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The Year of Living Dangerously

Posted by Dr No on 31 December 2009

yold.jpgThere is a curse, some say of ancient Chinese origin, which runs: ‘May you live in interesting times’. It seems the interesting times are already upon us. There is mayhem and mischief abroad. A long chill shadow has settled on our profession; and in the gloom that lies beyond, unsettling forces are at work. We shall face, in the months ahead, renewed and ferocious attacks, and on the outcome the future of our profession will depend. We are about to enter the year of living dangerously.

The threats are many, but one menace looms above all others: and that is the threat of revalidation. This half-baked, ill-considered crackpot fantasy, dreamt up by the goons and stooges of Whitehall, and their puppets at the General Medical Council, is set to spread like a cancer through the profession, sewing malignant deposits, until the body of the profession is weakened and subjugated to its evil influence.

Already, even before the battle has been joined, we have seen attrition in our numbers. The farce of applying for a licence, an expensive, meaningless exercise, removed some 13,500 doctors – 6% of all doctors - from the Register: 13,500 doctors who, having received their invitation to the party, decided that it was not a party they wished to join.

Over the next twelve months we can expect the GMC –already keenly congratulating itself on the so-called success of the ‘licensing campaign’ - to renew its attempts to embed revalidation into our midst. We are promised the appointment of local ‘responsible officers’ who will be responsible, not in the general sense of the word, but to the Council, and so ultimately to the State, for ensuring that all doctors meet the stringent revalidation requirements laid down by the Council.

The default position for revalidation is: Do Not Revalidate. Doctors will only be revalidated when they have satisfied the local ‘Responsible Officer’ that they have met all the requirements, and so placed the Herr Responsible Officer in eine position to actively sign off the doctor as being fit to practice. Woe-betide those doctors who, for whatever reason, fall foul of their Herr Responsible Officers: the Herr Responsible Officer has the power to withhold that doctors revalidation – and so, at a stroke, compromise that doctor’s career and livelihood.

Responsible Officers – usually the local medical director – will receive scant training. Just as scant will be their day to day accountability to individual doctors – they will instead be accountable – responsible – to the GMC. The opportunities for abuse, for the settling of new grudges and old scores, will be limited only by the zeal of the Herr Responsible Officer in tracking down the misdemeanours, imagined or otherwise, of his hapless former colleagues.

Six percent of all doctors chose not to join this party. How many more, faced with the leering scrutiny of a former colleague will say: this is an outrage to our professional standing – and chose to leave the party rather than be subjected to such humiliation?

How many more will fall into that grey area where some concern might exist about their professional practice – and so be forced to leave the party?

We cannot, at this stage, know for certain percentage of doctors will go, but it is likely to be in double figures, and might even run to twenty percent. If we add that figure to the six percent already lost at the licensing hurdle, then it seems possible that we may, over the next few short years loose some twenty-five percent of all doctors.

And so it will be that a staggering one in every four doctors will be lost to the profession. Many of those that remain will be sycophants, reliant of the favour of their local Responsible Officer for the continuance of their career; toadies for whom the cut of their jib pleases the eye of their Responsible Officer. Where once there was a body of independent spirits, there will become servants. The profession will be lost.

All of this is about to happen, on our watch. And yet, when we look around, we see little in the way of resistance. Opposing voices are scarce. The great body of doctors lies mute. It is often thus in the preliminary stages of a great conflict. Some hope that if they look the other way, the battle will pass them by. It will not. Others have decided that the might of the enemy is too great, and that opposition is futile. It is not. Yet more, absorbed fully in the folly of their own affairs, are blind – blind to the threat that lies all around.

Stern times lie ahead. Many will acquiesce. But to do so will be great folly, for it will allow the imposition of a scheme so dark in its conception, so invasive in its extent, and so damaging in its consequences that it will, dare it be said, make MMC and MTAS seem like a minor skirmish. Revalidation, as it is set to be implemented, has the power not just to wipe out a generation of doctors – it has the power to wipe out the entire profession.

And yet we can learn the lessons of MMC and MTAS. That time, we were caught napping, and a disastrous scheme was foisted upon us. This time we are fore-warned, and so we can fight.

Seventy years ago, Churchill rallied the faithful servants of Truth and Justice with words from the distant past: 'Arm yourselves, and be ye men of valour, and be in readiness for the conflict; for it is better for us to perish in battle than to look upon the outrage of our nation and our altar. As the Will of God is in Heaven, even so let it be.'

And so it must be. As we ready ourselves to enter the New Year, so it is that we must also ready ourselves to enter the fight that it is our honour and duty. We have before us the year of living dangerously.


This wonderful thing is now to become a requirement in nursing. Part of this will be based on a yearly appraisal. Woe betide any nurse who speaks out against unsafe or dangerous practice. If he upsets his appraiser, bye bye to his career! Toe the line is the order of the day!

I have spoken about this to my manager. He welcomes input and debate. He has stated that yearly appraisals are data protected and he will not comply with NMC orders.

Why is there no resistance? Are we all soft in the head? I am not, but interest in resistance appears to be minimal. It seems it is easier to do nothing. I am in dispair!

Nikita - it seems appraisal and revalidation have crept from being a medical 'obligation' to others as well. This is what happens. First they come for the doctors, then they come for the nurses...

I very much fear your manager - who sounds like a decent principled chap - is soon going to find himself between a rock and a hard place.

Dr No's first appraisal was deliberately paper-based, and not held on any central computer. Around 2005, his then appraiser 'persuaded' him of the merits of completing the forms electronically. Dr No was told that all the forms - including the potentially über-sensitive Form 4 ('Summary of Appraisal Discussion...') and PDP would remain entirely confidential. Dr No crossed his fingers and hoped this would remain so, but feared it would not.

A year or so later he was told these forms were to be anonymously assessed centrally to identify 'patterns of learning needs'. The creep had started...

By 2007, Dr No was told that all Form 4s and PDPs would be held centrally (and confidentially), but would no longer be anonymised as there was a need to 'create a visible trail for revalidation purposes'. No one seemed to notice that 'confidential' and 'visible trails' don't sit very well together.

By 2008, the local goons were telling Dr No that, in view of recent government statements on the 'need to ensure quality in the appraisal process', all Form 4s and PDPs will in future be evaluated, and, to allow this, the forms now need to be 'identifiable'. The creep has crept some more...

What is particularly sinister is how the goons have moved from a specific reason to remove anonymity in 2007 (to create 'visible trails') to the much wider, ill-specified reasons given in 2008 ('in view of recent [unspecified] government statements', 'the need to ensure quality in the appraisal process, [wtf does that mean?], 'all Form 4s and PDPs will in future be evaluated' [who by, and on what criteria?].

So - in the space of a few short years, Dr No's appraisal documents moved from tolerable confidentiality to a position where they are held centrally, in identifiable form, to be evaluated by unspecified apparatchiks against unspecified criteria...

Dr No now treats his 'appraisal process' with the disdain which it so richly deserves.

On a more positive note, Dr No is heartened that you have commented, in the way that you have. It seems we doctors and nurses are as we should always be: in the same boat, and singing the same tune, against the malignant forces of sinister management and intrusive state control.