Posted by: Margaret McCartney7 September 2012
There's something badly wrong with this strike. I believe fully in the right of a worker to withhold his labour. I think that the Government has treated doctors – and other public service workers – unfairly when it comes to pensions. But there is a bigger problem, and it's the NHS reforms. We should have vowed to strike, first, over that.
It's easy for politicians to spin doctors as being greedy or rich, and I fully expect this is what they will do. It would have been less easy for politicians to explain away doctors downing stethoscopes because of their fury over the health bill. This, we could have said, was because it was bad for patients and good only for the shareholders looking to the bits of the NHS carcass capable of turning a profit.
True, that bill (now an act) will allow for a few GPs to stop seeing so many patients and to make a whole lot of hay at cost to the taxpayer.
But fundamentally, it will mean far more doctors will be left with the responsibility to care for patients in a fractured, messy jigsaw of services which are liable to appear and disappear with the ebb and flow of profit and loss. It will mean more unfairness – for how can a company whose aim is to reward its shareholders care for patients better than one that does not?
As usual, the most ill will lose most. Good doctors may feel that their only option is to get involved and to make commissioning less bad, but frankly, this feels like something set up to fail.
This strike should be far more about the way in which doctors are being treated in the new NHS. What GPs do best is to care for patients. Yet we are being moved out of the consulting room and into management, where rationing decisions are to be repeated across England.
We have seen the same happen to nurses. Good nurses, risen to a high grade and delivering excellent front-line care to patients, have found their best chance of promotion has been into management, and away from direct front-line care.
We should be protesting because our core work, that complex, stressful, challenging and difficult duty which we trained for, is repeatedly undervalued. The fact that intensity of work has not matched resources; the fact that people have more, interacting, long-term diseases; the fact that revalidation requires more tick-boxes and time that takes us away from patients – all this is being politically ignored.
Instead, the response from the Government has been to start non evidence-based ‘league tables' for GPs, as though we should simply behave like a supermarket or a corned beef factory. We don't, because otherwise we would just get rid of the most time-consuming parts of our work – our sickest patients.
What should we do? We should consider, at least, withdrawing from revalidation (which a systematic review in 2010 found brought no evidence of improvement of performance) en masse – this would result in Governmental embarrassment but no inconvenience to patients. We should also consider telling the Government that we wish nothing further to do with commissioning, as it can only fail our patients.
The BMA should be shouting louder about the health act. It is on your and my watch, and we must take some responsibility. I need our leaders to come out and tell us what to do.
Dr Margaret McCartney is a GP in Glasgow