As independent contractors, GPs have enjoyed certain freedoms. These include the right to press their fingers together in a thoughtful way and the right to own a leatherette chair on castors for the purposes of gaining psychological advantage during consultations – wheel in to establish rapport, tilt back for reflection, swivel dramatically at the point of prescribing or referral, wheel back for professional detachment and wheel away at speed calling for the nurse if things get nasty.
They also have other inalienable rights including the right to blame everything that goes wrong on pressure of work, the incompetence of NHS managers or the government of the day.
Luckily, none of these privileges is threatened by the reforms – indeed several have been enhanced – but there is one freedom which is about to be withdrawn: the right to speak and write in everyday English.
As commissioners and in some cases employees of statutory bodies, GPs will need to be trained to speak NHS. This will be essential if they are to communicate with PCT clusters, commissioning support organisations, the NHS Commissioning Board, arm’s length bodies, regulators, the Department of Health and so on.
They should know from their previous dealings with officialdom that plain English doesn’t work. This is not, as they have wrongly assumed, because they were being ignored but simply because no one knew what they were going on about.
So what does it mean to speak NHS?
Take the simple English phrase: “I would like to buy a car but I am not sure which one I want.”
The NHS equivalent is: “I am considering going to procurement for a self-propelling transportational unit but have not yet conducted a needs assessment, evaluated the range of available options, the evidence base or the transit requirements of my children and young people, their carers and other potential stakeholders.”
Obviously this has been simplified for illustrative purposes, but you can see the problem. There is far too much clarity in the original version, which patently fails to take into account the needs of the driver and passenger populations and makes no reference to older people or hard to reach members of the family, such as grandma.
Let’s take another example.
“How do you want me to pay for that?”
In NHS this might be rendered as follows:
“It is not clear whether this should be the subject of a single-action tender or falls within the scope of Any Qualified Provider. Please amend the contract specification with reference to the principles and rules of co-operation and competition and the relevant regulations as amended and revert after a suitable period of reflection.”
Spoken NHS is far more complex than this, but we’re trying to ease you in gently.
Let’s take one more example, the ridiculously inadequate “I don’t really know what to do next”.
Here is a simple example, suitable for beginners, of how the problem might be expressed in NHS.
“The government has announced a national strategy for achieving certainty. ‘Sure Together Soon: new collaborative ways of thinking about the right thing to do’ is a 12 month consultation ordered in response to the Vague Inquiry.
“In his seminal report ‘We Don’t Have a Clue Between Us: lessons for the future’, Sir Keith Vague came up with a number of recommendations which the new overarching strategy seeks to address. These include the establishment of a Firmness Forum to develop certitude standards and a new regulator, the Decisiveness and Demonstrability Panel, to adjudicate in cases of long-running vacillation and general hopelessness.”
Doctors commonly complain that they fail to understand health policy. But that’s because they have not bothered to learn the language spoken by the natives. Talking louder and more slowly won’t do it.