Updated 30 July 2018

Dame Clare Marx has now stepped down as Chair of the review, as she will be taking up the role as Chair of the GMC from January 2019. Leslie Hamilton has been appointed as the new Chair of the review. Please see our press release for more information.

GMC announces terms of reference for gross negligence manslaughter review

The General Medical Council (GMC) has announced the terms of reference for a cross-UK, independent review into how gross negligence manslaughter, and culpable homicide (in Scotland), are applied to medical practice.

Led by Dame Clare Marx and covering the whole of the UK, the review will bring together doctors, legal and criminal justice experts, patients and employers.

They will examine what needs to be done to improve how existing law, procedures and processes are applied, whilst still protecting the public and maintaining confidence in the medical profession. The review will also look at how the GMC should handle cases involving gross negligence manslaughter and culpable homicide (in Scotland)*.

The work will be informed by the outcome of the Williams Review, a rapid policy review into the issues pertaining to gross negligence manslaughter in healthcare, announced by the Secretary of State for Health and Social Care last month.

The review aims to support just decision making and consistency in standards and processes where there are allegations of gross negligence manslaughter.

Some of the other issues outlined in the terms of reference include:

  • The quality of local investigations and the distinction between errors and failings which amount to gross negligence manslaughter.
  • Equality, diversity and inclusion issues, including whether there is fair and consistent representation of particular groups of doctors with protected characteristics in allegations of gross negligence manslaughter.
  • The lack of corporate manslaughter prosecutions against healthcare organisations as compared to individual healthcare professionals within organisations facing gross negligence manslaughter prosecution, and any differences in approach between the UK countries and the possible reasons for this.
  • The role of medical expert evidence and its appropriateness in relation to the practitioners being investigated.
  • Whether sufficient regard is taken into all the circumstances in which the medical practitioner found themselves at the time of the fatality, such as system pressures, errors or failures.
  • Whether there could be more clarity in GMC guidance and communication around the role of reflective practice.
  • The extent of emotional, pastoral and other support available for medical practitioners who are the subject of an allegation or charge of gross negligence manslaughter.

Dame Clare said:

‘Doctors are often working in an immensely pressurised system where mistakes can happen. This review aims to encourage a renewed focus on a just culture, reflective practice and individual and systemic learning. It’s vital that accountability is appropriately apportioned between healthcare systems and individual doctors and that doctors are supported to act on concerns.’

The review will be undertaken by a working group which will be finalised and published shortly. It will include an initial consideration of the issues, information acquired through research and consultation, including written submissions from a range of organisations and individuals across the UK. They may also follow this up with further direct conversations and oral evidence. The group’s learnings will be used to develop and refine recommendations for a final report, which will be presented first to the GMC and then published.

The working group will aim to report its findings to the GMC by the start of 2019. 

*In the terms of reference, ‘gross negligence manslaughter’ and ‘culpable homicide’ are referred to collectively as ‘GNM/CH’.