Accountable… but to whom?

In proposing accountability as the missing attribute of NHS management, you stop short of exploring its inherent conflict.1 For 65 years doctors and nurses have wrestled with having two masters, the patient (as ever) and the Service. The NHS has relied upon them juggling this tension within an overarching doctrine of patient priority. The General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) have been the ultimate arbiters of this, explicitly describing professional and unprofessional conduct. Paradoxically, doctors derive comfort from GMC disciplinary activity when it reinforces patient primacy, sometimes iconoclastically, as a few senior doctors have found to their cost.