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The accidental blogger


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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.