Recent news means I get to comment on this again…
In the dumbing down of the NHS, other healthcare professionals are to take over the job of doctors – these people normally have the word 'practitioner' tagged onto the end of their job title. There are Emergency Nurse Practitioners (who look at minor injuries in the A&E) and there are Medical Nurse Practitioners (who do most of the scut-work that House Officers used to do).
Now we have Emergency Care Practitioners who are Paramedics with some extra qualifications who are tasked to go out to out 'minor' calls and dissuade the people from going to hospital.
Research has shown that half of the people who call an ambulance don't need hospital treatment and that only 10% of our calls are 'life threatening'. ECPs are sent out to these 'non-emergency' calls in a desire to stop patients from going to hospital and to cover the lack of GPs providing out of hours cover.
But what has me thinking about this again is two recent news stories. In the first a Paramedic has been suspended by the Health Professions Council (on which I shall probably write later) because a young woman died.
The second is that the BMJ report that Paramedic treatment at home is 'viable' (I don't have a BMJ subscription so I can't read the original report).
It is obviously awful that a young woman died, but I honestly can't see that the Paramedic did anything worthy of being suspended. You can read the HPC report here. The patient, who had been having headaches for weeks previously and had been checked out twice and nothing had been found. Then when the patient became worse an ambulance was called and she was taken to hospital. She died five days later.
The Paramedic gets the blame.
I don't think that the treatment that he gave the patient was awful, certainly not worth suspending him in preparation for possibly sacking him. I've heard that he's previously been a damn fine 'medic.
This isn't the point of this post.
The point is that two other people saw the patient, that a hospital saw the patient – yet it is the ambulance Paramedic who is getting disciplined.
This is the tightrope that I walk every day. If I make even the slightest mistake (as in this case, not recording the patient's 'pain score'), then I can easily lose my job. I think that the reason why we are the ones to catch the hatchet is because we are reasonably cheap to train. It would also seem that ambulance trusts want to do anything to avoid bad publicity – so they suspend or sack crews in order to show that 'something has been done'.
So on one hand the government wants us to do more with some extra training (but not the 8+ years that GPs have), yet if something goes wrong we'll lose our jobs.
This government is going to have a rude shock when they realise that there aren't going to be a lot of ambulance staff willing to train up to be an ECP.
There is a simple rule that we tend to follow in order to keep our jobs.
'Take them to hospital'.
By taking the patient to hospital we are avoiding the responsibility if they later die. It is incredibly sad that we need to 'cover our backs' in this fashion, but it's the only way we keep our jobs.
Who is going to want to take that responsibility for another £2,000 a year? I know I wouldn't, and I have my nursing experience to back me up.
We do what we do incredibly well – we deal with drunks, trauma, chronic and acute medical problems. We deal with these by stabilising them and taking them to hospital. We do this very well. A bit of extra training will not turn us into Doctors, and we are fully aware of this fact. We are also mostly sensible people, and the feedback that we have got from the first set of ECPs won't have us running to join up.
Birmingham was lovely, highlights were seeing Paul Cornell (a writer I greatly admire) speak and watching Alan Davis, Staz Johnson and Mark Buckingham work their astounding artistic magic on flipcharts.
Now I start on a run of four nights. I may be grumpy. Actually, no, I will be grumpy.