Social workers in surgeries will not work

Locating social workers in GP surgeries is not the answer to the loss of public respect for social work, writes Michael Fitzpatrick

Locating social workers in GP surgeries is not the answer to the loss of public respect for social work, writes Michael Fitzpatrick

One popular response to the demoralisation of social workers, as a result of child protection disasters and the fragmentation of services, is the attempt to restore prestige by relocating social workers in GP surgeries and other universal services. But can social work’s crisis of professional identity be resolved by moving in with the doctors?

Public opinion surveys consistently reveal that, of all professions, doctors and nurses rank highest in popular esteem. The elevated social standing of GPs is – understandably – widely resented among social care workers who often have direct experience of the uneven standards that prevail in primary health care.

Politicians are particularly jealous of professionals who retain some of the respect and trust they have forfeited as a result of a series of scandals, most recently in the parliamentary expenses debacle.

Politicians’ envy of doctors’ status is expressed in an ambivalent approach. On the one hand, they delight in trying to cut them down to size: the tactic of “mud wrestling” with doctors’ leaders over pay was pioneered by Kenneth Clarke when he was Margaret Thatcher’s health minister in the 1980s.

We can expect more of this now that he has become a member of David Cameron’s coalition cabinet. Under the Blair/Brown governments ministers introduced commercial “payment by results” schemes into primary care and then complained that these led to excessive salaries, portraying GPs as venal and corrupt.

On the other hand, New Labour politicians were keen to take advantage of the popularity of GPs by using their surgeries as bases for the government’s social engineering projects. These include “welfare to work” schemes, the crusades against teenage pregnancy, domestic violence and obesity and the promotion of healthy lifestyles and approved modes of parenting.

The high priority given to the manipulation of behaviour in the cause of health in the Conservative manifesto for the general election suggests that we can expect to see even more of such policies under the new coalition government – and this is where social workers, in various guises, may be expected to play a prominent role.

The convergence of doctors and social workers as agents of authoritarian social policies carries dangers for both professions. For social workers, this means a further move away from playing a constructive role in response to the needs of children with disabilities or those whose parents have mental health problems. Instead they are carrying out surveillance and control functions in relation to a substantial section of the population (loosely defined by low income and social status).

Doctors will be pushed further away from the diagnosis and treatment of disease into the regulation of lifestyle and behaviour.

The pursuit of intrusive and moralistic policies by doctors and social workers implies a lack of respect for the autonomy of the individual patient/client that is likely to result in deteriorating professional relationships.

It is also likely to lead to a further decline in professional prestige – for doctors as well as social workers. If social workers stood up for the rights of their clients in face of coercive measures presented as supportive or therapeutic interventions, professional morale and status would be dramatically improved.

Michael Fitzpatrick is a GP in Hackney and author of Defeating Autism: A Damaging Delusion, published by Routledge

This article is published in the 27 May 2010 edition of Community Care under the headline “Doctors and social workers do not exist to police lifestyles”

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