All the doctors I know are leaving. Are we going to be screwed for healthcare in 5 years time ?

[Gigihadr]

Our NHS now has some of the worst health outcomes out of 19 wealthy nations compared in an international study.
But in 2010 the NHS regularly ranked 1st or 2nd in most international studies.

The UK is under-doctored, we have a 3rd fewer doctors per 1000 people than Germany or Spain

Our government response to the doctors we have left has been to erode working conditions and pay, ensure they have record levels of inflation and rocketing student debt

They are moving to better paid, better resourced systems/employers (they are a competitive international commodity) and I can’t blame them for that.

AIBU to think we are utterly screwed? why are we just sitting back and watching this slow motion car crash ?

Some of the general attitudes towards other health care professionals. Nothing you’ve posted ( I don’t think). This thread is long 🤣. I’ve just been reading about Consultants going on strike in July. I believe this will prompt action by the government - an NHS with Consultants on strike concerns me greatly.

Exactly the bloody point though, PAs are creeping in and doing roles and training that are outside of their scope and so they should have to complete a medical degree to do them. The HCA and nurse equivalent isn't the same of course as HCAs don't require any formal higher education, but going proportionally on the length of training it would be like them needing less than a year of training to be able to outearn you and do some of your role (of course the more interesting parts as they say other bits are 'boring').

You are correct a nurse is a nurse and a doctor is a doctor, the issue is an increasing amount of trusts and some individuals are blurring the lines to plug gaps and its an issue. It's not personal.

In Spain doctors are leaving to work in Aesthetic clinics. It is not just here but here is probably worst.

I think it's frustration to some of the roles being created rather than to individual HCPs. It should prompt the government into action but scarily I genuinely think they're not bothered. I left the NHS last year and I'd recommend the same to anyone else. The long term staffing plan is a shower of crap too its not going to get any better.

Everything is terrible now. Long waits on the NHS. I was talking to someone yesterday that has been waiting a Yr to see a heart doctor. Things are more difficult to treat if people are waiting before they eventually see a specialist. Diseases progress and more is required to sort them. Its a mess.

I think that instead of the long term staffing plan they are going to attempt ( and fail) to implement, fees should be paid for those studying medicine. Working in the nhs for so many years afterwards could be a stipulation. This would reduce the huge student debt faced by doctors and also ease the retention crisis.

I think nurses and allied health professionals should have their fees paid too, and as they do in Wales, have it where if you stay for 2 years you don't pay a penny back but if you do leave you then have to get a loan and owe it. It's just a mess all over for everyone isn't it.

I am a new consultant and I work in a real mdt specialty. I love mdt working and I completely respect all of my colleagues who are highly skilled. I have also worked with ANPs who are highly skilled and whom I would trust far more than some of my juniors. They are amazing skilled practitioners who absolutely can prescribe within their scope of practice and who often bring things to the table that doctors don't.

But, we all have our individual roles and as a consultant, I carry the overall responsibility in a way many of my colleagues are not comfortable to do. There kind of has to be a bit of a (functional, respectful) hierarchy because someone has to take overall responsibility.

Part of this is because of the way I've trained. I've done ten years plus of rotational jobs. It is absolutely shit from a work life balance perspective BUT the reason we do it, is I've seen how loads of different places work and had wide and varied experience. I've learnt things outside of what I do now which can influence the decisions I make because people are a whole bundle of things not one specific problem. I do not do things in just one way, because that is the way I've learnt in one place. I've seen things done lots of different ways. Our juniors are trained to have this wide and varied experience, so they can have that final oversight.

But I'm exhausted, everything I try to do is blocked by not having the funding, my juniors are going off sick or leaving and I'm frantically trying to cover. Admin is stripped to the bone, so I am doing a lot of the work myself. I'm so frustrated with services that I'm working with that are blocked by 'we are not commissioned for that' or 'there's no funding for this'. The system is broken. It's not working. I'm hoping things change because I can't carry on trying desperately to plug holes while nothing changes apart from new initiatives to spread resources even thinner, so we do something useless to lots of people, instead of something meaning ful and helpful to a few people. So things change, or it completely breaks and it goes private, either way I'll probably be able to help more people than I'm helping now.

Ps. I didn't vote for the strike because I can't bring myself to cancel appointments that people have been waiting a year for..... But it is because I'm soft, striking is probably the better thing to do long term.

She can prescribe 8f she’s done her prescribing course which ANPs do. I’ve actually been treated by a nurse at a walk in clinic for a severe ear infection and she prescribed abx and never left the room. So no doctor behind the scenes.

I admit I didn’t know about X-rays but google suggests that with additional training they can request X-rays. I think they can’t request MRIs. And there’s been studies done which show not only can nurses request X-rays but do so appropriately. https://pubmed.ncbi.nlm.nih.gov/1567524/

Yes they should. Years ago , fees were paid for nurses and the only debt was the maintenance loan. And this was paid off with time too. These days it seems the debt increases each year despite paying towards it. Complete mess.

More pesky nurses ordering X-rays. https://www.somersetlmc.co.uk/nursepractitionersandahpsrequestingxrayandultrasoundinvestigations

just messaged a ANP friend of mine who says she can definitely prescribe and order X-rays. The walk in clinic she works at often has no doctors. Just staffed by ANPs and sometimes by paramedics.

Yikes that's scary, no doctor on site at all? That's not good, I'd have refused to work there if I was any other HCP.

Yes they should. Years ago , fees were paid for nurses and the only debt was the maintenance loan. And this was paid off with time too. These days it seems the debt increases each year despite paying towards it. Complete mess.

Yeah its so sad, so many passionate people who would be an asset to the health service are priced out, and then of course so many amazing, capable people who are brilliant also leave once trained. The government don't care at all though :(

…And of course years before that, we were paid apprentices, given subsidised on-site accommodation, belonged to our training hospital. Far lower rate of attrition too.

It's interesting that you frame this as a good thing, rather than a very dangerous symptom of the terminal decline of the NHS.

What are your qualifications, @SisterDonnarix?

Of course nurses and allied health professionals should be able to order x-rays within their scope of practice. They are highly skilled and knowledgeable. For example, I work with children with cerebral palsy. They require hip x-rays every so often, which the physiotherapists should absolutely be able to order, they can read them better than I can. But they shouldn't be able to order every test if it's outside their scope of practice. Similarly an Ed ANP should be able to order an x-ray of an arm of it is suspected that it is broken, because they can certainly learn to read it and it is well within their scope of practice. We are shooting ourselves in the foot by downplaying ANPs usefulness.

But we provide a different perspective which is more overarching because of the very different way we have trained, which is why oversight is required.

Think you’ll find all UTCs/MIus in Somerset Devon and Cornwall are nurse led with no medical cover except maybe Bodmin. Many nurse prescribers in post those that aren’t use PGDs to administer medications. Most have masters level qualifications or work within protocols for specific minor illness/injuries. Lots of time spent reassuring worried well with common sense and first aid for mild conditions, assessing minor injuries and ordering and reviewing X-rays if required and wound care inc suturing. They are able to refer direct to specialty if needed and have an Ed reg/cons adviceline. It frees up ED docs to see sick patients

I don’t think I framed it either way to be honest. I was just correcting your misinformation.

However I have had good service from nurses at such walk in /urgent treatment centres. Took Dd with a broken finger. This was in Tenby, it’s a nurse led cottage hospital. Nurse ordered and did the x-ray, reviewed the x-ray, splinted finger up and told us to get into fracture clinic once back home from holiday. Great service.

In home town have taken Dd to see a nurse when she had a uti, abx prescribed. Thought holistically about whether Dd had undiagnosed diabetes and did a BM.

Ive had a similar experience with an ear infection and abx prescribed.

DD treated by an ANP in a same day emergency care centre. Initially sent for an x-ray and then pulled out of x-ray just before they did it as her d dimer had come back high. Sent for a CTPA, no idea who authorised that but positive for multiple PE. ANP prescribed blood thinners and sorted out all follow up care and answered questions. I never felt the need to ask to see a doctor as I felt confident in her ability.

I’m not a nurse myself but I am a midwife so I do believe that when people have a lot of experience in an area they generally may well know what they’re doing regardless of job title. Thankfully on the labour ward I work on the doctors including the consultants seem happy to ask midwives their opinions. I’ve been asked by a consultant before if I thought the woman I was looking after needed an em lscs or not, literally asking for my input as she weighed up what to do with a suspicious CTG. Because she understands it’s team work, that I have my own professional expertise and that as someone who has been caring for that woman for x hours i probably know her best out of all the staff. That I’m good at ctg interpretation to the extent I teach other midwives about it, that I’m good at obstetric emergencies and teach midwives and doctors around the country how to manage them as part of my role as a PROMPT instructor. That sometimes I will be working with an SHO who literally does not know how to operate a speculum.

But I do of course agree we need more doctors and better paid doctors. But we should get that in addition to nurses, AHPs with extended roles/extra training/prescribing qualifications.

If you don't allow the new doctors to get the hands on training then there will be no consultants in a few years. So train all the ACPs you like (they are often paid more than the doctor next to them) but don't expect consultants to be as experienced in ten years. Or there to be any doctors left at all. PAs earn £40,000 for a 35 hour week and no shift work. F2s earn £34,000 for a 40 hour week, plus do nights and weekends, and they have to sign the prescriptions for the PA. Total utter madness.
Personally I'd like an anaesthetist who has a medical degree in case something goes wrong, not just training on how the machine works.
I don't know one F1 or 2 who is not planning an exit strategy at the moment.

PS I think ACPs are amazing. But if they are going to take the training opportunities from doctors then it's a problem. You can't be good at something if you don't practice it.

Why would we need the others if we had enough qualified doctors?

Becuase they want to do the fun stuff doctors do without the requisite qualifications, and are using the NHS workforce crisis as a personal opportunity.

You are correct a nurse is a nurse and a doctor is a doctor, the issue is an increasing amount of trusts and some individuals are blurring the lines to plug gaps and its an issue. It's not personal.
Precisely. And it is in the places where staffing is at its worst, hence there is the least supervision where this is most likely to happen. There is a role for ANPs and other advanced practitioners but there are plenty of places where they are being used - abused really - to do things that are outside of their scope of practice. I have seen this both professionally and as a patient. That is not necessarily a criticism of the individuals (though there are of course varying degrees of competence just as there are with doctors) or of the concept of the roles in general, but of the way they are being used. It's also often robbing Peter to pay Paul, again, particularly in smaller Trusts and/or more geographically isolated places where the staffing pool is smaller and recruitment more difficult anyway.
I was a Consultant in Anaesthesia and Intensive Care and I hugely value my nursing colleagues. But we have lost a great many excellent nurses to these roles leaving the general nursing levels depleted. It's understandable. The pay, and possibly job satisfaction is much better than being a regular staff nurse, especially given that prospects for promotion and pay progression are so poor for "normal" nurses.By the time I retired most of the Staff Nurses on the Unit I worked on were band 5s with a few Band 6s and one Band 7 for the Unit. Not that many years ago we had an 8, about 4 7s and roughly equal numbers of 5s and 6s. I don't blame good, experienced nurses for moving into practitioner roles - it could be a decade or more before the band 7 role becomes vacant and I'd probably be looking for alternatives in their shoes too. But at least some of them are taking on tasks inappropriate to their role and level of training and the knock on effect is that gaps are then created and again, sometimes inappropriately filled in other areas too. Certainly when I was first appointed as a Consultant there were no newly qualified nurses in our ICU at all - new starters all had significant experience in ward nursing already and they got a substantial period of mentoring and supervision before they looked after a ventilated patient solo. Not now.
And it is even worse on the general wards. Quality nursing care is the bedrock of the NHS. Siphoning off the best to plug the gaps created by inadequate medical workforce planning and not valuing or paying good, experienced nurses a wage commensurate with the importance of their role doesn't help anyone in my opinion.

Do you suggest that no nurse or AHP with the required experience apply for these advanced practice jobs to prove a point?

“The environment - because actually making a meaningful difference would require huge investment and sacrifice and very few people are prepared to do it.”

^This

I wouldn’t worry too much- the NHS or lack of will be the least of your worries!