Medical Council (GMC) said it fully accepted the findings and recommendations of an independent review report into gross negligence manslaughter following widespread concerns about recent cases, including that of trainee paediatrician Hadiza Bawa-Garba, in which doctors seemed to be held personally responsible for systemic failures.

The report, chaired by Leslie Hamilton, backed last year's recommendation by the Government's Williams review to remove the GMC's right of appeal of Medical Practitioners Tribunal Service (MPTS) decisions, "as an important step towards rebuilding the profession's relationship with its regulator".

In his forward, Mr Hamilton, a former consultant cardiac surgeon, said the Bawa-Garba case had led to a "fundamental loss of confidence in the GMC" and called on the organisation to make fundamental reforms to end "toxic fear" that the health system was geared to "apportion individual blame rather than to learn from events and prevent future harm".

The Bawa-Garba Case

Dr Bawa-Garba was found guilty in 2015 of gross negligence manslaughter over the death at Leicester Royal Infirmary of 6-year-old Jack Adcock 4 years earlier. She received a 24-month suspended sentence.

Unease about the role of the GMC grew when it sought erasure of Dr Bawa-Garba from the medical register through the courts, in contradiction of MPTS advice, which had described erasure as "disproportionate" and had recommended suspension.

A decision by the High Court to uphold the GMC's position was overturned in the Court of Appeal in August 2018, after a crowd-funding campaign raised £350,000 to take the case forward.

At the time, the British Medical Association (BMA) said the regulator had "lost the confidence of doctors".


The review said the GMC "must acknowledge that its relationship with the medical profession has been severely damaged by recent events", take immediate steps to rebuild trust, and consider "how it can better support a profession under pressure as well as promoting a fair and just culture".

It called on the Government to introduce legislation to remove the regulator's right to appeal MPTS decisions "without delay".

Among other recommendations in the review:

  • In cases where a doctor was being investigated for gross negligence manslaughter or culpable homicide, an 'appropriate external authority' should scrutinise the systems of the department where the doctor worked, including education and training in cases where the individual was a trainee

  • Any decision to bring a misconduct case about clinical competence to the MPTS reliant on expert evidence should require the support of two expert opinions

  • The UK Parliament and the devolved governments should consider how reflective practice notes, which are "fundamental to their professionalism", could be given legal protection

  • The GMC should work with public and patient organisations to support better understanding of its role in regulating the medical profession within a system "under pressure"

Reaction to the Report

In its response, the GMC, which commissioned the independent review, said it accepted the challenge of rebuilding trust with the medical profession. Chief executive, Charlie Massey, said: "We share this report's desire for a just culture in healthcare, and acknowledge that we have a crucial role in making that happen.

"We are already making progress. Work is underway to address some of the key issues raised in this report but there is plenty more for us to do."

The BMA welcomed the review, particularly the recommendation to strip the regulator of its powers to appeal against MPTS decisions, and for action to be taken on reflective practice. Dr Chaand Nagpaul, BMA council chair, said: “It is also imperative to recognise, as this report does, that mistakes rarely happen in isolation from wider system pressures, and these must be considered as part of any investigation. It is simply not fair that one person should carry the blame for a mistake, no matter how grave, that is the product of a series of failings across the workplace.

"This review’s recommendation for the appropriate authority to scrutinise the environments that doctors find themselves working in is a positive one, and this area's particular focus on trainees, who often work under difficult conditions without appropriate support, is important."

Prof Russell Viner, president of the Royal College of Paediatrics and Child Health said: "The case of Hadiza Bawa-Garba has had a profound effect on paediatricians and the wider medical professional.

"The accounts of systemic errors, short-staffing, IT issues, and lack of support for this particular trainee that contributed to the tragic death of a child has led trainees to tell us they carry a sense of trepidation before the start of every shift. Many have experienced 'that shift' that could easily have ended in disaster.

"It is heartening that the review stresses that the public recognise the pressure on healthcare professionals who are working in an overstretched system and also that serious harm to patients is very rarely the result of an error made by one individual.

"We support the recommendation that, when there is significant criminal investigation into an individual, the systems around them must also be investigated. This is not about shifting blame or accountability, but recognising that individuals operate within a wider environment and should not become scapegoats – and failings of the system at large need to be addressed."

The Doctors' Association UK (DAUK) described the report as "excellent", and said the team behind it had listened to the views of many organisations. Dr Jenny Vaughan, the DAUK's law and policy lead, commented: "Clinicians are not above the law but going forward we must ensure that gross negligence manslaughter cases are only prosecuted where the healthcare worker has shown wilful dishonesty or been reckless in their practice.

"A greater understanding of the pressures of the system within which clinicians work is needed, while ensuring that patients and families get the answers they need in a timely way."

Independent Review of Gross Negligence Manslaughter and Culpable Homicide, independent review by Leslie Hamilton, published by the General Medical Council (GMC). Report.


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