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Beware - the 'practitioner'

Posted Jan 14 2009 7:27pm


The following is a piece written by a Consultant who works somewhere in Joseph, sorry Gordon Brown's NHS. I feel it neatly summarises the danger that is posed to patients by the growing power of a group of under trained and undereducated 'professionals' in the health service. The government has been all to keen to empower this new brand of worker because they are very easy to control, hence health care can be doled out as the politicians want, as opposed to being delivered on the basis of clinical need as decided by the most expert and knowledgeable staff. Of note these kind of encounters are becoming more and more frequent in many hospitals up and down the country, as the newly empowered quacks try to bully around people who have vastly superior levels of training and knowledge with which to make their decisions.

"Once upon a time, not that long ago, there was a clear balance of professionals who worked pretty well together as part of a team within hospitals to provide a good service for patients.

It didn't always work well - there were always the historical limitations of lack of resources and finance - the usual picture of demand being greater than supply.

However the idea of good team working and management worked well. Clinical firms were well delineated and well led. The hierarchy was clear cut, interactions between medical, nursing and managerial staff, while sometimes strained, was effective, well understood and fairly standardized across the NHS. Team members understood their own role within the team - but also understood and supported the role of other members - a concept central to good team work.

All this is now on the verge of ruin. The Government has done the unforgivable to address the problem of too few doctors, too few nurses - in the face of promising too many targets and creating too many managers.

Almost while we were sleeping has the new grade of team player invaded all ranks in all hospitals and is answerable to no-one.

The "practitioner".

The dreaded well-meaning high ranking officer with no team, supervision or even system for accountability.

A couple of anecdotes for you:

Last year I had arranged a PEG insertion in a rather old, terminally ill but not dying patient - after rather extensive discussions with him and his family.

Got a call on the morning of the procedure by xxxx, who was concerned about the plan - and had blocked it. This guy said he was a " gastroenterology practitioner" and, curious, I went to the ward to meet him.

His official name badge was startling. It took a while to read.

"Advanced Medical Practitioner for Hospital Gastroenterology and Nutrition"

This guy, while pleasant enough, had worked as a charge nurse on an orthopaedic ward and had recently been appointed to this incredibly ambiguous post.

It turns out that while his label was confusing, his job description wasn't - he was there to take all PEG referrals - and block them if he saw fit.

I never found out who decided on the need for such a person - but somehow the staff in endoscopy bowed to his decisions. Possibly because it meant less PEGs to put in.

The other day my SpR called me for approval to send a guy with COPD to ITU.

The patient was in his 60s and tiring on conventional treatment - he was not terminally ill and I agreed that ITU was appropriate. My SpR said that the ITU Consultant may be in touch.

45 minutes later I got a call from someone who intended to block his entry to ITU. Apparently the ITU Consultant had not even been informed but this new powerful clinician had thus far rejected the logic of both my SpR and the ITUSpR.

She proudly told me she was the "Anaesthetic Practitioner"

Speechless, I made my excuses, hung up and rung the ITU boss. Fortunately I got my patient to ITU.

The NHS has been invaded by a swarm of dubiously qualified people who have a dubious clinical setting. Are they doctors? Are they nurses? Are they managers?

No. They are PRACTITIONERS and watch out - as they are here to stay. I suspect that in the bigger scheme of things they are here with targets in mind, not clinical need."

The saddest thing about these new roles is that they are expensive and it would be much simpler to employ people with tangible skills who can actually get things done, as opposed to this new generation of obstructive, small minded, management-compliant 'practitioners'. The problem is that this trend is getting worse and it is showing no signs of reversing, the management like this new breed of compliant yes men as they will always do as they are told, they lack the expertise and power to actually stand up and fight for the interests of their patients. The corrupt and cynical management of the Department of Health has replicated itself up and down the country in NHS hospitals far and wide, the managerial Stasi continue to proliferate as the government tries to dis empower anyone who has the power to stand in the way of a health care system driven by political need and not the best clinical interests of patients.
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