The past year has seen turbulence within the profession in general

And perhaps nowhere quite so much as within the specialty of psychiatry. In January there was the rather sad reminder of public and patient safety in the psychiatric context when the Swedish popular politician Anna Lindh was stabbed to death in a crowded public place by a man who declared by way of explanation ‘Jesus spoke to me’. In that same month according to the Daily Telegraph

(Jan, 28) a headline proclaimed that NHS health chiefs hounded a family doctor to suicide by accusing him of sending too many patients to hospital and their that their hounding of him led to depression culminating in his death.

Needless to say the Suspended Doctors Group of the SCP continues its uniquely helpful work to suspended doctors of all medical and surgical specialties. The Group’s Honorary Secretary supported by its Chairman Dr Dennis Murphy and the whole Society carry out their vital advocacy. In his separate address Peter will be elaborating on a recent beneficial policy by the Department of Health and local trusts. At last it appears that the number of newly suspended doctors approaching the Group for help is diminishing. I have no doubt that such change has been greatly propelled by that Group’s efforts rather than by the activity of larger doctor-representative Goliath bodies.

Also in January the dreadful Dr Harold Shipman suicided in his cell. He casts a long and dark shadow over the whole public and profession which has been exploited by our political masters in securing ever more control over the medical profession. Perhaps it was inevitable that the chairman of the Bristol Neonatal Surgery Report long known as hostile to the medical profession since as far back as 1981 when in his BBC Reith Lectures Unmasking Medicine has become chairman of the new Healthcare Commission. This has swingeing powers over many existing healthcare bodies including the GMC. It has absorbed and replaced the Commission for H ealth improvement. This is bad news for patients and profession. Already further erosion of what remains of our rather threadbare self-regulation continues despite the acknowledged fact that self-regulation, whatever its faults it may be is superior to state control, for best overall treatment standards and minimisation of danger for patients.

There have been claims that Bristol (more an NHS systems failure) and Shipman (a uniquely evil individual) have led to the need for more state imposed controls over doctors because of alleged loss of public trust. Yet repeated independent public surveys have shown that the public, despite politician’s and bureaucrats, continue to trust their doctors to a degree that must turn many politicians a quite definite shade of green. In mentioning the profession in a balanced favourable light we all of us know that this must not to be coloured by complacency: just a modest recognition of what persuaded the late historian, Roy Porter, to title his widely acclaimed history of medicine, The Greatest Benefit to Mankind.

One of the more shameful recent injustices to registered medical practitioners has been the referral by the GMC of doctors in the Shipman area who stand accused of failing to spot that something was amiss with Shipman’s practice. Hindsight is perfect vision. Doctors are not trained to be super sleuths. That function is invested in police authorities for obvious reasons. Suspicions about Shipman’s practice were first reported to the police by a local family doctor (now sadly deceased). Their investigation concluded that there was no case to answer and, I repeat, the police are specially trained in crime investigation skills. That those doctors should now be the focus of prosecution verges on the incomprehensible. After a negative investigation by the criminal investigation body what more could possibly be expected of them in preventing the plausible Shipman from carrying out his wicked killings.

Let us move on. By April this year NHS statistics had been thoroughly discredited in the public press, accused of seeking to portray improvements in NHS patient services in a better light as day to day realities,failures and headlines regularly contradicted: the continuing treatment postcode lottery remains endemic.

Closer to our own field attention was drawn by three mental health charities, Rethink, Sane and the Zeto Trust to chaotic conditions in overcrowded psychiatric wards where even drug dealers ply their trade. They jointly declared that despite some 650 initiatives in five years that little has changed.

As plans to extend nurse prescribing were being mooted the clamour against the GMC proposal to withdraw prescribing rights from retired doctors unless they were revalidated has intensified from from many sources including this Society. The issue remains unresolved, though it is without any evidence base to support it, and is a distinct blot on the GMC as does it policy of referring more and more doctors to the High Court – yet another new development.

The BMA publication for the NHS Modernising Agency, National Institute of Health in England and the Department of Health entitled New Roles for Psychiatristswas launched earlier this year. It has been received by the society. Our formal comment on it is all but complete. Overall it is disappointing, rather disjointed as befits a report on the psychiatrists role which has been prepared by a kaleidoscope of different professionals, clinical and otherwise meeting together on just two occasions. Not surprisingly it offers more questions than solutions. The society’s response is aimed at clarifying a possible way forward.

Even more alarming has been the public announcement in August by the President of the Royal College of Psychiatrists, Dr Mike Shooter, who is approaching the end of his term in office. Hospital Doctor issue of August 19 quoted him as saying that the College should admit medically non-qualified professionals and become the College of Mental Health. Apparently, he believes increasing collaboration with other mental health workers makes this a logical step. I have to ask whose logic? His comments have understandably angered many colleagues and I am at a loss as to the provenance of his proposals and am unaware of any parallel suggestion from any other royal medical college.

The future for the discipline promises to be not green, perhaps red and certainly orange.

Dr Dermot Ward

Chairman

Society of Clinical Psychiatrists.