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GMC calls for doctors' reflections to be legally protected

The GMC has told the Goverment's rapid review into gross negligence manslaughter in medicine that doctors' reflections are 'so fundamental to their professionalism' that UK and devolved governments should consider providing legal protection.

The evidence submitted to the Williams Review, launched by health and social care secretary Jeremy Hunt in light of the GMC's successful bid to strike off junior Dr Hadiza Bawa-Garba in the High Court in January, also said the GMC will consider 'how human factors training can be incorporated into its processes'.

The news comes as GPs have called on the BMA to advise GPs to 'disengage from written reflection in both appraisal and revalidation' until new safeguards are put in place. The LMCs Conference motion, carried earlier this month, also saw doctors passing a no-confidence vote in the GMC.

GMC chair Professor Sir Terence Stephenson said: 'We have made it clear that the GMC will not ask for doctors’ reflective records as part of the fitness to practise processes. But we do not control the actions of the courts and recorded reflections, such as in ePortfolios or for CPD purposes, are not subject to legal protection.

'Therefore disclosure of these documents might be requested by a court if it is considered that they are relevant to the matters to be determined in the case. The likelihood of records needing to be produced in court may be reduced if reflective records focus on reactions to, and learning from, an incident.

'For our part, we have concluded that because doctors’ reflections are so fundamental to their professionalism, UK and devolved governments should consider how to protect them in law, if they see fit to do so.'

The GMC has commissioned a fundamental review of the application of the law concerning gross negligence manslaughter and culpable homicide to doctors which will be led by Dame Clare Marx.

The GMC also said its own review, which will look at why there are fewer cases involving healthcare organisations compared with individuals, is expected to report conclusions at the start of 2019.

It also said that the outcome of the Williams Review, due to report next month, will 'help to inform Dame Clare’s work when she reports her conclusions at the start of 2019'.

Dr Chaand Nagpaul, BMA council chair, said: 'Doctors’ personal reflections encourage openness and improvement through learning, and it is vital they are protected. This call by the GMC is in line with the BMA’s position and will form part of our own submission to the Williams Review shortly.'

RCGP chair Professor Helen Stokes-Lampard said: 'We welcome the reassurance by the GMC that they will not ask for doctors’ reflective records as part of their investigations – and we support their recommendation that reflective records should be protected by law.'

 

Readers' comments (21)

  • So they can still be produced, this is a question of trust, do you trust the establishment or the GMC .We all know the reflective answer to that.The Dr BG case needs to go to appeal first.

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  • Probably the most sensible thing I've heard from the GMC to date, the problem being that the ship of trust set sail some time ago.

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  • CENSORSHIP?

    doctors' reflections are 'so fundamental to their professionalism'....

    Really???
    Sure Ship man would have reflected
    very well

    I would give greater emphasis on
    peer based review and quality of work

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  • "I would give greater emphasis on peer based review and quality of work"

    THIS!

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  • The trust has gone. Reflect defensively.It is called risk management.

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  • Council of Despair

    bit too late i'm afraid.

    also it confirms our worst fears that right now we are vunerable - it's not a perception - the GMC have effectively admitted reflections can be used against us.

    the current logic is as follows;

    1. an incident occurs
    2. whether the doctor is right or wrong an apology is expected
    3. whether the doctor is right or wrong reflection is mandatory
    4. it is not good enough to say in reflection 'nothing can be learned' so you are obliged to put something that you have learnt.
    5. putting down that there was somthing to be learnt is viewed as akin to admission of fault
    6. those reflections can then be used against you - do you think that now lawyers are aware that reflections can be used in court that they won't ask for them when prosecuting doctors?
    7. in court 'expert' witnesses will be brought in to state that you got something wrong as it is impossible to provide perfect care and perfect documentation a fault can always be found.
    8. you will be hung out to dry


    the shrugging of shoulders by the GMC, RCGP, etc etc and declarations that it's c'est la vie and it's the price for being a doctor isn't going to help you.

    i would go so far that the Dr BG case is the most important case in UK medical history - if she fails we all fail.

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  • The GMC do not ask for reflections to be made available to them, but if they are, they will cherry pick them for any phrase which can be taken out of context to suggest lack of fitness to practice.

    And if you do not provide evidence of your reflections, you will be found to be lacking in insight and guilty of failure to remediate.

    Guilty if you do, guilty if you don't. The basic problem here is that the GMC do not conduct a fair and impartial investigation: they merely look for any scrap of information which could be used to convince the MPTS of someone's guilt based on the balance of probabilities. As the prosecution, they are not in the least bit interested in justice, merely finding someone guilty to justify their own existence.

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  • Spot on anon 2017

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  • I agree anon 2017
    Bit like witch trials in the Middle Ages.
    Chuck you in the water tied up. If you float you are guilty and burnt at the stake and if you don’t you aren’t but... whoops you seem to have drowned.

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  • All my reflections will be about all the things I have hit right!

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  • AlanAlmond

    There’s some pretty marked cognitive dissonance in the GMC position. What exactly is their role? I don’t think they actually know. They are prepared to take courses of action they fully admit they have little control over and which may lead to unintended adverse consequences and yet they do it anyway. They seem organisationally confused and lacking direction. What a sorry state they have got themselves into. You have got to ask yourself where is the leadership in this organization. Who is running this outfit? Are they up to the job? I would suggest that is in question.

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  • AlanAlmond

    Prof Stevenson is basically saying, we are quite happy to take the decision to pursue individual Drs through the courts, in conflict with our own tribunal service findings, but we completely obsolve ourselves of any responsibility for the outcome, that bit is apparently, nothing to do with the GMC and all the legal professions fault. This is muddled thinking and totally lame. And yet there he is taking this position. Embarrassing.

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  • AlanAlmond

    ...Absolve not obsolve

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  • AlanAlmond

    Prof Stevenson, it is for the very reasons you outline that the GMC uses a tribunal system to adjudicate these issues..and yet you’ve chosen to ignor the tribunal system. Can you not see the idiocy of your argument?

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  • I think anyone with half an ounce of sense will be very selective about what they say in there reflections. I think I should focus on what went well in future and build positively on that and plan to expand that to other areas on my practice...... anything that went wrong? mmmmh...I can't seem to recall anything...... nope, nothing written down anywhere....... must have been a good year!

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  • I bet my million dollar that the lawyer will be able to demand and produce the reflective evidence in criminal or even in negligence cases.
    I don’t believe in a word of holllow reassurance from the GMC that it would be protected.
    GMC in this article seems to be contradicting its own position.

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  • I’m happy to reflect, in person. No smart phones, no Mics.
    ‘I was not involved officer but I saw the whole thing and I learned a lot from it.’.If in doubt....refer. If in doubt....investigate.....if unsafe.....walk away. They hoped for an accelerated collapse of the NHS. Well, they’re getting it.

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  • I think the in this day of witch hunt and fault finding society ready to pin blame on some one, it is becoming very difficult to practice medicine especially as a GP where our very strength of managing risk and working with safety netting is becoming a problem when something goes wrong.
    Increasingly the Mantra of our work will be as what WTF! Said above; ’.If in doubt....refer. If in doubt....investigate.....if unsafe.....walk away
    Already most of us have started to work on this mantra.

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  • It is extremely disappointing that the legal position on Drs professional reflections for revalidation purposes was not considered appropriately before it was made a component of the compulsory appraisal process.

    The leadership of the GMC etc must reflect and feedback on the damage that had been done to the standing of the medical profession and the fact that the profession is feeling so victimised.

    It' is incredulous that only now the legal vulnerability that has been placed on Drs is being considered given that the appraisal process has been in place for years.

    How can this have been allowed to happen?

    I don't think any clinician disagrees with the need to do our upmost to protect patients to the best of our ability and thankfully the Shipmans are a rare breed.

    There is also an equally pressing need to take care of the professionals who work extremely hard in often inhumane working environments. Considering Dr BG - where was the heath and safety at work?

    The GMC question as to why so few cases are against the organisation compared to the individual surely doesn't need an expensive review process to find the answer. It is far easier to scapegoat one individual and close the case.

    In this era of blame and compensation there is no excuse for this to have been allowed to pass without proper legal consultation.

    I guess what we have to think now is better late than never.

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  • The popular press will not permit legal protection of reflections.....if reflections are protected "there must be something fishy going on".
    Courts will always have power to force disclosure in fatal cases.

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  • Politicians must reflect on their decisions in GMC style, "damned if you and damned if you don't " and throw their reflection to a bunch of lawyers to see how long they last, Hunt will be the first victim.

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