Dr Phil Hammond, broadcaster and sessional GP in Bristol

GPs need to become more involved in commissioning

On the day the Francis Report into appalling care failings at Stafford Hospital was published,1 I was speaking at a meeting in Bournemouth that was trying to encourage local GPs to become more active in commissioning. Should the two be related? I’d been up early that day, to do a BBC Radio 5 interview explaining why the lessons of the Bristol heart scandal, a story I’d broken in Private Eye 21 years ago, had not been learned. That led to what was then the largest public inquiry in British history, which made 198 recommendations on the need for a relentless focus on humanity, honesty, transparency, quality, and safety that put patients at the heart of the NHS.2 Most have been repeated by Robert Francis QC, who has trumped Kennedy with 290 recommendations, and I bet you can’t name five.

There are so many vested interests and barriers in medicine that prevent truly patient-centred care, it’s hard to know where to start: professional and institutional loyalty; fear of blame, failure, and litigation; exhaustion; lack of time, information, training, and motivation; not enough staff with the right skill mix; and more recently, market forces that undermine the neutrality of professional judgement and encourage self-interested decision making.

But you won’t get a more self-interested profession than politicians, and the failings at Mid Staffs—and indeed all the NHS scandals I’ve covered in the last 20 years—were made far worse by the politicisation of the NHS. This isn’t to say the NHS has not improved over the years. It delivers, by and large, care that ranges from competent to truly excellent. The problem is that the pockets of disastrous care are hidden from view and denied both by frightened front-line staff and a hierarchy that exists to serve its political masters and delivers only good news to Downing Street, in time for the next election.

As I watched Francis deliver his verdict, I was absolutely staggered that no individuals have been held to account. He passed out little bits of blame to everyone, conveniently allowing powerful politicians and NHS leaders completely off the hook. Labour politicians went into the commons debate expecting a roasting—Mid Staffs went on under their watch, and it was Labour who pushed hospitals to become Foundation Trusts when they were clearly not up to it and oversaw a bullying culture of hit your targets ‘or else’. But everyone in authority has got off scot-free. The Commons and NHS Commissioning Board heaved a collective sigh of relief and the debate became a pointless platitude-fest.

Francis was keen to avoid scapegoats, but we still need someone to take responsibility and be held to account for up to 1200 needless deaths. What message does this send out to NHS staff (including GPs), who may in future face criminal charges if we aren’t honest when we’ve harmed one patient? Once again, the bureaucrats are in the clear and the front-line staff will have to carry the can—in my view, senior managers should have resigned on Wednesday 6 February. If GPs do not get involved in commissioning, the same thing will happen to them. If we want a humane, patient-centred NHS, then clinical staff with similar values must get out of their consulting rooms and lead. The future may not be bright for the NHS, but if we don’t try to control our destiny, there will be no light at all.

  1. The Mid Staffordshire NHS Foundation Trust, chaired by Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Norwich: The Stationery Office, 2013. Available at: cdn.midstaffspublicinquiry.com/sites/default/files/report/Volume%203.pdf
  2. Bristol Royal Infirmary. The report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995: learning from Bristol. London: The Stationery Office, 2001.G