hoolet issue 43 - Winter 2004

Chris Johnstone Intro
Owls and the College
Whistle-blowing
The Child Within
Strength Through Joy
Bump Up
Coaching - A Support for Doctors in the 'Age of Unreason'
Christmas Eve at The Pole
Holy Smoke
Swimming Against the Tide
Salt and Shake
Modernising Christmas
An Agenda for Chaperoning

Calm Down, Calm Down, It's Only The NHS

By Chris Johnstone
Contact the editor by e-mail at christopher.johnstone@ntlworld.com

NHS24 took over our out of hours co-operative last month and for the first three days we received an email saying no-one in our practice had contacted NHS24 the preceding night. You don’t know my patients, but let me say that this is highly unlikely. So I asked my receptionist to phone NHS24 to ask if it was correct that no-one had contacted them the previous nights. She was told that if that is what the email said then it was true. Not that she would check, or ask anyone else or even ask us why were we bothering to phone, but that it must be true if that is what the email said. No liklihood of an error there then. My response was to rise from my chair and go and sort it out, but my partner put his hand on my arm and said “Chris, put your head back in the sand.” So I did, I sat down and thought about the rather bland film I’d seen the night before, rather than worry about another NHS glitch. It was some-one else’s problem and they would fix it in time. Which they did and NHS24 has been just lovely since. Honest.

This episode has changed my life. I used to get upset about everything, but not only get upset but try to do something about it. A long time ago I just used to rail impotently about all the awful things I came across. Then someone, who was obviously very pissed off by my repetitive whinging, said “Why don’t you do something about it?” So I did. I started writing letters. “Dear Beaurocrat/Consultant, Why oh why oh why......... Yours faithfully, Dr Angry of Paisley.” This was fine and I did feel a little better, but then a terrible thing happened. After receiving a variety of replies along the lines of “Thank you for your letter which fits just snugly into my bin.” I opend a different type of letter. “Dear Dr Angry, Thank you for bringing this problem to our attention. We have held many meetings with many people and have agreed that you are right and that we will change our system as you suggest.” Oh no, I had made a difference. I was elated as I realised that if one letter could effect this change, imagine what lots of letters could do, or phonecalls or sitting on committees. So you find me, twelve years later, sitting on more committees than I can count. And am I making more changes than you can count? Well.....no.

There appears to be a law of diminishing returns applying to committees. The bigger the committee, the higher up the hierarchy the committee is situated, the less it achieves. I am sure this has been noted many times before. Most of the work seems to take place in small conclaves and the big committee is just a rubber stamping body. But a rubber stamp in which everyone has to have their say and can last for hours and hours. So these meetings are an awful ordeal, the biggest danger is falling asleep and snoring so loudly that the Chair is drowned out. So for busy person who likes to achieve things and make all those changes there is a deep temptation not to attend, but to do something useful, such as seeing patients. But there is also a macho side to attending committees. If you miss the meeting, you are named and shamed in the minutes and you are perceived as a wimp for not being able to cope with four hours of management speak. Your standing in the managerial hierarchy is diminished and you are put on even more committees as punishment.

So I have progressed from impotent GP, through letter writing, to multiple committee member and I am not sure how far I have progressed at all. I do find out what is going on sooner, but it is difficult to know what difference is made. The NHS talks about clinical ladership, but to be a true leader takes a lot of time and clinical work gets relegated down the pile, until one is wholly an administrator. How long since seeing your last patient does it take until someone ceases to be a clinical manager and becomes a manager, because it is very rare to do both effectively.

It is the festive season again and Christmas seems to come round quicker and quicker each year. It has been a busy year for hoolet. We have had our tenth anniversary and despite a dearth of advertising revenue we are still here. I would like to thank the College for all its support financially and administratively. I would also like to thank our two advertisers who stuck with us. A hearty thanks to all the readers who replied to the questionnaire and especially to all the contributors who make hoolet what it is.

Merry Christmas to you all and have a chaperone-free New Year.

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