Someone I work with is behaving atrociously. WWSTD

which is better for the patient?  Certainly not the ordeal of patient transport.

Please don’t conflate convenience with effectiveness. One of the lessons of the Berwick report into patient safety is that we too often prioritise convenience over effectiveness in the NHS, when it should be the other way round.

Safety first, effectiveness second, patient convenience third.

Thats dreadful.  |Its not just convenience – its thew whole experience of going to outpatients using patient transport is a horrendous experience – I know I have accompanied people on it.  An immobile person will be left in unsuitable chairs for hours  and could be out of the house for 8 hours .

Sorry – the patient should be at the centre of things.  Its neither safe nor effective to take people to outpatients using patient transport if they are immobile

Do you not employ practice nurses for community monitoring of chronic complex diabetes?  My practice does

The fact of patient transport being poor is a reason to improve patient transport not for them to have lesser care because it’s more convenient.

This is what happens again and again, because it’s easier for the GP to pick up the pieces, people rely on us to do so. There’s only so far that can go because it’s papering over the cracks and sooner or later we’re going to run out of paper.

Do you not employ practice nurses for community monitoring of chronic complex diabetes?  My practice does

Yes we do, and usually there’s a good reason that they’ve been escalated to secondary care. Not least because our nurses are not specialist diabetes nurses.

There are people like this in all workspaces aren’t there? Those who try to foist off some of there workload onto others?

I work with adults with learning disabilities. My role is mostly in offering activities and opportunities rather than personal care or social care.

There are a few key workers who are always trying to shift some of the stuff they are supposed to be doing onto my department. Sometimes it’s ok as we have the capacity, sometimes it has a kind of logic (eg I have computer knowledge they lack, so it might make sense for me to help in that area), sometimes the service users themselves ask me as they know they’re more likely to get a result, but sometimes it’s just taking the piss.

We all know which key workers genuinely need a hand and which are lazy gits who are trying to get out of a bit of work. I am of course happy to help when there’s a good reason for it – and often when there isn’t, as it’s the only way something will get done. The lazy ones tend not to last long anyway as it’s a fun but draining job.

I feel for you OP. It seems like it’s becoming part of the system for you, which is hard to deal with.

Can I just add my thanks, GPs **** rock! My health centre has had a few problems recently with high turnover and lots of temps, but every GP I’ve seen has been great – nurses as well. I took flowers in last Christmas as I thought they all been so fab.

Thanks @easily.

Yes there have always been a few, but in the past 6-12 months it’s reached epidemic proportions.

The fact of patient transport being poor is a reason to improve patient transport not for them to have lesser care because it’s more convenient.

Its not about convenience – its about safety for the patient.  Its not to do with patient transport being poor – its the limitations of the service.  I can tell you have never been on it.

If its a morning appointment the patient will be picked up before 8, driven around for a couple of hours picking up more folk and then taking them to the hospital – then will be picked up again midafternoon then again a 2 hour drive around to get home.  ~food and fluids are hard to access, pressure sore risk from all that sitting on unsuitable chairs.

There is a risk to the patient doing this.  a not insignificant one.

Secondary care obviously think you are OK to do his care

I wonder if you are getting burnt out and losing sight of your values?

Not least because our nurses are not specialist diabetes nurses.

We have both community diabetic specialist nurses and the practice nurses are well trained as they do all the monitoring

Sorry @tjagain I forgot who I was discussing with. I bow to your superior knowledge of General Practice.

I wonder if you are getting burnt out and losing sight of your values?

Yes we are. Because we’re doing everybody’s work for them, and people like you seem to think that’s ok as long as it’s convenient for the patients.

I enjoy my actual job

Sorry Kramer – I totally get your point.  I think you picked a wrong example particularly as its not just about patient convenience in this case.

I don’t think its OK at all.  I see the pressure the whole service is under.

GPs have no ceiling on their job.  Whatever comes their way has to be dealt with.  Adding more and more work is unsustainable. Other parts of the NHS do not have this – they have a capacity to work to capacity  and then nothing else comes their way hence you getting the buck passed to you from hospitals

Appolgies

“Speak to the school. They can make a referral to Child and Adolescent Mental Health Services.”

I don’t how other ICB’s organise it, but where I am, only school can refer, GP referrals are rejected

@Kramer

@TroutWrestler

While we can write a referral, we can go into no greater detail than the GP,

I’m interested why you think that GPs will have more information than the school?

? Because the parent and child have gone first hand to the GP to talk about an issue that the school knows nothing about. The GP may have physically examined the child.

I have actually had exactly the same today. A parent contacted me to say she had seen the Primary Care Mental Health Nurse twice. At the first consultation the MH Nurse apparently said she was 99% sure the child was ASD, and gave the parent a screener to complete. At the second consult the MH Nurse reviewed the screener and said, 100% ASD. Then, go and get the school to refer to CAMHS.

The Mental Health Nurse who has seen the family twice, gathered information and seemingly made a diagnosis (!) wants me to make the referral to Child and Adolescent Mental Health Services, despite her having the training, the contact and the evidence.

I have no info, just secondhand info from the parent. Do I just write “MH Nurse says 100% ASD” on the referral?

@nickc

I don’t how other ICB’s organise it, but where I am, only school can refer, GP referrals are rejected

Direct from local Health Board Website

“The first steps to getting support from CAMHS is normally through seeing your Doctor or General Practitioner (GP) or asking the Named Person in School to make a “Referral”.”

Nb. The Named Person legislation was never actually passed.