Dear All,

something else to think about...

Liam


Posted by Andrew McIrvine on ASiT site (member of BMA council)
Sorry for a rare intrusion by dinosaur on the ASiT site but this is
really important to trainers and trainees.

It's all about dumbing down medicine as a whole. The DoH and their
managers really don't want us as a separate independent profession.
They want manageable skilled technicians who they can order about --
and so control targets.

This is going to extend way beyond surgery. A lot of countries now use
nurse anaesthetists. We now have a nurse consultant in Cardiology - and
only one Doctor consultant to support her - or is it the other way
round?
The 4-hour wait in A&E virtually sidelines doctors. Surely the triage
nurse can be trained to offload to the correct specialty quite rapidly?

Interesting that the Independent editorial has got the answers in first
- already rubbishing any protests you as juniors might have as
protectionism. They have only noticed that SCPs are being trained this
way rather late - but are suddenly very keen on the idea.

It is really about two things - money and political control.

It seems the RCS has not really seen this coming. In fact they have
designed the curricula and courses to train Surgical Care Practitioners
(strange terminology, very PC, presumably us surgeons are cast as
uncaring practitioners - unlike the retrained 'angels').

But they were sold the idea that they were training assistants to
replace the shortage of 'juniors' post Calman & EWTD. I do not think
they realised that the Govt was planning on training them up for
independent practice to replace those expensive and politically awkward
doctors. Great that we help plan for own destruction. Why and how can
they remain so naively trusting of a Govt who seems intent on
destroying the professions and probably the NHS as we know it?

I shall try and raise this issue at the BMA Council on Wednesday - but
don't hold your breath about union support. However this goes beyond
just surgery and needs wider debate and discussion. Who should be in
charge of the new health care team?

Good luck

Andrew McIrvine
On 6 Dec 2004, at 20:10, dermotoriordan wrote:

>
>
> As a follow up, below is the accomapnying editorial from the
> Independent.
>
> Hernia ops, vasectomies and arthroscopies are on the menu.
>
> Dermot
>
> ************************************************
> The Independent masthead
>
> A closed shop for surgery does patients no favours
>
> 06 December 2004
>
> An instinctive response to the report that nurses could be trained to
> carry out minor surgery would be horror: horror that anyone without
> full medical qualifications would be allowed to wield a scalpel after
> only two years' extra training; horror that this Government would be
> prepared to go to such lengths to reduce waiting lists and NHS costs.
>
> Certainly, the Government has its work cut out if it is to honour its
> promise to cut waiting lists to a maximum of three months by 2008. And
> we must be confident that corners are not being dangerously cut for
> the sole purpose of meeting overambitious targets and winning
> elections. But is it such a bad idea that nurses already trained and
> working in the health service should be encouraged to seek further
> skills, including the skill to carry out minor surgical procedures?
>
> Nurses are already becoming involved in diagnosis and prescribing as
> nurse-practitioners attached to GP surgeries. Such procedures as
> hernia repairs, vasectomies and internal examinations of joints are
> mostly without complications and currently take up vast quantities of
> highly paid surgeons' time. It is right to ask whether consultant
> surgeons, who have spent an average of 15 years in training, would not
> be better employed on more complex operations, leaving the simpler
> stuff to more junior and more cheaply trained surgical practitioners.
>
> Among the objections likely to be heard in coming weeks is that junior
> surgeons need to become adept at simpler operations before they take
> on the far greater complexity of heart and brain surgery. Another is
> that the nurses would be simply junior surgeons on the cheap - and
> might lack the all-round medical knowledge to deal with an emergency.
>
> Certainly, safeguards and supervision are needed and obvious worries
> must not be dismissed out of hand. The fact is, however, that the
> fiercest opposition is being voiced by junior surgeons. And it is
> pertinent to ask, as with much NHS reform, how far their response
> reflects concern for their own pay and prospects as part of a
> protected medical elite and how far it reflects real fear for the
> wellbeing of patients. These are quite separate things.

Though there are alternative views:

Andrew, Another dinosaur intruding if I may. I don't disagree with
anything Andrew
says but it is probably too late to stop this "initiative" and coming
in late with a
negative response is sure to generate accusations of protectionism -
natural spin!
I'm not sure the whole scenario isn't just symptomatic of overall
incompetent
planning rather than conspiracy on the part of government, but nothing
would
surprise me. There's no doubt it is politically driven by
undeliverable political
promises made to the electorate. However, the best response is to
take control by
embracing these SCP's and make them part of OUR team rather than
'independant
practitiioners', thereby making sure they are answerable to us and not
to managers;
that way they can be used appropriately and safely and we can maintain
standards of
care. If we try to stop it, it will almost certainly be introduced
with managerial
control and the game is then lost. There are already examples where such
practitioner
s are being used effectively and we should share experience and best
practice. I
accept there is a problem with who will train them and how this will
impact on
Surgical trainees, but better we have them inside our tent etc. Until
such time as
many more Specialists are trained, EWTD means there are not enough
doctors to cope
with the workload so help is needed. Best we decide which parts of
the routine
work WE delegate and which part WE retain for training our SpR's. We
all know that
it is the pre and post op decision making which is crucial to
successful outcomes
and at present only fully trained surgeons have those skills. Any
decision to
recommend a treatment should be qualified by where and by whom it
should be
delivered. If somebody else alters the 'where and by whom' then the
original
recommendation is null and void. Who then takes ultimate
responsibility? Not me.
If a patient is removed from my waiting list for treatment elsewhere I
write
stating my recommenda
tion only applied to the treatment being delivered by my team in my
hospital (where
I have control) and is therefore no longer recommended by me. Time
for an open
debate by all concerned and a unified response from the profession.
Bob Greatorex