Opinion: Clinicians – just another cog in the wheel, or a diamond in the mechanism?



National Officer Rob Quick considers the shifting status of health professionals

This year’s ASGBI Scientific Conference in Glasgow, with its overarching theme of patient safety, was the perfect platform from which to interrogate a growing perception – the deprofessionalisation of clinicians.

This trend has various facets. Professionally, the squeeze on job plans, SPAs and work rotas. Financially, through years of real-terms pay cuts. And from regulators, whether they be the General Medical Council or Care Quality Commission.

Many HCSA members will have noted the growth of "patient power," flowing from increased litigation, inquiries and defensive management. All of this spells greater scrutiny of individuals and their work.

Earlier this year the House of Lords Select Committee on NHS Sustainability highlighted the failure of workforce planning.

In his evidence to the same committee, Great Ormond Street NHS Foundation Trust chair Sir Cyril Chantler, a paediatrician, reported "a climate of fear amongst the workforce which was being created by top-down accountability and over-regulation."

Calls from NHS leaders and managers exhorting the need for greater "productivity" from hospital doctors reinforce the perception that clinicians are seen as just another cog in the wheel.

Yet a recent report by The Health Foundation suggests that productivity will not necessarily be achieved by managerialist commands to squeeze more "output" from consultants.

The think tank shone light on the range of factors that influence productivity, such as the availability of sufficient nurses and support staff, wage levels, delayed transfers of care, and the location and level of specialisation within a hospital.

In fact one can also point to overwhelming evidence that patients benefit from all employees being treated better, with improved engagement and recognition.

Professor Michael West, now at the University of Lancaster, has spent over a decade analysing NHS Staff Surveys, patient satisfaction surveys and mortality data. His findings sound obvious, but are often ignored.

If you treat NHS staff better, then patient outcomes are improved and there is a measurable reduction in patient mortality.

So consultants and their colleagues are far more than just cogs in the wheel, and it's time managers saw them for what they really are - diamonds in the mechanism.

Rob Quick is HCSA National Officer for West Yorkshire, North-East England and Eastern Scotland and a Fellow of the Chartered Institute of Professional Development.