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GMC advises doctors to seek legal advice if reflections ordered by court

The GMC and leading medics have advised doctors to seek legal advice if their appraisal reflections are ordered by court, in new guidance published by the regulator.

The guidance aims to 'reassure' doctors about the role of reflections in light of the Bawa-Garba case, which caused increased tension between the regulator and the profession, with some GPs saying the GMC has taken a step in a 'positive direction'.

However, other GP leaders have told Pulse they 'don't think [the guidance] is going to make much difference' to the relationship between the regulator and doctors, as trust in the GMC continues to falter.

The guidance, which was published jointly by the GMC, the Academy of Royal Medical Colleges and the Conference Of Postgraduate Medical Deans today, reminds doctors that their appraisal reflections are not covered by legal privilege.

Doctors should therefore ‘focus on the learning rather than a full discussion of the case or situation’ in their reflections and should ‘seek advice’ from their legal advisor if their reflection documents are requested by a court.

The GMC alluded to the advice ahead of its release in its response to the Hamilton review of gross negligence manslaughter, saying that doctors would be advised not to include factual detail in their appraisal reflections.

The GMC had previously recommended to the Government’s ‘rapid review’ of gross negligence manslaughter charges in medicine that legal protection be granted to cover doctors’ reflections.

However, the recommendation ‘was not considered workable or appropriate’ by the Government.

The latest guidance therefore advises doctors not to record factual detail in their reflections and to seek legal advice if their reflection documents are court ordered.

The guidance says: ‘Where a disclosure request is received, the owner of the learning portfolio or other reflective note should seek advice from their employer, legal adviser, medical defence organisation or professional association.’

However, BMA sessional GP subcommittee lead Dr Zoe Norris, who is a GP appraiser, told Pulse that even with legal advice, the question still remains, 'what should we and shouldn't we be putting in our reflection', adding it is unrealistic to ask doctors to exclude factal detail.

She said: 'Trying not to [include factual information] is almost completely unlearning everything we've ever done and people will find that really hard.'

She added: 'If they're going to expect doctors to go through and make sure every single entry is completely anonymised so it couldn't possibly be linked back, that's just going to take twice as long as it does now.

'It still goes against the grain of open and honest reflection. I think people are just going to find it too hard and will therefore withdraw from doing reflections in the same way.'

Speaking about the reflection guidance broadly, Dr Norris said: 'I don't think it's going to make much difference. It comes back to trust and the profession doesn't trust the GMC... and I don't think putting out a document is going to rebuild that trust.'

GP leaders voted in favour of a motion to stop written reflections in light of the Bawa-Garba case at the LMCs conference in March.

Pulse had revealed that elements of Dr Hadiza Bawa-Garba’s e-portfolio were included in materials seen by expert witnesses ahead of her criminal case, with GPs calling into question whether doctors could ‘reflect openly and honestly’ in light of this.

The guidance offers ‘10 key points’ for doctors to consider while reflecting, including advocating for ‘group reflection’ and that notes ‘should be anonymised as far as possible’.

GMC director of education and standards Professor Colin Melville said: ‘Reflecting on experiences, both good and bad, is hugely important. The GMC doesn’t ask doctors for reflective notes to investigate concerns; in fact we have called for those notes to be given legal protection.’

AoMRC chair Professor Carrie MacEwen said the new guidance ‘should reassure all doctors that it is possible to record events in a way that optimises learning and promotes active change in practice based on this learning’.

RCGP chair Professor Helen Stokes-Lampard said: 'Recent events have caused a lot of anxiety amongst all doctors, and particularly trainees, about how and when to reflect appropriately and effectively – and we hope this guidance goes someway to alleviate that.

She added: 'We welcome the clarity this guidance brings, and its focus on learning and using this to identify opportunities to improve our own practice, and ultimately patient safety – as well as the flexible approach to reflection that is advocated.'

Readers' comments (22)

  • . No legal training but surely a lawyers advice at this point would be simply ‘don’t record anything in the first place’ that you wouldn’t want a court to cross examine,and this would be an equally valid defence for not including cases in appraisal folders.

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  • Not sure how this will help anyone?

    Don't do it and appraisal/lawyers etc after you and the inference if lawyers involved is your possibly hiding something

    Do it and lawyers involved you get extra "stuffed" when disclose it to them.

    Regardless lawyers now know something reflective must be out there for them to drool over!

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  • David Banner

    Dear GMC,

    Please please please please campaign to scrap appraisal. This pointless evidence-free annual colonoscopy is not only driving valuable GPs to the exit, but could even result in them being prosecuted for the crime of “reflection”. Since nobody of sound mind will record meaningful reflections from now on, why insist on it? Appraisal has been a miserable failure, kill it now before it kills the profession.

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  • GMC dig a (compulsory) bear trap and advise predicted victims to ‘lawyer-up’ and they might survive. You couldn’t make it up.

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  • & you get billed for the fun!

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  • well lets just keep our reflections light.
    go to conferences and say you learnt loads.
    dont put in anything patient-centered at all.
    do the bare minimum as im sure all of us are doing far more but not recording it.
    screw em

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  • Vinci Ho

    I think until the legislation can be amended in such a way that there is a more optimal definition of so called gross negligence manslaughter (clear distinction to that with any intent) in medical accidents, this is merely scratching the surface and going around in circles .
    The reality is the reflection in appraisals will become meaningless and we are all going to be self-defensive with a shadow in the back of our mind all the time.
    Every time when there is a patient dies in a ‘medical situation’ , the clinicians will wonder to themselves,’sh*t, had I written or said something I shouldn’t have before ? Whom and what should be blamed instead?’
    Thank you to your great ‘achievements’ , GMC .

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  • They should have sought legislation to prevent such requests. Worse thing now is Trusts now demanding Appraisal Outputs, printouts from Clairty as a reference and part of thier contracts. I refused as should all GPs. I think NHSE will put a stop to this nasty habit

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  • Vinci Ho

    The truth is we , medical professionals , are taught and trained to be honest serving a code , which is in contrast to politicians. But now we have to ‘pay’ heavily for our honesty . Another sign of the times.......

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  • End of the line?

    Totally agree..

    Without honesty
    Without funding for support and training
    What is the point ??

    A Very time consuming overy beaurocratic
    waste of everyones time

    Remove the incentives to appraisors
    and online Portfolio companies

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  • This really has to be the nail in the coffin now for reflection. This 'guidnace'is a joke and serves the GMC's agenda only. We need our leaders to sort this mess out and and either ask for legislation for legal privilege, or scrap reflection. This halfway house is not acceptable and it's exactly where we were before. This leaves all doctors at serious risk.

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  • Sounds to me like a classic case of an iron fist in a velvet glove. Of course the GMC do not ask for reflections from a doctor under investigation. But if he or she does not present some reflections as part of remediation (odd, isn't it, how you are expected to 'remediate' even before you have been found guilty of anything to remedy...) then the GMC will simply say that you lack insight, and hang you out to dry anyway. And when you do voluntarily produce reflections from the so-called confidential appraisal process, the GMC will cherry pick your phrases, take them out of context wherever possible to use them against you, as they did in my case. As an appraiser now, I advise my appraisees not to document anything in their appraisals that they are not prepared to hear used against them in court. Because it can be, it is and it will.

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  • This just shows the GMC are clueless into how to manage doctors. The government are doing sweet f all.

    Why don't all you poor GP's on pulse just leave the UK? I really do feel sorry for you.

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  • You can envisage the scenario. A complaint occurs and you are investigated. You understandably refrain from entering too much detail in your portfolio for fear of losing your career and livelihood and your appraiser then asks you to enter more detail as it’s too brief. Same with the person conducting the revalidation. It’s a no win situation. And then the powers above wonder why doctors are leaving the uk. It’s pretty obvious. People vote with their feet

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  • any funded lawyers to proof read...?

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  • Why is Charlie Massey still in a job?
    Or any of the GMC execs for that matter?
    This guidance is completely clueless.

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  • GMC=bunch of madar chods

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  • Damned if you do; damned if you don't.
    Sounds like business as usual for GPs.
    Looking forward to my appraisal.

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  • No protection. No reflection!

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  • I thought a vote of no confidence means you suspend all activities until you come up with measures for change?
    I suggest as a profession, non-compliance with appraisal AND subs until the GMC scraps appraisal and reduces their role to historical functions. Then again, I'm not in the GPC. Dear GPC, you can contact me anytime ;p

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