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Wider political context underlying the NHS junior doctors’ dispute

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6317 (Published 24 November 2015) Cite this as: BMJ 2015;351:h6317

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Re: Wider political context underlying the NHS junior doctors’ dispute

1. This conflict is part of the destruction of the learned professions. Traditionally these were the Church, University Teaching professionals, Law and Medicine. Perhaps we could include those like the old-fashioned Bank Manager! Their characteristic was that the most senior practitioners regularly saw the individual client/patient/student. They would ask about your problem, assess your need, offer advice about past, present and future problems and hopefully offer a solution. In Medicine, Diagnosis, and Prognosis that validate the prescription of treatment. The practitioner is autonomous in reaching their decision. This underlies and drives the expenditure of the Health Service. Such autonomy or independence is anathema to any employing bureaucracy as the managers cannot control this process, at least directly. Hence ugly organisations such as the GMC and Nice. The GMC has usurped the duty of the employer to determine clinical competence as opposed to probity, forcing doctors to bear the cost, and Nice to support the State bureaucracy in the task of rationing health expenditure. Nice does the work of the Politicians by declaring that, for instance, a treatment is too expensive to be given to the hoi-polloi. The university staff have been brought to heel by setting up Universities as peculiarly nasty quasi-commercial organisation based upon the ideology of what I like to call American commercial brutal. The Law is being sterilised by attacks on Legal Aid and raising costs of going to Law and by attacks on more objective external standard such as the European Court of Human Rights. The Churches are considered irrelevant but this may well change if criticism of current policies continue. So far the State has not managed to destroy as opposed to damage professional autonomy in Medicine. Of course such autonomy can be even abused but that does not invalidate its need. Inevitably the bureaucracy seeks Guidelines and similar procedures to control this autonomy not-with-standing all Guidelines are out of date before they are written and if they are to be followed, pace GMC and Nice, they are de facto regulations.

2. Nothing happens to your clinical skills if as a senior 'junior' doctor you are made a consultant. If you are a to be consultant you must have been doing consultant work and taking consultant decisions well before such an appointment. It is in the nature of things that all doctors once they start to practice will take very important decisions, even those that involve life or death. How else to you learn your craft? A similar dilemma is faced by the military, particularly the army, the most junior officer or squaddie will in combat be faced with such decisions, involving not only others but also themselves. Concerns over Weekend working concerns confuse clinical care systems with clinical competence.

3. Beware of bureaucratic and political priorities wrapped up as concern for the customer,client or patient. They are all to often self-serving and are like the camouflage or the old-fashioned smoke screen.

Competing interests: No competing interests

25 November 2015
David H Marjot
Retired Consultant psychiarist
Self
Weybridge, Surrey