When I joined my CCG as a clinical lead 15 months ago I arrived with a healthy dose of terror. I knew I'd spend the first few weeks looking dazed and struggling to follow what was going on and I wasn't wrong, but before too long I'd mastered pigeon management-speak, worked out how to work the coffee machine, and felt like one of the team. The biggest hurdle I have come across is actually something which I hadn't seen coming - spiders.
I don't mean arachnids, I mean cunning venomous humans who appear harmless until you get too close, quiet until you step on their territory, threaten their power, or throw a light on their shortcomings, but who then attack with terrifying fervour with the sole intention of eliminating the threat. At school they were called bullies. In the NHS they’re called high fliers.
Now let me be clear, I work with a lot of NHS managers and clinicians and through my networks know of many, many more. The vast majority are respectful, honest, kind people. Sadly, however, not all. In every organisation it would seem are a few vicious bullies, throwing their weight around, terrorising colleagues, using the declared intent of 'trying to get things done' as their excuse. They appear disguised as clinicians, as managers, and even occasionally as patients. They are a threat to be feared and must be caught under a glass, inspected carefully, then chucked out the window.
I realise now I've been sheltered in GP practices. Small close knits teams may have squabbles but generally realise they need to look after each other. Large organisations however, with hundreds of employees, separate out into hunting packs, vying for power and control.
Now GPs have begun to explore other regions of the NHS in their roles as commissioners, we are exposed to this culture, in fact I'm a little concerned we may be the new underdog. There are plenty of people, GPs included, who think clinical commissioning is a ridiculous idea, doomed to failure. How on earth can a GP redesign entire care pathways, understand and improve the inner workings of NHS contracts, or operate at chief executive level meetings? We need to be put back in our place.
I’ve experienced this myself and seen it happening to colleagues - throw away comments, smirks and knowing looks, rolling eyes and being cutting off mid sentence. Some have been blatant enough to say GPs are punching above their weight, others just patronise and ignore us.
So what should we do about it? Play their game? Become secretive and aggressive, fight back with dirty tricks and intimidation? Become a whole squad of Dr Evils?
It is tempting, and it could be done. We may be naive tree huggers but we are all intelligent capable professionals. If we set our minds to it we could run rings around these bullies. But no, we mustn't, because we are doctors. We are the good guys. We must choose the moral high road, championing the patients’ causes with integrity and humility.
That doesn't mean we don't fight the culture though. We are very good at having awkward conversations, getting people to talk to us and confide in us. We should use that to open up this delicate issue for discussion, get people talking about their experiences, acknowledge this goes on, then draft in a whole army of hunters armed with glasses and magazines, and go get those spiders.
Freelance GP and commissioning GP at Coastal West Sussex CCG