Re-awakening professional identity: the path to a self-correcting NHS

One characteristic of a profession is the curatorship of a shared body of knowledge, values, and behaviours. Much of it tacit knowledge, applied instinctively, it can be difficult to codify into guidelines and algorithms.1 Like the professionalism of an elite athlete with unconscious flowing skill, the art of general practice is the ability to navigate the ‘swampy lowlands’ of uncertainty, complexity, and immense variety.2 Professional efficiency should be highly prized today, given the spiralling costs and complexity of health care. Yet, the identity of general practice is under threat as never before, the work we do is increasingly subject to external control and management. Costly, complex, and threatening bureaucracy makes it harder to exercise professional judgement instinctively in high-risk, uncertain, and time-pressured situations. Yet paradoxically, any reduction in professional efficiency only triggers more bureaucracy and controls. Why has this happened? The Bristol and Mid-Staffordshire scandals were especially damaging for profession-led health care.3 The concept of profession became associated with protecting colleagues, a tolerance of poor performance, and ostracising whistle-blowers. The state responded by developing external controls. Although logical, that response in our view has created a vicious cycle of ever-increasing external monitoring, diminishing GP morale, and productivity, creating yet more external control. There is an urgent need to break this cycle by rediscovering the importance of professionalism in providing effective and efficient health …