Wednesday, October 11, 2006

Forms of nursing

It seems a week can't go by without yet another form appearing that I am supposed to use to refer patients to a particular service. I totted up how many different referal forms I have in my box file the other day: 22 . Yes, twenty-two different forms to refer patients to different NHS departments. Alot of these forms have similar information requirements: they all need demographical details of course, as well as a few details of the presenting complaint leading to the referal. Some of these forms we have managed to get in electronic form from the originator, which we can then adapt so our clinical software can automatically fill out at least some of it. Of course, we need to ensure that the forms' authors are happy with it before we can start using them. Others, we can't, for one reason or another.

A particular bug-bear I have is the fact that we now have to communicate with the District Nursing team by writing them a note on a specific form and faxing it to their offices. They have been expecting this for the last 2 years or so, ever since they were reorganised so that they were no longer attached to a specific surgery, but in a "locality". Before this, if Mabel developed a leg ulcer, we would speak to the District Nursing Sister when she came to the surgery (usually a daily occurence to collect supplies). She would check to make sure there were no matters to be discussed before she left. In addition we had a weekly Primary Health Care Team meeting in the surgery.

Not any more. Oh no.

Now face-to-face communication is non-existant. I don't know most of the nurses who visit our surgery to run clinics. You can phone, but its just an answer phone. And if you do leave a message, you get a message back saying that they need a referal form. So you send the form, they see the patient (one assumes).

Of course, we don't get one back when they discharge patients from their case load. Neither do they keep their records anywhere near ours: they have their own folders, kept at the patient's house, which are later archived somewhere mysterious, never to be seen again.

And I haven't even mentioned the referal/discharge criteria which are being introduced by the management teams.

I'll give you 3 guesses how much consultation there has been with other professionals stakeholders as to whether this is necessary, never mind a good idea. And the first 2 guesses don't count...

Where the driving force behind these changes comes from is a matter of further irritation. Yep, the good old Department of Health. Bless 'em. Except of course that the decisions where made locally, not centrally. Except of course that the decisions were basically forced upon the local health economy by financial decisions further up the food chain. Decisions made in London. See how that links up? Clever, innit?

I could go into why these changes are apparently "good for patients". All I know is that the patients complain to me that they don't see the same nurse more than two or three times. The nurses are getting more and more officious (a sure sign to my mind of the stresses they are under and their levels of dissatisfaction with the way they are working). Inevitably, there are the usual recruitment freezes periodically (though, to be fair, recently there seems to have been an influx of community nurses, less well qualified than District Nurses, though forced to do the same job).

Gets right on my wick.

Bring on Practice Based Commissioning. Care to hazard a guess at one thing we're contemplating taking over from the PCT?

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