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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.