Tuesday, 6 November 2007

Enforced equality destroys excellence

Consultants are level 9
"Senior SpRs" are level 8
"Junior SpRs" are level 7
SHOs are level 6
FY1s are not mentioned

"Consultant" practitioners are level 8
Nurse practitioners are level 7
Ward sisters are level 6
Newly qualified nurses are level 5

This utterly ridiculous ladder shows an utter contempt for the rather obvious fact that doctors are not nurses and that nurses are not doctors. It attempts to weave together everyone under the 'practitioner' umbrella.

This simple ladder shows how the government is dumbing down our health care system. Training, education, examinations and experience are not important in preparing workers for their jobs. Everyone can be crudely lumped together under the same simplistic umbrella.

Nurse are trained for nursing and do not have a sufficient foundation of knowledge to be let loose as doctors, unless they are willing to train to as rigorous a level as medically qualified doctors and obtain a proper medical degree. Experience as a nurse is virtually useless in training to perform doctoring roles, the two jobs are completely different, this doesn't appear to have stopped the government trying to bizarrely merge the two roles.

Just compare the level 7 workers as an example. The NP has a nursing degree followed by nursing experience and a very short course to become an NP which does not include any proper examinations, they are then deemed level 7 competent, whatever that means. A junior registrar has managed to get into medical school, pass all their exams to obtain a medical degree, worked several years gaining doctoring experience and obtained the appropriate rigorous Royal College exams. Yet these two very different groups are both lumped in the same box which claims they are level 7 competent:

"Experienced clinical professionals who have developed their skills and theoretical
knowledge to a very high standard. They are empowered to make high-level clinical
decisions and will often have their own caseload. Non-clinical staff at Level 7 will
typically be managing a number of service areas."

One of these groups is highly trained and capable of practicing medicine independently to a high level, and the other is not. It is also clear that the DoH is trying to merge managers into this crude ladder that appears to be based upon very little logic.

By trying to lump a vast array of very different roles into the same simplistic boxes, the leaders of reform are insulting a vast array of highly skilled staff. Nurses are not trained to doctor, doctors are not trained to nurse, management roles are not practitioner roles; these different varied roles have evolved for a reason. The government is dragging us back to square one, and in the process advances in proper education and training are being purged.

By trying to make every NHS worker a branch of this universal health care practitioner, the government is dragging us back to the dark ages when anyone could have a crack at treating medical ailments. There was a reason that the different sub-specialised roles developed, it resulted in patients getting a much better service as proper regulation enabled dangerous quacks to be marginalised. The reverse is now true, the government's short sighted cost cutting agenda is already resulting in the minimally trained being dangerously let loose on the unsuspecting.

It is time that our roles were rigorously redefined. The BMA and Remedy must take a stand on this issue. Isn't it strange that the regulation of the medical profession is seen as such a problem, when the nursing profession can empower nurses to take on jobs beyond their means and at the same time allow these individual nurses to define their own areas of competency? There would be outcry if junior doctors were let loose in this manner to determine their own areas of ,within which they were free to independently practice; and junior doctors have been through much more rigorous training that includes a rather important thing called a medical degree. It's very sad that a medical degree and a proper education count for so little these days in this NHS of enforced equality.


Sam said...

I found this in Wikipedia while searching it for 'nurse practitioner': 'In the late 1960s into the 1970s, predictions of a physician shortage(in USA) increased funding and attendance in nurse practitioner programs. During the 1970s, the NP requirements relaxed to include continuing education programs, which helped accommodate the demand for NPs.'

Only a few years ago there was a terrible shortage of qualified doctors here so it seems the NHS workforce planners made yet another mistake and rushed into copying this idea from the Americans and pasting it here in Britain while also expanding medical school places and sending an open invitation to those from overseas.

You have every right to be angry. Another junior told me that she feels cheated and betrayed that she may face unemployment and a ruined career because of all this, especially that no one warned would be medics then that this situation may arise. Had she known, she probably would have stirred away from the profession she loves and is now letting her down! One wonders, where was the BMA while all this was happening? And, now that there is enough doctors, why has the BMA recently agreed to nurses making life and death decisions and why has the RCOG also recently agree to nurses performing surgical procedures and abortions? Very unfair!

Advanced Practitioner said...

Oh for the love of god get over yourself!

Who dictates that a medical degree is the be all and end all!

Yes you study for 6 years, with rigorous examinations and then continue to update your knowledge and skills!

A nursing degree is three years, with an advanced degree another three years, also with rigorous examinations! At least at the university that I attended. Then if you complete a MSc that is another three years FT or 5 years PT. Then there are the other aspects of training such as spending the last year with medical students in a teaching hospital and sitting the same exams and passing in the top percentage!

We are not doctors as you continually tell us!

But as said previously there are many ways to skin a rabbit and I sympathise with the end of the medical monopoly on care of the patient. Your own governing bodies are shafting you up the ar**, instead of continually moaning and taking cheap shots.

By the way Garth the framework above is for nursing career progression not medicine, again political incorrectness!!

Advanced Practitioner said...

instead of continually moaning and taking cheap shots, do something about it.

Advanced Practitioner said...

Garth, remember this!

In August 2004 the Working Time Directive (WTD) came into force to protect the health and safety of doctors in training by restricting hours worked (to a maximum of 58) and imposing minimum rest requirements (with a maximum of 13 hours of work in any 24 with at least 11 hours of rest between shifts). The next challenge will be WTD 2009, which takes the maximum working hours down to 48.

you cant' have it both ways!

Sam said...

'A nursing degree is three years, with an advanced degree another three years, also with rigorous examinations! At least at the university that I attended. Then if you complete a MSc that is another three years FT or 5 years PT. Then there are the other aspects of training such as spending the last year with medical students in a teaching hospital and sitting the same exams and passing in the top percentage!'

Are you saying you sat the medical finals with the last year medical students?!

This study pattern above does not then make your studies equivellent to that of a doctor. Doctors work so hard and cover so much at med school, integrate another tough BSc in a different decipline as well. Did you know that some integrate even a PhD while at med school? And, I am yet to meet a doctor who took between 3 to 5 years to finish an MSc ;)

jayann said...

advanced practicioner, I think the ranking thing may just be a touchy-feely 'we're all health care professionals together thing', but if it isn't, then I agree it's born of EWTD and, dare I say it, doctors' pay!

BTW rank 4 worries me, I can do without someone who may or may not be studying for something treating me, even under the direction of a rank 5 and above.

And, I am yet to meet a doctor who took between 3 to 5 years to finish an MSc ;)

it is not, sam, matter of 'taking' 3 to 5 years, it's a matter (Google helpfully tells me) of a given university's schedule. Cardiff's nursing MSc is one year full time, two years part time, is open ('normally') only to nurses

with a good first degree, with a minimum of 2 years clinical experience and (who) provide evidence of further study.

there are of course nursing MSc courses that take longer, as advanced practicioner suggests.

Sam said...

Actually Jayann, I think the junior doctor pay issue needs to be addressed. Why do medics out of all those who follow health careers have to pay their own tuition fees while all the others have that paid for them by the NHS?! Why are medics excluded from NHS bursaries and only get it for one year; 5, while all other health professionals get it the whole time they are at university? How can such highly qualified professionals graduate after 6 years of tough study with a debt or around £30,000 then earn arround £22,000 a year while other health professionals, besides earning around £19,000 a year when they first graduate, earn more and more for the other 3 years medics spend studying medicine?! Actually, by the time a medic graduates to earn £22,000, a nurse would probably be earning nearly £30,000 and would also be better off by around £65,000 money gained for those 3 years while medics are still at uni!

The BMA was not able to negotiate a better deal for the Juniors last year and this year! I think this is shameful!

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