Thursday, 13 May 2010

Clinical autonomy

Something I have noticed over the years is how increasingly restricted we have become in our clinical practice. Once upon a time our employers allowed us, as Consultants, total clinical autonomy. Indeed this was one of the conditions demanded by the BMA before they would agree to co-operate with the formation of the NHS. Increasingly this clinical autonomy is being lost, as managers control clinical practice by over rigid enforcement of protocols and guidelines many of which have little evidential base. Another example is referral management as described here. The concept of clinician discretion is gradually being lost. This culture of resigned obedience culminates in the sort of bunker mentality which afflicted the staff at Stafford hospital, too intimidated to speak out. The BMA of 1948 considered clinical autonomy one of its highest priorities. The BMA of 2010 is not the same.


  1. A culture of resigned obedience - how wonderfully apt. After years of repression now only thosecompletely careless of any career progression or even job security dare to speak out against the bullying, stalinist culture that pervades our local PCT. Only cynical careerists with no principles are successful in reaching senior posts and a loack of actual knowledge of the front line is viewed as a positive advantage. Access to services especially for old people is continually cut back whilst money is poured into a constant stream of consultants. The latest is compulsory management training for everyone consisting of outdated psychobabble which labels you as a certain personality type. If I were starting out on a career now I would not touch the NHS with a twenty foot bargepole and that is really sad.

    If the Libcons can do anything to turn this situation around they will have my gratitude but I am not too hopeful.

  2. Aha! Me too - have had to do child protection training (I'm a jobbing geriatrician), management training (I got to do a personality quiz too and got told if you are nice to people they will be helpful to you) and equality and diversity training (I am one of the ethnic minorities). All wasted an hour of my life, and I have to repeat it every year too (not the management one though, presumably my personality isn't going to change).