Guest Opinion Dr John Lockley - Clinical senates are conscience of NHS

When I tell my colleagues I've just been appointed to our local clinical senate council, they all say the same thing: 'Well done! What's a clinical senate?'

I'm not sure anyone can yet give a definitive answer. The nearest that comes to mind - and by far the best, in my judgment - is that the clinical senate is the conscience of the NHS.

There are 12 clinical senates across England, each dealing with issues related to its own geographical area. Each senate consists of a central council of 15-30 people, assisted by a much larger, looser association, the clinical senate assembly, a forum to provide the senate council with ready access to experts from all healthcare disciplines.

We are responsible for 'assisting commissioners, and the health economy in improving outcomes and quality (as well as) increasing efficiency and promoting the needs of patients above the needs of organisations or professions'. In other words, the conscience of the NHS, to provide ethical, balanced, wise advice on the broadest scale.

Why me? Well, I applied. I never expected to be selected because there are so many high-profile clinicians in our area. The fact that I'm not high profile is significant. Here am I, an everyday GP, involved in making important decisions that will affect thousands of staff and millions of patients.

One of the big criticisms of the NHS is that its decision-makers can sometimes be remote from the front line, so it is good news that grassroots clinicians have the opportunity to guide the NHS.

What power will the senates have? Absolutely none, I suspect. They have no executive arm, no legal jurisdiction, no money and no strings to pull, except for one - moral authority.

As a practising GP, I am all too aware of the excessive expectations being placed on primary care: this must be alleviated. I'm also aware of the extent of bullying within the NHS and determined to do everything in my power to get rid of it.

While the time I spend on senate activity won't be that much - one or two days a month, perhaps - the thought processes involved will be many, subtle, varied and intense.

Dr Lockley is a Bedfordshire GP and member of East of England clinical senate. The full version of this article can be found at

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