Yet another post that's not clinical, isn't positive and is about management. Such is my life, at present. Ho hum!
In a previous hospital, when I was training as a psychiatrist, the Chief Executive changed. In my previous job, in the previous hospital, the Chief Exec changed. In my current job, in my current hospital, I asked about management before even entertaining the post. The Medical Director explained that the Chief Exec was a reasonable enough soul and basically let him get on and do what was sensible. He also commented that he'd seen 3 Chief Exec's since he'd been Medical Director. There have been 2 more have since he made that statement, 6 years ago.
Nurses come and go. It's necessary for their career progression. In my corner they tend to start at band 5 on the wards, then progress to a band 5 post in the community, then band 6 in a CMHT or specialist team, then band 7 as a team leader or ward manager, then they're stuck. Band 8a Modern Matrons are managers. Band 8b Nurse Consultants are managers. So it goes. To progress from band 5 to a senior role, nurses need to move around and gain experience in different arenas, so often there's turnover of staff, in a good way.
It does mean, though, that managers and nurses are coming and going at a fair rate of knots. The stability, both within the organisation and with patient care, is through the medical workforce. Senior doctors (GP partners and hospital Consultants) tend to stick around for the long haul. It's been suggested in mental health that all that's good from New Ways of Working is jettisoned and, instead, a "modular" approach is used. A care coordinator (who's re-written as some sort of journies facilitator in new CPA speak) will stick with a patient as they move through Single Point of Access, Assessment teams, Early Intervention teams, Crisis Resolution teams, Home Treatment teams, In-patient care, Rehabilitation Teams, Severe Enduring teams and so on. The fact that a patient's bounced from team to team doesn't matter - the care coordinator will remain a stable point of contact. The fact they've squillions of people to tell their tale to and no continuity doesn't matter - their care coordinator will be that continuity. The fact that each team will have a different doctor (somewhere, that's accessible some of the time, to some people) won't matter - the care coordinator will magically ensure that biomedical and psychosocial psychiatrists and GPs seemlessly deliver the same consistent care.
It's an epic work of contemporary fiction that I fully expected to see shortlisted for the Man Booker Prize. I've been disappointed. Ho hum.
The crux of it is that care coordinators come and go at frequent intervals. A band 5 CPN will be after a band 6 post. A band 6 CPN will need some experience teaching student nurses or doing CBT or undertaking nurse prescribing or managing acute care or supervising colleagues or developing management expertise so will move through posts to gain the requisite skills to then apply for a team manager or more specialist role at band 7. After time at band 7, many will look to band 8. Care coordinators are set up to fail, "navigating" the various teams and services, but equally they sure ain't providing the continuity over the long term.
Doctors can. Doctors do.
The notion of polyclinics worries many folk. Jobbing Doctor has, astutely and succinctly, narrated the zeitgeist within ivory towers and how choice is eschewed in favour of didactic This Is How It Shalt Be. Today he posts on how there will be self evident bad consequences.
This perturbs me. Private healthcare can (and often is) riskier than NHS care. When my wife needed to see a Consultant, we waited a year rather than going to a private specialist. Private hospitals concern me, because I know just how scary a place they are outside of the working week. Friends work in them. The NHS does out of hours care better. The NHS has flaws, which are magnified by managers (at all levels, up to the DoH) making wholly unhelpful changes. Well, it's their job. They've got to do something.
Doctors need to be in the thick of it. We know what systems work. Folk have already said, we can sort it out on the back of an envelope over coffee in 20 minutes. Patients talk to us, day in day out. We're at the coal face. More, we're there for the long haul. For our patients, for our teams, for our organisations, doctors provide stability and continuity. It'll be a tragic day if that's lost.