Deputy doctors?
So the press are at it now, a full blown comparison of (add your favourite auxiliary health profession - The Times chooses pharmacists) practitioners as “deputy doctors”.
These pharmacists will have to be commissioned by their local primary care trust, just like a GP, and then choose a specialist medical area; for example, diabetes. Many will be employed by the NHS, often based in local health centres, where they will provide a service alongside GPs and other health professionals. Independent sector pharmacists — high street chemists, for example — can also become PIPs. But, like the NHS pharmacists, they will have to go on a prescribing training course and they will be allowed to prescribe only in the areas in which they have been trained.
I am sorry but just what is going on? Pharmacists are good at what they do but there is a difference between knowledge of pharmaceuticals & knowledge of pathology. And I am concerned enough about over-the-counter statins without having to add to the problems. Management of pharmaceutical interactions is a good thing, a duty which most doctors would be happy to defer to pharmacists about. Taking responsibility for diagnosing people’s illnesses & managing their condition without benefit of suitable training is another. And no, I do not recognise the training proposed as satisfactory, having seen the quality of its predecessors including that for nurse practitioners. Well intentioned, at-least the practitioners but breathtaking cynicism amongst the policy-makers.
The Ferret Fancier has dug up this paper by Alan Maynard which says it all:
Radical reform in the roles of the workforce other than physicians is taking place. Pharmacists and nurse prescribers are to be given the right to prescribe the full formulae, although medical groups (e.g. the Committee on the Safety of Medicines) are now questioning the safety of such policy. Nurses are being trained to carry out endoscopy, anaesthetics and minor surgery.
These reforms are part of Blair’s frustration with the slow rate of change in NHS service delivery. At the outset, he offered more funding in exchange for the NHS ‘acting smarter’. This exchange, he believes, has not been met by providers. More expenditure has not been accompanied by improved service delivery. Consequently, he is seeking to undermine the monopoly power of physicians with investment in other skill groups with enhanced roles. This bold policy is largely evidence free; many assert that nurses may be retrained to take over medical roles cost effectively but the quantity and quality of trials are poor. Such issues have yet to inhibit the Government!
Are there any people who work at Good Hope reading this? I am sure that verification of the item below would be of interest. I would like to know just how it got through medical oversight.
Cleaners at an NHS hospital have been told to turn over dirty bed sheets rather than use clean linen. Good Hope Hospital in Birmingham advised its staff to “top and tail†used sheets to cut the £500,000 annual laundry bill.
Posters instructing staff that this procedure would save 0.275 pence for every sheet re-used were pinned on cupboards and doors leading to the A&E and maternity departments. A health worker said that new patients were being given the same sheets as the previous occupant.
A hospital spokesman denied the practice. He said the posters had been issued three years ago but had since been removed.
Nurses are expected to call for strike action according to the Telegraph.
Dr Carter, who will give a speech at the congress on Monday, said: “There is a real sense of despondency and disillusionment with the Government because of the failure to pay the 2.5 per cent. It is seen as a slap in the face, bearing in mind all that nurses have done for this Government over the last 10 years.
“Having endured job losses, deficit-led cuts to services and increasing workloads, nurses are at the end of their tether.
“The mood out there is dark and despondent with nurses feeling under-valued and over-worked.”
Asked whether nurses were likely to take industrial action over pay, Dr Carter said: “We won’t know until congress starts. I will be having discussions with frontline members to a get a feel for the mood.”
The BMA has released a poll suggesting that the NHS will not be free at the point of use in 10 years.
A British Medical Association poll of 964 young GPs and hospital doctors found 61% thought patients would have to pay for some treatment by 2017.
Nearly half of all young doctors also expect to leave the NHS within 10 years, according to the survey.
Forum chairman Dr Andrew Thomson said it was time to have a debate about the future of the NHS because of pressures from the ageing population and new, ever-more expensive drugs.
“Doctors fear that current reforms are damaging the NHS beyond repair.
“We seem to be selling off the service to the highest bidder without considering the legacy for future generations of patients.
“Government reforms are having negative effects on both services and the morale of doctors. We need to find ways of moving the NHS towards a period of stability. At the moment it is under serious threat.
This is also the subject of a Telegraph article stressing the career intentions of the doctors.
This post by a practising GP illustrates very well indeed the part that the DoH does not understand.
There was no specific advice or help I could offer that they were not already receiving. He just wanted to tell me. So I listened.
In his book “A Fortunate Manâ€, John Berger says of the GP John Sassall:
He does more than treat them when they are ill, he is the objective witness of their lives. They seldom refer to him as a witness. They only think of him when some practical circumstance brings them together. He is in no way a final arbiter. That is why I chose the rather humble word clerk: the clerk of their records.
I wonder how I can knock the sense of these words into the heads of policymakers.
The Guardian takes a more in-depth view including interviews with a number of students.
Leigh Bisset, 26, a final-year medical student at the University of East Anglia (UEA) agrees. “This diabolical application system will either push people out of the country, or worse still, out of medicine altogether. Compassionate and caring doctors will be placed on an unemployment pile - £250,000 of taxpayers’ money, per doctor, wasted on a 10-question child-like application form,” he says.
“Every other job market in the UK has a much more vigorous screening system, even management jobs in McDonald’s require you to attach a CV. Your doctor has been selected on 1,500 words of imaginative writing - wouldn’t you rather know who else they have managed before you?”
Bisset is angry that his degree and dreams might go to waste. “After five years of training, hard graft, focus on treating patients and, hopefully, improving things for them, to have this vocation snatched away is heartless, incredibly demoralising and wrong. I cannot afford to be unemployed on graduation.”
It is not just doctors that are suffering from a lack of jobs. Nursing, midwifery and physiotherapy are all careers hit with a lack of funding which has resulted in poor pay and a shortage in positions. A survey of 2,500 recent physiotherapy graduates found that only 10% of them had managed to find work in their profession.
Richard Morford, 25, graduated from the University of East London in 2002. He is trying to relocate to be near his girlfriend, but says the lack of openings is making the move impossible.
“The main obstacle is that there are no jobs. Physio managers do not have funding to create posts or if an employee leaves, they are not recruiting for that post, but dissipating the job among existing staff. There is a huge drive for increasing productivity, morale is at an all-time low and they want to give us a payrise lower than inflation. Even though the NHS has trained us, we may be driven into the private sector or abroad, as there are no jobs.”
The unions suggest that the NHS should take a closer interest in the battle for Boots.
In a letter, Paul Kenny, the GMB general secretary, said that more than 100 village pharmacies could be closed to cut costs if Alliance Boots is “loaded up with debtâ€.
Mr Kenny has also called on Ms Hewitt to ensure that any successful bidder does not securitise the income from more than £1 billion of NHS contracts held by Boots to fund a takeover. In the letter, Mr Kenny wrote: “GMB members would like you, one of Boots’ largest customers, to call in Stefano Pessina to ask him, as a major supplier of medicines to the NHS, how the sums add up for the taxpayers.
The FT takes a look at people travelling abroad for treatment.
About 50,000 UK patients went overseas last year for cosmetic, dental or other treatment, according to a study by Treatment Abroad, a website promoting “medical tourism”.
It says 22,000 patients travelled for dental procedures, 14,500 for cosmetic surgery, 9,000 for the kind of treatments typical of National Health Service waiting lists, and 5,000 for infertility treatment - the NHS provision of which varies markedly around Britain.
The findings carry a large margin of error. They come from an e-mail survey of 500 clinics marketing services to the UK, to which only 132 - just over one-quarter - replied.
The website says this is “the first attempt to try to measure the numbers of patients travelling abroad from the UK for treatment”. If the figures are right, the company estimates that Britons spent about £135m on overseas treatment, excluding travel and accommodation.
My review of this sector a few months ago flagged up the lack of protection for patients which is why I am cautious. There is currently no provider offering insurance against treatment failures or malpractice & patients are left to fend for themselves.
The Economist catches up with worries about the turmoil in the private healthcare sector.
An innovative tender for independent operators to carry out treatments for the NHS had a galvanising effect on the private sector. Gallingly, most of the successful bidders were foreign firms.
There are subtleties in the way the contracts were awarded that makes this not so clear-cut as presumed. Success in the tenders doesn’t always mean best care or even the best bids.
What is good for BUPA may not, however, be so good for the NHS. If the company’s hospitals go to a rival, that will lead to greater concentration in the private market. Already a consortium led by Netcare, a South African firm that was among the successful bidders for the NHS tender, has acquired BMI Healthcare, the biggest chain of independent hospitals. The government had hoped that a vigorous external market in hospital care would reinforce its internal market in the health service. That objective may be thwarted if the private sector becomes too concentrated.
As previously mentioned, Capio is also now part of the same group. There is no appetite within the DoH for joined-up thinking about the implications of policy or other actions.