GMC warning over calls for GPs to stop written reflection

Doctors must continue to provide evidence that they are reflective practitioners, the GMC has warned, as GP leaders consider calls to disengage from written reflection after the Dr Bawa-Garba case.

The GMC warned that it expects doctors 'to collect, reflect on and discuss supporting information generated from the whole of their UK practice', despite fears among clinicians that to do so in the current system could leave them open to criminal prosecution or being struck off.

A leading medico-legal organisation, meanwhile, said that 'not documenting an incident or reflection during appraisal may lead to a greater risk of allegations of probity and referral to the GMC'. The Medical Protection Society (MPS) also called this week for 'legally privileged status' for written reflection.

The warnings come after LMC representatives backed a vote of no confidence in the GMC at the UK LMCs conference in Liverpool on 9 March, following a debate that heard GPs express concerns that written reflection on mistakes was no longer safe.

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A motion passed by the conference also directed the GPC to 'advise GPs to disengage from written reflection in both appraisal and revalidation until adequate safeguards are in place'.

Good Medical Practice

Asked whether GPs could comply with the requirements of Good Medical Practice without engaging in written reflection, a GMC spokeswoman told GPonline: ‘Reflection is an important part of life-long learning, and though evidence can take different forms, writing may help some doctors better focus their thoughts on the process.

'We expect doctors to collect, reflect on and discuss supporting information generated from the whole of their UK practice for appraisal and revalidation to demonstrate they have continued to meet the principles and values set out in Good Medical Practice.

'We require doctors to provide supporting information on continuing professional development, quality improvement activities, significant events, feedback from colleagues and patients (or those to whom they provide medical service), compliments and complaints.

'In addition to this, doctors in training will also have requirements around reflection that deaneries and employers place on them.’


Dr Pallavi Bradshaw, a medico-legal adviser for the Medical Protection Society (MPS), said: ‘Written documentation provides evidence that reflection has happened, and it is also used for appraisals and revalidation. It is this - the formalisation of the reflective process - which is under scrutiny.

‘Our advice is and remains that reflection is an important part of a doctors professional development, and furthermore, not documenting an incident or reflection during appraisal may lead to a greater risk of allegations of probity and referral to the GMC.’

The GMC spokeswoman also said: ‘The ability to reflect on one’s practice and experience, and to learn from it, is a core aspect of professionalism, therefore it is crucial that doctors continue to do this.’

Bawa-Garba case

Endorsing the call for GPs to disengage from written reflection would be a major step for the BMA given that the GMC's Good Medical Practice guidance states that doctors must 'regularly reflect on their standards of practice and care provided'.

GPC chair Dr Richard Vautrey told GPonline on Monday that the committee had 'yet to meet and discuss any of the resolutions and how we take them forward', although a decision could be formalised on Thursday at a UK GPC meeting in Edinburgh.

In the wake of the Dr Bawa-Garba case, some appraisers said they would accept verbal discussion as an alternative to written reflection.

GPonline also reported that hundreds of doctors had decided to boycott written reflection, after the campaign group GP Survival wrote to the BMA warning that the Bawa-Garba case could undermine openness in medicine.

In the case of Dr Bawa-Garba her medical defence organisation has confirmed that no evidence from her e-portfolio was used against her, but her former supervisor believes a training form attached to her duty consultant's evidence - notes on a discussion the senior doctor had with Dr Bawa-Garba - could have been seen by the prosecution and may have influenced cross examination.

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