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baigmk

Is this our future???

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Perhaps some of you know this already but it was new and shocking to me. Today after training in psychiatry for over 2 years, for the first time I thought about a career change. For a moment I felt that I could survive through anything but no, not this one. After reading a post in doctors.net.uk I downloaded a report published in 2004 following 2 meetings involving 600 delegates. Title is New role of psychiatrists. There were all the top names among delegates, DOH, RCPsych and BMA. Following are some of the points that this group highlighted. Full report is on DOH website.

The development of systems such as care planning and single point of entry,distributing theresponsibility for assessment and treatment can help to limit the role of psychiatrists.

There was a concern from users and non-doctors that the consultant may see the patient too early in their psychiatric career. It was felt that this medicalised the approach and worked against a holistic model. However this would require others to take up the gatekeeper/assessor role

Possibilities for retraining and refocusing during the psychiatrist’s career should be developed to allow for consultants and others to maintain a fresh and flexible interest in their careers, as part of their continuing professional development.

Although increasing efforts are being made to support a range of mental health professionals (nurses, pharmacists, non-professional affiliated staff) to change and adapt/extend their roles, relatively little attention has been paid to the need to develop an effective change process for psychiatrists

Diagnosis –the groups considered whether the use of diagnosis should be eradicated or whether it served a useful purpose and if so for whom and to what end. A number of concerns were raised given that a diagnosis may change over a person’s life and an individual may end up with several diagnosed conditions. Is diagnosis useful for the consultant or the patient/service user and if so why?

The groups asked whether it was better to spend time focusing on one team or being

a consultant to several teams. Would the former result in unequal services given the shortage of consultants?

Ward Rounds - groups considered whether these would be abolished since they represented

efficiency for consultants and not patients. A patient who is admitted on a Friday might have to wait a week to see the consultant at ward round; there should be instant access to a named nurse and a consultant. The patient would be given written details of when the nurse was on shift. Staff would be aware of issues with each patient and not

just their ‘cases’'

Outpatients would also be abolished, which would hopefully mean an end to leaving people waiting for hours and then not having time to be seen. A new way of booking appointments should be devised.

Beds – it was hoped that sufficient beds would be available and would not be controlled by

consultants.

Innovations

• No ward rounds

• Mainstreaming of mental health service into the general’ hospital (Australian Model)

• Management of health staff by social care staff and vice versa

• Self management of medication

In common with the study findings, the groups felt that SpR/consultant psychiatrists were often unaware of the skills and training possessed byother members of the team, and therefore how to best manage the team’s workload.

The groups identified that psychiatrists communication skills were vital but psychiatrists are

not formally appraised/tested in this. It was a concern that trainees were not observed in their patient contacts, and did not get sufficient feedback from colleagues and other stakeholders on how well they communicate with users, carers and team members.

There is no culture where consultants can admit the need for further help, advice and feedback

The value of learning by example, and observing a good communicator/manager/leader a part of consultant training was commented upon.

The groups felt that psychiatrist trainees and other healthcare professionals should be trained together in some tasks, for example a set of common core competencies (including diagnosis, communicating and managing illness). This would promote greater appreciation of team roles and responsibilities and may help address some issues of management.

It was agreed that psychiatrists needed to be trained to manage a team effectively, and that too much of a “top down” approach was often felt to be patronising to other staff.

' ... asked whether it was indicative of the fact that psychiatrists don’t really value the service user and carer input.

Parallel clinics, one run by the consultant, the other by nurses, have reduced waiting lists enormously.

Creation of “expert patients” to work within clinical teams.

The groups considered whether psychiatrists should be medically trained, and whether they

were truly allied to other hospital consultants.

Inclusion of service users and carers as part of consultant appraisal.

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Outpatient clinics were discussed as not being a good use of time and not being particularly patient orientated. Some consultants were trying new ways of working with outpatients such as e-mail correspondence,telephone outpatients and text messaging.

There was discussion about whether diagnosis was less important than needs

assessment by the MDT.

Studies are showing that patients value the input from consultants for complex assessment or

deteriorating conditions rather than for routine appointments.

Diagnosis should not be the prerogative of the Psychiatrist. Other professionals in the multidisciplinary team should be able to make diagnoses. One suggestion was for the psychiatrist to be available and run a parallel clinic alongside other professionals of the MDT.

Primary care professionals and other members of the multi-disciplinary team should be empowered by better training. It was also suggested that all professionals of the multi-disciplinary team have specialist training alongside the training that medical staff get.

A working model, started in response to a consultant manpower shortage, which uses a

Senior Nurse Practitioner working alongside the consultant, resulting in less use of consultant time. The SNP manages access, single point of entry and the assessment

process, acts as a co-ordinator within and between teams, facilitates discharge and

supports staff.

Text messaging is an effective way of answering discrete queries from users or other agencies, and is less disruptive than just using the phone.

There was a general belief that outpatients as a system of follow up has had its day. If outpatients are to be abandoned there need to be better systems for tracking to ensure medical responsibilities are covered. We need to define why a patient needs to be seen by a Doctor before teamscan determine when, where and how often and with whom patients are seen.

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Personally I'm not scared.

Change is practically impossible in the NHS and this is a load of political waffle anyway. &nbsp:lol:on't be disheartened.

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Roger Bannister: Quote: Perseverance

The man who can drive himself further once the effort gets painful is the man who will win.

Hope this helps you.

Just copied it from my post in the chill out.

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More PC nonsense

God, where is it going to end?!

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I am not scared either;

I can't wait for non-doctors to monitor/treat people by text-message after they decided that diagnosis is not necessary..

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How much of this will be a money saving exercise? Why pay a senior doctor to do something an OT will do for less salary? I fear these sorts of changes could happen in an effort to decrease NHS spending. :(

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How much of this will be a money saving exercise?  Why pay a senior doctor to do something an OT will do for less salary?  I fear these sorts of changes could happen in an effort to decrease NHS spending.  :(

good fear. let's think about it slightly differently (and more the way that NWW says)... why should a senior doctor do something an OT can do and is better at doing... hmmm... i can't think of any reason, can you?

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No, I cant think of any reason. looks like in near future there is not much for senior docs to do, so why to have them?

It is simply cost cutting and it wont work in long term, nurse prescribing and independent practitioner concept has already failed in US.

Cheers

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Forgive my ignorance or if my IQ has not helped me in understanding NWW. Can j tell us how its going to be beneficial for the future psychiatrists because it seems NWW has the support of consultants and RCPsych.

Why do other professions feel that their job is more valued if they take up some of the roles traditionally done by doctors

the document talks a lot about creating many new stupid roles that dont make any sense at all and that includes new posts for lead clinicians who will be employed in Band 7. Out of many bizzarre names and roles mentioned, aimed to improve patient care, there is not even a single mention of increasing recruitment to psychiatry or increasing the number of available consultant posts though workload on consultants and subsequent burnout was mentioned as the main reason why they should not be doing routine patient care.

Though I would agree that there should be some core skills shared by all the members of MDT, if people tend to take on roles of each other, they cant do justice to their original role at all. Why cant we just have doctors, nurses, OTs, pharmacists, psychologists and SW. Why are we creating so many other grades with confusing names and roles. So now we are going to have assistant and associate mental health practitioners, psychology associates, case managers, peer supporters, support, time and recovery workers and community development workers. Well no, I have not finished yet, there are new roles like gateway workers and responsible clinician and approved mental health professionsls.  Why do we need new consultant practitioners and why do nurse practitioners need to work in inpatient settings (Isnt there already nurses, consultants, staff grades and SHOs whose role they want to take on?) I fear that its SHO/StR/staff grade who is going to get replaced by nurse practioner wherever trusts can implement that. Why cant everyone do the job they have been trained for. Why do healthcare assisstants need to take on role of nurses, nurses of doctors and doctors of managers (in further future some of the nurses)?

The guidance states on independent prescribing.

Potential benefits of new ways of non-medical prescribing include:

• allowing service users quicker and more effective access to medication;

• increasing service user choice;

• providing services more cost effectively;

• making better use of the skills and knowledge of nurses and pharmacists; and

• supporting service redesign to allow new ways of working.

So it means many patients would prefer to have their medication prescribed by nurses rather than doctors but unfortunately they dont have the choice and of course our prescriptions services are not cost effective.

Another interesting point:

This new work involves a range of new skills and, in some cases, taking on some

of the activities traditionally done by doctors, including prescribing and physical

examination. Staff can be described as working at assistant, practitioner, advanced

and consultant levels in the different professions. The term ‘consultant’ is no longer

synonymous with medical staff only.

So we are talking about competency based positions rather than profession based.  And of course every one knows that doctors are the most expensive of these professions and there is considerable stress in NWW about other team members achieving the same competencies as doctors and yes they are cheaer to employ. Reliance and need for psychiatrists is going to become less and less as more and more roles develop for other professions. Now consultant does not has to be a psychiatrist, so why would someone employ an expensive doctor as a consultant? We will be ready for extinction in 20 years time. Thanks to RCPsych and our consultant colleagues.

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flexibility?

modernization?

toolkits?

can someone translate this rubbish

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It means cost cutting !

the real 'hidden agenda ' behind it all is the fact that you can employ 3 cpn's for the amount of money which will get you one consultant.

There may be , other , genuine reasons ,too.

but money seems to be the major driver of these changes

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Shrek...

I think this change is for good...

1. It takes a lot of unnecessary responsibilities off our shoulder... so we dont end up seeing a lot of benefit related patients ( patients who we think remain severely depressed inorder to claim incapacity/ disability allowance and benefits)... So we can see really seriously ill patients...

2. It gives an opportunity for the OTs, CPNs and social workers to practise and keep abreast of the latest literature regarding stuff...(rather than just depending on Sun or sunday times for knowledge...)

3. Once they start doing some clinical stuff, hopefully some of their agenda will blend with ours and we can have more meaningful discussions at MDT meetings... rather than giving some vague explanations like ' Peter is basically Peter isnt he... or thats just Peter being himself...'or the most common thing... 'He was confused...'

The points dont end there... but I think its too early to be disheartened... The only time we need to get disheartened is when they decide to cut down the salaries of us 'overpaid doctors'...

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Reply to J,

The fact is that I don't believe other MDT members can do all the roles of a senior doctor. In the CMHT I work for it is quite clear that the CPNs, OTs and SWs are not capable of diagnosing mental illness and initiating initial management plans in new patients. OK so if all the ideas in NWW are implemented I am sure they will receive additional training, but what is this going to consist of, realistically? Is it really going to compare to 5+ years of undergraduate training that doctors go through, and our postgraduate training/exams.

Are other MDT members going to be able pick up on organic causes of psychiatric illness even if they are competent at diagnosing functional illness.

Of course I don't think that consultants should be doing routine follow-ups on stable patients, even if they do have severe and enduring mental illness. But the reality is that with independent prescribing by nurses and pharmacists will come independent diagnosing and drawing up of managment plans.

With the new changes to the mental health bill, consultants will no longer be the RMOs.

Be honest, would you want your son diagnosed with schizophrenia, the entire management plan, including possible sectioning being done without him ever being seen by a consultant?

OK consultants may want to only deal with the most complex cases, with co-morbid physical or neurological disease, but it is a disservice to our patients if those with severe and disabling conditions are not seen by a consultant at key points in their illness - like the point of diagnosis, acute relapses, and hospital admissions.

I recently had the experience of being a patient, not in mental health services, but in another speciality. I saw a number of non-doctor HCPs, who were unable to give me an adequate diagnosis or treatment plan before FINALLY being referred to the consultant. I did not have a serious or complicated illness, and I am sure he was not intellectually excited by my presentation. However, he was obviously more intellegent, with better communication skills and more competent in managing my problem. It was such a relief to see him! And, in the end, does 5 appointments with nurses etc cost more than 1 appointment with a consultant?

And, as the biological aetiology of mental illness becomes better known, and treatments become increasingly sophisticated biological interventions, how long before the job of the psychiatrist is done by the neurologist.

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It means cost cutting !

the real 'hidden agenda ' behind it all is the fact that you can employ 3 cpn's for the amount of money which will get you one consultant.

There may be , other , genuine reasons ,too.

but money seems to be the major driver of these changes

Bingo !!!!

that is the actual reason behind all this meaningless change.. they say that they want to give more power to the patients or service users as they are called lately...

but one has to only go to the wards or the clinic to see that it has made things worse for hte patients... and these doctor's bodies are partly responsible for it as they go along with whatever shit the DoH and trust head honchos throw their way... cos after all, its a 'job' that they are doing and want to ruin their careers... i wonder where their conscience lies though...

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How about asking the CPNs and OTs whether they want to do this stuff? In my CMHT the other professionals haven't taken very well to this change. They don't agree with consultant led NHS! They don't like to take extra responsibilities for decisions. I still get called by the crisis team (!!!) when they 'are not sure' about a risk assessment which lands me with basically assessing the whole situation anyway. So I too think it's trying to take a lot of stuff out of a doctor's hand. And by the way I know that consultants are stretched then why don't they increase the number of posts?

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