Health Service Focus

Rebuilding trust after Bawa-Garba

In the wake of a review into gross negligence manslaughter and culpable homicide laws, Charlie Massey, chief executive of the General Medical Council (GMC), reflects on how the profession can begin to regain trust with doctors.

We commissioned the independent review into how the laws of gross negligence manslaughter and culpable homicide are applied to medical practice in 2018, against a backdrop of high anxiety in the medical profession. 

That fear arose from the tragic death of Jack Adcock, but it was about much more: the wider systemic issues that have troubled the profession for some time, in a profession which finds itself working under extreme pressure, and in environments where the risk of patient deaths is a constant. 

It should be borne in mind that cases like this are very rare. The vast majority of doctors who face suspension or erasure have not made innocent mistakes against a background of system pressures, but find themselves before a tribunal for behavioural or probity issues. 

But at the heart of the concerns we heard was the desire that, when those mistakes do happen, systems and regulators can support learning so that they can be avoided in future. That desire is shared by doctors and patients, and by the GMC. 

If you’re working in healthcare in the UK today, you might ask how the working group’s report will change things for you. Patient demand remains high; resources remain scarcer than any of us would wish; the likelihood of mistakes happening hasn’t gone away. 

But some things have changed over the last year. It is clear there is now consensus across the health service on a range of issues that affect welfare and your ability to provide the care you want to give to patients. 

Making the NHS a better place to work and retaining the doctors we already have is now universally recognised as the bedrock for building a sustainable workforce. There cannot be a single leader in the health system who does not recognise the need for a step change in culture and leadership, and a renewed focus on improving the wellbeing and workplaces of the people on whom the service is built. 

Put simply, we have reached a tipping point, and I believe that Leslie Hamilton’s report will play a key role in ensuring that positive changes are made. 

The report raises important issues and recommendations for the whole system, not just the GMC. Its recommendations are wide-ranging as the issue hinges on how all of the organisations involved – employers, coroners, police, the judiciary and regulators – interact after an unexpected death. 

For our part, we accept all of the recommendations. We will take those in our name forward but will also convene others to press towards a just culture where mistakes can be learnt from, a culture which benefits patients, doctors and other healthcare professionals. 

Some of that work is already underway. We have, alongside others, provided clearer advice on doctors’ reflective practice, for example, and are rolling out human factors training to all our fitness to practice decision makers. 

But alongside that work will sit the findings and actions from two other related reviews: independent research by Roger Kline and Doyin Atewologun into why some groups of doctors are referred to us for fitness to practise concerns more than others; and a UK-wide review of medical students and doctors’ wellbeing, led by Prof Michael West and Dame Denise Coia. 

This report won’t change things on its own. It will take work with many other bodies to embed its recommendations. And it will take determination to navigate institutional obstacles to reach our goal of a just culture and a fair system in which doctors and other healthcare professionals can be supported to learn and thrive. 

The tipping point we find ourselves at is an opportunity that mustn’t be squandered. None of us want to see a just culture just for its own sake, but because ultimately it will benefit patients. That is an aim we can all agree on and I urge doctors, employers and others to join us in acting on the recommendations set out by Leslie Hamilton’s working group.

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