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Why GPs must be free to speak out

GPs’ professional status and independent contractor role give them a freedom to speak their mind much envied elsewhere in the NHS. But this month that freedom is under attack on two fronts.

The first attack comes from the so-called ‘gagging clauses’ included in a number of CCGs’ new constitutions. It seems scarcely credible any part of the NHS would introduce this kind of restriction at this juncture; if the Francis Inquiry taught us anything, it was surely the value of a transparent health service. But our investigation this month reveals that hundreds of GPs belonging to the member practices of at least five CCGs are now forbidden from making any ‘public statement’ about their CCG or its members without prior written consent.

These clauses may not prevent GPs blowing the whistle on a patient safety incident – the Public Interest Disclosure Act trumps gagging clauses – but they do appear to cover pretty much everything else. Planning to write a letter to your patients explaining local referral restrictions? Want to query rationing in the local press or challenge commissioning decisions at a town hall meeting? You may have to think again.

The second assault on GPs’ freedom of speech is equally significant. In guidance published alongside the latest version of Good Medical Practice, the GMC states: ‘If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name.’ So, doctors should not blog, tweet, comment or post anything online anonymously.

The thinking behind this guidance is perhaps easier to follow. Several senior GPs have raised concerns about cyberbullying and anonymous online interaction lowering the tone of debate, even among professional colleagues. The GMC itself insists it is not restricting ‘doctors’ right to express their views’, but argues: ‘Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.’

Nonetheless, it seems inevitable the guidance will have a chilling effect. The psychiatrist who writes for the Telegraph under the pseudonym Dr Max Pemberton led the backlash, warning that ‘silencing doctors in this way means the public will no longer hear their views’. Other doctors who write anonymously online have stopped doing so or ‘outed’ themselves.

Pulse’s own GP bloggers Copperfield and Jobbing Doctor write anonymously in order to be able to relate their experiences more honestly. Anonymous comments, too, on Pulse’s website and in forums elsewhere, permit frank, open discussion. A recent story on the regulation of GPs self-prescribing, for instance, prompted intense, intelligent debate, with many commenters admitting they had written themselves prescriptions. Had those doctors been required to identify themselves before leaving a comment, would that debate have taken place?

In our Big Interview this month, LMCs conference chair Dr Michael Ingram describes his primary job as giving a voice to the ‘hacked-off GP’. Such GPs are worth listening to – not least because it’s likely they have a fair idea of what’s going wrong on the NHS frontline and the best way to fix it. Unfortunately, CCG gagging clauses and the GMC’s new guidance may mean we hear their voices rather less.

Readers' comments (5)

  • Medicine has (sadly) a culture of bullying and thuggery directed at itself. I recall routine bullying as a medical student and often over the years in hospital and even now in GP land. While some of the more overt thuggery has lessened, it persists. Remember those current "abusers" were likely themselves abused and so the cycle continues. They are now in powerful and influential positions but they learnt these behaviours back in their medical youth.

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  • I have blogged about the GMC guidance. I agree that it will have a chilling effect; and the GMC has refused to explain why it changed the wording from the perfectly reasonable version in the consultation draft to a much more draconian version. Oddly, they have attempted to withdraw from in a statement on, of all places, their facebook page, though they say they will not amend the guidance.

    See and subsequent blog posts.

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  • I wonder if the GMC 'guidance' contravenes the European Union Human Rights Act in some way?

    I am not sure if the guidance may effectively stem free speech and in a way act as a form of censorship?

    Would the guidance also go against the spirit of openness that should be fostered post - Francis?

    In addition i thought there were already laws which can be used against anonymous posters who post material which is offensive or litigious?

    Note - I speak for my self and I do not represent any particular group.

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  • Vinci Ho

    This is an extraordinary time as far as freedom of speech in this country is concerned......
    (1) Perhaps gagging order has already been existing in many organisations . If you are a member of an organisation , is it right to say that organisation can legally state in terms and conditions that you are not allowed to express any opinions which will harm the best interest of the organisation ? And also is it legal to punish you as a result? Francis report demanded doctors and nurses to whistle blow but that could be just 'easy said than done' as per current evidence of the reality .
    (2) GMC required doctors to identify themselves when they give opinions and comments on these web sites. So if you are not a doctor , you are fine . What then will stop the doctor to ask his non doctor friend to post them instead?
    (3) The part on material is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely , is very unfair to these doctors who were willing to say 'something' but they could be charged because he/she did not check first whether 'something ' represented the views of the profession more widely. The consequence is even more doctors would try to post anonymously or get somebody to post for them.
    (4) Then this leads to the question of how are you going to run this web site in the near future, editor?Pulse owns this web site and has its right to cleanse any comments . The Leveson inquiry could easily change the culture of journalism in this country completely if the PCC (Press Complaint Commission ) is to be replaced. I am very interested in your opinion , editor. At the end of the day, yellow journalism amongst certain members of the media had really pressed the self destruction button . As far as Pulse is concerned, if some doctor wanted to present to you sensitive informations about the NHS or DoH for argument sake and he/she wanted protection, what would you do? (You do not necessarily have to answer this , I understand) . Yes, everybody has to be responsible for what he/she had said or posted ( the IP address is always traceable anyway) but does the story of Bernstein/Woodward/ Deep Throat still have a role in journalism in this country?????

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  • This is only the start. As a former healthcare professional, and now a researcher in Cambridge, this latest GMC attempt to limit GPs making anonymous comment is the preamble to the privatisation of the State health care service.
    You will get a glimpse of the input of corporate interference with welfare by reading : THE HIDDEN AGENDA as published by the Centre for Disability Studies at Leeds University:

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