The pay offered to call-takers and to nurses is sufficiently higher 
than that agreed for co-op staff and GP nurses that there has been 
application for these jobs by a very large proportion of such staff 
and nurses.

Curiosly, nobody seems to have seriously suggested matching hte new 
market rates, (which cost would temporarily come out of GP pockets 
as does every consequence of change) but this may be because the HA 
exerts considerable pressure on pay and grades for staff and nurses 
in general practice.

However, there is an appreciable risk that the coming of an NHS 
Direct scheme to an area, driven by a political will to get it set 
up rapidly, will destroy the co-op which was one of the better ideas 
introduced into the NHS in recent years.  A pity.

The leadership of NHS Direct is said to be predominantly by nurses, 
including the RCN, and it would be a pity if that profession failed 
to learn from the experience of the medical professioon around 1990.

One reaction to these problmes is to increase co-op pay and 
conditions sharply to match what is offered, and this would have a 
knock on effect on staff in practices - which I am not averse to 
provided I don't find myself paying it all.

Another I suppose is to go down the route of professional autonomy - 
if the nursing profession chooses to move itself out of practices, 
and onto telephones, and feels that this is the best move for nurses 
or patients, then let them.  Don't replace missing nurses (it may be 
difficult anyway) and let things find an adjustment on their own.  A 
little thought on this suggests that most of us could produce a 
better scenario for patient care while standing on one leg and 
whistling, never mind if we are asked to _concentrate_ upon it.
--- OffRoad 1.9r registered to Adrian Midgley


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