Intended for healthcare professionals

Rapid response to:

Feature BMJ Round Table

After Francis, what next for the NHS?

BMJ 2013; 346 doi: (Published 10 April 2013) Cite this as: BMJ 2013;346:f2074

Rapid Response:

Re: After Francis, what next for the NHS?

The responsibility of healthcare workers to speak up about concerns features strongly in the Francis report. Doctors are very well placed to blow the whistle on poor medical practices (which often appear to be due to poor administrative decisions) but this can never happen until the doctors themselves are adequately protected. What better way to silence a whistle blowing doctor than to devise a clinical assessment they can be subjected to which they can only ever fail! An absurd idea, but this is exactly what the National Clinical Assessment Service (NCAS) has done. The NCAS performance assessment is so seriously scientifically flawed and poorly reported (see reference 1 for an explanation of a few of the problems); it is not able to recognise a doctor who should not have been subjected to the process in the first place. So why might a doctor be put into the process? Through the desire of a health board to silence a doctor who has raised an awkward issue maybe?

To label a doctor as underperforming clinically is a very effective way to deflect attention from the bullying and intimidation of an honest, competent, highly trained (at the tax payers’ expense) doctor. As an example, Dr Antoinette Geoghegan was referred to NCAS by her employer after she complained about unsafe practices and short staffing in her workplace. 2 Dr Geoghegan sent a six-page letter to the organization about her case, and the referral was subsequently dropped. But what did she fear from the assessment? Perhaps she suspected that she could only fail. In another case the Medical Practitioners Tribunal Service rejected the conclusions of an NCAS report on a doctor after studying the evidence in the report and declared the doctor fit to practice with no conditions attached, only for the local health board to blatantly ignore the GMC ruling and the lack of evidence in the NCAS report and ban the doctor from practising medicine based on the invalid conclusions of the NCAS report that they had commissioned.

It might be unthinkable to some that a body such as the NCAS with its panel of ‘senior scientific advisors’ might be hijacked in this way as a covert medium of doom for the innocent. But it does happen, and the issue is quietly lurking under the radar. Healthcare will never improve until there is a willingness to consider all aspects, even the unthinkable, with complete intellectual honesty, rather than strike out at easy targets.


Competing interests: No competing interests

19 April 2013
Helen L. Birch
Senior Lecturer
Stanmore, HA7 4LP