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Not our responsibility or our fault – doctors make their position clear


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Friday, 15 July 2011

Not our responsibility or our fault – doctors make their position clear

There is nothing quite as nauseating as righteous indignation and we have had an epidemic of the stuff in the past year.

Criminals caught in the act and politicians in a tight corner always resort to it. Lately, even decent people are taking it up.

NHS managers use it to point out the folly of putting doctors in charge, while doctors use it to protest against the reforms. It is difficult, impossible sometimes, to distinguish between genuine concern for patients and self-interest.

As a rule, those most worried about patients are busy looking after them while those most worried about themselves claim to be looking out for them.

In their crudest form, they are the placard waving extremists who tour the country looking for ministers to shout at and police to taunt. A group of them turned up outside the Confederation event last week, where they berated the government and played a loud rap number accusing the secretary of state for health of being a rotter – or similar; it was difficult to hear above the din.

The police restrained a woman attempting to cross the barrier. “Don’t touch my elderly wife. She’s disabled,” warned the man with the megaphone, his words expressing indignation but his tone triumphant. Another great photo opportunity in the bag.

These people are firmly against cuts, job losses, government, the police, Rupert Murdoch and any authority except their own. Whether or not you agree with them, at least they know what they stand for and it’s clear what they mean even when it’s not what they say.

This street theatre is less objectionable than the spectacle of well-educated professional people obfuscating and dissembling.

It sometimes seems as if there isn’t a doctor in the land who doesn’t welcome the reforms in principle but object to them in practice. The argument that the practice is up to them has largely fallen on deaf ears.

These protesters wave verbal placards declaring that they’re both for it and against it, subject to certain conditions, assurances, concessions, and cast-iron guarantees that they won’t be worse off as a result.

They cite obstacles and difficulties that make you question how they made it through medical school. Is commissioning really harder than telling someone they have six months to live?

Where others might storm a barricade, this lot would rather send in the BMA to negotiate with it.

There are honourable exceptions – doctors who are clearly for or against. Dr Michael Dixon, chairman of the NHS Alliance passionately put the case for change last autumn, urging his colleagues not to be remembered as the generation of doctors who failed to take the chance of a lifetime. Other leading GPs have come out in favour as well.   

Then there are those who have taken the equally honourable position of publicly opposing the reforms.

One stood up at the Confed and said he didn’t believe doctors would agree to take
difficult decisions about closing hospitals – an honest view that echoes what many privately think.

But if some of the leaders have made their positions clear, many of the rank and file remain worryingly ambivalent and disengaged. While they wait for certainty and conviction to be bestowed upon them by the secretary of state, the BMA, the RCGP, the Commissioning Board or whoever they believe to be in charge, other voices are growing louder – the nurses, the hospital doctors, the AHPs.

GPs will be the first to complain if the opportunity for a clinically led NHS submerges beneath a rising tide of apathy and compromise. It will be too late for righteous indignation then.


bobriggs says:
Jul 15, 2011 11:36 AM
I have seen the system from the other side these last year or so.
Place into the hands of GP's a huge amount of grants and finance and you will see how many are the 'caring for the patient' type and how many are rubbing their hands together at the thought of all that lovely loot they will get their hands on.
Maybe a better control should be put in place. I have seen different PCT's refusing to pass over information from one to another easily. GP's who do not care about the outcome of their diagnosis and prescriptions. Details held in paper form at one place not passed to another.
I now have a list of all those departments involved in my problems and who says what and when. 'Well done' says those that have to chase around the NHS trying to find patients notes.
Remember the Sir Lancelot Pratt of the Doctor film days and you should know that this is the more common situation rather and unusual.
drodgers says:
Jul 15, 2011 01:12 PM
Yours is a rather emotive article on this issue of whether people within and outside the service are infavour or against the health service reforms. I believe that we should return to a really simply structured NHS as it was before the internal market: all one team funded from a central budget with risks shared and with no purchaser/provider split, with Medical Officers of Health making epidemiologically based decisions to allocate care, the commercial model dispensed with in favour of the service model and with an end to the division in budgeting for elderly care between nursing and social needs. Dick Rodgers Rev Dr. FRCS (former clinical orthopaedic assistant, ordained and campaigning for various things including this issue) Thanks.
wendytyler says:
Jul 15, 2011 01:36 PM
Please can the author of the emotive article please put their name to their document. One shouldnt write such inflammatory comments about a group of health professionals anonymously.
perhaps it is written somewhere that I can not find?
jpatterson says:
Jul 15, 2011 02:00 PM
Hi Wendy
It's not our practice to add a byline to the editor's blog but it's not a secret either. I write the blog and certainly have no intention to shelter behind anonymity.
robinb says:
Jul 15, 2011 04:49 PM
righteous? indignation? maybe. The problem is that many GPs are now business men, survival means running an efficient practice and maximising qof points. GPs for years now have worked in a chaotic system, face increasing demands and as gatekeepers have to juggle use of resources. They are the easy target for PCTs making savings/cuts whilst hospitals remain all powerful. Conflicts exist between good patient care and resources. people are told to present early with symptoms, GPs referrals are subject to scrutiny by committee, performance management and balanced scorcards are the order of the day. How many reorganisations in the last 10 years? Each reorganisation costs millions. Yes put GPs in the driving seat but reality means they will be under the micoscope and freedoms will not be there. I "retired" a year ago and now do locum work. For the first time for many years I can simply be a doctor, enjoy my work and intend to be in clinical practice for a good few years to come. I remind me of my GP when I was a child, remembered with warmth and his skill and caring without which I would not be alive today. People want a doctor they can trust and talk to, who is skilled and caring. Reality is that to be this person becomes harder with each change we see. However it is the GP who endures. Righteous indignation is the domain of politicians, not of our profession.
jonfolb says:
Jul 16, 2011 10:36 AM
Speaking as a doctor working in the NHS, I totally oppose this bill in principle and on practice, because I believe it fatally undermines the founding principles of the NHS as a public service, and will result in a fragmented and unequal service that will provide worse patient care at greater cost. Neither have I ever met another doctor who supports these proposals. The issue at stake is much more important than self-preservation or protectionism on the part of the medical profession - it is about the guiding principles of healthcare provision in this country. Incidentally these are principles for which I am more than willing to join the placard-wavers whom you seem to regard with such scorn.
Jon folb
johnlindley says:
Jul 18, 2011 04:50 PM
This is a short version of what I wanted to say. I think the NHS is one of the finest humanitarian ventures ever conceived ... and it is doomed. The worst thing is - I don't know who doomed it!

I wish:
 - there was an agreed way to provide equitable health services, using a centralised service model (as referred to by Rev Dick Rogers above).
 - doctors were equipped with the knowledge of how to make the NHS 'better'.
 - voting politicians in parliament/lords could understand and appreciate every consequence of their decisions on healthcare policies.

The importance of the task at hand is too big to actually be achieved. The significance of the task at hand is too important to us and our children. The parliamentary voters cannot possibly appreciate the implications of their decisions. The doctors cannot diagnose this problem. That is why I think we are doomed.

The UK have taken on the task of trying to figure out a good model for delivering such a complex and vast health service. The NHS service model in my opinion is of significance to all governments and all people.

That is why I wave placards, argue with management (sorry boss), encourage staff/patients to get involved in developments instead of sitting on the sidelines. That is why I have a sore head and disengage when a new round of changes threatens those few pillars of stability within my workplace. Is there any light?
jcornell says:
Jul 20, 2011 02:00 PM
Designed as it is to provoke, such an editorial doesn't help constructive dialogue. Most of us do not have access to any sort of influence other than through the BMA. Leaders of national associations who support the proposals easily get air time, those that oppose directly can do so by protesting - though they do not propose any constructive alternatives. The majority of us probably support the concept of clinicians being much more involved but have serious reservations with some of the specifics and the potential consequences to the survival of the NHS of some of them - as far as they have been spelt out. I have been to see my MP (Labour) who is concerned and made the point that labour's problem is they did not have any constructive alternatives to propose beyond reacting negatively to the current Bill. It was suggested that putting some positive things and involving our local MPs would be a good start but was needed urgently to be in time for the Select Committee. I provided some comments and constructive suggestions as to how some of the negative aspects of the current proposals might be mitigated, and emailed to all MPs in South YOrkshire. One response from the PA of John Healey indicating that it would be brought to his attention was the sum total of the replies. Perhaps my suggestions were not up to much, but courtesy would dictate acknowledgement, and further discussion of the detail might have led to something positive. It seems to me that the BMA is our best hope of modifying the Bill and just "dissing" it leads us to be labeled as reactionary and therefore to be ignored. Expressing unequivocal total support should at least lead us to question understanding - surely no one thinks the Bill is perfect and there are no aspects of concern. All of us have mixed motives for whatever we do tinged with a dash of self interest but the main motive for the vast majority is to do the best we can for our patients and the future of an NHS. Being in the "middle" doesn't grab the headlines but it doesn't mean we are ambivalent or disengaged. John Cornell Barnsley GP
jpatterson says:
Jul 21, 2011 11:37 PM
A possible cure for nausea -- see latest blog