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Matt Morgan: Rekindling the NHS’s foundational flame

BMJ 2024; 385 doi: (Published 14 May 2024) Cite this as: BMJ 2024;385:q1069

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A new model of medical professionalism for the NHS

Dear Editor

Morgan reminds us of Aneurin Bevan emphasis on doctors’ involvement in the organisation of their own services, at the founding of the NHS. Bevan seems to have astutely foreseen the sociological theory of what constitutes a profession that emerged later in the 20th century. Reflection on this sociological theory is thought-provoking:

The eminent American sociologist, Eliot Freidson, explains that any profession, such as medicine, has the essential characteristic that it is controlled by its own members—the professionals.(1) This self-control is fundamental, because the knowledge and skills in a profession are so special that these are possessed by its own members—the professionals—only. It is this specialness that distinguishes professions from other types of work. Now, outside interference risks professional disorganisation and public disservice.

Friedson’s arguments can be persuasive in campaigning for greater involvement of doctors in NHS management. Yet, Freidson’s model of professional self-control can be criticised for allowing nepotism, elitism and discrimination to go unchecked.(2) As doctors, we are not infallible! Also, medical decision-making inescapably involves many value-judgments that affect patients and the wider public.(3) So, it seems only fair that the medical profession should have external oversight.

So far, the external oversight has taken the form a loosely-defined partnership between doctors, policy-makers and non-medical managers. But, this partnership model has not worked well. We need a new model that clearly separates the parts of medical services that should be controlled by doctors from the parts that require external control. This task will not be easy but it is urgently needed to avoid chaos. Public engagement and transdisciplinary interaction with colleagues in sociology, law and politics are good starting-points for formulating a new model of medical professionalism for the 21st century.

1. Freidson E. Professionalism: The Third Logic: Polity; 2001.
2. Waring J. Restratification, Hybridity and Professional Elites: Questions of Power, Identity and Relational Contingency at the Points of ‘Professional–Organisational Intersection’. Sociology Compass. 2014;8:688-704.
3. Sarela AI. The test of availability of medical treatment. Med Law Int. 2023;23:109-37.

Competing interests: No competing interests

20 May 2024
Abeezar I Sarela
Consultant Surgeon
The Leeds Teaching Hospitals NHS Trust
St James's University Hospital, Leeds