Hamilton review into medical manslaughter: summary of recommendations

The GMC commissioned leading heart surgeon Leslie Hamilton to review gross negligence manslaughter and culpable homicide in medical practice after the case of Dr Hadiza Bawa-Garba rocked clinicians' trust in the regulator. Read a summary of the review recommendations below.

Review chair Leslie Hamilton
Review chair Leslie Hamilton

The Hamilton review found that doctors' trust in the GMC had been 'severely damaged' by the Bawa-Garba case - and sets out key recommendations to rebuild professional trust in the regulator.

All recommendations from the review directed at the GMC have been accepted in full. Click here to read the final report in full on the GMC website, and read a summary of its recommendations below.

Rebuilding the GMC’s relationship with the profession

  • The GMC must acknowledge that its relationship with the medical profession has been severely damaged by recent events and learn from those events in the way it regulates.
  • The GMC must take immediate steps to re-build doctors’ trust, including examining the processes and policies that have contributed to doctors’ loss of confidence.

Families and healthcare staff

  • Following an unexpected death, there should be close adherence to the professional and statutory duty of candour to be open and honest with the family of the deceased.
  • All healthcare service providers should have clear policies and a named lead.

Equality, diversity and inclusion

  • The GMC should provide support for doctors new to UK practice including information about cultural and social issues, the structures of the NHS, contracts and organisation of training, induction, appraisal and revalidation, professional development plans and mentoring.
  • The GMC should work to ensure that NHS organisations understand the importance of an inclusive culture within the workplace, education and training.
  • The GMC should work to understand and share the experiences and contributions of international doctors practising in the UK.
  • Healthcare organisations should have published measures and aspirations for diverse workforce representation.
  • Health organisations must ensure fairness through mechanisms such as equality, diversity and inclusion training, unconscious bias training, auditing and monitoring.

Systems and expert witnesses

  • Where a doctor is being investigated for gross negligence manslaughter or culpable homicide, the systems within the department where the doctor worked should be scrutinised.
  • Expert witnesses should provide a statement on their competence to provide an expert opinion, say where their views fit in the spectrum of views in their profession and to make clear whether they believe the conduct of a doctor under investigation was ''within the standards that could reasonably have been expected, belowthe standard expected; far below the standard expected; or whether the individual’sconduct was truly, exceptionally bad'.
  • Doctors should only provide expert opinion to the coroner, procurators fiscal, police, CPS, GMC or criminal court on matters which occurred while they were in active and relevant clinical practice.
  • The GMC should be open and transparent about how doctors providing expert evidence are recruited.
  • Any case brought before a medical tribunal based on expert evidence should be supported by evidence from two expert witnesses.

Local investigations and consistency

  • Authorities in the four UK countries should quality assure the effective application of local investigation frameworks for patient safety incidents, including 'a specific focus on how healthcare service providers address human factors issues within their investigation processes'.
  • To ensure a consistent approach, if a coroner feels that a doctor’s conduct might reach the threshold for gross negligence manslaughter, they should discuss this with the Chief Coroner’s Office before the police are notified.
  • Healthcare providers should offer support and guidance for doctors involved in an inquest or fatal accident inquiry.
  • When the police, or procurators fiscal in Scotland, receive notification of an unexpected death they should have early access to appropriate, independent medical advice to help determine whether an investigation is warranted.

GMC policies and processes

  • The GMC should be stripped of its right to appeal against medical tribunal decisions.
  • The GMC should work to help patients understand its role in regulating the medical profession within a system under pressure.
  • The GMC and MPTS should review guidance on interim sanctions in cases involving clinical incidents, including those that result in criminal convictions, such as gross negligence manslaughter.
  • Timescales for progressing fitness to practise cases to medical tribunals should be sped up.
  • Government must bring forward legislation to give the GMC greater discretion to determine which cases are appropriate for investigation and greater scope for disposing of fitness to practise cases consensually.

Reflective practice and supporting doctors

  • Doctors should use the GMC's 'reflective practitioner guidance to limit the possible relevance of any recorded reflections in legal cases.
  • UK governments should 'consider how these reflections could be given legal protection'.
  • The GMC should work with the NHS organisations and the profession to improve support for doctors under investigation.
  • Induction and support should be provided for all doctors returning to clinical practice after a 'period of significant absence'.

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