GMC to tell doctors how to avoid reflective notes being used against them

Advice on how doctors can avoid reflective notes being used against them will be published this autumn jointly by the GMC and leading medical organisations, following the damaging Bawa-Garba case.

Plans to develop guidance on reflective practice jointly with the Academy of Medical Royal Colleges, the Conference of Postgraduate Medical Deans (COPMED) and the Medical Schools Council (MSC) are the latest step in the GMC's drive to tackle the fallout from the high court challenge that allowed the regulator to strike off Dr Hadiza Bawa-Garba earlier this year.

LMCs passed a vote of no confidence in the GMC in March over its handling of the Bawa-Garba case, and voted for the BMA to tell GPs to 'disengage from written reflection'. The vote forced the GMC to issue a warning to doctors, spelling out that they risked undermining their revalidation if they failed to provide evidence that they were reflective practitioners.

Deep concern among the medical profession over the safety of taking part in written reflection - with many GPs boycotting the process in the immediate aftermath of the decision to strike off Dr Bawa-Garba and LMCs warning that it was 'no longer safe' to reflect honestly and openly on mistakes - have pushed the regulator to work with clinical leaders to draw up fresh advice.

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GMC director of education and standards Dr Colin Melville said: ‘We know a lot of doctors recognise the importance of being reflective practitioners but are concerned about how their reflective notes might be used against them. The new guidance will address those concerns. Working in collaboration with colleagues from key medical education organisations will go a long way to ensuring we have guidance that will be a real and practical help to doctors.’

Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges said: ‘The Academy recognises the need for guidance to help doctors to become reflective practitioners as a natural and positive process. This will aid improvement and drive patient safety in education and training as a whole.’

COPMED chair professor Sheona MacLeod said the guidance would 'help clarify how doctors can safely demonstrate their professional approach as reflective practitioners, focussing on the outcomes of reflective practice, rather than on specific details’.

Manslaughter review

The GMC is currently reviewing how gross negligence manslaughter (GMN) laws are applied in health-related cases in England - with its chief executive Charlie Massey highlighting this month a 'postcode lottery' for prosecutions. A rapid review set up by health secretary Jeremy Hunt is covering similar ground.

Speaking earlier this month at a King's Fund event on lessons from the Bawa-Garba case, Mr Massey admitted the regulator hadn't anticipated the 'scale of the reaction' it would provoke.

He told the event in London: 'One of the most troubling things about this case has been around reflection. Many doctors are very worried. It is fundamental to what we consider as medical professionalism.'

Although reflective notes from Dr Bawa-Garba's e-portfolio were not used in evidence against her, the GMC has made clear that because this information is not currently legally protected, it could be used.

Mr Massey said earlier this month: 'For our part we have been clear we do not use reflective notes in our processes, we have called for reflective notes to be protected in legal processes. I think that would be highly totemic.'

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