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[Editorial] Gross negligence manslaughter

Tags: General

An independent review of gross negligence manslaughter (GNM) and culpable homicide, published on June 6, describes how the conduct of the General Medical Council (GMC) relating to the case of Hadiza Bawa-Garba severely damaged its relationship with the doctors it is supposed to regulate. The review acknowledges several serious concerns about the GMC that emerged from this, and other similar, recent cases. These concerns include an over-representation of black and ethnic minority doctors referred to the GMC and a potential conflict in the responsibilities of the GMC both to ensure doctors are safe to practise and to maintain public confidence in the profession. This dual role leaves the GMC open to accusations that some decisions are less about patient safety and more about appeasing the public mood.

Multiple system-wide failings and human factors must align for patient harm to occur. To address these risks, the focus must move to learning and future prevention rather than assigning individual blame. However, the review describes a continuing failure within the GMC and criminal justice system to appreciate the importance of systems and human factors that are crucial for an increasingly stretched National Health Service. The review's authors were clear that, although their remit was the application of the GNM law (the law was reviewed separately last year), many people thought the law in England and Wales should be changed to require wilful recklessness or intent to harm for criminal prosecution. The focus by the criminal justice system on investigation of individual doctors without accounting for or understanding human factors allows the criminalisation of errors while failing to hold wider systems to account.

It is important to identify reckless or deliberate action. However, criminalising errors in a sector with inherent risk and apparent bias is a serious barrier to fostering proportionate, fair, and consistent regulatory and criminal justice systems that are essential to constructively engage the UK medical profession and to maintain patient safety. Although this review is a good first step towards acknowledging ongoing problems, the degree of change required in both the GMC and the criminal justice system to restore trust is not yet evident.

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