GPs boycott reflective entries for appraisal after Bawa-Garba case

A GP pressure group has urged the BMA to support doctors who 'refuse to engage in reflective log entries in their appraisals' following an 'unforgivable' High Court ruling last week.

E-portfolios: GPs boycott reflective entries (Photo: iStock)
E-portfolios: GPs boycott reflective entries (Photo: iStock)

GP Survival has written to BMA chair Dr Chaand Nagpaul warning that 'hundreds of colleagues' had told the organisation they would no longer take part in 'meaningful written appraisal' after the GMC won a legal bid to strike off paediatric trainee Dr Hadiza Bawa-Garba.

The letter comes as BMA GP sessional subcommittee chair Dr Zoe Norris - who works as an appraiser - said she would advise all doctors to consider amending their appraisal reflections to read: 'I am happy to reflect on this case one-to-one with my appraiser. However, following the unjust treatment of a UK doctor by the GMC on 25 January 2018 I am not prepared to reflect in writing.'

Concern over the handling of Dr Bawa-Garba's case comes after reflective writing from her e-portfolio was widely reported to have been used in evidence in a crown court case that found her guilty of manslaughter by gross negligence in 2015.

Her medical defence organisation has made clear information from the e-portfolio was not used, although notes made by her duty consultant on a meeting with Dr Bawa-Garba after the event to discuss and learn from it formed part of his witness statement. The manslaughter conviction related to a case in which a six-year-old boy died at Leicester Royal Infirmary in 2011.

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Viewpoint: Dr Bawa-Garba case set back patient safety gains by 10 years

In June 2017 a medical tribunal ruled that Dr Bawa-Garba should be suspended for 12 months and that erasure from the register would be disproportionate. Mitigating factors the tribunal considered included her otherwise unblemished record as a doctor, good character, and four years of work at the hospital after the boy's death in which there had been no concerns over her competency.

Crucially, the tribunal also cited evidence of 'multiple systemic failures' at the hospital trust that were identified in investigations after the incident occurred.

But the GMC challenged the medical tribunal decision to suspend Dr Bawa-Garba, and the High Court has now backed the regulator's claim that she should be struck off.

Overstretched NHS

GP Survival warned that the outcome of the case against Dr Bawa-Garba showed that the blame for system failures in an overstretched NHS was being placed unfairly on individual doctors.

The 'unforgivable' decision to strike her off meant that 'no doctor can now feel safe in agreeing to cover rota gaps, and no sensible doctor can agree to take on additional work to cover for the failings of the system', GP Survival chair Dr Alan Woodall wrote.

The letter calls on the BMA to ask the House of Commons health select committee to investigate whether the GMC is fit for purpose, to lobby government for 'legislative change to combat the increasing trend to criminalise medical error', as well as calling for support to boycott reflective entries for appraisal. Dr Woodall wrote: 'I have rarely seen such anger and demoralisation as I have over the past week among all professionals in the NHS. Radical and urgent reform of regulation is needed to change the culture that has evolved before it causes wholesale collapse of the NHS.'

Dr Woodall's letter comes amid widespread concern over how Dr Bawa-Garba's case was handled and its implications.

Doctors leading a crowdfunding campaign have raised more than £200,000 within days to cover legal costs for Dr Bawa-Garba, who could now hire lawyers to challenge the GMC and the earlier manslaughter conviction.

Health secretary Jeremy Hunt has said he is 'perplexed' at how the GMC has behaved in this case, and expressed deep concern over the potential impact of the decision on 'learning and reflective practice' and how this could undermine patient safety.

Leading medical organisations have also spoken out about the impact the case could have on patient safety.

BMA chair Dr Chaand Nagpaul said: 'This is a tragic case for all those involved. However, the implications of this ruling, and the GMC’s approach, have caused widespread concern among doctors who are increasingly working in an NHS under extreme pressure.

'The case also raises questions and concerns about how doctors' reflections, which are an important tool for learning and professional development, are used. It is important that patient safety is not undermined through clinicians being deterred from engaging with reflective practices about patient care for fear of reprisal.'

* Note: this story has been updated to clarify that information from Dr Bawa-Garba's e-portfolio was not used in evidence against her

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