Responding to the GMC-commissioned independent review into gross negligence manslaughter (GNM) led by heart surgeon Dr Leslie Hamilton, the BMA said the regulator should ‘make clear’ that alternatives such as group reflection are equally valid.
The GMC should focus on ‘telling doctors what practical steps they need to take’, according to the BMA response to the review, by outlining 'a wide range of ways of meeting the requirement to reflect and let doctors use their professional judgment to determine what works for them'.
The BMA response says: 'It should make clear that it is acceptable for doctors to reflect in group discussions rather than alone. It should also make clear that it should not be necessary to reflect in writing (e.g. on e-portfolios) and that it is sufficient to provide evidence that reflection has occurred rather than provide the reflections themselves.’
Guidance for doctors on reflective practice - which will advise doctors how to avoid notes being used against them - is being drawn up jointly by the GMC and medical organisations. It is expected to be published in the autumn.
Doctors' willingness to record reflective notes and trust in the GMC has been hit hard by the high-profile case of Dr Hadiza Bawa-Garba. Dr Bawa-Garba was struck off in January 2018 after the GMC launched a High Court challenge over a medical tribunal ruling that she should be suspended for 12 months.
Dr Bawa-Garba won an appeal to overturn the High Court ruling earlier this month. Although reflective entries from Dr Bawa-Garba’s e-portfolio were not used as evidence against her, notes made by her duty consultant on a meeting he had with her after the death of six-year-old patient Jack Adcock formed part of his witness statement.
Some GPs have boycotted reflective practice, and a GPonline poll found 70% of GPs did not feel it was safe to record reflective notes in writing after the Bawa-Garba case.
The BMA response to the Hamilton review repeats earlier calls by the union for reflective notes to be granted legal protection - a widely-supported argument that was rejected by the Williams ‘rapid review’ into GNM in June.
‘The focus of reflection should be on learning, rather than what has gone wrong,’ the BMA said. ‘We would recommend that legal protection is provided to reflections in all education and training documents, such as e-portfolios and all annual appraisals, training forms and the annual review of competence progression.’
The GMC also supports calls for reflective notes to be given legal protection, but the Williams review said this was 'not considered workable or appropriate'.