The Weight Lanyards Still Carry: The End of Political Messaging in the NHS?

The case for and against a blanket ban on political symbols

Our loyal subscribers may remember that in an earlier edition of On-Call, we wrote a piece titled ‘The Weight Lanyards Can Carry’, where we spoke about how commonplace political messages can be in the NHS and how the medium tends to be the lanyard itself or a pin fastened upon it.

The lanyards may not be able to speak, but they serve as potent symbols of personal beliefs and affiliations, which become baked into our daily interactions.

So why are we resurfacing this topic? No, it is not because we are running out of content. This profession does well to keep us busy. It’s because of Lord Mann’s review into the rising tide of antisemitism, which recommended that NHS staff should be prevented from plastering political badges on their uniforms. 

The natural question was then to ask to what extent the NHS will curb ‘political symbols’. So many standpoints and statements are inherently political in nature. Frequently seen examples include the poppy, expressing support for the LGBTQ+ community, or even NHS badges (remember, a belief in a socialised healthcare system is not ubiquitous and is therefore inherently political).

The Argument For Self-Expression

Across the NHS, many will be asking what happened to autonomy and self-expression, and this brings us nicely to the idea that these values must always be balanced against the perceptions and psychological safety of those around us (especially our patients).

Here’s a suggestion: What about an outcome-based approach? So the rule becomes simpler: if a message fosters a positive work environment and enhances patient trust, it should be permitted. Conversely, if it leads to division or sows a sense of distrust among patients or colleagues, it should be set aside.

The real challenge, of course, lies in the sorting process. There is no objective standard here. What one person views as a universally acceptable message of support, another may perceive as exclusionary or divisive. You may believe orthopods and radiologists battling it out for the worst speciality to be dragged into a crash call is a ubiquitous message, but reality says otherwise. 

So maybe things are more subjective than we give them credit for, and so perhaps the decision by some medical bodies to implement blanket bans on all political messaging starts to make practical sense. People frequently misunderstand this policy as a targeted renunciation of specific causes, but that misses the point.

The Blanket Ban

The blanket ban rule acknowledges that objective truth is rarely found in these highly nuanced, lanyard-worthy issues. To protect the integrity of the doctor-patient relationship from implicit bias or discomfort, a total ban is introduced as a precautionary measure. 

This leaves us with the "easy" route: a blanket ban mirroring the model used by our French colleagues, where secularism dictates that no religious or ideological iconography may be worn while under the employment of the state.

Yet, for many in the UK, the idea of outlawing a poppy or an NHS badge feels deeply troubling. Critics of a total ban would argue that we need to evaluate the degree of division a symbol actually causes. While an NHS badge is political by definition, it is difficult to imagine it causing significant discomfort to a patient or fracturing society.

Do Royal Colleges Stand To Gain From the BMA’s Pay Deal?

The Royal College of Surgeons… it just has the prestigious feel to it, doesn’t it? Their new home as of 2021 in Lincoln’s Inn Fields is possibly the swankiest Royal College building in the country, despite what the RCP guys will tell you. That maroon and black tie makes it easier for some surgeons to hand over their doctor title as well.

To pay for all these things costs money, though, and lots of it. This often comes from the huge fees the college takes for mandatory postgraduate exams and memberships. So steep are these fees that many trainees have begun to see the college as financially self-serving.

But could the new BMA deal increase revenues even further for these colleges?

The new deal achieved by the BMA may remove the financial burden from candidates and hand it to the government, but may actually increase college revenues if the government agrees to fund the first couple of attempts.

We may see an increase in total exams sat. If you have paid hundreds for your MRCS Part A, the impetus to pass the exam on the first attempt is likely high. There may be a reduction in urgency when the government agrees to fund the first couple of attempts, potentially leading to more exam sittings, and more revenue for the colleges.

Is the above a valid economic mechanism? Maybe. But we know that exam behaviour is not purely financially driven. Even with exams being free, trainees still face the huge opportunity cost of revision time and a delay in progression if they fail.

Medicine’s Teaching Paradox: Why Doctors Resist the Teaching They Ask For

Has medical teaching become an inconvenience?

For the most part, doctors want to be taught. Many resident doctors are doctors in training, and all doctors hope to better their skills and knowledge.

But there is a paradoxical attitude that some members of our community hold: Trainees often call for more consultant-led teaching, although this enthusiasm can quickly wane when a ward round starts overrunning, or a consultant takes the opportunity to turn the encounter into a teaching session, with the accompanying fear of being ‘grilled’.

Yes, finishing a ward round at 2.30 pm and glancing over to your double-sided jobs list will naturally be a point of concern. But such issues are structural issues within the NHS that need to be raised and highlighted to individuals with staffing responsibility. To believe that consultant-led teaching should be the first item to be dropped is to degrade our profession further.

Resident Doctor “Grilling”

In the context of teaching, a ‘grilling’ is a pejorative word for the bombardment of questions that can come a resident’s way from an overly keen consultant.

There will be doctors who love nothing more than the opportunity to show their knowledge, and these individuals will likely be found manning the anaesthetic machine in some corner of the hospital. But for the most part, it’s hard to escape the feeling that many doctors jump to label a set of questions fired their way as a ‘grilling’ that should best be avoided.

A growing body of medical education literature has, in recent years, done its best to shed light on the problems that can arise through consultant teaching. Indeed, practices that attempt to teach by humiliation, belittlement and mocking do exist, and fault here lies with the consultant in question, not with the idea of teaching through direct questioning, which is one of medicine’s oldest and most effective teaching methods.

A comparison with US programmes shows how different the emphasis on medical education is. Take this account from Liberty Medics, which highlights how teaching is a fundamental part of most residency programmes. Each morning starts with a ‘Morning report’, which is a form of case-based learning that lasts one hour. A ‘noon conference’ lecture follows, which is also one hour each day. Grand rounds also exist, but are often mandatory and draw a large attendance (without needing the bait of a free lunch).

This removes the ‘lottery’ of effective teaching seen in the UK. UK doctors rely on being lucky enough to have a supervising consultant who is passionate about teaching in order to learn.

We need to change the culture. Every doctor should go to work with the tacit expectation that they will frequently have questions put to them throughout their training. Their knowledge will be tested, and consultants will teach. As we said, consultant time will have to be freed up in order to facilitate this, but as a start, we need to begin by changing the culture.

“Let me tell you what Radiology Regs hate. It’s a version of the ‘Gambler’s fallacy’ playing out across the NHS. ‘I’ve had 3 negative CT heads this week, so this next one must be positive. ’ Past events are not going to change the odds of the next one.”

“You are not your accomplishments. You are not your failures. You are you.”

“Yes the FRCR is tough - okay, but my rads friends receive so much dedicated teaching time from seniors and have so much protected time to prepare for those exams. One of the most difficult parts of the MRCP exams is the zero teaching or prep time in most places. You are asked to study in the midst of crazy on-call rotas and medical jobs.”

“That time of year when mandatory e-learning comes around, and I reunite with Level 1 fire safety training again.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

The Intensive Care guys likely already know about Deranged Physiology, but this is the GOAT resource for all medics who feel they need a better grounding in our body’s physiology. Fight the allegations that our generation of doctors don’t care about the basic sciences! (not sponsored).

August is coming around, which means new rotations, new hospitals and new parts of the country for some. The question of whether one is ready to buy their first house and whether it makes sense mid-training is always on doctors’ minds. This 2026 breakdown from the guys at Medics Money is the place to start.

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The Rota Revolution - Are Self-Rostering Rotas The Way?

You are a doctor, which means you are bound by your rota. If you are a medical student, then you will be bound to your rota very soon. Your discussions will become based around it. You will check it every morning before you reply to that WhatsApp message from your aunt that you’ve been meaning to reply to for a week.

Rather than your future being at the behest of the rota coordinator, is there another option? Self-Rostering is a method of rota creation where power is placed back in the hands of doctors. There are many ways this could work.

This model has traditionally meant the utopian idea of doctors choosing when they want to work. A more realistic model, however, is for the rota coordinator to collect ranked preferences from doctors while ensuring all staffing levels are met.

It may be difficult to create a system in which doctors make fixed choices about when they want to work, as some days may lead to staffing issues. Equally, those who choose not to participate have fewer grounds to complain as they had the chance to influence their rota and didn’t take it.

So perhaps we should change the name from Self-Rostering to Preference-based rota design (within fixed clinical constraints).

Now personally, the On-Call team are cautious not to create problems in places where there aren’t any already. We see the leave request system as satisfactory (in most departments) and fear the level of departmental chaos a preference-informed system would cause rota coordinators. We know from systematic reviews that it will require a significant expansion of rota coordinators to handle the system, as well as to handle the increased frequency of staff requests for shift changes.