Posted by: Witch Doctor | February 29, 2008

Tooke – The role of the doctor will be fudged


The Tooke Report is not really about MMC. Not really. In fact MMC metamorphosed into something that was not MMC.

Everything that is going on in healthcare just now is tightly intertwingled. Like a ball of wool that has unraveled and reassembled itself into a hopeless knotty mess.

MMC cannot be teased out.

It is about the future of the NHS.

It is about rationing.

It is about creating a market in health care.

It is about cheap labour.

it is about profit.

The Witch Doctor thinks The Tooke Report grasped this as best as it could.

There are two points that have to be addressed before the training requirements and the future prospects for junior doctors becomes meaningful.

1. The role of the doctor needs to be defined.
2. The concept of health care as a commodity needs to be addressed.

Until these two aspects of healthcare are clarified, any changes that are made will only be of the “tweaking” variety.

The government’s response to The Tooke Report was published today.

No-one seemed very impressed.

Remedy was the least impressed of all.

Read what they say.

Here is the bit about “The Role of the Doctor” in todays document from the Department of Health

Tooke said:

” There needs to be a shared understanding of the roles of all doctors in the contemporary healthcare team that takes due account of public expectations. Given the interdependency of professional constituents of the contemporary multiprofessional healthcare team we suggest a similar analysis extends to other healthcare professional groupings. Clarity of the doctor’s role must extend to the service contribution of the doctor in training, doctors currently contributing as locums, staff grades and associated specialists, the CCT holder, the GP and the consultant. Such issues need to be urgently considered by key stakeholders. Notwithstanding the need to keep such a key issue under constant review, stakeholders should seek to reach public consensus before the end of 2008, so important is the issue for current NHS reform.

Education and training need to support the development of the redefined roles for each professional grouping and provide the necessary educational foundations to enable them to practise safely and effectively, and to aspire to enhanced roles.”



The government’s reply was short and sweet.

“The Inquiry noted the difficulty in meeting service needs now and in the future without having a clear understanding of the part each healthcare professional plays.

I accept recommendation 5 in principle. Consideration of how the roles of clinicians need to develop is key as part of the NSR.

In the recommendations, the Inquiry notes the wider agenda for modernising careers in other healthcare professions and the need to ensure overall coherence. It also noted that several professional constituencies have begun work on this issue and the work of the NSR.

The NSR work has the active involvement of a wide range of stakeholders from across the clinical profession: medical, nursing, allied health professionals and healthcare scientists, as well as employers and SHAs.

Current trends in the health system, including changing demand patterns, more care delivered closer to home, the introduction of new technologies and increasing managerial complexity, will require changes to the ways in which clinicians deliver healthcare in the future.

The work considers the drivers for change over the next 10 years and beyond, how they will impact on what patients need and expect and what this means for the roles and responsibilities of clinicians. Key to that is understanding how this translates into both how we need to train our clinicians in the future, and the implications for existing clinicians, including how their jobs will change and how we support these changes.

This work will form part of the NSR, which is due to report by the end of June.”

NB If, like The Witch Doctor, you get floored with abbreviations, NSR stands for NEXT STAGE REVIEW.

The Juggernaut will go on relentlessly.

This government is making damned sure that it will put strong marketing forces into play so that doctors are tamed and put into wheelie bins where they belong.


The Medical Profession will have to work out how to say NO.

The NHS Plan has reached this stage because a minority of “reasonable” members of medical profession have driven it or at least facilitated it for their own reasons.

These doctors will continue to be “reasonable” for their own reasons.

The silent majority will have to say “NO”

That’s all they need to do.

And when they say “NO” the issue should not be even remotely connected with GP opening hours, GP salary or terms or conditions.

The issue is about patients becoming commodities.

redapple.jpg a red apple ……………………

The Witch Doctor – Link to a random page





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  1. […] and the plight of the missing generation of junior doctors who are too old to benefit from whatever reforms the government introduces as a result of the recent Tooke review, and too young to have made it safely to registrarship […]

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