Category: Insurance case law · Reviewed by Amy Price, Account Executive · Last reviewed June 2026
The decision of McNair J establishing that a professional is not negligent if they have acted in accordance with a practice accepted as proper by a responsible body of professional opinion.
Mr Bolam was a patient at Friern Hospital, a mental institution managed by the defendant hospital authority. He was suffering from depression and his consultant psychiatrist advised that he should undergo electro-convulsive therapy (ECT). At the time, ECT was a recognised but controversial treatment which carried a small but real risk of fractures arising from the violent muscular contractions induced by the electrical current.
Mr Bolam signed a consent form for the treatment. He was not warned of the risk of fracture. He was not given any relaxant drug to reduce the muscular contractions and was not physically restrained beyond manual support of his lower jaw and shoulders by nurses. During the ECT he sustained dislocation of both hip joints and fractures of the pelvis on each side of the acetabulum.
Mr Bolam sued the hospital authority alleging negligence on three grounds: (i) the consultant should have administered a relaxant drug before the ECT; (ii) if no relaxant was used, the patient should have been more firmly restrained; and (iii) he should have been warned of the risk of fracture so that he could give informed consent to the treatment.
The medical evidence at trial was sharply divided. One body of competent medical opinion favoured the use of relaxants; another body considered relaxants themselves carried risks (including death) and that the better practice was to use manual control alone. There was also a divergence of opinion about the proper degree of restraint, and a difference of view about whether and to what extent patients should be warned of risks where warning might deter them from accepting treatment that was otherwise in their interest.
McNair J directed the jury on the law. The jury found for the defendant hospital. Mr Bolam’s claim accordingly failed.
The issue was the proper standard of care owed by a medical professional, and by extension any professional exercising a special skill, when assessing whether their conduct amounted to negligence. Specifically, the court had to consider how to direct a jury where there were two or more bodies of competent professional opinion within a discipline, each of which approved or condoned the practice complained of and the alternative practice.
A subsidiary issue concerned the law relating to warning of risks: was a doctor negligent in failing to warn of an inherent risk of treatment where a responsible body of medical opinion would not have given such a warning?
McNair J directed the jury that the test for professional negligence was not whether the defendant had departed from the highest standard of skill or from what the judge or jury, with hindsight, might consider the better practice. Rather, a professional was not guilty of negligence if they had acted in accordance with a practice accepted as proper by a responsible body of professional opinion skilled in the relevant art. Equally, a professional was not negligent merely because there was a body of opinion that took a contrary view.
Applying that direction to the medical evidence, the jury was entitled to find that the consultant had acted in accordance with a responsible body of medical opinion in choosing not to administer relaxants, in using only manual restraint, and in not warning the patient of the risk of fracture. The jury returned a verdict for the defendant and the claim failed.
The Bolam direction has since been treated as authoritative not only in medical negligence cases but across all professional negligence claims, including those against solicitors, accountants, surveyors, financial advisers and insurance brokers, subject to the later qualification in Bolitho.
A professional exercising a special skill discharges the duty of care owed to the client or patient if they act in accordance with a practice accepted as proper by a responsible body of professional opinion skilled in the relevant art. The existence of a contrary body of opinion does not make the conduct negligent. The standard is that of the ordinary competent practitioner exercising and professing to have that special skill, not the highest expert standard.
Bolam is the foundational standard-of-care test in professional negligence and therefore central to the assessment of claims under all professional indemnity policies. For brokers placing PI cover, the Bolam principle determines the likely defensibility of a notified claim: where the insured’s conduct conformed to a recognised body of professional opinion, the claim should fail and the insurer’s exposure is limited to defence costs.
Several practical consequences flow from this. First, evidence of compliance with professional guidance, codes of practice and recognised methodologies is a powerful defence and PI insureds should retain such records. Second, the test recognises that professions evolve and that there can legitimately be more than one acceptable approach; this is particularly important in disciplines undergoing rapid change such as financial advice, IT consultancy and surveying. Third, the focus on the ordinary competent practitioner means that proportionate, profession-specific underwriting questions are essential when assessing risk — a sole practitioner is held to the same standard as a partner in a magic-circle firm only in respect of the work they hold themselves out as capable of performing.
For insurers, Bolam also explains why expert evidence dominates PI litigation: liability frequently turns on a battle of professional experts as to whether a responsible body of opinion supported the conduct in question. The test was qualified in Bolitho to require that the body of opinion be logically defensible, but Bolam remains the starting point.
By Matt Bartlett, Director, on 2026-06-06. Next review: 2026-12-06.
This entry is part of the Apex Insurance Wiki. Last reviewed by Matt Bartlett on 2026-06-06. Apex Insurance Brokers Limited, FCA FRN 724952, Companies House 07014570. Not regulated advice — consult your broker on your specific position.
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