Failure to document reflection 'could increase risk of GMC referral'

GPs who do not document reflection during appraisal could face an increased risk of referral to the GMC, medico-legal experts have said as the GPC considers calls for GPs to withdraw from written reflection.

The advice comes 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.

The GMC has also issued a warning that doctors must continue to provide evidence of reflection following the vote. The regulator confirmed earlier this year that although it never asks doctors to provide their reflective statements when investigating a complaint, these documents can be requested by a court.

LMCs also directed the GPC to 'advise GPs to disengage from written reflection in both appraisal and revalidation until adequate safeguards are in place', although 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'. A decision could be formalised on Thursday at a UK GPC meeting in Edinburgh.

Medical Protection Society (MPS) medico-legal adviser Dr Pallavi Bradshaw told GPonline: 'Our advice is and remains that reflection is an important part of a doctor's 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 MPS advice comes after the organisation set out its response to the government's rapid review into the application of gross negligence manslaughter rules, launched amid widespread concern about the implications of the case of Dr Hadiza Bawa-Garba. Dr Bawa-Garba was struck off earlier this year after a High Court challenge by the GMC.

Dr Bradshaw added: 'The GMC requirement is to engage in reflection. Doctors are constantly reflecting in its widest sense through audits, de-briefs, teaching and evidence driven practice. The 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.'

Written reflection

The MPS has called for 'special legal privilege' for written reflection to encourage openness and transparency among doctors.

Dr Bradshaw said: 'While it is not possible to afford legal privilege to every process or situation requiring reflection, and this would undermine its fundamental purpose, we believe there are certain situations where providing a truly confidential environment is in the public interest.

'Written reflections with the sole purpose of education and training should be given special, legally privileged status so they cannot be disclosed to a third party (i.e. the court, regulator, employers or the police). This should include reflections documented in education and training documents, such as e-portfolios and all annual appraisals, training forms and the Annual Review of Competence Progression - whether completed by a doctor or a consultant/supervisor.'

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.

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