Wednesday 5 March 2008

Approved Clinicians

The new Mental Health Act legislation makes for interesting reading, to folk working in mental health. It allows nurses (and others) to hold Approved Clinician (AC) status. Being an AC means they can be the Responsible Clinician (RC) for a detained patient, instead of a psychiatrist being the Responsible Medical Officer (RMO). Most psychiatrists will have AC status so can still be RCs come October, but not all psychiatrists will automatically convert to having AC status. The change opens up the option of nurse lead units where psychiatrists have a much more modest role and aren't directly either involved or responsible for detained patients' care.

Tainted Halo asked, "I'm very interested to see how doctors embrace this new world freedom?! . . . what do the learned shrinks think they'll do with it?"

In my corner, we're having none of it.


Well, frankly, we're in the happy position of not needing to. Looking after detained in-patients isn't an onerous duty for us. We're in an urban setting so have benefits of covering a relatively small, tight geographical patch. We've easy access to psychiatrists, section 12 approved doctors and Approved Social Workers. We've frequent review of patients on the ward which is multidisciplinary. The reviews are frequent so they can be small (i.e. just a couple of people meet with the patient each time, rather than a room full of folk to face). As such there's frequent (daily to weekly weekly) input from medical, nursing, occupational therapy, pharmacist, social work and physiotherapy staff.

Recent presentations by CSIP and the DoH explained that change wasn't necessary in units such as ours. Fantastic to hear that for once central agencies aren't advocating change for changes sake.

Since we're able to have our cake and eat it, offering detained patients input from a wide range of professionals all working together, all seems well. The Healthcare Commission have been very happy with our mode and standards of care. We've not had issues from the MHAC either, who are oh so very rigorous. Since our patients, commissioners, carers, Healthcare Commission and MHAC are happy with what we're providing, as are we, we're able to say we've considered other service models but for now ours addresses patients' needs.

If it ain't broke, don't fix it.


Lucy said...

It sounds like you are fortunate indeed. It makes a pleasant change to hear good things about the workings of the mental health system in this country.

XE said...

Hurray for good interdisciplinary care! Sounds like you've got it down pat :)

Thanks for the blogroll by the way!!

Anonymous said...

Very interesting to hear the view of practitioners how the MHA 2007 is going to impact (or not) the treatment of the mentally ill. Do you think this will further enshrine the postcode lottery that we have when it comes to NHS treatment?

The Shrink said...

"Do you think this will further enshrine the postcode lottery that we have when it comes to NHS treatment?"


Anonymous said...

"Do you think this will further enshrine the postcode lottery that we have when it comes to NHS treatment?"

I don't think it will effect it so badly in terms of 'postcode' - but certainly by the difference in criterion that Shrink highlights in his shared team approach - these are issues of organisation, not (so much) government.

In terms of 'we're not having it' - is this an agreed team plan to not enhance nurses or others to RC status or simply 'we're not rushing into it - but will get there'?
I raise this as, tho I am happy to hear your system works just as it ought to have 'the old way', it's much the same as how they introduced s25 supervision - because no-one was doing s117 aftercare properly. Those who did s117 all fine would not particularly benefit from 'enhanced service provision' to incorporate the s25 provisions to do what was meant to happen - as your functional service would also appear to be running in regards RMO/ASW etc. However, they run risk of becoming 'behind' the advances of other areas because they haven't incorporated the changes to 'improve' their service by utilising the available options and find that their functioning becomes determined by the wider organisational differential pressures.
One idea springs to mind - if your nurses aren't being encouraged/permitted to gain RC status - they may find themselves financially at a loss to their counterparts in other areas who will no doubt negotiate pay increases commensurate with responsibility - and maybe vote with their feet to richer climes?

Anonymous said...

"- but certainly by the difference in criterion that Shrink highlights in his shared team approach - "

... that other services might not have

The Shrink said...

We've no objection to nursing or other staff developing Approved Clinician status, but nobody's keen for it, in our corner. Quite the opposite - they're all hugely keen to avoid it!

As you know the nurses salary, through Agenda for Change, can be augmented in other ways now. We've many band 7 staff (I've half a dozen in the community I work with, with others on in-patient wards) and band 8 too. We're looking at further developing this. We've high levels of staff retention so constantly are seeking to "develop roles" to keep good staff but enhance pay through improving banding.

But, will a Trust (especially a Foundation Trust counting the pennies) want to employ a Consultant Psychiatrist (who's an AC) and a band 7 ward nurse, or employ a Consultant Psychiatrist (who's an AC) and a band 8b ward Nurse Consultant (who's also an AC)?

I can see that some areas will greatly profit from AC for organisational reasons (whether patients will profit remains to be seen!) but I really can't see how change would improve patient care in my corner.

Cockroach Catcher said...

I do admire the foresight of the government. Some of us on Blogsphere will have to watch out now that Nurses can “section” some of us who “delusionally” think Stalin is still alive. What is the condition called in ICD11 or is it 12 now? Are some new Institutions going by Stalags? Or am I just hallucinating? No, we ignorant people are not allowed a vote on this. (Editor: that was only for the European Constitution.) You mean that other country across the Channel.

“You really have flights of ideas.”

Oh yes, I know I am being watched, so are you, some more, some less. Some by Google, a few by Yahoo. When is that date again? Better pack.

The Cockroach Catcher

The Shrink said...

". . . now that Nurses can “section” some of us . . ."

Not true.

The European Court of Human Rights wouldn't wash non-medics diagnosing mentally illness so the initial assessment and medical reccomendations for detention under the Mental Health Act still needs a section 12 approved doctor +/- another doctor.

The exception would be a patient who leaves hospital for the forseeable future but is on an SCT. A nurse (who was the RC) could then recall the patient to hospital and then they'd be detained under section 3.

Am Ang Zhang said...

Thank goodness for that; the disadvantage of retirement really, can only talk in cyberspace. No need to pack yet.