We asked readers what behaviour and process changes do they believe are needed for the NHS to deliver consistent, financially sustainable 24/7 working. These are the most popular answers regarding workforce
Change doctors’ contracts
With the junior doctors and consultant contracts about to be renegotiated, this is a real opportunity for provider trusts to show their commitment to introduce seven-day working.
Trusts will need support from commissioners, who must show demonstrate their own commitment by favouring services from seven-day providers.
It’s important employers don’t attempt to “make an example” of consultants by forcing them into weekend working, but at the same time consultants need to accept that they are central to the modernisation of the NHS.
Appropriate use of skill-mix
There is a growing body of evidence which demonstrates that appropriately trained allied health professionals can perform tasks traditionall the domain of medical practitioners.
Within radiology, trained radiographers now undertake image interpretation in an expanding range of areas which include ultrasound, skeletal x-ray, chest x-ray, CT head, mammography and examination of the large bowel (barium and CT). Provided that the trained radiographers work within a defined scope of practice and are intergrated into a multidiscplinary team they can support efficient, effective service delivery and patient care. This can allow the consultant radiologists to concentrate on the more complex cases and deal with the ever increasing workload of CT, MRI and interventional procedures.
Trust and truth
I completed a five year action research study into behaviours of the NHS. What became absolutely apparent from the research was that clinical and non clinical staff are tired of being treated like children. To deliver consistent and sustainable change the NHS management and leaders of the NHS need to understand that staff will support and encourage all that us needed to make the NHS strong and efficient as long as they are treated fairly, honestly, without bullying and in a culture that is non discriminatory, appointments’ are made on merit and that staff are truly encouraged to be involved in decision-making.
Trust and truth are two of the most needed qualities that the NHS must embrace if it is going to succeed.
To achieve this we need to address three concepts: motivation, capability and ability. If we address those elements from organisational change and individual support then we can achieve all that we set out to wish for. Ask staff and managers what motivates you, what is the organisational capability and do we have the abilities to make the change… if we find these answers we are on are way.
Consistent leadership and holding to account
- Agree what effective, visible leadership looks like in your healthcare organisation and then model the behaviour from the board/executive down;
- Reward and recognise behaviours that support the implementation of the agreed model;
- Hold others to account if they don’t consistently demonstrate the required behaviours, and be rigorous about performance manangement and removal if necessary;
- Encourage constructive challenge and empower staff to change what they they find unacceptable – without blame when they make mistakes, as they will;
- Challenge up to the board if the culture they espouse is not modelled from the top.
Create a new ‘breed’ of director
We need a career structure to create “generalists” that can work in or out of hospitals. It’s 10 to 15 years away from being realised but having a new type of training for doctors to be the interface between traditional GPs and hospital consultants, manging care homes/nursing home patients, preventing admission and facilitating early discharge.
Hire the right people for the job, not the people in the right place at the time
Working in a support role within IT for the last 15 years I have seen people promoted to manage very specialist functions because they happened to be in the right place at the right time. The last head of ICT we had was an ex psychiatric nurse with very little idea of what he was doing. This cost the NHS due to the purchases he made being unfit for the purpose – he fell for the sales person flattery.
This needs to stop. Hire people that are trained for the specific job and get an improved, more cost effective service.
In order to deliver 24/7 care we would need to spread doctors over a longer period. However, I am not convinced that increased doctor numbers are needed. Currently junior doctors carry out a lot of tasks which could be carried out by differently skilled staff. These include a lot of clerical tasks (chasing results, booking tests) and phlebotomy/cannulation.
The addition of “firm clerks” or physician assistants to medical teams (as in America) would be less expensive than increased numbers of doctors. This would also mean that the junior doctor in a firm could spend a greater proportion of their time doing tasks needing their skills such as assessing patients, interpreting results and talking to relatives. This would improve their training. Currently a lot of trainees spend a lot of time carrying out tasks which do not enhance their training.
The physician assistant would also be permanent in the hospital and understand the hospital processes and give continuity to the medical firm when junior doctors switch over.
For some reason the nursing profession has voiced disagreement when this idea has been previously suggested. This seems to be bourne out of politically correct concerns that doctors should not have ‘assistants.’ This suggestion is, in fact, the medical equivalent of an HCA and could make a huge difference to day to day ward work and mean junior doctors skills are utilised much more efficiently. It has always confused me why hospitals use such expensive and highly qualified staff to carry out essential but time consuming and basic clerical tasks.
Get rid of politics and coruption in OUR NHS
As a nurse but first and foremost a citizen we need to make honesty our first policy, we need to regain the trust of the public. The majority of staff in the NHS provide excellent care but those who don’t should be sacked. People lives are at stake. Each clinician is responsible and accountable for their practice but they need to be given support when they report bad practice for the right reasons. It is time we decide as a society if we want to provide quality care and if we are prepared to keep OUR NHS and agree that ethics must come before cost. There is far too much corruption going on in the board rooms and some NHS managers and DH ministers should be facing criminal prosecutions for all the cover ups.
The wisdom of crowds: your views on 24/7 working
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Staffing and management: your top ideas