Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 holds that a clinician is not negligent if they acted in accordance with a practice accepted as proper by a responsible body of medical opinion. Bolitho v City and Hackney HA [1998] AC 232 added that the responsible body of opinion must itself be reasonable, logical and withstand logical analysis - the court can reject an opinion that does not stand up to scrutiny.
How does Montgomery change the law on consent?
Montgomery v Lanarkshire Health Board [2015] UKSC 11 holds that a doctor must take reasonable care to ensure the patient is aware of material risks and of reasonable alternatives. Materiality is judged from the perspective of the particular patient, not a responsible body of doctors. Bolam does not protect a clinician who failed to disclose a material risk.
How is causation proved in a clinical negligence claim?
The default test is "but for" causation on the balance of probabilities. Where injury has more than one cause and "but for" cannot be cleanly satisfied, material contribution can apply - see Bailey v MoD [2008] EWCA Civ 883 and Holmes v Poeton [2023] EWCA Civ 1377 (which confirmed it applies to indivisible as well as divisible injuries). Loss of chance below 50% is generally not recoverable (Gregg v Scott [2005] UKHL 2).
How does the Pre-Action Protocol for the Resolution of Clinical Disputes work?
Obtain medical records first via subject access request (UK GDPR / DPA 2018, response within one month). Send a Letter of Notification (optional) and then a Letter of Claim setting out facts, allegations of negligence, the causal link and main heads of loss. The defendant should send a reasoned Letter of Response within four months. Independent experts are usually needed on breach, causation and condition/prognosis. ADR is encouraged.
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