In his latest post, Dr Grumble criticises the current tendency of Trusts to employ HCAs as nurses, nurses as doctors, etc. I have to say I have come to agree with Grumble. This is no more than providing a sub standard service on the cheap
When the concept of the Specialist Nurse was first put forward I could agree with some of the logic. Once a patient with a chronic condition had been sorted out by the consultant his ongoing care is often no more than routine monitoring, and I could accept that this work could be undertaken by a specialist nurse.
However once installed it is the case that some Trusts are extending this role to what I consider an unacceptable degree. This was brought to my attention by an old friend in general practice. He had referred a patient for a specialist opinion. After some months the patient received a letter telling him that he had a first appointment in the relevant hospital department with a specialist nurse, who would then decide whether or not the patient would go onto the waiting list to see the consultant.
This is wrong. Firstly the implication is that the nurse, with her few weeks extra training is better qualified to make this decision than an experienced GP. It is a form of rationing, and referral management combined. It is an insult to the GP, and the PCT are definitely not getting the service they are paying for.
But as ever the patient is the one that stands to suffer the most. He can be denied the specialist care that his GP thinks necessary, by someone simply not qualified to make that decision. And it is going to get worse. When you throw nurse prescribing into the mix the potential is there for patients to be seen and treated without ever having seen the specialist. They may as well never have been referred in the first place. They would be far better off had the GP managed them himself.
When management try to get the work of doctors done by nurses the potential for disaster is obvious.
This may seem like a humorous exaggeration, but the potential consequences of nurses doing the doctors job is not funny, as the case of Rebecca Cain illustrates.