Just one in four doctors comfortable with reflective practice, huge BMA poll reveals

Only one in four doctors are comfortable with reflective practice, according to a BMA poll of thousands of doctors that lays bare the extent of the impact of the Bawa-Garba case on the medical profession.

Responses from almost 8,000 BMA members showed that just 26% felt comfortable with reflective practice, while 74% felt some level of concern that it could be used against them.

The findings demonstrate the extent to which doctors' confidence in the process of recording reflective notes has been undermined after Dr Hadiza Bawa-Garba was struck off earlier this year following a High Court appeal by the GMC.

Further findings from the BMA poll reflect deep concerns among the profession about the culture they work in. Half of respondents (49%) said they practice defensive medicine because they are working in a 'blame culture', while just over half (55%) were fearful of being unfairly blamed for errors caused by pressures or system failures.

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Health and social care secretary Jeremy Hunt warned within hours of the Bawa-Garba court verdict that he was 'deeply concerned about possibly unintended implications here for learning & reflective practice' - and the poll findings appear to bear out those concerns.

Some GPs began a boycott of written reflection shortly after the Bawa-Garba ruling, and LMC leaders voted earlier this year for the GPC to instruct GPs to 'disengage from written reflection'.

The LMC vote forced the GMC to issue a warning to GPs that they risked undermining their revalidation if they refused to take part in written reflection. The regulator has since promised to set out guidance for the profession on how to avoid reflective notes being used against them.

Reflective notes

The GMC itself has said it will never use doctors' reflective notes against them in fitness to practise cases, but its call for legal protection for this information has been rejected by the government following recommendations from the Williams review last month.

The poll findings, revealed to coincide with the BMA's annual representative meeting in Brighton last week, came as doctors backed a no confidence vote in the GMC over its handling of the controversial case of Dr Hadiza Bawa-Garba and called for a public inquiry.

Dr Bawa-Garba was struck off earlier this year after the GMC launched a High Court appeal to overturn a medical tribunal ruling that she should be suspended for 12 months.

In his keynote address to the 2018 LMCs conference earlier this year, GPC chair Dr Richard Vautrey said the health secretary had been right to warn after the Bawa-Garba case that 'for patients to be safe, we need doctors to be able to reflect completely, openly and freely about what they have done, and to learn from mistakes'.

Dr Vautrey added: 'We need a system that does the same, that not only learns the lessons but does something about it and puts in the necessary resources and workforce to reduce the risk of doctors and other NHS staff from ending up in dangerous situations. For without change, the next time it could be me pursued by the GMC, it could be you standing in the dock, it could be any one of us scapegoated by an unsafe and overwhelmed system. It’s not only unfair, it’s unjust and the system must change.'

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