Doctors being investigated after the death of a patient should expect official investigations to take into account their working environments and pressures.
The GMC-commissioned review “Independent review of gross negligence manslaughter and culpable homicide in medical practice” came after the events that lead to the unfortunate death of ack Adcock, a six-year old boy and that actions taken by the GMC against Dr Hadiza Bawa-Garba, a paediatric trainee found guilty in 2015 of gross negligence manslaughter.
The report found that “The decision of the GMC to seek this doctor’s erasure from the medical register following her criminal conviction caused consternation and outrage across large sections of the medical profession in the United Kingdom (UK) and overseas. Some described it as a ‘toxic fear’. Many questioned why an individual trainee working under pressure should carry the blame for what they considered to be wider systemic failings within her working environment. They recognised her situation in their own working lives…”
The report also found that “…vulnerability felt by many doctors reflects their sense of working in healthcare services that are under considerable strain and where individuals trying to do their best for their patients can too easily be blamed for mistakes arising from wider system failures.”
The reports conclusions and recommendations include:
- The GMC must acknowledge that its relationship with the medical profession has been severely damaged by recent events and then the GMC must learn from those events in the way it regulates.
- The GMC must take immediate steps to re-build doctors’ trust in its readiness to support them in delivering good medical practice for patients. This should include examining the processes and policies that have contributed to doctors’ loss of confidence and considering how it can better support a profession under pressure as well as promoting a fair and just culture.
- The GMC should work with healthcare service providers, national bodies and representatives of overseas doctors to develop a suite of support for doctors new to UK practice.
- Where a doctor is being investigated for gross negligence manslaughter or culpable homicide, the appropriate external authority should scrutinise the systems within the department where the doctor worked. Where the doctor is a trainee, this should include scrutiny of the education and training environment by bodies responsible for education and training.
Charlie Massey, Chief Executive of the General Medical Council, said:
“We share this report’s desire for a just culture in healthcare, and acknowledge that we have a crucial role in making that happen. We are already making progress. Work is underway to address some of the key issues raised in this report but there is plenty more for us to do.
“Regardless of any geographic and legal differences, there needs to be greater consistency in the response to an unexpected death. Support for, and involvement of, patients’ families must be a priority before, during and even after an investigation into an unexpected death. Doctors need to feel they are part of a just culture when things go wrong.
“The report highlights the new evidence that the public are acutely aware of the pressures facing UK heath systems, and that this can affect their confidence in the care doctors are able to provide.”
‘This reinforces why we must all do what we can to make sure doctors are training and working in safe environments, for the benefit of patients, and why the GMC must work with the system to effect change.
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