Doctors not doctrine will cure the NHS
The dictionary defines ideology as “the body of doctrine, myth, belief, etc, that guides an individual, social movement, institution, class, or large group”.
Most of the time it is exactly these things that hold us back, make us cling to the outmoded and reject what’s new or different, blind us to our failings and our weaknesses or make us arrogantly insensible to reason and debate.
Fortunately nothing is our fault. Westminster and Whitehall decide our fate, set the rules, configure and reconfigure the system, meddle in our affairs and put obstacles in our way. We soldier bravely on in the best interests of patients, selflessly toiling against the odds and laughing in the face of adversity.
One of our favourite myths, that all the problems of the NHS would be solved if they were left to frontline staff is now being tested. And how have we taken the news of the liberation of the NHS, the stripping back of bureaucracy, the decentralisation of control, the reduction of waste and the focus on patients and outcomes?
Not very well, it has to be said.
Generally speaking, reaction has been of three kinds.
1) It’s not really true. Whatever the government says in the white paper it has a completely different agenda.
2) It’s the right idea but it won’t work. There are too many immovable obstacles in the system, too much vested interest, too many risks, too few rewards – and anyway it’s all been tried before under PBC, PCGs, fundholding.
3) Great, let’s get on with it. (And if we don’t hear so much from the third group it may be because “Doctors line up behind government policy” doesn’t make for very exciting headlines.)
The negative voices have plenty to object to. So, for example, there is no place for competition in the NHS. Or competition is a good thing but the policy won’t deliver it. Or the incentives are missing, misaligned or wrong. There won’t be enough support or people of the right calibre. It’s moving too fast or not fast enough. No one is telling us exactly what to do. Or what the government really means by freedom is what the poultry industry means by free range – you still end up plucked and stuffed.
You can understand some of the practical objections to the policy. It asks tough questions, it’s risky and important pieces of the puzzle are still missing. But there is a much more basic cause of GPs’ anxiety: They are being asked to trade a secure and predictable existence for a trip into the unknown.
You have to sympathise with their trepidation, but it would be surprising and disappointing if the profession didn’t get over it. It would really be very hard to explain why when offered the levers of reform that GPs bottled the opportunity.
What’s missing is a sense of the excitement that GPs are in a position to get it right.
Or perhaps our biggest ideological weakness is a shared belief that the NHS is condemned to permanent failure.