GMC confirms reflective entries could be used against doctors in court

GP leaders have demanded legal protection to stop reflective statements being used against doctors in court, as the GMC confirmed to MPs that no such protection currently exists.

Responding to questions in a letter from health select committee chair Dr Sarah Wollaston, GMC chief executive Charlie Massey defended the regulator's approach to fitness to practise cases and said there was 'no evidence of bias in GMC decision making related to ethnicity'.

The exchange of letters comes after the controversial case of Dr Hadiza Bawa-Garba, who was struck off by the GMC after a High Court challenge last month.

Dr Bawa-Garba was convicted of gross negligence manslaughter in 2015 following the death of a six-year-old boy at Leicester Royal Infirmary, and the decision to strike her off was confirmed after the GMC challenged a medical tribunal's decision that she should instead be suspended for a year.

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What role did reflection play in the case of Dr Bawa-Garba?

The medical defence organisation that represents Dr Bawa-Garba has confirmed reflective entries from her e-portfolio were not used to secure the 2015 conviction, although notes made by her duty consultant on a meeting he had with her after the incident formed part of his witness statement.

Amid widespread concern among doctors and senior NHS figures that patient safety could be affected if the medical profession feels unable to reflect honestly and openly on mistakes for fear of being left open to prosecution, Dr Wollaston wrote to demand clarification from the GMC on its stance.

The Torbay MP asked for clarification from the GMC on its 'position on reflective practice, and in particular its implications for posible criminal or fitness to practise cases'.

She called for clarity on when the GMC would appeal medical tribunal decisions, evidence on any 'institutional bias against doctors from an ethnic minority' and comments on inconsistent use of manslaughter charges in medical negligence cases.

Legal privilege

Mr Massey wrote in reply that the GMC 'never asks doctors to provide their reflective statements if we are investigating a concern about them'.

But he added: 'Recorded reflections (such as e-portfolios) are not subject to legal privilege under UK criminal law. As a result, these documents might be requested by a court if it is considered that they are relevant.'

In a comment posted on GPonline, chair of the GP Survival campaign group Dr Alan Woodall wrote that medical defence organisations should campaign 'for reflective statements and error review to have protection from being used in any criminal or regulatory prosecution, as I believe the airline industry has under EU rules'.

GPonline reported following the decision to strike off Dr Bawa-Garba that GPs had begun boycotting reflective entries for appraisal.

Mr Massey's response to Dr Wollaston said the GMC challenged the medical tribunal ruling on Dr Bawa-Garba after receiving legal advice that its decision was 'wrong in law'. He said black and minority ethnic (BME) doctors were disproportionately represented in complaints made to the regulator, but that there was no evidence its decisions in these cases were biased by ethnicity.

The GMC has launched plans to bring together 'health professional leaders, defence bodies, patient and legal and criminal justice experts...to explore how gross negligence manslaughter is applied to medical practice'.

Health secretary Jeremy Hunt has also announced a review into how gross negligence manslaughter is applied in healthcare.

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