Medical profession at 'crisis point', warns GMC manslaughter review chair

The medical profession is in crisis and working in a climate of 'toxic fear', according to the chair of the gross negligence manslaughter review commissioned by the GMC following the Bawa-Garba case.

Dr Leslie Hamilton

In a progress update published by the GMC, Dr Leslie Hamilton - who replaced Dame Clare Marx as chair of the independent review in July - warned that health leaders had a lot of work to do to regain doctors’ trust.

‘The medical profession is at a crisis point,' Dr Hamilton said. 'There is a climate of toxic fear. For the first time ever, places at medical school were available through "clearing". We have heard reports that more trainees are keen to take an immediate break after completing their foundation training, with burnout and better work-life balance being the motivators behind their decision. All leaders in the health system need to win back the confidence of doctors.'

Dr Hamilton’s revealed that the gross negligence manslaughter (GNM) review’s working group received more than 800 written submissions from doctors, patients and other parties. A key message coming through ‘very forcibly’ related to the importance of a competent and fair investigation system that encourages a culture of learning rather than blame.

Bawa-Garba case

‘The high profile conviction of Dr Hadiza Bawa-Garba, a trainee paediatrician, has understandably caused alarm within the profession,’ Dr Hamilton wrote. ‘Doctors report that this case has created a climate of fear within the medical profession, which is compounded by the increasing pressure of work, particularly for many trainees, who feel unsupported.’

Dr Bawa-Garba, was convicted of GNM following the death of a patient at the Leicester Royal Infirmary and later struck off the medical register after the GMC challenged a medical tribunal ruling that she should face a 12-month suspension. Following a high-profile appeal, the decision to strike off Dr Bawa-Garba was overturned earlier this year.

The campaigning group Doctors Association UK - who launched a ‘learn not blame’ campaign in response to the Bawa-Garba case - told GPonline they felt Dr Bawa-Garba’s successful appeal was a ‘very small step towards a more just NHS where doctors can practise without the fear that the mistakes that they make under pressure are going to put their personal reputation and their professional life on the line’.

Reflective notes

Another key area respondents to the GNM review have focused on is reflective practice. A GPonline poll found that 70% of GPs do not feel it is safe to reflect in writing in the wake of the Bawa-Garba case, during which it was widely reported that notes from her eportfolio had been used against her.

This led many organisations, including the BMA, to call for doctors’ reflections to be granted legal privilege. The government rejected this view earlier this year, but the GMC has since published reflective practice guidance for all doctors.

The mental wellbeing of doctors undergoing investigation is also a major focus of the review, and Dr Hamilton admitted in his blog that he himself had had to deal with ‘psychological pressure’ following a patient’s unexpected death during his time as a cardiac surgeon, adding: ‘How the law of gross negligence manslaughter is applied in medicine needs to be reviewed with urgency.’

The review’s working group will be running workshops across the UK in the coming months to gain further understanding of the views of doctors and their representative organisations. This will be followed by the submission of oral evidence later in the year.

A report will be published in early 2019.

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