Medical examiners will investigate deaths in the NHS and the General Medical Council (GMC) will be stripped of its right to appeal fitness-to-practise decisions, following the conclusion of the rapid review of gross negligence manslaughter cases.
The recommendations arising from the Sir Norman Williams into gross negligence manslaughter in healthcare were reported earlier today. Health and social care secretary Jeremy Hunt has accepted them in full.
All deaths that are not referred to the coroner will be subject to a medical examiner’s scrutiny going forward, in a bid to “improve the quality and appropriateness of referrals of deaths to coroners and to increase transparency for the bereaved and offer them an opportunity to raise any concerns”.
In its evidence to the review, the Medical Defence Union (MDU) said it had supported 34 medical members with manslaughter investigations since 2014. According to the union’s submission, there is only one or fewer prosecutions for every 10 investigations, indicating a significant level of over-investigation of doctors.
Responding to the introduction of the new system, British Medical Association (BMA) council chair Dr Chaand Nagpaul said: “We welcome the sentiment that there must be a more consistent approach regarding prosecution for gross negligence manslaughter. While we wait to see the impact the roll-out of the medical examiner role, we still believe that the chief coroner should be consulted before any death is referred to the police for a gross negligence manslaughter investigation, and that a more robust, national approach must be adopted to minimise regional variations.”
The GMC will also lose its right to appeal fitness-to-practise decisions under the report’s recommendations. “This will help address mistrust that has emerged between the GMC and the doctors that it regulates,” the report explained.
Nagpaul commented: “The BMA has long-opposed the right of the GMC to appeal fitness-to-practise decisions. We know that doctors going through this process find it stressful enough, in many cases leading to anxiety and depression, without the added worry that any decisions made by the Medical Practitioners Tribunal Service can be overridden by the GMC taking the case to a higher court.”
“Therefore, we are glad that to hear the secretary of state announce that the regulator will no longer have this right. Removing this right brings arrangements for doctors in line with that of other healthcare professionals, where this responsibility rests with the Professional Standards Authority.”
Hunt ordered the rapid review after Dr Hadiza Bawa-Garba was struck off in January over the death of Jack Adcock. It was her “catalogue of errors” that left Jack Adcock’s sepsis undiagnosed. She was sentenced to two years in prison, suspended for two years, following his death.
Dr Pallavi Bradshaw, education services lead at the Medical Protection Society, welcomed Hunt’s full acceptance of the review’s recommendations.
Bradshaw said: “We want to see a culture that promotes and supports openness and learning from mistakes. The unintended consequences of a greater number of criminal sanctions, creates fear and may stunt the open, learning culture we all want to see. The implementation of the reviews’ recommendations will be a very positive step in the right direction.”
Dr Michael Devlin, head of professional standards and liaison at the MDU, added: “This is an excellent and thorough report and shows the review team really listened to the many organisations like the MDU who used their experience to contribute to the review.”
“Too many doctors in England are investigated and prosecuted for gross negligence manslaughter. Since 2014 the MDU has assisted just under 40 members with investigations.”
“We pointed out in our evidence to the review the distress manslaughter investigations cause for doctors involved, and the fear and concern this generates more widely among healthcare practitioners. There is an urgent need to improve the speed of the process and decision-making which would benefit healthcare professionals as it would the families of the deceased. The public interest lies in identifying and prosecuting only cases that are the medical equivalent of deliberately driving down the motorway on the wrong side.”
“The report recognises that a number of changes need to be made to the current system to ensure greater fairness and consistency for doctors, while ensuring families and relatives get the answers they need.”