> And I have to agree with Drs Dunn and McCormick, who are
> making a lot of
> sense, and whose views are not as irreconcilable as they
> might at first
> appear.

I don't consider our views as at all irreconcilable. We have both said that doctors doing jobs that could be done by someone cheaper should not be the norm Dr McCormick has added that from time to time it is appropriate for doctors including consultants to do whatever needs to be done to get things moving including acting as porters etc.. I did not state this, but it agrees with my views. I think our views are pretty much the same.

> Now of course, I work in a department that has 12 doctors on
> the floor at
> our busiest time, while our nurses number something around 12
> or 13 at the
> same time.

Now I'd say that you might be able to run your department with fewer doctors and more HCAs cheaper. It depends on how much your workload varies, but with that number of staff I'd think it is predictable that at any one time you'll probably have at least one doctor doing something that could be done by someone else. You can drop that doctor. What you certainly don't need to do is to add in ENPs.

> It's more efficient for the doctor to get the TTAs etc, isn't
> it, rather
> than leave the task lying around for half an hour, and risk
> miscommunication
> in the process.

If you've got more free doctors than free nurses. However if you've got more free doctors than free nurses, you probably need more nurses.

> And are our F2 SHOs really paid much more than our
> experienced nurses on an hour-by-hour basis?

In a word: yes.
Actual hourly rate compared to band 5 nurses is about 50% more if the doctor is on a 1A scale (the extra paid study leave and bleep free training contributes a fair bit to the difference). Nursing work that needs a nurse above a band 5 is not work I'd expect a FY2 to be able to do in any case, so if you've got a lot of band 6 and above nurses, you might want to think about replacing them with band 5s. Band 3 HCAs (i.e. HCAs with extended roles) come in at under half the price of FY2s; band 2 HCAs about 10% cheaper than that.

> Which reminds me, there's nothing wrong with "entering data
> in the computer"
> if by that you mean clinical records, which to my mind should
> be done by the
> treating physician, and not by anyone else. But perhaps
> you're referring to
> some other data.

Depends on how quickly and accurately they can do it. Different hospitals all use different computer systems and it is still at least theoretically possible to qualify in medicine without the ability to touch type, so new doctors tend to be pretty slow at doing things. My understanding is that the Royal Free has a pretty good computer system. With the right system, entering data gets pretty good, fast and accurate. With the wrong one, you're probably going to get your data entry better and cheaper by someone else doing it- particularly if they double up as the person who goes in with the experienced doctor to see patients as mentioned in previous posts.

> Anyway, what we're now left with is a lot of overqualified
> and frustrated
> nurses and other AHPs (is that a recognised abbreviation?) who are
> desperately trying to muscle in on medics' territory, presumably as
> government know that it's going to be cheaper that way.

The government may think it's going to be cheaper. "know" implies that it's correct. Compare your band 7 nurse (and a lot of ENPs are on higher bands than that) on £17 an hour seeing 2.5 patients an hour with Dr Cotttingham on £75 an hour and his two band 5 nurses on £12 an hour and one band 3 HCA on £8.50 an hour seeing 20 patients an hour and the latter works out considerably cheaper per patient. And that's tweaking the figures to give a considerably higher rate of work and a lower rate of pay for ENPs than suggested in the "Way Ahead" or elsewhere on this thread; the highest level of support that Dr Cottingham could reasonably ask for; and Dr Cottingham's pay worked for direct clinical care hours only with his managerial and teaching input coming for free and that he has been given a few Clinical Excellence Awards. Substitute a staff grade for Dr Cottingham (as you probably should) and it gets a lot cheaper.

Matt Dunn
Warwick


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