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The accidental blogger


Blog headlines

  • Structuring a PCN Social Prescribing Service for the post COVID world
    25 February 2021

    This week we have a blog by Nick Sharples.

  • Community-Oriented Integrated Care
    18 February 2021

    The blog this week is a short extract from a paper considering an approach primary care networks could use to move towards community-oriented integrated care.

  • Strategy Unit releases opensource model for planning vaccine centre capacity
    11 February 2021

    This week's blog is from The Strategy Unit who are sharing an opensource model to help with vaccine centre capacity planning.

  • Time to talk day
    4 February 2021

    A small conversation about mental health has the power to make a big difference.

  • Supporting Staff: the emergence of ‘long-covid’
    28 January 2021

    As we are now well into a second, or is it now the third, wave of Covid-19 it is becoming apparent that Covid is something we have not experienced before and it has unique implications for staff management. It is not just the possibility that staff may become acutely ill with the virus, but that for some they may go on to develop persistent debilitating symptoms that will affect their ability to go back to work. This article looks at the implications of long-covid for HR and service managers when looking to support health care professionals (HCPs) return to work.

  • Link of the week: Clinically-Led workforce and Activity Redesign (CLEAR)
    21 January 2021

    This week we are sharing a link to the Clinically-Led workforce and Activity Redesign (CLEAR) site that is funded by Health Education England.

  • So much more than an extra pair of hands
    14 January 2021

    The introduction of the additional roles reimbursement scheme for primary care networks has started to grow capacity in general practice to address the unsustainably high workload that has put so much pressure on GPs.

  • Primary Care Networks – how did we get here?
    7 January 2021

    This week we are sharing a blog by PCC’s chairman David Colin-Thomé.

  • A year like no other
    17 December 2020

    On 5 July 1948 the NHS was born, over the last 72 years challenges and changes have been remarkable but the service has probably never been tested as much as in the last nine months. There have previously been numerous re-organisations, multiple changes to hospitals, mental health services and a shift from the family doctor towards more integrated primary care services delivered by a range of professionals. However, rapid transformation of services to embrace digital technologies, and a shift change to work differently has been forced upon all areas of the health service this year.

  • Guest blog: David Hotchin
    11 December 2020

    This week we have a guest blog that was submitted to us by David Hotchin, written by a retired friend....obviously, he's used a little poetic licence.

  • What now for commissioning?
    3 December 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What now for primary care
    4 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • Boosting your resilience
    30 October 2020

    The last year has been a difficult one, who would have imagined last Christmas that we would have been in lockdown, with the NHS seriously tested by a global pandemic. So much change has happened and the resilience of people working in and with health and care services has been seriously tested. Resilience is our ability to deal with, find strengths in and/or recover from difficult situations. Its sometimes referred to as “bounceabiliy” – but bouncing in what way?

  • Link of the week: National Cholesterol Month
    23 October 2020

    Every month or week of the year seems to be an awareness week, October has more than its fair share.

  • New redeployment service offers talent pool of motivated, work-ready individuals
    15 October 2020

    People 1st International have shared some of the work they are doing to support people displaced from industries due to the Covid-19 pandemic. There is an opportunity for health and care services to benefit from this workforce.

  • Link of the week
    9 October 2020

    Article published in the BMJ looking at the ability of the health service to quickly bounce back to pre-Covid levels of activity and considers if it is desirable.

  • Virtual Consultations– the patient perspective
    2 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article.

Friday, 19 April 2013

The accidental blogger

A recent edict by the GMC insisting that doctors who aired their views on social media should use their real names got the derision it deserved, firstly because there is no logical or ethical basis for restricting doctors’ freedom of speech, secondly because it is unenforceable.

There is a long and honourable tradition of writing under a nom de plume. Everybody knows that Dr Phil Hammond writes Private Eye’s medical news column, but A Doctor has more freedom and authority than Dr Hammond would enjoy in his own right. 

The authors of other blogs remain well hidden and with good reason. Detaching the author from the person allows us to consider the ideas on their own merit without distracting considerations about the character or motives of the man or woman behind the words.  

Many blogging doctors offer amusing and acute insights into the challenges and dilemmas faced by their profession and the occasional absurdities of the world they inhabit. Writing as themselves would inevitably oblige them to consider the effects of their words on their patients or taken out of context in the local papers.

The GMC, confronted with the absurdity of its position, has already started back-pedalling and it is safe to assume that it will be business as usual for doctors in cyberspace for the foreseeable future.

The controversy raises a bigger issue about anonymity, accountability and the impact of the NHS reforms.

The NHS has always operated in anonymous blogger mode. The faceless bureaucracy that Andrew Lansley sought to dismantle had its uses. The fact that no one knew who they were gave NHS managers the ability to take decisions that they did not have to account for directly to patients or the public. (Whether or not they made good use of this freedom is another question.)

The theory goes that by holding commissioners directly to account the public will get the services they want, the guilty will have nowhere to hide when things go wrong and the people making decisions will have a clearer mandate for the decisions they take.

It’s an attractive theory but the opposite is true. Directly accountable commissioners will twitch and dance to the ever-changing tune of public opinion just as MPs and local councillors do. They will be terrified of doing difficult things. They will make safe decisions and avoid the big changes that the NHS needs to make not just to provide better services but to have any prospect of long-term survival.

There may be other reasons why doctors are suspicious of the reforms – workload, financial pressure, erosion of pension rights and so on – but this is the main one. The CCG will be held to account for a show it does not run. And doctors – members of a club they did not choose to join – will be the fall guys.  

CCGs are too small to make big service changes and that the prospects of them taking collective decisions about such changes are remote. The NHS England business plan, published last week, makes this abundantly clear. There will be two QIPP agendas, the one written by CCGs and approved by NHS England, and the one written by  NHS England that addresses tariffs, hospital reconfigurations and services that cannot possibly be commissioned locally.

Three cheers for the realisation that health investment is a long term business and that chipping away at unit costs year by year will not work, but such a strategy will be nationally directed. CCGs will be not be running this show but playing minor parts scripted from above, just as PCTs did.  

Many have argued and continue to argue that this is just as it should be. The inevitable tension between national and local priorities cannot be resolved at the grass roots. The trouble is that the realignment of Andrew Lansley’s reforms with reality has yet to put the local autonomy genie back in the bottle. The myth that CCGs remain in charge of everything is still out there.

It means that doctors will still have their names on the blog. They just won’t have written it.

nick.ford@nhs.net says:
Apr 19, 2013 03:19 PM
As always, one of the more useful and informative pieces available on NHS Networks. It's the way you tell 'em.

Forward with the shining banner of culture change, personal accountability and transparency!


Peter Rabbit.