GMC manslaughter review maps route to rebuild trust after Bawa-Garba case

Doctors' confidence in the GMC has been 'severely damaged' by the case of Dr Hadiza Bawa-Garba, according to a landmark review of medical manslaughter that sets out steps to rebuild trust.

The independent review commissioned by the regulator calls for legal protection for doctors' reflective notes, greater controls on expert witnesses and measures to end a postcode lottery in how gross negligence manslaugher laws are applied across England.

The review chaired by leading surgeon Leslie Hamilton calls for scrutiny of 'the systems within the department where the doctor worked' in all cases where a doctor is being investigated for gross negligence manslaughter or culpable homicide.

It backs plans to strip the GMC of its right of appeal against medical tribunal decisions, echoing the findings of a rapid review commissioned by the government in the wake of the Bawa-Garba case.

Fitness to practise

The review also calls for the GMC to speed up processing of fitness to practise cases to bring them before a medical tribunal more quickly, and for the regulator to have greater scope to dispose of cases consensually rather than proceeding to a full investigation.

The review findings come just two months after Dr Bawa-Garba - a junior doctor convicted of gross negligence manslaughter following the 2011 death of six-year-old Jack Adcock at Leicester Royal Infirmary - was granted permission by a medical tribunal to return to work.

The decision that Dr Bawa-Garba could return to work under strict supervision came just over a year after the GMC won a High Court case and struck her off the medical register - overruling a 12-month suspension initially imposed by a medical tribunal.

This decision to strike off the Leicester junior doctor was later overturned on appeal, but only after a hugely damaging period that sparked widespread anger across the medical profession over a 'culture of blame' in the NHS.

GMC trust

LMC leaders at the time backed a vote of no confidence in the GMC, some doctors began a boycott of written reflection for appraisal, and former health secretary Jeremy Hunt said publicly he was 'deeply concerned' about the unintended consequences of the GMC's actions.

GMC chief executive Charlie Massey said: 'We commissioned this independent review following the tragic death of Jack Adcock and the prosecution and conviction of Dr Hadiza Bawa-Garba for gross negligence manslaughter.

'The series of subsequent proceedings that followed have undoubtedly affected our relationship with the doctors we regulate. The report says we must rebuild trust with the profession, and we fully accept this challenge.

'Having reflected as an organisation, we are committed to acting on that and taking forward all the recommendations in this report directed to us.'

Medical error

BMA chair Dr Chaand Nagpaul said: 'When an error is made in a medical environment that is so serious that a patient loses their life, though incredibly rare, it is a tragedy, causing unspeakable distress to the person’s family and loved ones, as well as to the health professionals involved.

'We therefore welcome this review, which takes on board many of the points the BMA raised in its own submission - not least on the need for a just culture based on learning rather than blame.'

He backed the review's call for the GMC to be stripped of powers of appeal against medical tribunal decisions and its support for legal protection for reflective notes.

Dr Nagpaul added: '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. The BMA has repeatedly called for systemic pressures to be explored and recognised when errors occur.'

The BMA chair added: 'That doctors from black and ethnic minority communities are more vulnerable to complaints and investigation, and are disproportionately represented in fitness-to-practise proceedings, is another concern that the BMA has long been raising, and we welcome this review’s work and recommendations in this area.

'A call for all healthcare systems to ensure an inclusive culture within workplace, education and training environments, is core to the BMA’s values and its vision for the NHS.'

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