Estimated read time: 6 mins
Medical expert opinion is crucial in criminal,
civil, coronial and GMC processes. It can determine whether or not a
case, an investigation or in the worst scenario a conviction for gross
negligence manslaughter (GNM) is pursued or closed. In the family courts,
medical opinion is relied upon in relation to decisions where the lives and
wellbeing of children are at stake.
expert opinion is undoubtedly important for all involved as it can lead to
changes that improve patient safety and ensure a just outcome. However, it can also
lead to a doctor losing their career.
therefore vital that a large and diverse range of doctors make themselves
available to provide medical expert opinion. Sadly, however, this is not the
case and this is why Medical Protection has launched an ongoing campaign to
encourage more doctors to take on this work, and to reduce the barriers that
stop them from doing so.
Protection are not the first to raise this problem. Three reviews in the past
decade have highlighted the issues around the recruitment of experts. The
report of the Working Group on Experts in the Family Courts1 highlights that there is
currently a lack of appropriately qualified doctors willing to undertake expert
work. This leads to delays in the judicial process, with potentially harmful
consequences for children and families. Instruction of an expert often relies
on word of mouth, and there is no central register. The Williams Review into
Gross Negligence Manslaughter in Healthcare2 highlights similar concerns, as does
Leslie Hamilton’s 2019 Independent Review of Gross Negligence Manslaughter and
Culpable Homicide.3 Both these reviews called for improvements in the training of medical experts,
and support for those wishing to undertake the work.
the Williams and the Hamilton reviews recommended that experts should be in
current, relevant, clinical practice. Ongoing involvement in clinical work
helps to ensure that experts are up to date; it also allows for a more
realistic assessment of what is ‘reasonable’, as opposed to ‘textbook’, or
‘gold standard’ practice. This is because those working within a system are
best placed to understand its challenges and imperfections. Such understanding
is crucial as systems issues often play a key role when things go wrong in
medicine; they inevitably impact on the care provided by a doctor, so they
deserve consideration within an expert report.
looked at the role of the medical expert and stated that it should be mandatory
for expert reports to include consideration of any system issues that may have
played a role in an adverse patient outcome. Medical Protection has also called
on the GMC to set this out in the next iteration of Good Medical Practice. Taking
this broad focus, rather than simply scrutinising the actions of an individual
in isolation, can improve patient safety and reduce the medicolegal risk faced
could be argued that the majority of consultants and GPs, particularly after an
initial period in post, should have the requisite technical knowledge to
provide an expert opinion in their field of practice. However, very few come
forward to do the work. While barriers are varied and complex, they include
financial considerations, lack of training and support, and fear of criticism.5
also difficult to combine the demands of the court with those of a busy
clinical practice. Experts describe how hard it can be to persuade employers to
allow them to take time out to perform their duties. But employers should
recognise the gains associated with supporting employees to participate in
expert work. By doing so, they will be building up a resource of skill and
experience that can be tapped into as required; for example, those who
undertake expert work will be well-placed to conduct SI investigations and root
cause analyses and share learning with colleagues. Allowing doctors to
diversify their skill sets and role may also improve job satisfaction and staff
retention and prevent burnout.
Protection report makes clear that NHS employers, NHS England, the GMC and the Academy of Medical
Royal Colleges all have a role to play
in bringing about positive change in this area. But we as doctors also need to
step up. Doctors should consider putting themselves forward to provide expert
opinion if they have relevant experience; ideally, while being in current
clinical practice. All doctors who have achieved a Certificate
of Completion of Training and who
are on the appropriate register should possess the clinical knowledge to act
as an expert within their field, and should feel empowered to do so.
This webinar series and supporting podcasts explore the crucial role of expert witnesses in legal proceedings, including the skills required and the importance of using a diverse pool of experts. Our panel will cover topics including the training required to take the stand, what it takes to put together a well written report and a comprehensive overview of the knowledge needed to be an effective expert witness to comply with your duty to the court.