they could (if they were capable as a person of passing though the training and exams), of course they wouldn't be just a nurse any more as they'd have to be retrained, I thought that was implied?
Scrap NHS reforms, doctors tell Lords.
- Thread starter stockhausen
- Start date
they could (if they were capable as a person of passing though the training and exams), of course they wouldn't be just a nurse any more as they'd have to be retrained, I thought that was implied?
Would just like to add my 2p's worth to the debate
Commissioning model - this is already in practice in the NHS, there are already GP commissioning groups who have paid for health services from NHS organisations for a number of years. The actual commissioning model isnt new, its just being adopted as the de facto way forward. The problems that the reforms face (IMO) are that they are less clear on how they will measure outcome success and what outcomes they want to measure and how it will be overseen.
CQC - The BIGGEST issue with standards of care in the NHS currently, that will become a more critical factor as private healthcare companies get involved, is the underfunding of the care quality commission. They are already struggling to inspect the currently registered providers, and are having to push back the registration deadlines for GPs and Primary medical services contracts providers. Without a strong regulatory body who have the resource to investigate incidences or trends, the standard of care is at a high risk of being compromised.
'Any Willing Provider/Big Society' - The talk of clinicians and healthcare professionals running their own organisations as a social enterprise or similar, is not going to work in the future commissioning system, as the current financial requirements (bonds, guarantees, etc) seem to restrict competition to larger healthcare providers. There needs to be more support for mutual organisations.
The reforms CAN work, but they need proper investment and to be fully developed so that care does not fall at the hands of the likes of Circle or Assura, who dilute a focus between profits and patient care.
Re pathways, referring elsewhere is good practice if you are referred to someone who offers more specialised treatment. They will have a much higher standard of care than if you had a bunch of 'generalists'. There should be some lower skilled staff doing general monitoring of patient conditions or you will be paying someone £40k to walk round a ward taking temperatures and occassionally doing a treatment.
Commissioning model - this is already in practice in the NHS, there are already GP commissioning groups who have paid for health services from NHS organisations for a number of years. The actual commissioning model isnt new, its just being adopted as the de facto way forward. The problems that the reforms face (IMO) are that they are less clear on how they will measure outcome success and what outcomes they want to measure and how it will be overseen.
CQC - The BIGGEST issue with standards of care in the NHS currently, that will become a more critical factor as private healthcare companies get involved, is the underfunding of the care quality commission. They are already struggling to inspect the currently registered providers, and are having to push back the registration deadlines for GPs and Primary medical services contracts providers. Without a strong regulatory body who have the resource to investigate incidences or trends, the standard of care is at a high risk of being compromised.
'Any Willing Provider/Big Society' - The talk of clinicians and healthcare professionals running their own organisations as a social enterprise or similar, is not going to work in the future commissioning system, as the current financial requirements (bonds, guarantees, etc) seem to restrict competition to larger healthcare providers. There needs to be more support for mutual organisations.
The reforms CAN work, but they need proper investment and to be fully developed so that care does not fall at the hands of the likes of Circle or Assura, who dilute a focus between profits and patient care.
Re pathways, referring elsewhere is good practice if you are referred to someone who offers more specialised treatment. They will have a much higher standard of care than if you had a bunch of 'generalists'. There should be some lower skilled staff doing general monitoring of patient conditions or you will be paying someone £40k to walk round a ward taking temperatures and occassionally doing a treatment.
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- 30 Jul 2006
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- 12,129
Yes, I do. Why don't you look up 'Triage'
I do. Many Doctors work in Hospitals with Hospital Pharmacies - so what
And you are seriously suggesting that Pharmacists have so much more insight into what drugs a Hospital patient is taking are you? Get real pal.
Quite so.
Do you have any evidence that this is such a HUGE problem?
"tens to hundreds of thousands of complications a year" . . . Based on your figures, a very improbable maximum of about 200,000 then
I'm not questioning the value of Pharmacists, just your somewhat strange and unsubstantiated apparent assertion that "Doctors regularly prescribe things with dangerous complications".
Nurses would be the ideal choice - it is nurses who lead the clinical assessment and decision making at the top hospitals triaging patients for appropriate referral. They are doing this role already with the sickest patients going. Guess you like most people don't have a clue what nurses do across the spectrum of roles.
And yet most doctors run to the BNF to find a dose and when it's used off label who do they ask - the nurses. Nurses have always been doing this that a large proportion of them are paid nowhere near what they deserve is partly due to the propaganda peddled by various parties, the incompetence of another significant majority, their union being as much use as a chocolate teapot and the fact that in the main it is a female dominated profession and therefore is not given the same sanction as a traditionally male dominated one.
Nurses can prescribe there is a section in the BNF dedicated to it. They also quite often work in local protocols to give a specific drug eg my old work - benzypenicillin - to a specific patient group for a specific condition. Which really is not different from a junior doctor following a protocol and the fact that everything is so protocol driven then there really is a very blurry line.
Exactly, thanks for addressing the argument I made, rather than all the ones others thought were easier to shoot down.
Technology has moved on dramatically in the last 60 years, so it is natural and correct that job requirements can also change as a result. It is not in any way a reflection on current GPs to say that, for a significant part of their role, they are overqualified, and hence their use is an inefficient use of limited resources.
I would rather someone over qualified treats me to be honest.
Even if it means poorer treatment on another occasion, or a lack of treatment for someone else that could have been made if the appropriate efficiencies were in place?
Caporegime
- Joined
- 18 Oct 2002
- Posts
- 33,188
This is EXACTLY what should happen, GP's spend 7 freaking years learning all kinds of crap they will never, ever use when they leave the hospital and spend 40 years getting silly money to dole out antibiotics.
Why teach someone to do quite a lot of surgery, and a crap load of stuff they don't use.
Theres two options really, GP clinics in hospitals where just about all doctors spend SOME time every week in a GP office and some time every week in the ER so every doctor in the UK pretty much gets a constant varying contact with lots of different diseases and problems, diagnostically they will stay sharp and not miss anywhere near as many things and, with a decent system for which doctors are in where, people with a skin problem can get an appointment on a day a dermo will be in the clinic, a guy with a potential heart problem can see someone more specialised in heart problems, etc, etc, etc.
GP's are as now, utterly wasting the vast majority of what they learn, being overpaid for doing very little and seeing relatively few rare cases, which makes it harder to spot other more complex cases.
So one option is vastly better GP's and paying doctors to be doctors, not basic diagnosticians. The other option is what you said, train people for far less time to be great diagnosticians, not surgeons and everything else for years, and chemistry that they don't need, etc, and then we don't have to pay GP's highly trained doctors wages, for a duty they simply don't perform.
I havent read anything as nonsensical before, up till now.
You are not comparing like for like.
A junior doc still has up to 7 years to go before being considered fully trained.
A prescribing nurse is at the extreme end of nursing education, often worked for many years, and completed post-graduate courses. Not to mention afew further years of supervised practice before allowed to prescribe.
Caporegime
http://www.guardian.co.uk/society/2011/oct/04/nhs-charging-operations-york
Patients on waiting list for minor operations are told they'll have to pay up to around £250 for the op. Is this the future for the NHS under Lansley's plans? How long until hip replacements and cancer ops are done the same way?
Patients on waiting list for minor operations are told they'll have to pay up to around £250 for the op. Is this the future for the NHS under Lansley's plans? How long until hip replacements and cancer ops are done the same way?
Associate
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They are also usually limited to a certain area or fixed list of drugs they can prescribe, rather than blanket right to prescribe anything (unless this has changed recently)
Pharmacists are also able to prescribe some common medications (I`m not entirely sure of the scope that they are allowed to prescribe) if they do a post-graduate qualification. Again, this was introduced a few years ago, so I don't think many pharmacists can do this at present.
As i menioned you do get some senior nurses who are good at triaging patients. However, bad GPs triage patients, good GPs make a diagnosis and management plan that will either resolve the problem or refer the patient to an appropriate specialty.
Associate
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These same traige nurses will also never have the guts to discharge a patient with chest pain that is musculoskeletal in origin, send home the man with single episode of haematuria that has resolved or discharge the patient with a resolved TIA with low risk score (last 2 with outpatient follow-up), but the junior doctors would do these things. Have to say I`m yet to go to nurses for guidance for my off-license prescriptions. Using the BNF is the best way to prescribe any medications you are unfamiliar with, not basing on what people think it might be.
You're assuming that the diagnosis of TIA was "right". The same patient with a "TIA" may be in fact having some other benign pathology, which the junior doctor recognised and acted accordingly. Even so, you're comparing a "good nurse" with a "bad junior". Rather, how about saying some triage nurses discharging clear cardiac pain as "musculoskeletal" (which i'm sure has happened too). Or a "good" junior who realised that the "gastric pain" the patient was having was actually a heart attack contrary to the triage nurses assesment.
Agree the BNF is the way to go. Seek advice, look it up to see if it's right before signing anything
It does not matter how they got there it matters who is most fit to do the job. So let me ask you a simple question - who is going to be the best bet to judge lets say for example a paediatric problem - the GP who has been in post for 2 years or the nurse equivalent who has most likely done A+E, ITU or HDU, has a solid theory base relevant to what they are looking at along with real practical experience - oh and who works out a darn site cheaper. Would do no harm to have such a nurse running the paeds side of things at a GP's would it. I know who I would want my kids to see - the one who, well, has experience of sick kids.
But where are you along the training pathway though because when you are deep into a speciality the BNF does not answer your questions or give you reasonable guidance and your consultant is most likely MIA. Like most doctors you will turn to the people who know that stuff or where to find it.