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A strike aimed at the wrong target

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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

Readers' comments (5)

  • Mark Struthers

    Evidence, evidence, evidence! I think patients expect doctors to keep up to date and expect the government to provide the evidence. Of course, as a government quango, the GMC must do what its told.

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  • Mark Struthers

    The evidence on GMC decision-making came in a press release.

    Commenting on the GMC decision of 24 May 2010, Professor John Walker-Smith said:

    “I am devastated that the GMC has decided to erase me from the medical register. At each stage of the GMC’s investigation and hearing I have put forward strong evidence contesting the central allegations against me. It is deeply disappointing that the GMC has chosen to impose a sanction of such severity despite the evidence they had available to them. I have always and will continue to vigorously contest any suggestion of wrongdoing on my part.”

    “For 40 years I dedicated my career to paediatric gastroenterology and am proud of the worldwide recognition I have received from my peers in the medical community. I have always been committed to the care of children and my first concern has been to do the best for them. I am forever indebted to my colleagues, family and friends for their support and understanding during what has been a difficult and prolonged investigation. I will now be considering the GMC’s findings in detail with my legal advisers.”

    The medical profession were united. The brotherhood did not question the evidence; doctors said nothing and did nothing about the quality of decision-making or the mercy dispensed.

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  • Mark Struthers

    Professor John Walker-Smith appealed to the High Court.

    The Canary Party: FOR IMMEDIATE RELEASE: Wednesday, March 7, 2012

    “World renowned pediatric gastroenterologist Prof. John Walker-Smith won his appeal today against the United Kingdom’s General Medical Council regulatory board that had ruled against both him and Andrew Wakefield for their roles in the 1998 Lancet MMR paper, which raised questions about a link to autism. The complete victory means that Walker-Smith has been returned to the status of a fully licensed physician in the UK, although he had already retired in 2001 — six years before the GMC trial even began.

    Justice John Mitting ruled on the appeal by Walker-Smith, saying that the GMC “panel’s determination cannot stand. I therefore quash it.” He said that its conclusions were based on “inadequate and superficial reasoning and, in a number of instances, a wrong conclusion.” The verdict restores Walker-Smith’s name to the medical register and his reputation to the medical community. This conclusion is not surprising, as the GMC trial had no actual complainants, no harm came to the children who were studied, and parents supported Walker-Smith and Wakefield through the trial, reporting that their children had medically benefited from the treatment they received at the Royal Free Hospital.”

    Doctors in Britain were silent.

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  • Mark Struthers

    Professor John Walker-Smith has written a book.

    Enduring Memories: A Paediatric Gastroenterologist Remembers. A Tale of London and Sydney. John Walker-Smith. The Memoir Club, 2012. ISBN: 978-1-84104-538-2

    "This is the second edition of the autobiography of a doctor who has contributed to the development of a new specialty within paediatrics, both nationally and internationally. The need for a second edition relates to his involvement in a General Medical Council (GMC) Hearing from 2007 to 2010. His involvement concerned his investigation of 12 children within the autism spectrum who had bowel symptoms. However the Hearing involved two other doctors and was also involved other issues, including the possible role of MMR and the onset of autism. The Hearing was the longest ever held by the GMC and he gave evidence for longer than any other doctor before him. In this edition there is a chapter called the Trial in which he relates his personal experience of the Hearing (Trial), with overtones of Kafka."

    In 'The Trial', Professor Walker-Smith, writing of 'The Hearing Chamber', said,

    "I found this "chamber" to be a deeply deceptive room. I regarded the absence of traditional symbols of justice to be highly significant. There were no visual assurances that justice would be done in this room. It seemed to me that the purpose of this room was to deceive the defendants into thinking that this was a room where normal "business" meetings would be held. The implication was that the Hearing was a normal business meeting. This was far, far from reality, as all the lawyers and Panellists knew from long experience. I saw it as a dishonest room where a defendant might be lulled into a false sense of normality. Thereby entrapment by the prosecution might occur. The chairs and the tables had stainless steel fittings. These came to symbolise instruments of torture in my mind. Indeed by the end of cross-examination I came to regard the room as a "Torture Chamber"".

    Of course, Dr Margaret McCartney will have nothing to say.

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  • Mark Struthers

    Liberté, égalité, fraternité. Margaret's call to arms has gone down like a lead balloon. The brotherhood is totally united: doctors will not boycott revalidation.

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