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At the heart of general practice since 1960

Don't let the door hit you on the way out, Sir Liam

Jobbing Doctor reflects on the undistinguished achievements of the departing Chief Medical Officer

Jobbing Doctor reflects on the undistinguished achievements of the departing Chief Medical Officer

I can remember several Chief Medical Officers. George Godber, Donald Acheson, Kenneth Calman, and latterly Sir Liam Donaldson. In their own ways they were all leaders in their fields before taking up the job of Chief Medical Officer (CMO).

As Sir Liam is to leave his post in May 2010, presumably to do other things, it is as well to reflect on what being the CMO actually means.

Firstly, you expect the CMO to give impartial and expert advice on a range of medical issues, and Sir Liam has not been shy about doing this.

His one achievement in this area is to guide into legislation the ban on smoking in public areas. This will be the thing that Jobbing Doctor will praise him for, although it is clear that there was a reluctance from the politicians initially (as evidenced by the fact that other countries introduced it first, and we had to wait for a review of how it played in Scotland, where the devolved Government took early action).

His advice on other areas is more contentious, and I remain unconvinced that his assessment of swine ‘flu' was ever close to the truth. His baleful and unwise prognostications played into the hands of the media, resulting in panicky headlines about 65,000 deaths. This was a bad error.

His latest advice on alcohol in children may have some grounding in science, but will fall on deaf ears and is unachievable.

Secondly, you expect a CMO to represent the views of the medical profession at the top table. This he has not done. It may be connected with the fact that he specialised in public health, and had no significant patient contact. Certainly there has been very little evidence that he listens to jobbing doctors at all.

Finally, you expect the CMO to be an independent mind. This is his biggest failure. There seems to be absolutely no evidence that he has spent any time advising Government about the consequences of their constant and unwise meddling in the way that the NHS is run.

He has been CMO at a time that more resources have been pushed into health care, and yet his voice is strangely silent when you consider the whole range of useless, expensive and divisive changes introduced by a series of politicians.

The roll call of half-baked and useless policies is a very long one, and has included a huge computer project (expensive and not fit for purpose), independent sector treatment centres (expensive, and of dubious value and quality), Alternative Providers of Medical Services (hugely divisive, wasteful and ineffective), polyclinics (a rehash of health centres of the 1960s), Private Finance Initiative (short-term gain for long-term pain) and so on.

We would expect a good CMO to be able to engage with and represent the best views of all the professionals, and the current CMO has merely been a tool of the Government.

Finally, when he did get a clinician involved in looking at primary care, he chose a specialist cancer surgeon from London to advise on General Practice! Lord Ara Darzi is a great surgeon, but knew very little about general practice when appointed, and it shows. His recommendations are long on hubris and short on practicality.

So Sir Liam is due to disappear into the distance of honorary degrees and other honours, bejewelled and ermined, no doubt.

I don't think his time at the Department has been a distinguished one, and that is a shame because he is a pleasant and intelligent man.

But, I'm afraid, that is not enough.

Jobbing doctor

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