Medico-Legal Committee

Last updated:

BMA response to Sir Norman Williams Review

A rapid policy review into the issues pertaining to Gross Negligence Manslaughter (GNM) was commissioned by Health and Social Care secretary Jeremy Hunt in the aftermath of the Dr Bawa-Garba ruling.


Purpose of the Review

Working with stakeholders, the Review will consider:

  1. how we ensure healthcare professionals are adequately informed about:
    • where and how the line is drawn between gross negligence manslaughter (GNM) and negligence;
    • what processes are gone through before initiating a prosecution for GNM;
    • in addition, provide any further relevant information gained from engagement with stakeholders through this review about the processes used in cases of gross negligence manslaughter;
  2. how we ensure the vital role of reflective learning, openness and transparency is protected where the healthcare professional believes that a mistake has been made to ensure that lessons are learned and mistakes not covered up;
  3. lessons that need to be learned by the General Medical Council (GMC) and other healthcare professionals' regulators in relation to how they deal with professionals following a criminal process for gross negligence manslaughter.


Oral evidence

The BMA gave oral evidence to the rapid review on 4 April 2018. Given the fact that these issues affect the whole profession, a number of colleagues from different branches of practice attended the hearing.

The BMA reiterated the significant and wide-ranging impact of the ruling against Dr Bawa-Garba on doctors in general. We provided evidence of our concerns and recommendations across the whole pathway of GNM.



The BMA firmly believes that through the recommendations that it is advocating, it is possible to reduce the number of investigations and prosecutions and promote this culture of openness and transparency.

Adoption of the recommendations will in our opinion, lead to an improved and more coordinated and consistent approach between the Police, the Coroner, the Crown Prosecution Service and the General Medical Council when dealing with a doctor who is accused of GNM.

Some of our key recommendations include:

  • That any GNM cases in healthcare are referred only after consultation with the Chief Coroner.
  • That a national police unit is established to investigate GNM cases in healthcare.
  • The test for bringing a prosecution is a difficult balancing act and to introduce consistency in a relatively small number of cases, it should be for the Director of Public Prosecutions to personally authorise all prosecutions involving accusations of GNM in a healthcare setting.
  • That only experts who are in active clinical practice and hold a licence to practise are instructed in GNM cases.
  • That it should be compulsory for all expert witnesses to go through core training including report writing, courtroom skills, cross examination and criminal law and procedure.
  • That a mandatory human factors training programme is developed for everyone involved in the prosecution process for GNM in healthcare.
  • That the exception reporting process is standardised, extended to all doctors and a national database for exception reports is established so that data can be properly analysed and used to improve training and working experiences for doctors and outcomes for patients.
  • That legal protection is provided to reflections in all education and training documents.
  • That Section 35A (1A) of the Medical Act 1983 is amended so it excludes information provided for the sole purpose of education and training.
  • That the GMC should lose its right to appeal Medical Practitioners Tribunal Service (MPTS) decisions.
  • That everyone involved in the prosecution process receive training on cognitive bias.

Read our full response (PDF)


GMC review

The BMA will also participate fully in the independent review by the GMC into how gross negligence manslaughter, and culpable homicide (in Scotland), are applied to medical practice.

Read about the GMC review


Contact us

For further information about this project contact Reena Zapata, Senior Policy Advisor, Medico Legal Committee.

Find out more about the Medico legal committee and see how you can get involved.