Friday, 22 June 2007

Dumb me down porridge

The following email has been sent to GPs by an Out Of Hours service:

"Dear Doctor

Further to a recent feedback meeting with our
ECPs I am writing to advise you that at this early stage we would normally expect an ECP to be asked to accompany you on a visit to the prisons, rather than them being sent on their own.

This is because they need some further supervision and experience within the setting of the prison before they will be confident to deal with calls on their own. Unfortunately due to sickness absence it has not been possible to implement our planned training sessions for
ECPs and doctors yet but we will rectify that as soon as possible. In the meantime, until more confidence is attained by the ECPs we would be grateful if you would undertake visits to the prisons and ask the ECPs to come along with you. In due course when they have gained further experience and we have provided them with some extra training, we can of course review this.

On analysing the figures I can confirm that over the last three months there have been twenty six visits to the four prisons we cover, so we would not anticipate a significant impact on workload.

I appreciate that you may have concerns over the time prison visits will take but I would like to reiterate that this is a temporary situation to enable us to develop the confidence and expertise of our
ECP workforce."

This is a strange email to send. If ECPs are working unsupervised already then I do not see why they should need supervision in this particular instance from the GPs, this assume the premise that ECPs are safe to work unsupervised in the first place, a dubious assumption in my opinion.

More worryingly an alternative perspective on this could be that the ECPs realise that they are well out of their depth working in an unsupervised manner, hence they are not ready to work unsupervised in prisons. This then begs the question, if the ECPS do not feel happy to work unsupervised here, then should they really ever be let loose on patients in an supervised way?

It is also dodgy that the OOH service thinks that a small amount of supervised work will suddenly transform the ECPs into safe independent 'practitioners', the OOH service can then re-review the situation and deem that the ECPs no longer require any supervision. This is without any examination or testing of the ECPs' skills or knowledge.

It appears this kind of dumbed down second rate method of training up independent 'practitioners' or 'quacktitioners' is symptomatic of the general dumbing down of medical standards. It used to be the case that one needed to have studied medicine at a high level to be able to practice independently, now anyone can have a crack after going on a few courses and watching a real professional for a few weeks; there are no standards being upheld for this new breed of quack.

Is it fair that prisoners will be left with this second rate standard of care? Is it safe that the OOH service can make decisions about what roles certain non-medically trained staff are able to safely perform? It seems that the answer to both these questions is 'no', and the patients are the ones will yet again suffer as a result of this cost cutting short-termism.

And who carries the can when it all goes horribly wrong and a serious mistake is made by one of these independent practitioners? It would not surprise me if the GPs were handed some of the blame for their role in the 'training' of the ECPs, while the OOH service washed its hands of any responsibility altogether.


vinay shanthi said...

am pretty sure when things go wrong it will be called 'systems failure'. some people in npsa (or its affiliated bodies)are 'ALREADY churning out that excuse' when asked as to who will take the blame if and when any one among the whole load of practitioners goof up. there is anonymity in numbers. that is the reason for 'group practice' or 'team efforts', so that no one can be held responsible and people can do 'root cause analysis' etc when the cause if obviously the dumbing down of care

Anonymous said...

That's a bit harsh isn't it? I mean, I'm guessing here, but surely the circumstances of dealing with medical issues in prisons and with prisoners are a bit different from your average? The fact that additional training and supervision is needed for those circumstances doesn't necessarily say anything about abilities in the outside world, does it?

ecparamedic said...

I read the letter as a request for a bit of support for a colleague working in an unfamiliar environment.

I think it's quite sad that you seem to have twisted a request for a bit of professional courtesy into a cudgel to beat some poor sod who's trying to do his/her job.


Garth Marenghi said...

I disagree as you may have guessed.

It demonstrated how some staff are being given roles they will never be adequately trained for.

ecparamedic said...

Of course you disagree, it's what you do. I'm sure you are a joy to work with.

Thankfully the vast majority of Doctors I work with are supportive and helpful to their colleagues. Including, shock horror, those of us that you choose to denigrate with your broad 'quacktitioner' brush.


Garth Marenghi said...


I am glad you feel you know me well enough to comment on my supportiveness of my colleagues.

If you feel that doctors should blindly support all new roles, independent of whether they are cost effective or safe, then I am slightly bemused by this.

I think it is important that people speak out when they feel mistakes are being made, in fact it would be irresponsible not to.

I would argue that those who support some of the new roles are being irresponsible with their actions.

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