Why are we looking this gift horse in the mouth?

I am beginning to despair. For all my working life the medical profession has been united over the running of the NHS. Managers and politicians, we all agreed, weren't the right people to lead it.

The GP Record, by Fran Orford www.francartoons.com
The GP Record, by Fran Orford www.francartoons.com

You can't deliver healthcare to patients as though they were shoppers at Sainsbury's. Patients are different. Healthcare is different. Lay managers may be nice people, competent outside the realms of medicine, but ultimately they aren't clinicians.

And we've kept up this chant for decades: clinicians should be in overall charge of healthcare delivery. We have all seen how managers and politicians have done it in the past - mainly badly and, mostly, expensively.

But now that we've actually been given the chance to run the NHS, a large proportion of the profession is queuing up to complain. They say we are being set up to fail. We're not trained to be managers. We haven't got the time. It's a sneaky cover for privatisation; or else for rationing.

What's the matter with us? We've been offered the chance of a lifetime and are doing our best to steer clear of it. Or is the real truth that, as a profession, we just love moaning, but when opportunity arises we run away?

Without doubt, managing healthcare isn't easy. It involves making difficult decisions; distributing finite resources; rationalising service delivery; supporting the Cinderella specialities; and imposing and policing standards. Doctors are well-placed to deliver all of these and more besides. And yes - it does involve risk, responsibility and complex decision making.

But it has always been like this. Nothing has changed. Organising healthcare effectively and equitably is the same complex problem it always was. If we object to non-medical leadership of the NHS but fail to take control when the job is offered to us then our earlier protestations seem like the actions of a loudmouth who criticises everything but hasn't the knowledge, the ability or the guts to do the job himself.

Please can we be consistent? As a profession we can either acknowledge the uncertainties and the difficulties, then resolutely go on to lead the NHS into the future; or else we should shut up, permanently, and let the managers and politicians get on with it. We can't have it both ways.

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