GMC announces terms of reference for gross negligence manslaughter review

The GMC has announced the terms of reference for a UK-wide independent review into how gross negligence manslaughter is applied to medical practice, following the Bawa-Garba case.

The terms include whether sufficient regard is taken into all the circumstances in which the medical practitioner found themselves at the time of the fatality, such as system pressures, errors or failures, and whether there could be more clarity in GMC guidance and communication around the role of reflective practice.

Led by Dame Clare Marx, the review will bring together doctors, legal and criminal justice experts, patients and employers to examine what needs to be done to improve how existing law, procedures and processes are applied, while protecting the public and maintaining confidence in the medical profession.

Dr Hadiza Bawa-Garba case

The review has been launched amid widespread concern about the implications of the case of Dr Hadiza Bawa-Garba involving the death of a six-year-old boy, who was struck off earlier this year after a High Court challenge by the GMC. 

The review will also look at how the GMC should handle cases involving gross negligence manslaughter and the equivalent offence of culpable homicide in Scotland. The work will be informed by the outcome of the Williams Review, a rapid policy review into the issues pertaining to gross negligence manslaughter in healthcare, announced by health and social care secretary Jeremy Hunt last month.

Other key areas to be reviewed will include:

  • The quality of local investigations and the distinction between errors and failings which amount to gross negligence manslaughter.
  • Equality, diversity and inclusion issues, including whether there is fair and consistent representation of particular groups of doctors with protected characteristics in allegations of gross negligence manslaughter.
  • The lack of corporate manslaughter prosecutions against healthcare organisations as compared to individual healthcare professionals within organisations facing gross negligence manslaughter prosecution, and any differences in approach between the UK countries and the possible reasons for this.
  • The role of medical expert evidence and its appropriateness in relation to the practitioners being investigated.
  • The extent of emotional, pastoral and other support available for medical practitioners who are the subject of an allegation or charge of gross negligence manslaughter.

Dame Clare, an orthopaedic surgeon at Ipswich Hospital NHS Trust, Chair of the Faculty of Medical Leadership and Management, and former president of the Royal College of Surgeons of England, said: ‘Doctors are often working in an immensely pressurised system where mistakes can happen. This review aims to encourage a renewed focus on a just culture, reflective practice and individual and systemic learning. It’s vital that accountability is appropriately apportioned between healthcare systems and individual doctors and that doctors are supported to act on concerns.’

The review will be undertaken by a working group which will be finalised and published shortly. It will include an initial consideration of the issues, information acquired through research and consultation, including written submissions from a range of organisations and individuals across the UK. They may also follow this up with further direct conversations and oral evidence.

The group’s learnings will be used to develop and refine recommendations for a final report, which will be presented first to the GMC and then published. The working group will aim to report its findings to the GMC by the start of 2019.

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