A Matter of Honours !

Self-regulation is dead.  Long live self-regulation.  In 1858 The Medical (Registration) Act led to the establishment of the General Medical Council.  At that time government regulation and control of medical standards was still unacceptable to the average United Kingdom citizen.  In effect it was government`s tacit recognition that the people did not trust politicians.  Last month journalist Alan Judd (Daily Telegraph 26 June) reprised that public sentiment in a penetrating piece whose title urged Trust your doctor - not the fixers and spinners in Whitehall. All newspapers please copy!

The perennial tension that has beset a self-regulated medical profession and government of the day has been a necessary interface between doctors, inter alia, spending public monies on necessary and better patient care and government's natural reluctance to drain its coffers.  Doctors are the biggest spenders on health resources and also embody the most cogent appraisal and criticism of government health policy.  More direct control by government of doctors facilitates more control of spending and inhibits doctors` ability (in an NHS) to speak out fearlessly on behalf of patient treatment needs.

Milestones in eroding our self-regulation were the 1983 Griffith Report which introduced aggressive general management which effectively began the sidelining of doctors by managers whose priority was money management for their political masters.  1989's Working for patients  further  disempowered  doctors within the NHS with its  the internal market, purchaser/provider split together with gagging work contracts for consultants.

And then there has been the Honours system.  I, like many people, am in favour of an honours system; of distinction awards, of knighthoods and peerages for outstanding doctors, provided the perception of merit and honour`s advisory role is in the gift of a medical peer group and not within that of administrators, managers, civil servants and the like, as has now become the order.  Offices such as that of Chief Medical Officer are in essence civil service appointments.  It is probably reasonable that such non-clinical medical practitioners, having forsaken clinical practice, participate in the usual civil service control honours system.  There loyalties will of course be to political masters which is fine so long as we are cognisant of that when we inspect proposals affecting doctors training and NHS patient service policy.

The inexorable tension focuses most keenly  between the medical profession, perhaps particularly its clinical practitioners,( via their elected leaders such as BMA chairman of council, HCSA president, and president of GMC) and government of the day.  However,  the effective removal of historic honour`s advisory gifting, from peer registered medical practitioners and instead vesting it in managers/administrators and politicians, it should give us pause.