Chris Lancelot: Can we handle a professionally-led profession?

The government is still generating sensible healthcare decisions.

The GP Record, by Fran Orford
The GP Record, by Fran Orford

Latest in the firing line are access targets for GPs and A&E. At long last clinicians will be able to return to treating patients according to clinical importance, rather than time spent waiting.

Does this herald a new phase in the NHS in which decisions about health are left to the professionals? I hope so: it's long overdue.

I have always maintained that a profession is an occupation which cannot be monitored with simple targets - it's far too subtle. Targets don't work in healthcare: they neither measure 'good clinical care' nor produce the changes in behaviour that politicians expect. Worse - targets can be gamed by those managers intent merely on making money for their trust rather than caring for its patients.

So I look forward to a further bonfire of targets, heralding a gradual return of the medical profession to the professionals. I think we know how to handle this responsibly, don't we?

Or do we? Before the target culture was imposed there was much within the profession which we doctors failed to address. In particular, we weren't confronting colleagues we all knew were lazy and/or incompetent. I said at the time that if we failed to put our own house in order then NHS managers would try to do it instead but, not being clinicians, wouldn't be able to do it easily. We didn't. They tried. Mayhem.

If we are to return to a professional (and target-free) culture then we have to fulfil our side of the bargain. Each of us must be prepared to confront those colleagues who, sadly, are failing. Unlike managers, we don't need targets to tell us who they are: we just know. It takes a professional to spot a fellow professional's failings.

This is already part of our 'duties as a doctor' as described by the GMC. Historically we haven't been good at doing it. But from now on each of us must actively be involved with policing medicine. If this means reporting failing colleagues to the PCT or the GMC, then so be it. It is our duty - to our profession, to the patients and to the NHS.

It's either that, or back to targets again. Which would you rather have?

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