Conveniently, the Health and Social Care Bill completed its final parliamentary stage on the eve of the budget, ensuring it was in hours knocked off the top of the news pile by Porgie’s Biddy Tax. But, mean as the Biddy Tax is, it is not the erosion and loss of the Pensioner’s Allowance that will hit Granny hard in the years to come, it is the erosion and loss of the NHS brought about by the Tories’ now soon to be unleashed health service reforms that will hit Granny – and indeed the rest of us when we need healthcare – hard. So the question arises: what are we going to do about it?
The Establishment, by which Dr No means the medical Royal Colleges, have, by and large, adopted a Vichy position: we do not like the reforms, but will collaborate in the interests of our patients. No doubt Marshal Pétain had similar thoughts about the French people – ‘it is necessary to stop the fighting’ – as he chose to sign up with the Nazis.
Others, meanwhile, may simply claim pragmatism, and advance the cause of the rule of law, the civil obligation to obedience. Indeed, few would disagree that pragmatic collaboration is a correct course to follow. But the question Dr No can’t help wondering is: is it the right course to follow. The question arises because, as Doctor Zorro reminded us recently, there have been many dark episodes in medical history when doctors may have done the correct thing by the rule of law, but by any other court have most definitely done the wrong thing.
It is a commonplace that the first duty of a doctor is to his or her patient. Indeed the GMC – that close friend of doctors – includes a similar notion as the first duty in its summary list of the duties of a doctor. In its quaint second person addressing-the-doctor way, Good Medical Practice says ‘you must make the care of your patient your first concern’.
Now, it seems to Dr No that this core guidance, which all good doctors would readily agree with, places the Royal Colleges in a spot. Most have conducted surveys and taken ballots, and in some shape or form issued statements to the effect that a majority of their college’s members believe the reforms will harm patient care. On these counts alone, given the GMC guidance to put patients first, the colleges’ and their members duties are clear: they should refuse to cooperate with reforms they believe will harm patient care. But – it seems – the spirit of Marshal Pétain is abroad.
GPs, who are required to get involved in commissioning, are likely to find themselves in an even hotter place. Most GPs lack even basic commissioning skills – monkeys commissioning bananas springs to mind. The monkeys might wish to remind themselves that the GMC is quite clear that doctors must work within the limits of their competence. Cavalier GPs who ride the commissioning cart while lacking in competence risk feeling the heat of the GMC breathing down their neck.
It seems to Dr No that there is a sound case for carefully reasoned civil disobedience. Such disobedience is neither wanton not maverick, but a reasonable response to unreasonable circumstances; a balanced resolution to the conflict between civic responsibility and professional calling. Consider this: if a third of GPs – about 10,000 – refuse to go along with the reforms, then the reforms will falter and stall. Even if only a third become objectors, there is safety in numbers. Suing 10,000 GPs for anti-competitive practice – say referring patients exclusively to NHS providers – simply is not going to happen. There is no need for Dr Finlay to be shy: Dr Spartacus will protect him.
Appeasement, and cooperation with the reforms in the interests of patients is certainly an option, as a similar appeasement in the interests of the French people was an option for Pétain. But those doctors contemplating the Vichy option might wish to reflect: not only history, but his own people, judged Pétain harshly. He was convicted of treason.