![\"Richard](\"http:\/\/www.bmj.com\/site\/blog\/icons\/bmjh7648e.jpg\")
Two weeks ago I spent 90 minutes in a goldfish bowl with about 30 GPs. The goldfish bowl is a process to encourage reflection, and it certainly caused me to reflect.<\/p>\nTwo weeks ago I spent 90 minutes in a goldfish bowl with about 30 GPs. The goldfish bowl is a process to encourage reflection, and it certainly caused me to reflect.<\/p>\n
The goldfish bowl features in the leadership course of the Royal General College of Practitioners. Somebody with some pretensions to having been a leader is asked into a central ring of five or six GPs. The remaining GPs sit in an outside ring. The GPs in the centre have read up on the \u201cleader\u201d and ask questions that aim to explore his or her experiences, thoughts, values, and anything else that might be useful. After some conversation, those in the central ring shut up and those on the outer ring make observations and suggest further topics for discussion. Those in the central ring then begin again, and the conversation may move between the rings. It\u2019s leadership\u2019s equivalent of dissecting a frog.<\/p>\n
I\u2019d done it once before and found it fun. No preparation is necessary. You talk about yourself, and if like me you never know exactly what you are going to say until you\u2019ve said it, you learn about yourself. You also meet \u201cbright young things\u201d (well youngish) and discover what they think of you. The experience is, I imagine, a little like having your portrait painted or appearing in somebody\u2019s novel.<\/p>\n
Just as last time, the main question the GPs had for me was \u201cHow come a nice guy like you ends up working for a wicked, private company?\u201d Nobody was that blunt, but that was the central question.<\/p>\n
Generally GPs did think of me as OK because when I edited the BMJ<\/em> it became friendlier to general practice, and when I was very first at the BMJ<\/em> it was my job to develop a section for GPs. I was also viewed as left wing with a strong social conscience. So how could I leave the BMJ<\/em> and join UnitedHealth, a private company that was caricatured in its early days of\u00a0working with the NHS as \u201cthe shark in the goldfish bowl\u201d (a very apt image in the circumstances).<\/p>\n People inevitably develop their own theories to explain my Mephistopholean conversion. I\u2019d sold out for the money. I\u2019d been a fake all those years at the BMJ<\/em>. I\u2019d had some kind of values or mental breakdown. Or perhaps I\u2019d been seduced by smooth talking, Machiavellian types.<\/p>\n I explained how my change was prompted primarily by deciding I\u2019d been at the BMJ<\/em> long enough (25 years) and that it was time to let younger people come through and do new and interesting things (a decision amply vindicated in my mind by the wonderful developments in the BMJ<\/em>.) \u201cMost people,\u201d I warned solemnly, \u201cgo on too long in their jobs.\u201d<\/p>\n Then I explained how I believe that the public sector plus the private sector is more powerful than either alone, reminding the GPs that most of them are in the private sector. I think that private companies have a lot to offer the NHS, not least in supporting commissioning and introducing new ways of doing things. \u201cNew entrants\u201d are very important in encouraging innovation, not least in the \u201cold players\u201d\u2014 look at the effect of low cost airlines. (And yes I know health is different, but it isn\u2019t that different.)<\/p>\n Certainly, I said, I like very much what I\u2019m doing now, working with people in 11 centres in low and middle income countries to counter chronic disease. Even here the GPs were suspicious, thinking that I was forcing American ways on people in poor countries. I explained that the people in the low and middle income countries propose and run the programmes. We simply fund and work with them.<\/p>\n I doubt that I convinced many, and the narrative of my life, perhaps reflected someday in an obituary, will be that I was a reasonable person who went off the rails. Perhaps the obituarist will speculate on why. As I learnt from a very experienced Fleet Street editor, once a narrative is established\u2014for example, that Alexander Fleming alone discovered penicillin when a spore floated through his window,\u00a0that doctors are good and drug companies bad, that the public sector has high values and the private sector low values\u2014it\u2019s impossible to run against it no matter whether it\u2019s right or wrong.<\/p>\n Competing interest:<\/strong> RS works for UnitedHealth Group running a philanthropic programme in low and middle income countries. UnitedHealth UK offers commissioning support services to the NHS, but RS has no responsibility for the UK company.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Two weeks ago I spent 90 minutes in a goldfish bowl with about 30 GPs. The goldfish bowl is a process to encourage reflection, and it certainly caused me to reflect. The goldfish bowl features in the leadership course of the Royal General College of Practitioners. Somebody with some pretensions to having been a leader […]<\/p>\n