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Future of medics: the problem with the vision

Like ‘mom and apple pie’, it’s hard to disagree with the findings of the RCP’s Future Hospital Commission.

It proposes that medicine should be restructured to provide more comprehensive, integrated and personalised care.

Carefully thought out and developed, there’s a lot that senior NHS doctors, managers, commissioners – and indeed policy makers – can take from it.

But, of course, it’s a vision, an ideal. It does little to set its proposals in context with the current financial predicament the NHS finds itself in.

For many health economies around the country, the management are focused on surviving the next six months rather than whole scale reorganisation for the future.

The vision requires more generalists and better support from specialists. And a more comprehensive seven-day acute service.

Hmmm. More doctors. At the very least more senior doctor time in hospital, probably at weekends. That’s going to cost, unless the government can re-negotiate the consultant contract on much more favourable terms for the Treasury…

There was another story this week that didn’t get much coverage.

A new breed of health professionals are about to graduate in Aberdeen – and the venture is attracting interest from health boards and trusts alike.

Physician associates. They’re not doctors, but can do most things that junior doctors can.

The origins of the role lie in the US, where there are thought to be 100,000. A two-year training course for students who already have a science undergraduate degree, is being followed with a one-year internship.

Prof Steve Heys, the director of the course in Scotland, says: “They are not doctors on the cheap. It’s an expansion. The new physician assistants will make a major contribution to healthcare provision and will also enhance the quality of care provided.”

I don’t think anyone would disagree that there are things that juniors do that don’t have to be done by doctors. But, it doesn’t take a huge leap of the imagination to see the direction of travel – it would be very tempting to use such personnel as a replacement rather than an expansion.

A renegotiated contract creating an elite group of well-paid principal consultants (who’ll get the opportunity to specialise), backed up by cheaper junior consultants (who will be more generalist), supported by a smaller group of trainees and an expanded body of more affordable specialty doctors, physician associates and senior nurses.

Then maybe the vision could be delivered, but at what price for the profession?

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One Response to “Future of medics: the problem with the vision”

  1. ella says:

    Sometimes I think that doctors are being phased out. Training doctors are slowly being replaced by midlevels who say they deal with the simple cases and leave the complex cases for doctors. That means those in training are having more and more cases taken from them making them less and less competent which midlevels then like to complain about (doctors being incompetent). Then you get midlevels who are offended by the notion that they can only deal with simple cases and assert that further training has made them as good as or better than doctors at dealing with all types of cases. And there are those midlevels whose role was to support doctors, actually complain about how junior doctors are deskilling them. Even though I constantly tell the nurses that I am willing to learn and practice my skills at NGT insertion, dealing with acutely ill patients, prescribing certain IV drugs etc and to please inform me of anything that is going on in the ward, I am never told about these things and only handed discharge papers to sort out because well, there’s a nurse for that. The role of the doctor is disappearing.

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