Views & Reviews No Holds Barred

Fed up with forms

BMJ 2014; 348 doi: (Published 02 April 2014) Cite this as: BMJ 2014;348:g2519
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret{at}

Where’s the joy in medicine? Junior doctors are the scaffolding that supports the great weight of the NHS. We who use and work in the NHS should cherish them through their stress and sleep deprivation. But thanks to the medical leadership of the past decade, junior doctorhood has been emptied of professional pride and filled with multiple bits of paper to check “competencies.” The feedback forms, 360° appraisals, team assessments of behaviour, and end of placement reports are the tick box nonsense to which we now subject them.

For me, several years removed from training, the stony bureaucracy and burdensome administration are astonishing. Modern shift patterns have broken teams where peer and consultant rapport made being a junior doctor survivable. Now, rather than judge juniors through a colleague who has taught them and seen them on the job we use anonymous comments from someone on a feedback form. This causes huge distress. The moral contract of medicine, of choosing to do a job out of care and love, has been fractured because of the unyielding training structures that senior doctors have bequeathed.

Here in primary care, the paperwork is also piling up. The Care Quality Commission is a form fetishist’s delight. And the quality, innovation, productivity, and prevention programme (QIPP) is a time draining exercise where I must wordily excuse sending patients to hospital and invent ways to send even fewer. Referral forms are rows of boxes of symptoms to tick, with no room for the narrative that explains what my patient is scared of and why. As for ongoing learning, every time I look something up I am meant to document it, to prove to my appraiser that I am taking my professional responsibilities seriously. Frankly, it is not much fun.

“Trusting is not a matter of blind deference, but of placing—or refusing—trust with good judgement,” said the philosopher Onora O’Neill. But was it good judgment to rely on a rise in paperwork to prove professionalism? Of course not. We are meant to be workers with vocation, who think, reflect, critique, and support each other. Now we are doing none of these things without a bit of paper to prove it. We should ditch the forms; lift our heads from our desks; and look at and listen to our patients and each other instead. This, fortunately, is where the joy in medicine still resides.


Cite this as: BMJ 2014;348:g2519


  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I’m an NHS GP partner, with income partly dependent on QOF points. I’m a part time undergraduate tutor at the University of Glasgow. I’ve written a book and earned from broadcast and written freelance journalism. I’m an unpaid patron of Healthwatch. I make a monthly donation to Keep Our NHS Public. I’m a member of MedAct. I’m occasionally paid for time, travel, and accommodation to give talks or have locum fees paid to allow me to give talks but never for any drug or public relations company. I was elected to the national council of the Royal College of General Practitioners in 2013.

  • Follow Margaret McCartney on Twitter, @mgtmccartney

  • Find out more about the doctor behind the column: read Margaret McCartney’s recent BMJ Confidential, “Singing the praises of evidence,”

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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