As any number of battle-scarred PCT managers will tell you, attempting to manage GPs is very much like herding cats.
GP partners’ self-employed status offers them a freedom much envied by hospital colleagues. Over the years, their ability to robustly express their views and operate largely outside formal NHS management structures has become integral to the profession’s sense of identity. Perhaps more than any other part of the health service, GPs have been free to speak truth to power, patients and the press, unafraid of contractual repercussions.
CCGs, though, have been displaying impressive cat-herding mettle of late.
Already some are showing an appetite for performance managing practices to rival that of PCTs, with close monitoring and tight restrictions on prescribing, referrals and other activity. And this week we reveal that one of the lesser-known side effects of the NHS reforms will be to effectively gag hundreds of GPs.
Practices in Oldham and Dorset have been forbidden to make ‘any public statement or disclosure concerning the [CCG] or any of the Members’ without explicit approval. GPs in Essex were facing a similar clause in their constitution, although this is now to be reconsidered.
How those restrictions will be applied remains to be seen, and certainly one CCG insists it is not trying to stop GPs talking to the media ‘in general’. But according to the letter of the law – and CCG constitutions are about nothing if not the letter of the law – it would appear GPs won’t be able to say anything at all publically, about their CCG or its practices, without the official OK.
Restrictions on free speech may seem some way down GPs’ list of problems at the moment – behind, say, an imminent hike in QOF work, the phasing-out of the MPIG, revalidation and rationing. But the ramifications of gagging practices are huge.
Presumably anything from a call from the local paper to LMC newsletters and even tweets that might in some way be linked to your CCG will be subject to ‘sign off’.
Whistleblowing on matters of patient safety would remain protected by law, as our guide confirms. But if you have wider concerns about the way your CCG is being run, disagree over rationing measures or simply want to air your views about the NHS in your area, chances are you will need permission.
As a medical magazine, of course, Pulse has an obvious vested interest in protecting freedom of speech. Interviewing plain-talking, ever-quotable GPs is one of the joys of the job, and allows us to get under the skin of primary care in a way that is rarely possible in more restricted sectors.
But fighting this kind of gag is very much in GPs’ interest too. The fact that most CCGs are able to operate without restricting their members in this way suggests gagging clauses are entirely discretionary; the fact that at least one CCG is reconsidering its clause suggests they can be is very much in GPs’ interest too. The fact that most CCGs are able to operate without restricting their members in this way suggests gagging clauses are entirely discretionary; the fact that at least one CCG is reconsidering its clause suggests they can be successfully fought. GPs across the country must make their voices heard – while they still can.
Steve Nowottny is editor of Pulse