Download Lord Phillips of Sudbury RCP Report 2005

Becoming
a doctor
Journey or
destination?
Becoming
a doctor
Journey or
destination?
The King’s Fund and RCP reports
Our conversations with hundreds
of doctors
The themes which have emerged
Becoming
a doctor
Journey or
destination?
A profession under siege ?
“Medicine, like the law, has lost lots of confidence. It is
losing its sense of leadership”
Lord Phillips of Sudbury RCP Report 2005
“The profession is often regarded as being arrogant...
actually it is its diffidence that is the problem …and the
fact that it does not sell (what it is doing) particularly
well...”
Sir Graeme Catto RCP Report 2005
Becoming
a doctor
Journey or
destination?
The possibility of a new compact
There are three in this marriage …
State and taxpayer
The profession
The patient
Becoming
a doctor
Journey or
destination?
2004 On Being a Doctor
A new compact in which doctors had
“a duty .. to engage in improving
health services with a reciprocal
obligation on .. government and
managers to develop .. health policy
that allows the highest standards of
professional practice to flourish.”
Becoming
a doctor
Journey or
destination?
2005 Doctors in Society
“The entry of multiple health
providers, the wish for more
equal engagement between
patients and professionals,
and the ever-greater
contribution of science to
clinical practice all demand a
clear statement of medicine’s
unifying purpose and doctors’
common values.”
Becoming
a doctor
Journey or
destination?
Conversations on professionalism
 Students see professionalism as highly relevant
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Doctors:
Want to debate their future
See their professionalism as a touchstone
Are not sure who leads the profession
Felt they are too often silent on matters of the day
Are uncertain of their role in teams
Are ambivalent about their role in management
Becoming
a doctor
Journey or
destination?
Leadership of the profession
“No one leads it – that is part of the beauty and
problem of medicine.” (Norwich)
“The profession is unleadable … We do not value our
colleagues who put themselves in positions to lead.”
(Norwich)
“Who is nationally leading medicine, we have got royal
colleges, GMC, BMA maybe 3 groups with varying
responsibilities, no one of them actually speaks for the
profession as a whole.” (Swansea)
Becoming
a doctor
Journey or
destination?
Leadership for public interest
“We are duty bound to speak when we disagree with
public policy, that is part of our professional duty.”
(Liverpool)
“There is a fine balance between the fact that we are
directly government employees but equally we have a
professional responsibility” (Liverpool)
“Dietary choices, us or Jamie Oliver. There is some
high ground for us to recapture.” (Leeds)
Becoming
a doctor
Journey or
destination?
Leadership on the ground
“I can’t envisage a scenario where other members of
the team would take responsibility for a decision in lieu
of a doctor.” (Liverpool)
“It is changing. … the most able leader should be the
person with the leadership qualities as opposed to
which profession they belong to.” (Liverpool)
“Doctors who have become managers have had to
define their own skill sets … no recognised mechanism
exists for gaining the expertise...” (Norwich)
Becoming
a doctor
Trust and truth …
Journey or
destination?
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Patients trust doctors
Civil servants
Viewers trust TV newsreaders
Journalists
MORI 2006
95%
48%
66%
19%
Becoming
a doctor
Journey or
destination?
Trust and reputation are fragile
 c 50 % of inpatients/33% GP patients wanted more
information/involvement (Picker Institute)
 c 33% received conflicting information from health
professionals (Picker Institute)
 Information about diagnostic tests, side-effects, and
discharge medications was confused or nonexistent (Healthcare Commission 2006)
Becoming
a doctor
Journey or
destination?
A new compact?
 Relationships are changing – can government’s
role be redefined and limited? Where do managers,
other professions and patients fit in?
 Is transparency here to stay -will performance be
tested, measured and transparent to all?
 Should doctors (some or all?) be trained and
involved in management?
 Is it possible to give patients explicit entitlements
and in return they accept responsibilities?