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super7577

Nurse prescriber clinics!

19 posts in this topic

With nurses now trained to prescribe medications, nurse clinics (with full prescribing powers, independent of doctors) will surely follow.

Does any trust have one set up or in the process of setting up? Will the need for psychiatrists reduce? Will they be successful?

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Psychiatry is being taken over by nurses.In ten years they wouldn't need anymore doctors in teams.The nurse consultants will replace consultants.

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You can't have full prescribing and diagnosing powers without close to full medical training. Doctors will always be needed in psychiatry, stop being so paranoid.

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Magna I am not being paranoid.Things are changing fast and it will change.You would be called paranoid if you told somebody that there will be nurse consultants or for that matter even told somebody that nurses will become managers, its another thing that the over hyped managerial responsibilites taken up by nurses/socialworkers is sadly responsible for the current state of nhs.

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I agree with sandoc. I have a nurse in my team who is going for the nurse presribing course. He said that he would have independent prescribing powers at the end of it. He is also going around local pharmacies saying that he would be a prescriber soon- and they should dispense medications if they get his presriptions(apparently in the past, they have refused to dispense- by what he called as 'lack of awareness')

When I asked him, whether he could prescribe any drug in BNF, he said Yes, but added that he would restrict himself to prescribing drugs that r relevant to psychiatric practice. Now how many times do we prescribe non psychotropics? Not many times!

He also said that nurses usually prefer to discuss with the doctor first, before initiating treatment and have yearly reviews. Now how many doctors does a team require if nurses can prescribe, and r needed only for yearly review? Just one- and that would be the consultant! Soon the trust would be asking what role do the career grade doctors have, and why should they be paid as much, when they can appoint 2 nurses to the same post, for the same money!

There is not going to be a big change tomorrow, and I feel doctors would still have role for the near future, which will gradually reduce, and in about 10 years time- I would say it would all change.

Just notice all the changes that have happened since I joined Psychiatry not so long ago. All assessments in A& E, medical wards etc were carried out by SHO's, which have been gradually replaced by Liaison nurses, self harm teams, crisis teams etc- and at the moment all SHO's do is ward work and clerk patients! This should have been strongly resisted by doctors, but they didn't which allowed people to question the need for doctors. They say that they will call doctors to deal with complex cases- but if an SHO does not get any training in simple cases how can they deal with more complex ones?

At the end of the day- the Govt wants the work done at low cost- and if they can train people who they can pay less to do a job for them- they will

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A couple of nurse prescribers that I have spoken to are planning to run clinics at CMHTs totally independent of doctors and deal even with complex cases! Does their enthusiasm stem from a lack of understanding of what they may face (tricky medication issues, resistant cases, high risk patients, patients with physical conditions etc)? Or am I underestimating how well non-doctors can practise psychiatry? I wonder...

By the way, allied mental health professionals will be 'RMOs' for the MHA purposes as well. The need is dwindling..

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Psychiatry is the only speciality where everyone can pretend to be a &quot:lol:octor'.I just hope it doesn't go the psychotherapy way, where trusts employ more nurse specialists and psychotherapist instead of psychiatrists trained in psychotherapy.

The current lot of consultants in someways are responsible for whats happening.Most of them don't want to really confront the nurses or mangement.Most of the medical directors are more bothered about how they can cut the banding of SHOs rather than training issues.

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Talking about piecemeal medicine,I knew a few nurse practitioners in my former trust who were doing a physical examination course that would have allowed them to examine patients independently..Apparently the idea was to entirely exclude SHOs from the admission process...I wonder why?? ;)

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The problem with a lot of these things is that nurses generally work within a set framework, or protocol. That is fine until things occur that don't fit into their training or that don't have a protocol that can be applied. That is where the doctor steps in, to be able to think outside the box, and use our considerably wider knowledge about illness to cope, and to take responsibility for those actions. The responsibility is something that nurses, however well trained and experienced, are reluctant to take and I don;t know how many will want to step up to that level. I know a lot of nurses who just want to do nursing, they would have done medicine if they wanted to do what we do. We need to fight to preserve the boundaries between our roles.

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An almost completely nurse led service will be unacceptable to the public. They'll end up making most of us sub-consultants so that they can quote that how under their government most patients get seen by a 'consultant'.

I can't envisage more cuts in training posts.

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I can't envisage more cuts in training posts.

Not until the next set of reforms- 'Remodernising medical careers'

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Thankfully you can only really get away with one 'modernisation' per generation in any field, anything more frequent would be seen as a waste of money. They've trimmed our training posts as far as they go.

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There is also likely to be an effect on training. One problem that I foresee is that doctors will end up being there for 2 things - complex cases and accepting overall responsibility. If doctors stop taking care of more straightforward cases, how will juniors learn? I found myself in a situation in A&E where nurse practitioners took care of the more straightforward cases, which had a big impact on learning for doctors although probably reduced waits.

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Most crisis and liaison assessments by nurses that I have seen are protocol driven and constrained in their scope. They often fail to tease out the finer relevant details and sometimes miss the point altogether. Risk assessments are at the best average and the ability to diagnose in complex cases almost non existent.

If I was paying privately, I would want to see a person qualified for the purpose. NHS is different though. Anything goes..its a sociopolitical tool.

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If I was paying privately, I would want to see a person qualified for the purpose. NHS is different though. Anything goes..its a sociopolitical tool.

Couldn't agree more :(

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My recent experiences with SNPs have only served to reinforce my impression that they are an underqualified, overpaid, work shy, incompetent lot whose 'assessments' & liasion work are rudimentary at best..Their appointments have done nothing to reduce the workload of junior doctors.If anything, they delay cases being seen by the SHO, which usually means that you end up seeing them at 3 am rather than 10 pm...

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Agree. When I was on the SHO rotation I got sick of the home treatment team seeing all the new cases and calling me in only when they needed medication prescribing. Of course then I'd have to start the assessment from scratch which is a pain in the neck for the patient and myself when the patient keeps saying 'They've asked me that already'.

I found the HTT had little or no structure to their assessments - they just subjected patients to a barrage of random and disjointed questions in the hope they picked up something they could act on. I used to dread doing 'joint assessments' and just wanted to get on with it myself. I found the HTT's presentations in the MDT meetings lacked any kind of clarity or thought and seemed to be a 'scattergun' approach - bombarding us all with useless facts in the hope one or two might be relevant.

I despised the HTT for taking away useful experience that I needed for the membership exam and I loathed having to call them when I received a GP referral out of hours. Sometimes I didn't, feigning ignorance about the system or whatever.

At a time I was involved in presentations at Part II standard I felt their standard was appallingly bad and entering their office occasionally the banter going on was not about patients (surprisingly), it was general gossip - everyone 'aving a laff'.

I just got sick to death of them and wanted nothing to do with them! I felt all referrals should come to SHOs first, then involve the HTT as necessary. They may do an OK job in the community but their standard of presentation needs to improve drastically.

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couldnt agree more on snp,

they have no basic knowledge about the psychopharmacology, just becos they have done one course on prescibing doesnt make them psychiatrists..

they have even started to attend the case presentations and journal club meeting now, soon they woudnt need junior doctors anymore if all their work can be done by nurses..

nhs is definitely doomed, sooner or later..........

the nhs is all about cost effectve, managers are least bothered about the care that pts receive. i would rather see someone private then be seen by them..

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I like and agree with the last run of posts. Our jobs are not under threat from nursing staff with half our intelligence, brutal but true despite my respect for them in their traditional roles, and i honestly feel they have only half our work ethic too.

I can actually envisage greater numbers of psychiatrists in the future for a number of reasons. Firstly our remit appears to be extending with revamps in the mental health act (e.g sexual deviants), mental health has been being brought more into focus in recent decades (e.g national service framework inclusion) and perhaps least American trends of increasing private uptake of of psychotherapists may well cross the pond (as too has car numbers, gun crime and obesity).

P.s I'm not Mystic Meg, just an optimist.

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