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Dr Mike Dixon: Post-Francis report, this is a critical time for GPs to assert leadership skills and trustworthiness

From Dr Michael Dixon, chair, NHS Alliance

I think I should expand on views expressed by me in your article, GP leaders back Sir David Nicholson.

Firstly, if clear warnings about safety and quality were given by hospital chief executives and chairs, and were ignored, then this is a very serious issue.  These claims need to be investigated and explained, and we will require a means of reassurance that this will not happen again. 

I feel that the events in Mid Staffordshire Hospital and elsewhere were much more than blips or faults in the system.  They were a direct and predictable result of the NHS as it is.  That is to say, a centrally controlled managerial hierarchical system, where pleasing the man or woman above you was more important than the patient.  How can ‘gagging clauses’ that hide the truth from patients who use and pay for the health service ever be right?

The same conditions that led to the Stafford Hospital tragedy still exist, and the conspiracy of fear is still alive and well.  More regulation and more performance control will not solve that.

Scapegoating frontline clinicians and managers, or demanding resignations from senior ones, is far less important than a really determined effort to set things straight. Widespread cultural change will be more important than any amount of recommendations, and people and structures to carry them out. 

We could start by celebrating and recognising good care and compassion, seeing it as much a part of quality (in the GP Quality Framework) as meeting biomedical imperatives, respecting outspoken clinical leadership, and empowering patients as friendly critics. 

For general practice, this will be a critical time for us to assert our leadership as local commissioners and providers, and as a more trusted force than the barristers, politicians and managers who have acted predictably, but who are unable to create the necessary visceral change that can be achieved by frontline GPs and patients working together.