----- Original Message -----
From: "Danny McGeehan"
Subject: Re: BMJ Correspondence
> We live in a democracy and the public and we need to be consulted. I see
them going the same way as Hawker et al when the whole thing goes pear
shaped, which it definitely will.
>
> All this money has gone into A & E modernisation and yet has a penny gone
into employing more nurses, paramedics and doctors. No, only more project
managers and data collection clerks. The whole thing makes me sick, only
massaging statistics.
Oh, I agree to a large extent Danny. But I'm a little more pragmatic, i.e.
regardless of the existence or otherwise of a viable mandate or of robust
peer-reviewed appraisal, I'm willing to give anything a try, within reason.
Returning to patient flow mathematical modelling, while I can't quite see
how it works for streaming, when applied to "see and treat" it works very
well (perhaps this is where it originated). But I still live in a real
world, much as I enjoy toying with mathematical models!
So yes, "see and treat" is very attractive, in fact, it's what we used to do
15 years ago, without even realising it at the time. The problem is, we need
sufficient middle-grades and seniors to make it work properly, and in a
sustained fashion. At its most basic level, you will need two "senior"
doctors working clinically to make it work, one for resus and majors (and
possibly for complex minors), and the other solely for "see and treat"
duties. In order to cover 16 hours each day, and let's face it, the minors
"bulge" in most departments lasts at least this long, then you will need at
least 4 to 5 consultants, together with 4 to 5 registrars (or equivalent) to
cover your department. This is assuming each consultant provides 24 hours'
clinical service each week (6 sessions) and each registrar provides 32
hours' clinical service each week. But even this level of commitment doesn't
allow for 24-hour resident cover, which many would consider to be more
important than "see and treat", nor does it take account of annual leave
etc. You will, of course, also need 16 hours' ENP cover per day, which
translates to at least 4 full-time ENPs. I am very happy to implement "see
and treat" when our department reaches these levels, but until then we can
only really "pilot" it very occasionally to give us some idea of how it will
work.
Ironically, our trust have just given us additional funding which will bring
some of our staffing close to these levels. However they now expect instant
results, even though I warned them that it will take around 1 year to
recruit the necessary staff, possibly longer. And I have copies of letters
from 1997 (which were ignored at the time) requesting such staffing and also
warning of the 6 to 12 month lag time for recruitment. But that's managers
for you, they still think they're running a supermarket or something like
that.
Interesting times...
Adrian Fogarty
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