Tuesday 10 February 2009


I know what a medical Consultant does. I've been trained to do the job over many years, I've ongoing appraisal and CPD and Job Planning and meetings that define my role iteratively.

Some roles are clearly medical and Consultant roles. In my corner, elliciting psychopathology and ascribing significance to this, to generate formal diagnosis, is seen as a Consultant Psychiatrist's job. Nurses (especially non-medical prescribers) have to be able to generate a sufficiently robust formulation, but formal diagnosis remains medical. DVLA work and fitness to drive is medical. Assessment of capacity is everyone's business but assessment of testamentary capacity or ability to undertake Lasting Powers of Attorney or fitness to stand trial is seen as medical work (because it's only accepted when done by a medic). Mental Health Act 1983 work is done by doctors (and even within the ammended Act, it's only doctors who can make Assessments and recommend compulsory admission).
We do more. Complex management plans. Case Conferences and Journal Clubs and Clinical Effectiveness. Taking a lead in safeguarding cases, saying How It Is. Expertise in medication, ECT and interventions. Being the one to speak up in court. Teaching of every discipline. Management meetings. We see a lot of patients out of hours (last weekend a Consultant Psychiatrist was called 16 times and drove out and undertook 12 assessments, and had worked 2 other nights in the month, for which she receives the princely sum of £183.50/month for being on-call, i.e. pay of £36.70/night for each night she had to be on-call). I like to know about and input in to every management plan (and at least everyone gets a Consultant Psychiatrist's input then, after a CPN sees them and discusses care with me when they're back in the office and we meet up each afternoon). Audit.

On top of that, we spend a lot of time seeing patients.

Senior clinicians, seeing patients, using their clinical expertise whilst also doing enough management stuff to develop their service as they'd wish. Life as a Consultant Psychiatrist is fairly clear.

In fact, mine is very clear. I share my Job Plan and Appraisal with anyone who's interested. Lots of folk have been curious. Nurses, OT, secretaries, managers. Why not? I'm busy, I do loads, I critique what other people do, it's only fair that we're transparent and folk can see what I do. My folder's a lever arch file full of stats so they can see how many patients I see, what my out-patient activity is, how many home visits I do, how many in-patients I look after, what their length of stay is, what comments (some) and complaints (none, yay!) there've been, what my sickness is (still at 0 days over the last year), everything.

I don't expect everyone to wish to be as open. But I'm surprised at how opaque non-medical Consultants can be.

So, without any rancor, could I pose the question more widely. Rather than existing senior posts, of the non-medical Consultant posts that are high profile (eg the SHA need to agree), what do these posts involve that the non-Consultant posts don't? What is the raison d'etre behind a Nurse Consultant, Physiotherapist Consultant, Occupational Therapist Consultant or Social Work Consultant?


Nurse Sandra May said...

I actually have no idea!

But I thought I would finally comment on your blog and tell you how much I enjoy reading it.

I am tentatively posting again on my blog... ( http://keepcalmcarryonnursing.blogspot.com)

Anonymous said...

Now Shrink, you must be aware at how extremely unfair this question is.
It is whatever they say it is - variant betwixt SHAs.

I'd love to see them develop with the same broad uniformity as medical but you've got a couple hundred years head start.

However, and on a scary note - I received my AMHP authority last month. Involuntary admission for assessment under MHA is my limit.
I used it the first time this week.
The medical team made me jump through a couple of (generally acceptable) hoops before a bed was available but odd how even when the Director of MH and the State MH Act authorises me to admit for assessment - I still have to do that little bit extra to keep the medics happy before they make a bed available.

Cat said...

Tainted_Halo - the Code of Practice says that it is actually the doctor's responsibility to find the bed, rather than the AMHPs although I don't know anywhere that that is practice.

As for consultants, well the only social work consultants I've ever come across have used the term in the business sense - namely, they come in to organisations and are employed to provide consultancy on management of particular issues (usually organisational) so it isn't the same as the medical model in any way nor does it attempt to be. And quite rightly in my view - I like the different structures that exist and being slightly separate from the usual hierarchy in the NHS as we are seconded to the MH Trust from the local authority.

Anonymous said...

cb: yeah the bed allocation remains the medical prerogative - and the extra clinical detail might help with placement . But since it took 36 hours to actually get them to hospital, they could have waited for that info and just given me the go ahead on my assessment.

BTW - I'm in Oz.

Ian, Mr

(I use my gf blogger name T-H to receive comments)

GT said...

i've never met one, i do not know of one. dunno if it's related or not but i was encouraged to consider the nurse prescribing course once but i felt it involved taking on tons more responsability on the cheap for the nhs.so? nah i did'nt.

Anonymous said...

You know what? You can be (they can be) a Specialist Clinical Psychologist, a Highly Specialist Clinical Psychologist (!), or a Consultant Clinical Psychologist. Isn't some part of this to do with a perceived need to create a 'career structure' and also a salary/status one, for people who work with and alongside doctors?

(I think I know what a medical consultant is, or rather, I think I knew, in the old days of Senior Registrars and Consultants.)

Unknown said...

ISN Solutions offers a managed IT services agreement that will ensure your organization has access to a range of IT skills at a FIXED COST and gives you access to our IT professionals from help desk through to network administrators and planners.