Calls for protection of reflective statements

The AOP and the College of Optometrists have had their say on a review into gross negligence manslaughter in healthcare


Professional bodies, including the AOP and the College of Optometrists, have put forward submissions on a review of gross negligence manslaughter in healthcare.

In February, the Secretary of State for Health and Social Care, Jeremy Hunt, asked Professor Sir Norman Williams to conduct a rapid policy review into issues relating to gross negligence manslaughter in healthcare.

Explaining the purpose of the review, Sir Norman highlighted that the panel would look at the processes that are involved in an individual coming to face an allegation of gross negligence manslaughter in the criminal courts and/or before their professional regulatory body.

"We will also be considering how reflective learning, openness and transparency can be properly sustained to ensure that there is a robust learning process when errors are made," Sir Norman highlighted.

"There may be lessons to learn for regulators in how to approach all of the above," he observed.

The deadline for written submissions on the review was 13 April.


In its submission, the AOP highlighted that members can and do provide reflective statements in the evidence they provide to General Optical Council (GOC) investigations.

"In our experience this evidence is often helpful to practitioners, patients and the GOC itself," the submission noted.

The GOC's statutory scheme for Continuing Education and Training does not require formal reflection by registrants, except in the context of peer review.

However, the GOC has expressed an intention to focus more on continuing professional development in the future.

"Encouraging more reflection and openness among healthcare professionals is clearly to the benefit of both practitioners and patients, in optics as elsewhere," the AOP submission emphasised.

"We therefore think it is vital that the Government and the healthcare professional regulators ensure that the use of reflection and openness is not compromised by the regulators' fitness to practise decisions, or by the application of the law on gross negligence manslaughter in the healthcare context," the statement concluded. 

The College of Optometrists

The College of Optometrists outlined in its submission that reflective practice is an "extremely beneficial" way of improving healthcare for patients and it is working hard to help practitioners to develop these skills.

The submission contended that practitioners should not be dissuaded from reflection on the basis that these documents could be used against them in disciplinary or legal proceedings.

"For this reason, we would urge the review to find a solution that prevents this from happening," the College of Optometrists concluded.


The British Medical Association (BMA) has called for gross negligence manslaughter cases to only be referred after consultation with the chief coroner.

It has also asked for a national police unit to be established to investigate such allegations in healthcare.

In order to ensure consistency across a relatively small number of cases, the BMA contends that the director of public prosecutions should personally authorise all gross negligence manslaughter prosecutions in healthcare.

The BMA has also called for a range of measures to make sure that expert witnesses and others involved in the prosecution process have the appropriate level of experience and training to be equipped for gross negligence manslaughter cases.

The association called for legal protection to be provided for all reflections in education and training documents.

General Medical Council

The General Medical Council (GMC) argued as part of its submission that doctors' reflections are "so fundamental to their professionalism" that they should be given legal protection.

The GMC does not ask for doctors' reflective statements as part of its fitness to practise cases, but highlighted that it does not control the actions of the courts.

The submission highlighted that at present recorded reflections are not subject to legal protection.

"Therefore disclosure of these documents might be requested by a court if it is considered that they are relevant to the matters to be determined in the case," GMC chair, Professor Sir Terence Stephenson emphasised.