Unsocial Hours for Junior Doctors

Just like GPs working in the NHS no longer like working beyond 6.30pm fours days a week, Junior Doctors working in NHS Hospitals now have an issue about working what they consider unsocial hours. But what are unsocial hours – one NHS definition is quite simply weekends and after 8pm on weekdays.

GPs are still required through the out of hours services to work after 6.30pm until 8am the next morning and at weekends. This nevertheless is costly to the NHS arising from agreements made in 2004 by the Labour government. Now the Conservative government is trying to claw back some common sense and is finding it hard to settle.

The UK has become a nation that works and is ‘open’ seven days a week. Churches are empty on Sundays but shops are full. There has been a dramatic change in the day to day lives of UK residents. Many work on Saturdays and Sundays and take time off during the week. The idea of a five day week Monday to Friday has been replaced by a four day week, or a 36 hours week spread over 7 days not 5. The weekend is no longer unsocial. Patients fall ill at any time day or night and a familiar face providing health care is very welcome not a strange working in another practice or called in to cover in a hospital that is struggling to man its wards.

We need to start to think around the problem of manning the NHS 24 hours 7 days a week. If we do not settle this current ‘strike’ the NHS will continue to fail.

 

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Being More Business Like – Time is Running Out

The very nature of general practice in the UK is being challenged by ‘progress’. Progress in new technology. Progress in personnel and health and safety legislation.  Major changes are taking place in the way GP Practices are expected to provide services, how theses services are funded and managed and finally how standards are monitored and measured.

The Care Quality Commission now expects a GP Practice to work to the same standard as NHS Hospital Trusts.  The CQC expects GP Surgeries to be run professionally and to be able to demonstrate their professionalism.  Looking through the many reports already issued by the CQC it is clear that many practices still have not got the message.  Looking back 50 years or more a GP Practice Manager was a rarity. A surgery might simply be two rooms in the doctors house. There were no computers. There were few practice nurses, only doctors seeing patients twice a day without appointments until the last patient had been seen. Telephones were also a rarity as patients would simply turn up sit and wait to be seen. Records were kept either on wooden shelves or in wooden four drawer cabinets and were often strewn around the consulting room unfiled.

The change in the way doctors surgeries are built, manned and managed has changed slowly over my lifetime. Doctors started to employ more staff from 1966 onwards as a result of the Doctors Charter. Health Centres were replaced by purpose built modern surgeries financed under the Cost Rent Scheme. Computers started to appear for repeat prescription and later for patient records, appointment systems and so on. Now we have all singing and all dancing computer systems linked to the NHS exchanging records and clinical letters, passing prescription orders to pharmacies. Referrals can be made on Choose and Book. Patients can interrogate web sites, look at their own records, book appointments and order own prescriptions.

All these changes need to be managed by professional and committed people. There are many skills required principally being able to deal with computers, and all the software entailed in accounts, payroll and patient record keeping. It is no longer asking patients to take a seat in the front room until the doctor calls. Yet the worry is that there are still some practices, some doctors, some nurses, some managers and their staff that have not received the message that the Care Quality Commission will be on their backs and that their practices must be run in a professional manner and that they will be accountable for the standards and the quality that exist in their practices.

Recently inspectors have asked for cleaning schedules visible for visitors to see. Managers are being asked for risk assessments if no defibrillator is provided. Practices need an emergency plan in case the place is flooded!  There is always a flavour of the month that needs to be attended to – it is an ever changing picture. Be prepared and be prepared well in the motto you need to follow. Do not think it will not happen here because sadly it does.

 

Robert Campbell – January 2016

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