Posts Tagged ‘Bureaucracy’

We continue to waste junior doctors’ time

By Dr Deborah White, member of the BMA’s junior doctors committee - 14th September 2010 10:48 am

I recently made the transition from hospital junior doctor to GP registrar. I was thinking as I checked my blood results on the computer the other day how much more efficient this process was than the end of day ‘chasing of the bloods’ in hospital. If all is normal, results can be marked as such and filed in the electronic record with a couple of clicks. If there are abnormal results, I can ask the staff to arrange a repeat or for the patient to come in to see me with another couple of clicks. And there is a clear audit trail.

Looking at, and acting on, laboratory results is clearly a medical responsibility, but the laborious copying of results into the ‘bloods folder’ to be taken on the ward round was not good use of my time as a house officer. Things had moved on by the time I was an SHO, and we often had a mobile computer to take on the ward round to check results, but there was still the time-consuming completion of request forms for the next day to be done by my house officer.

This isn’t the worst of it, as any junior hospital doctor knows; there are plenty of tasks that fall to trainee medical staff which could and should be done by clerks, porters, or other staff. One of my ‘favourite’ completely inappropriate uses of medical time in hospital posts was hand-delivering requests for investigations, when it is not possible to request them online or on the phone, and the internal mail is far too slow and unreliable to use.

Another was phoning round the wards to find out where my consultant’s patients had been placed in order to put together a patient list. As a medical SHO last year, I would sometimes phone every ward in the hospital I hadn’t been to that day to make sure no patients had been missed. Yes, it was my responsibility to make sure all my consultant’s patients were seen, but should I really have had to spend time ringing round: “Hi, it’s Debs, Dr Blogg’s SHO, just wondering if you had any of my patients tucked away on your ward?”

No wonder the recent coverage of the BMA’s cohort study, which traces the career progression of junior doctors who qualified in 2006, the year after me, shows that trainees spend more time carrying out administrative tasks than they do in formal training. Juniors in their first year of specialty training reported that they spent 66% of their time on clinical duties and 14% of their time on administrative tasks, which was greater than the time they spent in formal training in a clinical setting, at 13%.

Such poor use of my time would be unthinkable as a GP registrar. I have 12 hours of protected educational time per week, and when it comes to admin, my trainer tells me to delegate - I have got more important things, i.e. my training and patient care, to attend to.

Read the full cohort study.

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Posted in BMA | 2 Comments »

New safeguarding quango can ban doctors

By Francesca Robinson - 21st December 2009 6:41 pm

The government’s new safeguarding authority - which will have the power to remove doctors from their jobs - is creating an unnecessary and “burdensome” layer of regulation, warns the BMA.

NHS jobs are now covered by the new Vetting and Barring Scheme (VBS) and all children and adults receiving any form of healthcare are categorised as “vulnerable”.

Launched in October, the scheme replaces existing arrangements for spotting potential abusers with much stricter controls for protecting vulnerable people.

The Independent Safeguarding Authority (ISA) which runs the scheme will be able to automatically bar doctors accused of the most serious offences without any right of appeal.

If the concerns are less serious the individual will have the right to make representations as to why the bar should be removed. They will also be able to appeal to an Upper Tribunal but only on the grounds that the ISA has made an error on a point of law or fact in making its decision.

The VBS is the government’s response to the Bichard Inquiry set up after the murders in Soham of Holly Wells and Jessica Chapman by Ian Huntley. It operates in England, Wales and Northern Ireland.

Employers face fines of up to £5,000 if they fail to refer to refer an employee whom they have concerns about.

Doctors must start registering with the VBS from July next year. There will be a one-off fee of £64 for the criminal records and other background checks. Once registered individuals will be continuously monitored. As many as nine million people could be required to undergo the checks.

The scheme has already received widespread criticism for being overly prescriptive because it will extend to parents who transport their friend’s children on behalf of a sports or social club.

Paul Flynn, deputy chairman of the BMA’s consultants committee, said: “One of our concerns is that this scheme will create a whole new dimension of scrutiny of patient safety incidents which are not necessary and it will add considerably to the burden of regulation.

“Another concern is that the ISA will have the power to take away a doctor’s ability to earn a living with no right of appeal. While the GMC and other bodies can question a doctor’s fitness to practise and remove them from their job there is always a right to appeal their decisions.

“This is a very blunt instrument for dealing with a serious problem.”

An ISA spokesman said: “The scheme offers a common sense, proportionate approach to safeguarding and it is what we believe the public would rightly expect.”

Read more on how the new VBS will work. 

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Posted in Hospital Dr News | 1 Comment »

Cameron would rename the Department of Health

The Guardian - 2nd November 2009 1:43 pm

David Cameron will rename the Department of Health to ensure that it is committed to improving the health of the entire nation.

In a speech setting out his five priorities for the NHS, the Tory leader said the DoH would become the “Department of Public Health” and that a Conservative government would publish a white paper on public health.

Stepping up his bid to make the Tories the party of the NHS, he also promised reforms to cut costs and extend “patient power”. The Conservative leader repeated his pledge to ring-fence the health budget, but insisted that money would be better spent.

The £4.5bn annual bill for administering the NHS was “astonishing”, and must be slashed by a third over the next four years, he said.

In a speech in London setting out Tory priorities for the NHS, Cameron insisted: “Spending on the NHS cannot stand still. But that does not mean we are simply going to pour money in as Labour have done. If we change nothing, and if productivity keeps falling at the rate it is today, then even with real-terms increases in spending we couldn’t hope to cope with the pressures on the NHS.

“That’s why, as well as those increases, we urgently need reform to make our whole health service more efficient. We are determined that a Conservative pound will go much further than a Labour pound.”

Cameron said that five priorities would determine his approach to health policy: making the NHS patient-led, measuring health outcomes, putting healthcare professionals in charge, getting the government to focus on improving public health, and reforming long-term care.

Read more at The Guardian.

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We need a clean sweep of medical bureaucracy

By Mr Munchi Choksey, consultant neurosurgeon at University Hospitals Coventry and Warwickshire - 21st September 2009 9:55 am

The NHS is a very large, complex and unwieldy organism. It is also a seething mass of individual ambitions, career aspirations and people with time on their hands. Every year it seems we do less real clinical work and spend a lot more time talking about it.

The matter was brought home to me when I recently opened the clinical notes of a very fit, 37-year-old non-smoking lady, sent to me with back pain.

Out popped a 44-page folder, pertaining to her recent admission for a hysteroscopy. 

Read through it, looking first at nutrition (page14), patient-carer teaching information (p16), social circumstances (p17), Waterlow scores (pages 18-20), acute pain algorithms, post-operative physiotherapy, post op recovery, etc, etc.

It all looks very reasonable, until you consider the consequence: a massive investment of time, for virtually no yield in terms of increased safety.

It took me back to the urology firm on which I did a medical student locum - remember those? We were expected to clerk ten to 12 men usually over 65, within 30 minutes to get them ready for a list that started promptly at 0800.

Mostly, this was a ‘heart and lungs - tick’ exercise: however, I am not aware that anyone came to grief through the process. The modern process - largely nurse-led - is cumbersome, slow and probably not very effective. That is because it is being run by people who are totally averse to the concept of a managed risk.

We have forgotten that a core feature of the delivery of medical care is really the management of that risk. As the famous examiner once said to the disappointed candidate after one of those dreadful, career-halting rigmaroles that passed for professional examinations: “Son, as you leave here and walk down the steps, the first bird you see may well be a canary - but it is much more likely to be a starling.”

We in the NHS are in the grip of a metastasising illness, a proliferation of bureaucracy that will ultimately, like ivy, strangle the noble NHS oak tree we all love so dearly.

Time for a clean sweep of the Augean stable, perhaps?

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