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Gagging clause

29 March 2012

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Dr Phil Hammond may be best known as a TV comedian, but as a practising GP he is serious about the health service, as his recent Question Time face-off with Andrew Lansley demonstrated

“I’m taking a swipe at everything – myself, the doctors, nurses, politicians, patients – but in a supportive way. The theory is that no health service in the world can survive with the tsunami of chronic disease that’s coming its way, and actually we as patients have a duty to look out for ourselves. The strapline I use is that we have to learn to pleasure ourselves in a safe and sustainable way.”

Dr Phil Hammond – GP, comedian, whistleblowing campaigner, Private Eye columnist and now host of a new panel feature at this year’s Management in Practice Events (see Box) – is talking about his current Rude Health tour, for which he has performed a gig in Winchester the night before our interview.

His versatility is perhaps partly explained by his energy. Far from being tired, he’s happy to elaborate his views – in a rapid-fire delivery that will be familiar to audiences of Have I Got News For You and countless other TV and radio shows he has regularly appeared on – on the state of general practice and the health service.

Comedy and medicine are not such unusual bedfellows, which Dr Hammond explains by virtue of doctors “inherently tending to be quite fond of their own voice” with a “self-confidence not always proportional to their ability”. Indeed, ‘comedy docs’ past and present include Harry Hill, Dr Paul Sinha, Monty Python’s Graham Chapman and the Goodies’ Graeme Garden. Dr Hammond is rare, however, in that he continues to practise as a GP, currently working a day a week at a walk-in centre in Bristol, where he resides.

Of practice managers, he is highly supportive. “I think practice managers have a crucial role and they’re a bit underused,” he says. For the past four years he has attended an annual practice management conference in Lincoln, where he has been “really impressed by the intelligence and expertise of practice managers.”

He has worked in the NHS for more than 25 years, and his passion for the health service will have been evident to the public when he had a lively exchange with Andrew Lansley on a recent edition of the BBC’s Question Time. Dr Hammond told the health secretary that the medical profession was “deeply suspicious” of England’s controversial Health and Social Care Bill, and described the policy detail as “wonk”. Hammond’s performance garnered significant column inches the next day; the general consensus being that he ‘wiped the floor’ with Lansley.

He demurs modestly on the topic, however. “I don’t think I did wipe the floor with him, I was slightly embarrassed by it, to be honest,” he says. “What you want is a nuanced, intelligent debate. The thing that depressed me slightly about Question Time is that you have to make very broad brush strokes and it’s very adversarial, so it’s almost like a teenage debating society.”

Before the cameras rolled, Dr Hammond received a call from Private Eye editor and Have I Got News For You regular Ian Hislop, who told him: “Whatever you do, don’t get angry because you’ll look mad”. This was easier said than done, says Dr Hammond. “I found it’s very hard not to get angry with Lansley because he does that thing that Blair did: you know, ‘I understand your concerns about Iraq, but I’m right’. Lansley does the same: ‘I’m sorry that you’re not intelligent enough to understand my reforms, but I’m right’.”

He describes the health secretary as someone “who knows the most and listens the least”, and that the heated level of televised debate was ironic: “I was actually trying to make the point that Lansley needs to start speaking the language of compassion. What will unite the health service is if he talks about how his reforms are going to serve that and make the NHS more humane, both for the people who work in it and the people who use it.”

High-pressure humour
This seems key to his outlook of the health service. While he stresses that he doesn’t have a political view (“I don’t belong to any political party”) and that his objections to the bill, which he describes as “a huge leap of faith”, are non-ideological, he does object to the government “imposing the biggest ever top-down reorganisation we’ve ever had, having expressly promised in their pre-election pledges that they wouldn’t. I think that’s basically why there is no trust there. And to make this stuff work, particularly health reform for which there’s no evidence base, ultimately it comes down to trust.”

He worries too about the increasing pressure put upon general practice, which he believes is “working above its capacity” as a result of the financial climate and the need to make huge efficiency savings. “Most practices I’ve worked in are probably experiencing 10-20% reduction in their income from previous years. So to try and save money practices are cutting back drastically on the use of locums, they’re devolving as much as possible to practice nurses and making people do a job and a half.” GPs, he says, are “working to the bone, they’re doing extra work, and on top of all this they’re supposed to get involved in commissioning too. There are enough workaholics in general practice already without them getting up at 3am to try and figure out commissioning. If we’re not careful and we force this thing too quickly and there are too many confusing changes there are going to be a few burnouts. And that’s what worries me the most.”

In this current environment, is it difficult to find the humour? “Comedy thrives in dangerous times and it’s really important to have it, he says, describing the palpable sense of relief he felt from an audience after he did a comic stint at the end of a recent health summit, at which Lansley had spoken. “He’s very good at sucking the energy out of the room.” Of the current healthcare climate, Dr Hammond says: “It is serious, but golly, you’ve got to laugh, otherwise you will go under.”

His humour has often found its inspiration in the health service, particularly the interaction between patients and clinicians. But is there a fine line between laughing at medical comedy and laughing at patients? He describes his early Radio 4 series, Struck Off and Die, as occasionally focusing on “the callous nasty stuff that sometimes keeps you going at 3am as a doctor”, but says that he has mellowed now.

“I did Have I Got News for You once and I made a joke about irritable bowel syndrome (IBS) that was a bit of a cheap shot,” he recalls. The next day in surgery, his first patient had IBS “and was worried that I would just take the piss. And that’s the only occasion that’s ever happened in 20-odd years.” He says the experience taught him a valuable lesson that “actually you’ve got to be a little careful as a doctor and comedian, that you don’t make jokes about people’s diseases that are cheap shots.” He criticises the comedian Frankie Boyle for making jokes about people with Down’s syndrome, for instance. “There’s no need for it. There are far more important targets to take the piss out of,” says Dr Hammond.

Accountable cultures
One thing he’s found interesting, which seems to have shaped his view of the health service, is “I always feel more accountable as a comedian than I do as a GP. As a comedian there’s a very simple outcome measure: you either make people laugh or you don’t. Whereas I think it’s still possible in the NHS to be quite mediocre or possibly even a dangerous doctor and have a waiting room full of patients.”

This is a relevant concern for Dr Hammond: he exposed the Bristol paediatric heart scandal in the 1990s in Private Eye, and gave evidence to a public inquiry that found up to 170 babies treated at the Bristol Royal Infirmary might have been saved if they had been operated on elsewhere. He now campaigns in support of whistleblowers, which has made some “a bit reluctant to employ me”, he believes.

“I think what came out of the Bristol inquiry is the need to change the culture of the NHS to something which is humane, with a fair-playing culture,” he says. “We’ve got to be really grown up about the fact that we harm patients. And we admit it and we learn from it and we share our mistakes with patients so they can learn from it too. I think that’s vital and we haven’t got there yet.”

He says managers have a huge role to play in this. “The General Medical Council keeps reiterating it’s a professional duty of doctors to blow the whistle, but that’s completely pointless if managers don’t listen. Managers have to listen and act on it,” he says. He believes federations of GP surgeries will support a more open culture. “If general practices are to survive, they’ve got to coalesce into larger management groups, they’ve got to share their data and open themselves up to scrutiny,” he says. “I think everyone has to be part of a federated model.”

At the time of writing, Dr Hammond’s GP contract is soon to expire. His primary care trust says it can no longer afford to fund the GP side of the service. Dr Hammond is sanguine, however: “I have no truck with that, we’ve got to make savings and they’ve decided they can use the money more efficiently. But if any of your readers wants to offer me a couple of sessions a week I’m more than happy to consider it.”

Readers could have the opportunity to ask Dr Hammond themselves at the upcoming Management in Practice Events, when he will be hosting the new panel discussions. He is more upbeat about this than the Question Time experience. “Given what’s happening in general practice, that’s where the action is, so I’m really looking forward to it,” he says. “I’m good at getting the audience roused and participating, and that’s what we need: a really good grown-up debate. With a few laughs.”