Bolam, Bolitho and Montgomery in General Practice: A Guide for Legal Professionals
Clinical negligence claims involving general practice are unique. Unlike secondary care, primary
care requires a GP to manage uncertainty and non-specific symptoms within the constraints of short
consultations.
For solicitors instructing a GP expert witness, a clear understanding of the three “pillars” of
medical law – Bolam, Bolitho, and Montgomery is essential for defining breach of duty and
evaluating the strength of a claim.
1. The Bolam Test: The Standard of the Reasonably Competent GP
The Bolam v Friern Hospital Management Committee decision remains the foundation of medical
negligence law. It establishes that a doctor is not negligent if they act in accordance with a practice
accepted as proper by a responsible body of medical opinion.
• The GP Comparator: In litigation, the defendant’s actions are compared to a reasonably
competent General Practitioner, not a hospital consultant or sub-specialist.
• Clinical Judgment: The law recognises that there is often more than one “correct” way to
manage a patient. If a responsible body of GPs would have acted similarly, the Bolam test is
satisfied.
• Avoiding Hindsight Bias: A robust GP expert report must assess the case based on the
knowledge available at the time of the event, particularly in complex cases of delayed
diagnosis.
2. The Bolitho Clarification: The Requirement for Logic
The Bolitho v City and Hackney Health Authority ruling refined Bolam by asserting that the court is
not bound to accept an expert’s opinion if it does not withstand logical analysis.
For a GP expert witness report to be defensible, the expert must do more than state that a course of
action was “standard practice.” They must demonstrate:
• A reasoned evaluation of the clinical risks.
• Why a specific course of action (e.g., “safety netting” instead of immediate referral) was
logical.
• Transparency in how they reached their conclusion.
3. The Montgomery Reformulation: Informed Consent in Primary Care
The Montgomery v Lanarkshire Health Board judgment shifted the focus of consent from the
doctor’s perspective to the patient’s perspective.
A GP is under a duty to ensure the patient is aware of “material risks”- any risk to which a
reasonable person in the patient’s position would likely attach significance. In general practice,
Montgomery is frequently cited in cases involving:
• Prescribing medication with known side effects.
• Discussing the choice between treatment versus specialist referral.
• The pros and cons of minor procedures performed in the surgery.
A risk may be “material” even if the statistical probability is low, provided the potential
consequences for the patient are serious.
Breach of Duty vs. Causation
Establishing a breach of duty under Bolam or Montgomery is only the first step. To succeed in a
clinical negligence claim, Causation must also be proven.
The GP expert must determine, on the balance of probabilities, whether the alleged negligence
directly resulted in the harm suffered. In cases of delayed cancer diagnosis or sepsis, this requires a
detailed analysis of disease progression and whether an earlier intervention would have changed the
clinical outcome.
Why Choose a Specialised GP Expert Witness?
The landscape of primary care is evolving, with increased use of remote consultations and
multidisciplinary teams. A CPR Part 35 compliant expert report must apply these legal principles
accurately to the modern GP environment.
As an experienced GP expert witness, I provide independent, objective, and logically reasoned
evidence that helps the court and legal teams navigate the complexities of general practice
litigation.