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Doctors must feel able to report errors and reflect on mistakes openly, says BMA

Responding to the Health Secretary’s announcement of a number of patient safety measures1 and recommendations from Professor Sir Norman Williams’ review on gross negligence manslaughter2, Dr Chaand Nagpaul, BMA council chair said:

“As we have seen with recent cases, when mistakes occur in the medical environment, the outcome can be tragic in leading to an unexpected death, with extreme distress both for grieving families who have lost loved ones and to doctors and other healthcare professionals who may lose their career as a result.

“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. While the assurance that regulators will no longer be able to request reflective material during their investigations is a welcome step, we still believe they should be given full legal protection, which would foster an open environment to apply systemic analysis to adverse events to improve patient safety.

“The BMA has long-opposed the right of the General Medical Council (GMC) to appeal fitness-to-practise decisions. We know that doctors going through this process find it stressful enough, in many cases leading to anxiety and depression, without the added worry that any decisions made by the Medical Practitioners Tribunal Service (MPTS) can be overridden by the GMC taking the case to a higher court. Therefore, we are glad that to hear the Secretary of State announce that the regulator will no longer have this right. Removing this right brings arrangements for doctors in line with that of other healthcare professionals, where this responsibility rests with the Professional Standards Authority.

“In our evidence to this review, we raised several concerns about the growing number of doctors being investigated for gross negligence manslaughter, and the inappropriate criminalisation of medical error, especially in the context of wider systemic factors. We will therefore be monitoring closely how – as recommended by Sir Norman – prosecutors review where the bar is set for pursuing criminal cases. 

“We welcome the sentiment that there must be a more consistent approach regarding prosecution for gross negligence manslaughter. While we wait to see the impact the roll-out of the medical examiner role, we still believe that the chief coroner should be consulted before any death is referred to the police for a gross negligence manslaughter investigation, and that a more robust, national approach must be adopted to minimise regional variations.

“Likewise, the data programme announced today must ensure it takes account of the workplace pressures and different contexts in which doctors work. Comparative data for individual doctors may not be the best way to address safety and often disregards the wider factors affecting patient outcomes or the context in which a professional is practising.

“Safely delivered patient care is a doctor’s number one concern, but it can only be guaranteed if employers, regulators and the government recognise the need for a learning culture and address the system pressures on doctors’ ability to provide care to patients. Furthermore, we cannot stress enough how important resources and funding are in guaranteeing patient safety, ensuring a sufficient number of doctors and healthcare workers are able to meet growing demand. The Prime Minister recently announced a long-term funding plan for the NHS, and this opportunity must be used to provide enough staff and ease the system pressures that contribute to mistakes being made.

“System leaders – from government to employers – must work collaboratively to create an environment in which staff work with adequate resources to provide safe quality care, and also feel confident to raise concerns, show candour, and to reflect and learn. To fail to do so is to fail those staff and, crucially, to fail patients and their families too.”


Notes to editors

The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

1. For full details and press release, please contact the Department for Health and Social Care’s media office.

2. Read the full report here.

For further information please contact:

British Medical Association, BMA House, Tavistock Square, London, WC1H 9JP
Telephone: 020 7383 6448 
Email: [email protected]
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