Public health doctor England

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DH control blurs loyalties for Public Health England

Doctors could find that their duties as medical professionals conflict with their roles as civil servants at PHE (Public Health England), the BMA says.

Despite repeated calls for PHE to be an independent NHS special health authority, the government has set it up as an executive agency of the Department of Health.

Its employees would therefore be civil servants, and the BMA public health medicine committee is trying to reconcile the management code for this group with the GMC duties of doctors and existing provisions in the consultant contract.

PHMC co-chair Richard Jarvis said most parts of the codes had the same objectives, but there were issues that would need formal negotiation to resolve.

‘In particular, we would wish to retain public health doctors’ ability to advocate on behalf of their populations, which does appear to conflict with aspects of the civil service code,’ he said.

‘None of this would be an issue if PHMC policy — that PHE should be an NHS body — were adopted.’

Conflict of interest

There are several areas in which the codes might be incompatible. The GMC and the consultants’ contract prioritise patient needs, with other concerns, including those of employers, being subordinate to them.

But the civil service code gives primacy to ‘public service’ — traditionally seen as the Crown, via ministers and government departments.

The civil service code also states that official information must not be disclosed without authority, whereas the consultant contract maintains that doctors should be able to publish books and articles and deliver lectures without prior consent from employing organisations.

Doctors have also traditionally been accountable to society via the GMC, whereas civil service accountability to society is through employing departments.

BMA council chair Mark Porter met new public health minister Daniel Poulter earlier this month to talk about the potential conflict between public health doctors’ professional duty to act as health advocates and the civil service code, with its strong emphasis on confidentiality.

Dr Jarvis and his counterpart at the BDA (British Dental Association) have also written to PHE chief executive designate Duncan Selbie to urge discussion on PHE terms and conditions.

A DH spokesperson said: ‘Our reforms put the public where they belong, at the heart of health and care services.

‘We are working with representatives of the BMA and BDA to ensure that health professionals can work effectively within PHE. Work on PHE’s terms and conditions is ongoing, and we will provide an update this autumn.’