A letter from the PCT

Andy and I were at medical school together. Andy is a country GP now. He is only recently an ex-rugby player. He is well over six foot tall and has huge hands. He swears like a trooper with a vocabulary that would surprise the DK. He is happily married with two teenagers and like most of us was, until recently, a happy family doc. He is one of the kindest people I know.

He has just sent me an email.

It illustrates better than anything I have seen exactly what this government has done to the medical profession, and to the NHS. Well meaning protocols, written by over-promoted semi-literate fools are bringing the British medical profession to its knees. This is why doctor’s morale is rock bottom. We cannot work in this environment. This is the new world of of clip-boards and protocols, of rules and regulations, of hospital-at-night and health care professionals.

There is no room for doctors.

I toyed with presenting the email cynically, as a “good news from Stalin” announcement, or whatever. Instead, I am merely going to remove the swear words and present it verbatim. Note particularly the illiterate letter from the PCT with its bizarre verbal neologism. NHS protocols are often written like this.

I have no further comment. Make of it what you will.

Hi John,

I am going effing bonkers. As you know, I look after a residential home for people with severe congenital physical and mental handicaps. Some of them, obviously, are female. I do not perform smear tests on them. I know, I know, many handicapped people are sexually active and it is important to give them the same preventative medical care as anyone else. But these young women are not sexually active and, frankly, for most of them their spastic contractures would make penetrative sex of any sort impossible.

I took the decision not to do the smears. The patients are mostly not competent to weigh up the issues themselves in order to give or withhold valid consent. I have thought about this carefully, and I have had long talks with their carers and families before reaching my decision. They have never been sexually active, the chances of any of them developing cervical cancer are negligible and the prospect of inflicting a vaginal examination on them is unthinkable.

Even to attempt the examination on these largely uncomprehending patients would be traumatic and degrading, and anyway it would be impossible to complete a satisfactory vaginal examination because of the flexion deformities.

So, as I say, I decided that these women should not have smears. I documented that decision in the medical records and noted that it had been fully discussed with the families and carers, all of whom were in agreement.

I wrote to the PCT so that they can avoid sending repeated reminders for these women and their carers to fret about.

And that is the end of the matter. Or so I thought.

I have just received a letter from the PCT saying that:

“national guidance now states that women cannot be ceased from cervical screening on account of learning disability, however profound that disability is. The only circumstances in which women can be ceased from screening are when they have sufficient competence to be able to consent to be removed from the programme”

All these women will now receive regular letters instructing them to book smears and if they do not, they will be sent reminders. Each time a letter arrives, the protocols in these institutions dictate that a ‘best interest meeting’ has to be convened – relatives, carers, therapists and the family doctor will all have to provide their views.

The whole process will be repeated at frequent intervals

I am no longer permitted, as the family doctor, as an experienced medical professional, to make a clinical decision, despite the GMC guidance on ‘do no harm’ and ‘make the patient your priority’.

The protocol dictates that the default position is to assault these vulnerable patients unless a vast swathe of people can regularly make the case against.

I give up.




Andy