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Reaction: Dr Hadiza Bawa-Garba reinstated to the medical register

Charlie Massey, GMC chief executive:  

We fully accept the Court of Appeal’s judgment. This was a case of the tragic death of a child, and the consequent criminal conviction of a doctor. It was important to clarify the different roles of criminal courts and disciplinary Tribunals in cases of gross negligence manslaughter, and we will carefully examine the court’s decision to see what lessons can be learnt.

As the independent regulator responsible for protecting patient safety we are frequently called upon to take difficult decisions, and we do not take that role lightly. We are sorry for the anguish and uncertainty these proceedings have had on Jack’s family, Dr Bawa-Garba and the wider profession. This was a complex and unusual case; while the decisions we took were in good faith, we know that investigations and hearings are difficult for everyone involved.

Although gross negligence manslaughter cases in medicine are extremely rare, this case has exposed a raft of concerns, particularly around the role of criminal law in medicine, which is why we have commissioned an independent review to look at how it is applied in situations where the risk of death is a constant, and in the context of systemic pressure.

It has also been a lightning rod for the profession, highlighting issues that have gone unaddressed for far too long. While the GMC is not responsible for decisions to prosecute gross negligence manslaughter cases, we have reflected on what we can do to address the concerns we’ve heard about this case. Doctors have rightly challenged us to speak out more forcefully to support those practising in pressured environments, and that is what we are increasing our efforts to do.

Dr Chaand Nagpaul, BMA chair:

We welcome today’s judgement of this important case reversing the erasure of Dr Bawa-Garba from the medical register and restoring the decision of the Medical Practitioners Tribunal. We recognise the hard work of all involved, including Dr Bawa-Garba’s legal team, in securing a positive outcome. The BMA was pleased to be able to intervene in this case on behalf of the entire medical profession. 

We hope that Dr Bawa-Garba will now rightly be given space to resume her career. 

Today’s successful appeal in no way detracts from the tragic circumstances of this case and the unexpected death of a young boy, and we once again send our deepest condolences to Jack Adcock’s family. 

The GMC’s successful high court appeal in January, which overturned the Medical Practitioners Tribunal’s (MPT’s) 12-month suspension of Dr Bawa-Garba and resulted in her erasure from the medical register, caused widespread alarm amongst doctors and undermined the role of the Medical Practitioners Tribunal’s Service (MPTS). We know that doctors going through MPT hearings find it stressful enough and the perception of a risk of double jeopardy can only exacerbate this problem. 

Today’s judgement vindicates the BMA’s position that the MPTS is the right body to determine a doctor’s future in these complex and difficult cases, in which wider systemic pressures affecting patient safety need to be considered. It demonstrates that our call, acted upon by the Government, to remove the GMC’s right of appeal of MPTS decisions, was the right one. 

It also raises serious questions over the GMC’s ill-judged handling of the case. As a regulator it has lost the confidence of doctors and must now act to rectify their relationship with profession.

Lessons must be learnt from this case which raises wider issues about the multiple factors that affect patient safety in an NHS under extreme pressure rather than narrowly focusing only on individuals.

Today’s judgement is a wake-up call for the Government that action is urgently needed to properly resource the NHS and address the systemic pressures and constraints that doctors are working under and which compromise the delivery of high-quality, safe patient care.

Dr Rob Hendry, medical director at the Medical Protection Society (MPS):

We are very pleased the appeal submitted by Dr Bawa-Garba’s legal team has been successful. MPS supported Dr Bawa-Garba for seven years; we know how much this will mean to her, and to the profession. The strength of feeling on this case amongst our members and the wider healthcare community has been unprecedented.

It is vital that lessons are now learned to avoid other doctors having to go through the same ordeal. A gross negligence manslaughter conviction should not automatically mean that a doctor who has remediated and demonstrated insight into their clinical failings is erased. The removal of the GMC’s power to appeal MPTS decisions – a recommendation by Sir Norman Williams which was accepted by the Government – must also take effect quickly.

While we await the introduction of the necessary legislation, the GMC should publicly commit to stop using their power of appeal immediately. This would be a real statement of intent from the GMC as it seeks to regain the trust of the profession. Swift implementation of the William’s review recommendations, and timely completion of the GMC review led by Leslie Hamilton, will be key in rebuilding confidence.

Dr Chandra Kanneganti, BMA GP Committee member and chair of the British International Doctors Association (BIDA):

I think patient safety is the winner here. The judge said that the tribunal looked at all the issues. It looked in detail about systemic failures, how to support Hadiza, how to get her back to training – they looked at everything – so they could not understand why she should not be back on the GMC register.

I think it’s a great judgement. This will encourage doctors, including our GP colleagues, to reflect more now, now that any error they may do, they have some support. We have a support culture not blame culture. This is a huge impact – not just nationally – internationally now because everyone is looking at us to see how this will go on. This will go on to become a good culture where everybody can reflect on the things that go wrong and try to learn from their errors, not blame each other for that.

Professor Derek Bell, president of the Royal College of Physicians of Edinburgh:

We note today’s ruling and are pleased that Hadiza Bawa-Garba has won her Court of Appeal challenge. Looking ahead, it is vital that lessons are learned from this case. It is important to explore the wider issues that create the potential for patient harm, particularly understaffing. We must encourage an open and no-blame culture where the focus is on identifying and addressing risks and failures in systems of governance, and where all staff and patients are empowered to raise concerns over standards of care. Only by doing so can we ensure that we learn from cases such as this and prevent similar tragedies from occurring.

Sarah Harris, regulatory partner at law firm Kingsley Napley LLP:

Practitioners will welcome this decision, which raises further awareness that poor practice by doctors may well, in many circumstances, be partly attributable to systematic failings in the hospital setting.  With increasing cuts and under-funding, health practitioners will be pleased to hear that such factors are properly being considered by fitness to practise panels and that the Courts are supporting those panel decisions.