Open and shut case

Published: 18/04/2002, Volume II2, No. 5801 Page 13 14

The NHS is at a critical point in its development, with the publication of the new GP contract due today and the imminent arrival of a consultant contract, which will ask newly appointed consultants for a bigger commitment to NHS work.

After the launch of the NHS plan, which was broadly welcomed by the profession, confidence in the reform has been on the wane among doctors. Getting them back on board is a government priority, and as part of that initiative a major conference in London is being held today focusing on improving working lives for doctors.

Heading the conference is chief medical officer Professor Sir Liam Donaldson who, speaking to HSJ before the conference, makes it clear that this is part of a charm offensive to ensure that the NHS plan targets can be met. He also details what is expected of doctors and other professional staff in return for improved working conditions: 'I start from the position that to be successful in what it is trying to do, particularly when it is changing and reforming in a major way, the NHS has to take staff with it. It has never been as explicit as it could have been about how to motivate staff and to gain their commitment.

'If you look at other sectors, particularly the private sector, no respectable chief executive would attempt to try and achieve major change, major goals and objectives without acknowledging that that can only be done with a committed and motivated workforce.

And to get a committed and motivated workforce you have got to do something for them.

'You can't just expect them to follow you, unless you take account of their concerns. Get them to buy into the changes you are trying to introduce. That means addressing not just terms and conditions of service, but recruitment and retention. It is about getting a commitment, motivated workforce.'

So there is no question of what the government wants from this.

But does Sir Liam think this is something of importance to staff?

'We have got to recognise that we have a much more heterogeneous workforce now and people have different aspirations.

'There are some groups of staff for whom work is everything.

They would like to work all the time - like me, ' he laughs, adding that it is not necessarily a good way of working.

'But there are others who want to have a significant balance in their lives, ' he acknowledges.'

He gives an example: 'It is traditional for students to talk about taking a gap year, but I think people will increasingly want to take gap years later in their careers, perhaps before taking up a substantive consultant post.'

Flexibility - or rather inflexibility - is something Sir Liam knows about. People thought he was 'a bit odd', when he gave up a career in surgery for public health, he admits.

Although Sir Liam seems to believe that people attach importance to the promised new flexibilities and the plan, he knows they have other priorities.

'On the whole they like the idea of clearer priorities, they like the idea of a greater emphasis on primary care. They like the idea of a much greater focus on the patient.

They like the idea of quality being put high on the agenda, alongside activity targets and financial targets. But what I hear is that the workload is very heavy, that there is not enough explanation at local level of the policies. When new policies come in they are often under-briefed on them.

'They are worried by very specific things like the European working-time directive. Some of the solutions to this directive, particularly the junior doctors, are not easy and that is something that doctors are very concerned about and we need to get them to help us to find the right solutions.'

But there are no quick-fix solutions on offer here: he can only acknowledge the professional dilemmas NHS staff face.

'I think people are prepared to work very hard, but when people worry is when their heavy workload is leading them to have to compromise those high standards they believe they should maintain.'

So how is that going to be addressed? 'First of all, to say that we acknowledge the problem and that extra resources are coming through and must be used to help to relieve the burden.'

Today's conference is so significant that the Department of Health is hoping that the prime minister will address it. This follows on from Mr Blair's closed meeting with doctors' representatives in February.

Although there will be conferences for other professional staff groups over the coming months, doctors seem to be the favoured few. Is this part of an attempt to demonstrate a better working relationship with doctors? 'Yes, I think it is, but it is not a superficial exercise. One of the things that has really surprised me coming in to much more contact with doctors around the country over the last few years is that it is all these things they tackle me on.'

As far as Sir Liam is concerned, the time for inaction is over and those trusts and other NHS organisations not pulling their weight will be called to account.

The Improving Working Lives strategy has been attacked for paying lip service to improving the lives of NHS staff, but for the chief medical officer, this is not a cynical exercise.

What does he say to critics who argue that it has been blown off course by reorganisation?

'I hope not. I do not know that it has slipped down the agenda, and I haven't got evidence that it has.

'It will not slip down the agenda very far. Strategic health authorities are going to be in much closer touch. The organisations which are not giving their attention to this will be the ones to be shown to be falling short.'

So, what about those contract negotiations? Does the proposed seven-year ban on private work for new consultants have to be a hard and fast rule for the new contract?

'That is the position; that is the government's declared position, ' he states, tight-lipped.

Although he will not elaborate, he stresses that this is not likely to change. The British Medical Association has made it clear it doesn't want the ban, but both sides have indicated that an agreement can be reached.

And what is Sir Liam looking for from the GP contract? 'A much greater emphasis on quality. I think the NHS wants that and GPs want that as well.And much more incentive to multi-professional team working.'

How did Sir Liam respond to the recent NHS Confederation paper, The Problem of Unhappy Doctors, showing that discontent among doctors is not necessarily related to pay and conditions, but more fundamental issues like the erosion of a culture of deference.

'The bit I took out of it was that doctors expected something back from their employer. They expected to be valued and to have the opportunity and the right to have their career developed and to be protected from criticism and from attack, and in return you would have their commitment.'

Sir Liam has made clear what is on offer to doctors and how essential it is that they work with government. Whether they believe that what is promised will be delivered and that it represents a fair settlement remains to be seen.