The Bawa-Garba case and its wider implications

On 13 August 2018 the Court of Appeal overturned the High Court’s decision to remove Dr Bawa-Garba from the medical register following the successful outcome of her appeal.

Responding to the news, Dr Chaand Nagpaul, BMA council chair, said: "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.”

“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. 

“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. 

“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.” 

The BMA had set up specific pages related to the Bawa-Garba case updating doctors on legislation regarding Medical Negligence Manslaughter and the Reviews that have been commissioned following the ruling on this specific case. 

Details of the case of Dr Bawa-Garba and its wider implications can be found by clicking on the link. The pages will be regular updated by the BMA. 

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.Below are some excerpts from the BMA's Response to the Sir Norman Williams Review. 

Purpose of the Review

Working with stakeholders, the Review will consider:

  • 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;
  • 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;
  • 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 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.

The BMA has also updated its guidance regarding reflective practice. Read more here...

In its meetings with various stakeholders since the ruling, the BMA:

  • has secured a commitment from the GMC that it will never ask for reflective statements as part of its investigations. In addition, the GMC is reviewing all its documentation to make sure that it is absolutely clear that it does not seek reflective notes from third parties such as Royal Colleges.
  • will be contributing, with others, to the development of GMC guidance for all doctors and medical students on how to approach reflective practice (due to be published by the GMC in the summer)
  • has updated its own guidance about reflective practice.


Updated 23rd August 2018