Dr John Robertson, formerly Professor of Media Politics at the University of the West of Scotland, believe a partisan approach to data is damaging a doctors’ professional body.
‘Almost nine out of ten Scottish GPs believe patient care is being jeopardised by a lack of resources, according to a new poll.’ STV News, 28th April 2016
‘Top doctor blasts SNP for lack of funding as he warns of longer waits to see a GP and a future without family doctors’ Daily Record (Glasgow) 27th January, 2016
As I finish this paper, the comments of Sarah Smith, ‘BBC Scotland News Manager’ or some such honorary title, to Nicola Sturgeon, on the last televised leaders’ debate on 1st May are fresh in my mind. She pointedly and intently probes the First Minister with the question: ‘Do you accept there is a crisis in general practice?’ It’s said as a challenge.
Of course, there isn’t any such crisis in Scotland. My recent reports for Newsnet.scot: ‘Does trade union for Scottish GPs represent its members’ views on NHS?’ and ‘Scottish GPs: Most satisfied and least stressed in the UK and possibly the world.’ based on evidence from reliable academic sources such as The Commonwealth Fund of New York, demonstrate this clearly. Sarah’s ‘crisis’ is a social construct manufactured by the utterly partisan Royal College of General Practitioners (RCGP) and the BBC itself.
The SNP of course dare not defend itself, directly by challenging these lies because to do so would draw further unsubstantiated attacks using, once more, this deeply flawed source, the RCGP.
Four GPs and seven unidentified citizens have approached me confidentially, to complain about the RCGP Scottish Region (A registered charity with patron HRH Duke of Edinburgh and celebrity fellow, Jamie Oliver, above) and its Chair, Dr Miles Mack.
These approaches and comments follow my previous report for Newsnet.scot: ‘Does trade union for Scottish GPs represent its members’ views on NHS?’, which questioned the accuracy of, and the political motivations behind, the RCGP’s recent barrage of negative comment against the Scottish Government. Three further GPs or retired GPs wrote openly on the site. Perhaps most important at this time, was their astonished reaction to what they described as Dr Mack’s ‘bizarre’ insistence on the Scottish Government adopting the English NHS proposal for GP reform. They directed me to useful sources from England revealing these proposals to be flawed. I’ll refer to these below and provide links to them.
The above headlined quotes are only two of many, based on RCGP attacks, which you can easily find yourself, with a quick Web search of any combination of three or four of these words – RCGP, Scotland, GP crisis, Miles Mack. I’ll be attempting to summarise fairly, all of their key points which I think are wholly legitimate and important, in the public interest. Most of the other comments were personal attacks on Dr Miles Mack, often correlating his RCGP media activity with a lack of presence in Dingwall. This was anecdotal, uncorroborated and sometimes offensive so I have simply binned it. As a media-active academic, I’ve had similar criticism, myself, from a few colleagues and a few students. It’s the kind of thing some journalists called ‘anecdotal evidence’. It’s not evidence at all, it’s just anecdote.
Dr Miles Mack, Essex-born, Dingwall-based, award-winning, chair of the RCGP Scotland Region, champion of over-worked GPs and, especially, of rural GPs, above on the left, is one of the most media-active chairs of any professional association I’ve ever witnessed. His media output is awesome. Try Googling him by just typing in Miles Mack and see screen page after screen page of hits. Nearly all of his media output is along the lines of the above headlines.
I’ve previously criticised the RCGP and, for that matter, the BMA, for their use of shoddy research to justify scare stories about the alleged perilous/parlous state of primary care in Scotland. Of course, Scotland’s mainstream media have been a comfortable conduit for RCGP propaganda.
In the most recent example, they make use of a tiny sample (150 of c5 000 (0.3%) Scottish GPs,) ComRes online survey, to over-confidently and irresponsibly, assert:
‘89% of GPs say they worry that lack of resources is putting patient care at risk and 58% plan to leave or reduce their hours within five years’
The RCGP report is here and the ComRes original here.
Leaving aside the obvious difficulty in relying on a sample of 150 GPs out of a population of around 5 000 Scottish GPs (0.3%) and the RCGP’s frankly simplistic reading of the results, there are real problems with this reliance by ComRes: on self-assessed online surveys with sometimes leading questions, and all-to-predictable results.
Here’s just one example of a leading question.:The above headline: ‘89% of GPs say they worry that lack of resources is putting patient care at risk.’ was in response to a question, more of a prompt really: ‘I worry about lack of resources putting patient care at risk.’ Ask any health professional that question and who among them do you expect would admit to not worrying if such a thing were to be the case? Further, the headline omits the fact that only 42% ‘strongly agreed’ with the prompt while 47% only ‘somewhat agreed.’ Who wouldn’t ‘somewhat’ agree that a shortage of resources might ‘somewhat’ worry them? These are people ‘somewhat’ high in empathy according to psychopathy tests.
ComRes is a ‘survey factory’ producing cheap, fast results, to suit customers’ needs. I’ve shamelessly referred to my 30 plus years of teaching research methods to undergraduates and to postgraduates in an effort to dominate the discourse, many times in the past, so it’s probably better if I refer you to The Validity of Surveys: Online and Offline .
For those with other lives, I’ll sum up. Small sample, online surveys of ‘caring’ professional groups (teachers, nurses, doctors), based on respondents’ self-assessment of their feelings, to questions about how stressed and over-worked they feel, are damned near SFA-use and carry a big health risk (pun intended) if you intend to say anything confident about them. OK RCGP Scotland Region? Do pay attention.
To counter the misrepresentation of Scotland’s GPs in the above survey, I offered the results from an international study of primary care providers, globally, from the highly-respected academic (not ‘market’) research group, the Commonwealth Fund of New York, which revealed UK GPs to feel that they are less-stressed and more satisfied than virtually anywhere outside of the Netherlands and Scandinavia and much, much, much less/more so than the poor GPs of the USA.
Further, the Scots GPs were, significantly, less stressed and more satisfied than the English sample. The data is in my previous two Newsnet reports https://newsnet.scot/?p=116523 and https://newsnet.scot/?p=116905 If you don’t trust me and would like to see the raw data, email me at email@example.com and I’ll forward the original file to you.
In response to ‘How stressful is your job as a general practitioner/primary care physician?’ 62% of English GPs responded ‘Very’ or ‘Extremely’ while only 32% of Scots did. 19% of the English GPs reported ‘Extremely’ while only 7% of the Scots did. With regard to satisfaction, 65% of the English GPs were’ Satisfied’ or ‘Very satisfied’ and the figure in Scotland was 80%! Now these are statistically significant differences and if it they are representative of the wider population of GPs, they would suggest very strong evidence of a clear superiority in the strategic direction and oversight of the NHS environment, by the Scottish Government, in sharp contrast with that of the English system. I don’t think we need to Hunt for possible explanations as to why English GPs might be stressed and unhappy. Also, I wonder if one of the Scottish sample was a GP in the lovely, low-stress, town of Dingwall?
Now, RCGP, here’s a very important point. Despite the clear superiority of the Commonwealth Fund over ComRes, I would still hesitate to make claims as strongly asserted as Dr Mack’s many headline soundbites. They are both admissible pieces of evidence, one stronger than the other of course, but in the end, still just that. Nothing has been proved despite the ridiculous, mostly Daily Record-hosted, headline claims, the RCGP is now complicit in.
Moving on now, to the seven GPs who agreed with much of what the Commonwealth Fund research suggests. Below is a summary of their mostly shared key points. They did not, to be fair, agree with some of the evidence I presented, suggesting superiority in nurse practitioner performance and patient satisfaction, over GPs. It isn’t my intention to disrespect GPs but it was my intention to present the evidence as I found it. As Professor Mary Beard insists, it is the purpose of academics, even retired ones, to make things more complicated not less so. These are the key points shared by most or all of them:
1. Though sympathetic to the idea of a greater role for nurses, they insisted that there were areas where their longer, University-level education and training and their experience in ‘medico-legal’ areas made them essential members of teams of health professionals and often better-equipped to lead them. I agree entirely and feel sure I’m not the only one who does, including members of the current Scottish Government.
2. There was dissatisfaction with the centralising tendencies, undemocratic and non-transparent nature of the RCGP, among most of them. Some wanted to see a separate organisation in Scotland responsive to non-metropolitan perspectives. Most expressed unhappiness with having to pay c£500 per annum for very little return. One reported that membership of the RCGP had not been obligatory, in order to practise, in the recent past. The expenditure on a new plush London HQ was especially annoying for some of them.
3. Notably, regarding democratic accountability, there seemed little awareness, in the group, of how the RCGP Scotland Region Chair was chosen. Most did remember being balloted for the UK leadership of RCGP but none knew how the Scottish Chair was identified. I’ve scoured the RCGP web-pages for the information but can find nothing there. I’ve made email requests for this information but have not had even an acknowledgement. I might be wrong and I remain happy to be corrected but I suspect there is no democratic process here in the Scottish branch’s procedures. If so, this is particularly important given the contemporary, high profile, media-active and controversial approach of current chair Dr Miles Mack.
If the Scottish Region Chair is simply appointed by the board in London, this might suggest a kind of archaic, colonial, appointment comparable to a Secretary of State or a Governor. Now, I know the RCGP won’t be the only such organisation in Scotland with a democratic deficit but in the context of contemporary politics, a severe lack of democratic accountability should limit the influence of such organisations in the political arena. That limitation of distorting or even dishonest influence, in the public interest, requires the media, especially the BBC, to be responsibly proportionate and balanced in allocating publicity to them.
4. There is quite wide dissatisfaction across members in Scotland, several of them felt, with current RCGP Chair, Dr Miles Mack’s high-profile aggressive campaigning which comes across as overtly hostile to the SNP government at a time when the latter is engaged in important negotiations with the BMA.
5. Dr Mack’s apparent willingness to allow mainstream media, especially the well-known Labour-supporting, Daily Record, to repeatedly dramatize, to simplify and to frame his arguments through selective editing, was specifically regretted by three of the GPs who also felt that their disappointment in this is widely held among their peers.
6. There is evidence, most felt, of an inappropriate political agenda within the RCGP Scotland Region. This is a broadly conservative position including favouring the Union over independence. Three of the group had seen an internal email recommending a No vote in the 2014 Referendum! One felt that the Lib Dem party, once strong in the Northern, rural areas, such as that around Dr Mack’s Dingwall base, lay behind some of the RCGP’s activity.
7. In particular, Dr Mack’s support for the English GP reform proposals were baffling for most and were so, for most GPs they knew. There was, to their knowledge, no groundswell of support among Scotland’s 5 000 GPs for any such notion.
There is a large ‘grassroots response’ in England, to the English Government’s ‘General Practice Forward View’ summarised at http://www.resilientgp.org/blog/. This offers a detailed critique beyond the space available here. In summary, however, it argues:
‘This plan is very short on detail, and detailed immediate plans are what we need. There is a recognition of the issues, but a lack of urgency in a dire situation…..If the government and NHSE were serious about maintaining high quality General Practice for the rising population of the UK [sic], this plan would include immediate emergency measures alongside the longer term vision. We look forward to seeing the GPCs next step in light of today’s report.’
So, to conclude, the RCGP Scotland Region appears to have a very serious democratic deficit which they should address and which must be seen to limit its authority in the public sphere. Consequently, it should adopt a more responsible and mature approach to the use of evidence in making its highly partisan case. Media, especially the BBC in Scotland, should recognise this and act accordingly, as they do with other more leftist trades unions, to downgrade its presence. Finally, in my view Dr Miles Mack should consider resigning in the light of his ideologically distorted behaviour which can only damage the reputation of the organisation.