The question on the lips of every GP this week must be: is there anything for which NHS England won’t try to blame someone else?
Unsurprisingly, NHS England’s response to its botching of the 2018 annual flu vaccination programme has been to attempt to blame the whole thing on GPs. Never mind that it announced the new two-vaccine programme in February, months after most surgeries had already ordered their flu vaccines for the following season; never mind that it gave surgeries a deadline of just over a month to get orders in; never mind the wild inaccuracy of its claim that ‘suppliers have confirmed that there will be enough[…]vaccine to meet demand’; it wasn’t NHS England’s fault.
Given that as a result of this fiasco flu vaccine uptake has fallen back this year in all key groups, it’s no surprise NHS England are so keen to shunt responsibility on to GPs. The lack of vaccine supplies could cause large numbers of avoidable deaths from influenza – far better to suggest any deaths are due to GP surgeries and practice managers mysteriously and abruptly forgetting how to order flu vaccines (despite their having done exactly this successfully for decades) than to take responsibility for the campaign it ran.
This narrative illustrates the way NHS England has created what is essentially a hostile environment towards GPs and frontline staff around the country.
It damages trust and morale, with knock-on effects on the fabric of the health service and on patient care
Back in 2013, its deputy chief executive blamed the troubled birth of the NHS 111 service on GPs, who had chosen through ‘local commissioners’ to put the service in place, rather than acknowledge that it had obliged commissioners to do it. Its head of Patient Safety blamed us in 2015 for not reporting patient safety events. When NHS England’s arrangements with Capita led to hundreds of thousands of clinical documents going missing, it blamed GPs for ‘not […] complying with guidance’, and doubled-down on that by suggesting GPs ‘risked patient safety and confidentiality’ by forwarding misdirected mail to Capita; it’s not clear whether those same GPs were responsible for NHS England being criticised by the National Audit Office for ‘understating’ the scale of the problem despite knowing how many items had actually been misdirected a year before giving evidence.
It’s not just GPs NHS England blames for things. NHS England’s acute care director blamed ‘ridiculous waste’ in acute trusts for seemingly all the health service’s problems, and predictably suggested that tackling this would cost ‘nothing extra – except the willingness and time to think it through with colleagues’, supporting the government narrative that NHS efficiency is the problem. And when the issue of deteriorating A&E performance, even through the summer months, was raised earlier this year by the BMA, NHS England talked about ‘extensive planning for winter’ and did a bit of pre-emptive blaming of councils, social care, and frontline clinicians: ‘staff getting vaccinated against flu will also help reduce the pressure on services over winter’. That takes the focus off their mismanagement in the past, and the suffering patients are being put through as a result right now, and suggests it will all be all right this winter because they’re now giving it serious thought. Then there’s the dogwhistle reference to ‘bedblocking’, which lets them pass the blame on to local councils who are conveniently responsible for social care.
Sometimes the hostile environment is even more overt. Yorkshire and Humber’s area team medical director said practices unwilling to ‘transform’ – by which he meant ‘do what I say’ – must be ‘allowed to fail and wither’, and NHS England’s most recent director of primary care Dr Arvind Madan notoriously suggested GPs should be happy when small practices closed and their colleagues lost their livelihoods as it is ‘a rationalisation of providers’. Interestingly, at the same time he was surreptitiously expressing these views through an anonymous forum profile, he was quoted publically in Pulse as saying ‘NHS chiefs have not done enough to save struggling practices from closing’. Similarly, immediately after Pulse broke the story of Dr Madan’s comments, NHS England’s spin machine went into overdrive, e-mailing round a circular seeking to clarify his views ‘and those of NHS England’ and suggesting he’d been misquoted. A raft of his supporters took to social media with remarkably similar messages dissembling about what he said, for example, ‘if you read the article he is not saying small practices should close’ from Professor Clare Gerada, and ‘@arvindmadan did not say small practices should close’ from one of his leadership fellows. It took the public exposure of his profile to make the truth stick, demonstrating that NHS England will say what they want people to hear in public, while doing the exact opposite in private.
All this speaks to systemic problems in NHS England. Why, in Dr Arvind Madan’s case, did NHS England send out an e-mail suggesting their director of primary care had been ‘misquoted’ when he hadn’t? Why didn’t they contact Pulse to clarify? Why were they happy to mislead people delivering care to protect one of their own? Individuals can make mistakes, but when organisations do it as frequently as NHS England has, something is rotten. That matters because it damages trust and morale, and those have knock-on effects on the fabric of the health service and on patient care.
Amidst the systemic failures at NHS England, and their use of the blame playbook, there are some signs of a shift in attitudes. Through the campaigning I have done with GP Survival on NHS England’s mismanagement of pensions, I can say we have been heartened by the approach taken by the interim direct of primary care, Dr Nikita Kanani, in particular in forcing Capita to sort out the pension of a doctor who had been forced to rely on medical hardship charities.
It is concrete action like this we need, as well as an end to blaming frontline staff of all stripes when things go wrong, to bring this hostile environment to an end.
But it will take a sea-change in NHS England’s organisational culture, its sense of accountability and how it relates to the clinical staff who do the work it oversees, to do this.
Dr Nick Grundy is a GP in Teddington and chair of GP Survival