Too many stars are bad for you

Editor—In her personal view Cardozo describes the contrasts between the NHSand commercial medical interests and practice.¹ She feels “undervalued” and “demoralised” by her NHS work in contrast with commercial appreciation and success. I suspect that much of her problem comes from working in a three star NHS trust.

I work in a trust that has never had any stars. The management works hard to pursue priorities that are shared by patients, clinicians, and politicians. The outcome is that we feel valued and involved, even if there is a large measure of frustration. And we get no stars.

I suspect that to earn three stars you need to be blindly adherent to government priorities at the expense of other issues. Investing in your clinicians is an essential part of sustainable practice. Without enthusiastic clinicians today's stars may well be tomorrow's black holes.