Reflective Statements

Doctors who are going through a fitness to practise process will greatly benefit from a reflective statement. What are they, and how will it help a doctor?

What is Fit to Practise?

Doctors who are going through a General Medical Council (GMC) fitness to practise process must demonstrate to the GMC that they are fit to practise; pose no risk to public safety and/or will not bring the profession in to disrepute.

According to the GMC, being fit to practise means:

“…doctors must be competent in what they do. They must establish and maintain effective relationships with patients, respect patients’ autonomy and act responsibly and appropriately if they or a colleague fall ill and their performance suffers.

“But these attributes, while essential, are not enough. Doctors have a respected position in society and their work gives them privileged access to patients, some of whom may be very vulnerable. A doctor whose conduct has shown that they cannot justify the trust placed in them should not continue in unrestricted practice while that remains the case.”

Fitness to practise is in the present tense (also referred to as “current impairment”). In practice, “current impairment” considers the fitness to practise of a doctor at the point of consideration (i.e. case examiners or fitness to practise hearings) not the time in the past when, for example, something went wrong. Reflective statements can greatly assist a doctor in putting forward evidence of steps taken since the time in the past to demonstrate fitness to practise in the present.

Reflective Statements – what are they?

A reflective statement, as the name suggests, is a written piece setting out the doctor’s reflection(s) and thoughts on an incident(s), the insight they have gained from this and the remediation steps put in place.

Reflective statements should not merely be an account of events, but must show reflection on a deeper level to gain adequate insight.

The GMC recommends doctors take a “structured approach to reflection” involving three questions:

What? – Your thoughts at the time of an experience. Explore your thought processes when you take a particular action or decision and how it may have impacted on your actions and feelings. The what is where you record enough narrative about the event to put your reflection in context.
So what? – Consider the significance of what happened as well as the values and feelings at the time of and prompted by the experience, and why these may influence future learning or actions.
Now what? – What processes and opportunities can help you to learn from the experience and identify future actions, reflect on those actions, and use these to develop further.

Reflective Statements – do they matter?

Yes. A well written and thought through reflective statement can be important evidence to show a doctor’s fitness to practise is not impaired.

This is the case during all the GMC’s fitness to practise investigation stages. A well written and comprehensive reflective statement could result in a GMC fitness to practise investigation being closed at the triage or Case Examiner stage, thereby avoiding the need for an expensive and stressful fitness to practise hearing before a Medical Practitioner’s Tribunal.

If GMC allegations are referred to a Medical Practitioner’s Tribunal, reflective statement can equally be instrumental in achieving positive outcomes for doctors.

How to write a Reflective Statement

With more than 10 years’ experience representing doctors facing GMC fitness to practise investigations, we can assist and represent doctors through the entire process, including advice and guidance on reflective statements.

Developed by leading legal representatives for medical professionals facing health and social care tribunals, Insight Works Training have designed unique and practical courses with focus on impairment, reflections and remediation.

Courses are delivered by both leading healthcare experts with years of experience in mentoring and coaching who also sit on regulatory tribunal panels and, leading legal experts in the field of defence at health and social care regulatory tribunals.

Insight Works Training will help give you a clear and easy to follow understanding of the regulatory process, explanation of the central role of impairment, how to approach insight and remediation, how to evidence this at your hearing and a directed approach to presenting your learning with evidence in writing and verbally.

Worth going it alone before the GMC?

MPTS Legal Representation – Does it Pay?

Our GMC & MPTS Case Success

In upholding the appeal, Alan Bates, sitting as a Deputy Judge of the High Court, said:

Failure to assess witness credibility and reliability The panel did not sufficiently evaluate the general credibility and reliability of key witnesses, whose evidence was essential to the charges. It failed to consider factors such as contradictions between witnesses' accounts and whether their testimonies should be approached with caution. This omission undermined the panel's ability to justify its conclusions.
Lack of explanation for preferred evidence The panel failed to provide adequate reasons for preferring the complainants' evidence over the appellant nurse's and the paramedic's. Simply stating a preference for certain witnesses' accounts without detailed justification left the appellant without a clear understanding of why her evidence was rejected.
Errors in evidence evaluation The panel assessed each charge in isolation without considering broader patterns or contextual evidence. It failed to recognize that inaccuracies in one allegation (contradicted by CCTV) could cast doubt on the reliability of witnesses' accounts in other allegations, leading to flawed conclusions.
Improper handling of contextual evidence The panel neglected to evaluate the behaviour of the complainant nurses during the investigation, which was relevant to determining their credibility. Additionally, it overlooked the appellant nurse's claims that the allegations were fabricated to remove her from her managerial position.
Insufficient reasoning for findings The panel provided inadequate reasoning for its findings of misconduct. It did not fully explain how the evidence supported its conclusions, including why the NMC had met the burden of proof for each disputed allegation. This failure left the appellant with unsubstantiated conclusions, undermining the credibility of the process.

Lessons

This case highlights several critical considerations for fitness to practise tribunals. One key lesson is the importance of thoroughly evaluating the credibility and reliability of witnesses, particularly when their testimony is central to the charges. Without such assessments, the accuracy and fairness of the tribunal’s findings can be compromised. Witness accounts must be examined not only in isolation but also in a broader context, taking into account patterns and inconsistencies to achieve a holistic evaluation.

Additionally, tribunals must provide clear and rational reasoning for their decisions. Merely preferring one witness’s account over another without detailed explanations can lead to procedural unfairness. Ensuring transparency in decision-making fosters trust in the process and supports robust outcomes. Tribunals must also maintain procedural fairness by upholding the burden of proof on the prosecuting body. Accused parties should never feel pressured to disprove allegations, as fairness is crucial to preserving the system’s integrity.

Finally, the impact of procedural delays cannot be underestimated. Prolonged proceedings can cause undue harm to the accused, affecting their career and reputation. Timely resolutions are essential to upholding justice while minimizing unnecessary stress on all parties involved. By focusing on these principles, fitness-to-practise tribunals can enhance the fairness and effectiveness of their proceedings.

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.