The letter below was sent in by a Proletarian reader who works as a junior doctor in the NHS.
As the 5 November date for the posting out of strike ballot papers approached, junior doctors in England will not have failed to notice the flurry of emails from our ever-impartial colleagues at the General Medical Council (GMC) and Health Education England, solemnly warning us that although it would be inappropriate for our worthy colleagues to take a position one way or the other with regard to strike action (the very idea!), junior doctors should consider the decision to strike very carefully indeed, remembering our duty to follow GMC guidance – and so on and so on.
Junior doctors – well-versed as we are in the increasingly corporate managerial language of the ‘Modernising Medical Careers’ (MMC)-era training programmes – are by now only too familiar with these sorts of thinly-veiled passive-aggressive threats, with their hectoring, Blairite, school-marmy reminders that we remain free to do exactly as we are told.
The point is that no junior doctor will be fooled for one minute by Health Education England’s Pontius Pilate-like pronouncements about its own impartiality regarding junior doctors’ strike action, because every junior doctor knows full well that since MMC was imposed upon us in 2007, the training programmes have increasingly become the means by which NHS management structures have sought to frighten us into subservience – by making working harder and harder for less and less money (‘teamwork’) and shutting up about rampant managerial incompetence (‘professionalism’) preconditions of career progression (or being allowed to keep your job, in other words) via the Annual Review of Competence Progression (ARCP) process.
For consultants and GPs, the means by which they have been frightened into silence, of course, has been the GMC itself, which over the past 15 years or so has been transformed from its traditional role of enlightened professional self-regulation – a role that served profession and public alike perfectly well for the first nearly one-and-a-half centuries of its existence – into being essentially a tool of Downing Street.
In this respect, the GMC’s trajectory has paralleled that of the BBC in recent years: and, like the BBC, there has been a concomitant collapse in quality, while costs, along with self-congratulatory rhetoric, have risen exponentially.
So although the proposed strike action by junior doctors is of course to be welcomed and supported wholeheartedly, the unavoidable truth is that doctors will only be free to resume their role of acting in the best interests of the public when they break free once and for all from the corporate managerial structures into which they have been straightjacketed – with the naive acquiescence of too many within the profession – by successive governments from Tony Blair on.
The obvious means of achieving this would be – in the first instance – a collective profession-wide declaration of no confidence in the GMC, followed up in short order by an organised boycott of the annual retention fee.
Those who might baulk at such a course of action would do well to recall the fact that we are talking here about an organisation that, despite its much-trumpeted statutory duty to protect the public, has evidently not lifted a finger to defend the NHS against successive government privatisation and cuts programmes, preferring instead to slavishly follow Westminster’s lead in attempting to scapegoat doctors for the NHS’s ills; an organisation for whom it actually took recourse to the Freedom of Information Act to force it to reveal data on how many doctors had committed suicide or otherwise died whilst subject to its Court of Star Chamber-like Fitness to Practice proceedings in recent years.
The GMC claims to work “with doctors, for patients”. The truth is that it seems to do neither of these things; rather, it seems that the GMC works “with the government, against doctors, against patients, for itself”. The fact that our professional body, through its actions, ends up working counter to the interests of patients is reason enough for any doctor to oppose it – and, indeed, to oppose it as a professional and ethical duty.
I believe it is therefore essential that, as a profession, we take the necessary steps to reclaim our autonomy, and Declare our Independence from the post-Blair era GMC. If in this we do not all hang together then, as Benjamin Franklin warned, we will, most assuredly, all hang separately.