In message <[log in to unmask]>, "J.B."
<[log in to unmask]> writes
>Current changes in the management of minor injuries units are
>amounting to a gradual (and quiet) revolution.
There have been concerns raised on this list about the quality of care
(and implications for risk management) delivered by MIUs and of the
workload implications for the remote Consultants with responsibility fo
them.
There is a third alternative to the choice of:
1) full Consultant-led 24-hour A&E or
2) ENP-delivered care in a (usually) 9am-9pm ish MIU, supervised to
greater or lesser degrees by remote Consultants or GPs.
What about MIU's staffed by ENPs and Staff Grades (or whatever title you
want to give experinced career middle grades). Let me immediatley
declare a very large slice of vested interest here, as a staff grade
working in a full 24-hour unit that takes referrals from a couple of GP-
run MIUs locally.
Will you agree that the wide range of skills offered by a Consultant
(management, research, teaching, budget-holding, hiring & firing and a
very high level of clinical skill) are not necessarily required on a
full-time basis in some of the smaller MIUs? The hopefully good level of
clinical skill (somewhere between an ENP and a Consultant) that a staff
grade could provide, without necessarily the other qualities decribed
above, would be more appropriate. Research suggests the quality of care
provided by middle grades is superior to SHOs, and on a par with GPs
working in A&E. It would be expected that a middle grade resident in an
MIU could deal with the large bulk of requests from ENPs to a remote
Consultant, thus taking the strain off their workload.
Cost-benefit analyses do not flatter nurse practitioners in general, if
you include the medical time required for support. Traditionally the
resident medical input to such units has been from GPs. But very few GPs
have the time or the inclination to do the job regularly, and this is
particularly true of the more recent recruits to primary care. GPs and
Consultants also cost twice as much per hour (rough guesstimate) as a
staff grade.
There is no one ideal model for MIU satellites around a central full A&E
unit. An appropriate cost-effective mix of staff and skills in one area
may be very different from what's required elsewhere.
===========================================================================
Dr. Gautam Ray (e-mail: [log in to unmask])
Sussex, U.K.
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To err is human, to forgive is not management policy
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