Contention with NHS England and the Care Quality Commission
Letters and articles challenging our cumulatively massed micromanagement and commodification within healthcare
The latter part of 2016 brought a personal coda. In many ways this was not only a climax, for it also served as a dire demonstration of my many years writing about our increasingly ratcheted and managed healthcare and its dangers. In particular, I recurrently urged caution of the ever-greater procedural squeezing and corralling of its professionals. This selection of writings describes the drama of this denouement and then the questions and analysis I offered to the relevant authorities.
The writings derive also from my earlier long-term tracking and documentation of the evolving and extensive – if unintentional – damage. My prophesies of where this would lead have proved mostly accurate: any personal gratification from this is grim and saddened.
Crucial to all this is our jettisoning certain principles of trust and autonomy. For these are essential if we are to sustain the kind of healthy professional identity and integrity that lead – mostly – to our better care and judgements: all these depend on individuals’ experience, informed intelligence and vocational conscience. Trust is a professional cornerstone, but now increasingly mistrusted and so driven out. Unless we are very careful, institutional power and professional integrity become inversely related.
I am not suggesting that we should abandon ever-present vigilance and thus discriminating mistrust. But the wisdom and workability of our professions lies in the balance (and thus style) we find for ourselves, or command in others, of trust v mistrust; of nourishing diversities of competence v punishing deviants for non-compliance. The balance is crucial, yet subtle and delicate. It is not easy.
Recent management and economic policies have made small GP practices almost extinct. Those few that remain are now, almost always, heroically and perilously vulnerable. This hostile environment, together with my age, bodes ill for any lengthy Appeal process. How could I possibly, even eventually, recover and rehabilitate my practice? Even legal redress could not enable me to continue my work.
So, my submission and abdication are coerced, but my thinking and contention remain free. Many professionals throughout our welfare services have communicated to me how my plight and story are redolent of their own working experiences and predicaments.
No written replies were ever received from NHS England. I made several further informal attempts at contact. Eventually a senior officer said this to me: ‘Look, a lot of us at NHS England agree with most of what you say. We hope you keep writing… This is strictly off the record, you understand…’ The voice was wearied, stoic and apologetic.
The CQC remained steadfast in its inaccessibility and silence for several months. Eventually, a letter – a kind of fortified defensive position – was received. You can read it, and my reply, below in wrong, wrong, WRONG … OUT! In ix, below.
Death by Documentation & Introduction
ii The Family Doctor and the Grid (Section E)
iii General Practice is the Art of the Possible (Article 75)
iv CQC Inspection and Closure of my NHS General Practice (Article 76)
v The Proof of the Pudding is in the Eating (Article 77)
vi When is Compliance Necessary for Public Safety? (Article 81)
vii When is Change Progress? (Article 84)
viii Should All Doctors Be Resuscitators? (Article 86)
ix wrong, wrong, WRONG … OUT! (Article 89)