In 2015, Dr Hadiza Bawa-Garba, a junior doctor specialising in paediatrics, was found guilty of gross negligence manslaughter in relation to the death of Jack Adcock, who suffered heart failure after going into septic shock. Dr Bawa-Garba received a 2-year suspended criminal sentence, which she appealed. Her appeal was rejected in December 2016.
In June 2017, the Medical Practitioners Tribunal Service (MPTS) rejected an application that Dr Bawa-Garba should be struck off, instead deciding she should be suspended from clinical practice for 12 months. The GMC rejected this decision and took the MPTS to the High Court, and in January 2018 won its appeal which argued that Dr Bawa-Garba should be struck off from the medical register. Dr Bawa-Garba then appealed the High Court ruling, and on 13 August 2018 the Court of Appeal ruled in Dr Bawa-Garba’s favour. The GMC has fully accepted this judgement.
The Bawa-Garba case has raised a number of serious concerns among the healthcare profession, including: the applicability of gross negligence manslaughter within healthcare; the degree to which an individual can be deemed culpable within a complex and stretched healthcare environment; and the implications for reflective practice and a learning culture within the NHS. A number of reviews and initiatives have been set to explore these issues and provide clarity for both the healthcare profession and the public. The RCOG fully supports this work, and has contributed to the reviews established by a number of national bodies as well as continuing to develop our own initiatives to support our trainees and members.
On 6 February 2018, then Secretary of State for Health and Social Care, Jeremy Hunt MP, launched an urgent review of medical malpractice cases. The review was led by Professor Sir Norman Williams, former President of the Royal College of Surgeons.
The review reported on 11 June 2018 and made a number of recommendations about:
- Allegations of gross negligence manslaughter against healthcare professionals
- Reflective practice
- Professional regulation
- The President gave oral evidence to the Williams review on behalf of the RCOG
- The RCOG also submitted written evidence (PDF 775kb) to the review panel
Both our written and our oral evidence were informed by the work of the RCOG’s Supporting Our Doctors Task Group, Workforce Task Group and Trainees’ Committee.
On 22 February the GMC announced that it had commissioned Clare Marx, past President owf the Royal College of Surgeons, to lead a UK-wide independent review into how gross negligence manslaughter and culpable homicide (in Scotland) in healthcare are initiated and investigated in the UK. On 30 July, Clare Marx stepped down as Chair of the review following her appointment to the role of Chair of the GMC. Leslie Hamilton, a member of the working group, is the new Chair of the GMC review. Full details of the review are available on the GMC website.
- The RCOG submitted written evidence (PDF, 661kb) to the review panel, again based on input from the RCOG’s Supporting Our Doctors Task Group, Workforce Task Group and Trainees’ Committee
- The RCOG has also arranged a bespoke round-table with members of the review panel and RCOG representatives, including members of the RCOG’s Trainees’ Committee, Supporting Our Doctors Task Group and Professional Development Committee. This round-table will provide an opportunity for the RCOG to highlight the specific concerns our workforce has about the issues raised by the Bawa-Garba case, recognising that O&G is a high-risk, high-litigation specialty. The round-table will take place in September, after which we will share key points with our membership.
The review is holding workshops with doctors and other stakeholders across the UK in September and October. You can register your interest in attending on the GMC website.
RCOG support for doctors
The RCOG is committed to ensuring our members receive better support from the College to manage workplace challenges. We have a number of initiatives under way which aim to address the issues raised by our members formally via surveys and focus groups as well as more informally and anecdotally.
Our Supporting Our Doctors Task Group is piloting a number of initiatives to explore how the College can better support our members, including how to resolve more issues at a local level where possible and prevent inappropriate referrals to the GMC. Find out more about this work.
Our Workforce Task Group is also developing initiatives aimed at improving the welfare of the workforce. Find out more about this work.
- Guidance on reflective practice (published September 2018 by the AoMRC, GMC, COPMeD and Medical Schools Council)
- Reflective practice toolkit (published September 2018 by the AoMRC and COPMeD, for use alongside the above guidance)
- GMC guidance: Raising and acting on concerns about patient safety
- Letter from NHS England to Responsible Officers (PDF, 129 kb) regarding the use of written reflective practice in appraisals
- Article in the BMJ about how doctors should use e-portfolios in wake of the Bawa-Garba case (8 Feb 18)
Information about the Bawa-Garba case
- Health Select Committee correspondence with the GMC about the Bawa-Garba case (published 13 Feb 18)
- Blog by GMC Chief Executive Charlie Massey, published in the BMJ (30 Jan 18)
- BMA response to the Bawa-Garba ruling (30 Jan 18)
- Medical Protection Society statement on use of e-portfolio content in the Bawa-Garba case (30 Jan 18)
- AoMRC statement on the Bawa-Garba ruling (26 Jan 18)
- Medical Protection Society response to the judgement (25 Jan 18)
- GMC statement on High Court judgement (25 Jan 18)
- Timeline of events leading up to the High Court ruling on 25 January 2018