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a stethoscope image cbJune 14 2018

The Williams Review into gross negligence manslaughter in healthcare has not recommended that doctors’ reflections should be given legal protection in the criminal courts. This is “a missed opportunity to promote a genuine learning culture,” the GMC has said.

Its comments follow the publication of the rapid policy review conducted by Professor Sir Norman Williams at the Health Secretary’s request made in February. The report covers:

  • the process for investigating gross negligence manslaughter;
  • reflective practice of healthcare professionals;
  • the regulation of healthcare professionals.

Among its recommendations is that “those professional regulators that have a power to require information from registrants for the purposes of fitness to practise procedures should have this power modified to exclude reflective material.”

However, the review recommends that registrants “will still be expected to cooperate with their regulator in line with their code of practice and to be open and honest with patients (or where appropriate the patient’s advocate, carer or family) when something goes wrong with their treatment or care (the professional duty of candour).”

In its submission to the review, the GMC had pointed out that it does not ask for doctors’ reflective notes in its investigations.

Responding to the publication of the review, Prof Sir Terence Stephenson, GMC Chair, said the regulator was “disappointed” by the recommendations. “We wholeheartedly support the Secretary of State’s desire to create a learning culture. The best way to achieve that is to legally protect doctors’ reflective notes,” he said. 

“We are concerned that, in accepting these recommendations, the Government is missing an opportunity to protect all doctors by not going ahead with a recommendation to enact this legal protection. We are also surprised that the Review has focussed on the GMC’s right of appeal given the case remains before the courts. If the recommendation to remove this is pursued, it will significantly reduce our ability to protect patients.”

The BMA's view is that doctors must feel able to report errors and reflect on mistakes openly. Dr Chaand Nagpaul, BMA Council Chair, said: “If we, as doctors, and the wider health service are to learn from these mistakes and to prevent such tragedies occurring, the NHS needs a dramatic shift away from the current culture of blame. Addressing these errors needs to consider the system as a whole, rather than targeting individual doctors, who are often doing their best in the most difficult situations, in an NHS which is under pressure without adequate staff, beds and facilities.

“Doctors must feel able to report errors and reflect on their own mistakes openly, without the fear of these reflections being used against them at a later stage. Only then can true improvements to patient safety be made.”

The medical indemnity companies have welcomed the report and the Health Secretary’s acceptance of the recommendations. The Medical Defence Union (MDU) said it was hopeful the recommendations will lead to fewer needless investigations of doctors, while the MDDUS has called for compulsory non-claims cover.

Dr Pallavi Bradshaw, Education Services Lead at the Medical Protection Society (MPS), said: “Since the Medical Practitioners Tribunal Service (MPTS) was created, we have consistently argued that the GMC should not have the power to appeal decisions by the tribunal service. 

“This power is both detrimental to the interests of healthcare professionals and unnecessary – as the Professional Standards Authority already has the authority to appeal decisions made by the MPTS and also by all other healthcare professional regulators.

“The removal of the GMC’s right to appeal was a central recommendation in our submission to the review. Doctors appearing before the MPTS would have cause for greater confidence that the tribunal and the GMC are moving further towards being separate, independent entities. This is good news for the profession.”

Links:
DHSC announcement on the Williams review     
‘Gross negligence manslaughter in healthcare’ report
GMC comment 
BMA comment
MPS comment 
MDU comment 
MDDUS comment         

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