Sunday, March 06, 2011

Preliminary Reflections of a Responsible Officer

It is now nine weeks since I, in my existing capacity as Medical Director for a Primary Care Trust (PCT), was appointed a Responsible Officer.

Now, I would like to pretend that the position was fiercely fought over, with many applicants of a high professional calibre, and that only by virtue of my greater skills and experience was the Appointments Board so impressed as to be eager to secure my services. As many other Responsible Officers will no doubt concur, the truth is actually far from the latter, and in most PCTs the existing Medical Directors have been shoe-horned into the role for the sake of expediency; essentially in order to meet the Government's deadline of having a Responsible Officer appointed by the 1st January 2011. No doubt it has been the same process for the acute trusts.

Nonetheless, here I am. For the first time since retiring from my army commission eleven years ago, I am an officer again. Not only that, it is now official that I am a responsible one; a title which, for reasons best known to themselves, caused both my wife and my medical partners to unite in previously unknown depths of merriment.

However, despite the aforementioned cynicism, for the past three weeks I have dutifully donned my mantle of responsibility and sallied forth, prepared to be...well...responsible; and therein lies the problem. What, I have found myself asking on an almost daily basis, am I currently supposed to be responsible for? Feeling as though I am the epitome of the idiom 'all dressed up and nowhere to go', I have plundered such sobering documents as HM Government's 'The Medical Profession (Responsible Officers) Regulations 2010', the Department of Health's 'The Role of Responsible Officer: Closing the gap in Medical Regulation – Responsible Officer Guidance', and the General Medical Council's document 'Revalidation: The way ahead', searching for inspiration and guidance. It is true that there are, within the aforementioned formidable tomes, many pages of legalese and aspirational directions that are no doubt supposed to clarify the nature of the undertaking. However, with the general turmoil the NHS is currently enduring, along with the still less than clear future format for so-called 'strengthened GP appraisals', and indeed a continuing fog around the precise manner in which the process of revalidation will happen, the diligent fulfilment of the role of Responsible Officer seems to be a somewhat Sisyphean task.

Questions abound, not least of all: will the present Responsible Officers retain a role when the PCTs are abolished in 2013, and if so, to whom will they be answerable? Will they be employed by the GP Consortia, or linked through to the Commissioning Board? Other conundrums are: who revalidates the Responsible Officers?; can a Responsible Officer continue to act as an appraiser for GPs, on behalf of whom he (or she) will eventually provide statements to the GMC in respect to revalidation?; and can a Responsible Officer act on behalf of partners within his (or her) own practice? The more one considers the subject, the more the whole process is seen to be fraught with the huge potential for conflict of interest. Untangling these labyrinthine riddles is currently a challenge for the Strategic Health Authorities; thereby in itself lending an interesting extra dimension to their own Danse Macabre.

So, in summary, nine weeks into the job, I know from the Oxford English Dictionary that being responsible means that I have an 'obligation to do something' and that I now 'have control over someone'; other than that, I remains in a state of obfuscation. It will be fascinating to see how long it takes for enlightenment to occur. Meanwhile, I will endeavour to maintain the illusion of conscientious behaviour as befits my newly anointed status.

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