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How should doctors use e-portfolios in the wake of the Bawa-Garba case?

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k572 (Published 08 February 2018) Cite this as: BMJ 2018;360:k572

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Re: How should doctors use e-portfolios in the wake of the Bawa-Garba case?

Editor,
GP Appraisal is dead.
The fatal blow was administered by the fallout from the Bawa-Garba case.
We now know the following (1)
1. Even if Bawa-Garba’s reflections “did not actually go on to form part of the evidence before the court and jury” the MPS acknowledged that it “may well have been the case” that the reflections, as The BMJ has stated, “fed into the trial.”
2. Doctor’s reflections are potentially disclosable to courts, tribunals, and coroners, as legal advice obtained by the Royal College of Paediatrics and Child Health points out.
3. The GMC can obtain reflections if it is considering fitness to practise proceedings against a doctor; but it has assured doctors that “the GMC does not ask a doctor to provide their reflective statements if it’s investigating a concern about them.” However, if a deanery reports a trainee to the GMC, it may send along the reflective statements, as happened in a recent case.
4. In April 2016, Health Education England circulated a letter from postgraduate deans in London and the South East which read, “Recently, a trainee released a written reflection to a legal agency, when requested, which was subsequently used as evidence against the trainee in court.”
5. “Doctors in training must continue to write reflections, especially when there are things that do not go well. This is an essential part of training and is needed to progress through a postgraduate training programme.”
6. Failure to record reflections honestly could give rise to a referral to the GMC (so, we are damned if we do and damned if we don’t).
This appalling state of affairs represents a stab in the back and a total betrayal of all doctors who are participating or who have participated in GP Appraisal as Appraisers and Appraisees. I have been both.
I was in the original initial cohort of GPs to be trained as Appraisers in the UK and from 2003-2015 I appraised about 10 GP colleagues annually. At the outset of GP appraisal the endeavour was pitched as a confidential, supportive, reflective, peer to peer process to promote professional development. I well remember that at the outset I and other colleagues raised misgivings about the possibility of ‘mission creep’ and the process evolving from being educational to regulatory, which is exactly what happened. But it is now crystal clear that Appraisal has the potential to be persecutory. This egregious perversion of the scheme’s original aim is yet another grotesque twist in the accelerating death spiral of medical practice in the UK.
Three years ago I took early retirement from General Practice in the UK and am now practising in Australia. Medical practice here is far from perfect, but it’s a libertarian paradise compared to the UK. Unless this matter is rapidly and robustly resolved to restore the confidence of doctors in the purpose and process of GP appraisal I foresee the already steady stream of colleagues who are leaving the UK to practise elsewhere turning into a torrent.
How on earth have our professional organisations allowed this awful state of affairs to come to pass?

1. BMJ 2018;360:k572

Competing interests: No competing interests

11 February 2018
Stephen Longworth
GP
General Practitioner and BMA member
CY O’Connor Village Medical Centre, Piara Waters, Western Australia 6112