"In my locality, Transforming Community Services has actually meant Terminating Community Services.
As a result one of my residents in a Nursing home has fallen into the clutches of an "Outreach Practitioner", who this morning gatecrashed my surgery to thrust a paper into my hand, with the request to "sign this".
Fortunately I read it, & it was a request for a liver scan.WTF? Why?
"She keeps going high in the morning & low at night. I think it's her liver. Liver disease can cause hypos & I noticed she's had an ocular melanoma. We need to find out if she has metastases."
It takes about 30 seconds to ascertain that the LFTs on her last diabetic clinic with us were perfectly normal & the melanoma was treated with laser at an early stage, not by enucleation, over 10 years ago.(a) I think we'd have known by now.(b) All she needs is her bolus insulin in divided doses (as her consultant has already instructed).(c) She's 90 years old & has end-stage cerebro-vascular disease. What the Hell use is a liver scan?A little knowledge is dangerous.
When medical students reach that stage we educate - even ridicule - them into thinking "common things first, rarities last", but noctors' university training gets them diplomas without benefit of the cultural memes handed down in medical apprenticeship since the days of John Hunter & William Osler. So they think exotics first & 'simples' (such as cocked-up insulin dosage) last.So if anyone thinks they might be cheaper than real doctors, think again."
Numerous pseudo-doctors have been deployed into roles that were only previously done by doctors. This has led to a lot of patients getting a rather raw deal. Whether this be diverting Orthopaedic referrals to physiotherapists and away from the consultants, or seeing the nurse practitioner at the WIC with your chest pain, the costs in terms of patient care are obvious. This dumbing down may save money in the short term, however in the long term in may well cost a lot more to pay for the consequences of the substandard care that a lot of patients are getting these days.
The government has decimated Out of Hours General Practice in this country in the last ten years. Now instead of properly trained doctors covering patients at night, we are seeing nurses replacing doctors because they are cheaper. If they had kept GPs in charge of Out of Hours care we would not be in this mess and patients would not be dying as a result of the shambles that has resulted. The government has taken over and wrecked a perfectly good doctor led system, it has now been replaced by a numpty led shambles.