70% of GPs say writing reflective notes is unsafe following Bawa-Garba case

Seven in 10 GPs believe that it is unsafe to record reflective notes in writing following the Dr Bawa-Garba case, according to a GPonline poll.

(Photo: iStock.com/sturti)
(Photo: iStock.com/sturti)

The survey of over 400 GPs also found that 58% of GPs had changed the way that they record reflective notes following the case.

Some 83% of GPs said that they thought the government should legislate to prevent doctors’ reflective notes being used against them in court - despite previous calls for legal protection being rejected.

The findings demonstrate the extent to which doctors' confidence in the process of recording reflective notes has been undermined after Dr Hadiza Bawa-Garba was struck off earlier this year following a High Court appeal by the GMC.

Although reflective entries from Dr Bawa-Garba’s eportfolio were not used as evidence against her, notes made by her duty consultant on a meeting he had with her after the incident formed part of his witness statement.

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Speaking in her capacity as an appraiser, Dr Zoe Norris, chair of the GPC sessional subcommittee, told GPonline that almost all her discussions with GPs are now directly related to the Bawa-Garba case.

‘Doctors are very anxious that they aren't penalised for changing how they reflect, but also about how their reflections may be used to implicate them in legal or GMC cases,’ she said.

Reflective notes

Speaking to GPonline, GPC chair Dr Richard Vautrey said: ‘These survey results reflect concerns raised by our own members, and are further evidence that the whole medical profession has been rocked by this tragic case.

‘It is crucial that doctors’ personal reflections - which encourage openness and improvement through reflection and learning - are protected.’

A BMA poll of 8,000 members earlier this month found that just one in four doctors were comfortable with reflective practice, with the majority feeling some level of concern that it could be used against them in some way.

Some GPs began a boycott of written reflection shortly after the GMC's High Court's appeal and LMC leaders also voted earlier this year for the GPC to instruct GPs to 'disengage from written reflection'.

The LMC vote forced the GMC to issue a warning to GPs that they risked undermining their revalidation if they refused to take part in written reflection.

The GMC itself has said it will never use doctors' reflective notes against them in fitness to practise cases, but its call for legal protection for this information has been rejected by the government following recommendations from the Williams review last month.

Patient safety

Less than 15% of respondents who took part in the GPonline poll said they feel safe recording reflective notes in the current climate.

One GP said: 'The case has highlighted the medicolegal vulnerability of such reflections. As a result I have reduced the amount of reflection I write for my own portfolio and in appraisal summaries. I will appreciate such reflections having some protection in law if we are to be able to continue to encourage doctors to write about incidents and capture their constructive individual and organisational learning and development as a result.'

Another commented: 'I don't write reflective notes in my portfolio because I worry I could be the next Hadiza [Bawa-Garba]. I keep a personal, private paper diary of reflection notes that I can destroy if the need ever arises.'

Some GPs also raised concerns about the impact the case has had on patient safety, with one saying: 'We (GPs and other doctors) have written these notes in good faith, to learn and to show learning, to have our honesty used against us is a breach of our trust and will cause harm to patients in the long run. Mistakes happen, we need to learn from them and not be afraid to be open and honest.'

Another simply commented: 'Bad for patients' safety as encourages blame culture.'

GMC chief executive Charlie Massey said: 'Reflection is central to professionalism and life-long learning and contributes to improved patient care. Doctors must feel supported to reflect openly and legal protection would provide much needed assurance. We have been vocal in our support of legislation and, though the Williams review did not address this, we hope there will be opportunities for the government to reconsider.  

'In the meantime we’re working in partnership with the Academy of Medical Royal Colleges, the Conference of Postgraduate Medical Deans and the Medical Schools Council to produce fresh guidance to help doctors reflect in a safe and positive way.’

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