A GPonline poll of 400 GPs found that seven in 10 GPs believe it is unsafe to record reflective notes in writing following the High Court hearing of the GMC appeal culminating in Dr Bawa-Garba being struck off.

58% of GPs have changed the way that they record reflective notes, and some 83% of GPs think the government should legislate to prevent doctors’ reflective notes being used against them in court, despite the government rejecting the recommendations from the Williams review (commissioned by the then Health Secretary, Jeremy Hunt).

Dr Bawa-Garba's reflections were not used against her as evidence but notes made by her appraiser formed part of his witness statement in the case.

This case has rocked the medical community, to the extent that LMC leaders voted earlier this year for the BMA to instruct GPs to disengage from written reflection. The GMC responded warning GPs that they risk undermining their revalidation if they refuse to take part in written reflection.

Although the GMC has said it will never use doctors' reflective notes against them in fitness to practise cases, there is no formal legal protection in GMC investigations, nor indeed in relation to civil proceedings.

It is imperative for safety and learning in healthcare (as in other industries such as aviation) to learn from mistakes and near misses, to reduce harm to patients.  It will be interesting to see whether the current Health Secretary, Matt Hancock, will seek to address this dilemma.

The Court of Appeal heard Dr Bawa-Garba's appeal on 25 & 26 July 2018. Judgment is reserved and expected in September.