Recovering from a hernia op., a middle aged psychiatrist with personal issues approaches the interweb in a state of high anxiety.
Having worked as a full-time adult psychiatrist in the NHS for twenty years I feel like Blackpool rock - if broken - would have those letters running through me. The last fifteen years I have been a consultant in a new town. One famous for being the most godless town in the U.K. and a border town, in the sense that most of its residents are borderline. 'Borderline PD' being the ugly fashionable label my profession currently pins to the damaged and abandoned.
Recent changes encourage the NHS to atomise into competing little empires - Foundation Trusts - driven by finiancial targets, and the monsterous one that has absorbed our sleepy county and its little new town along with it - is an ambitious little empire.
New ways of working was an idea that grew out of a crisis in recruitment to psychiatry in the 1990s - 15% of posts were unfilled - noone wanted to do the job. The burden of huge case loads and the difficulties inherent in applying the primitive science of psychiatry to the oceans of human misery made the task a tough one. The pressure to stop bad things from happening was absurd.
Any suicide, voilent or worse incident would lead to searching enquiries and enthusiastic mud slinging adding an insane guilt to the task......if something has gone wrong, then which doc shall we blame?
So new ways of working came in - which involved us just being responsible for patients we were directly working with (and not all our teams contacts) - but the Dept of Health in general and the Foundation 'Trust's in particular sensed a money saving opportunity.
If services could manage without docs - when medics could not be recruited - why not reorganise to do without 'em.
Lets call it new ways of working, so its sounds good, but actually get nurses or community care workers etc to do it - just pay doctors to do purely medical things - such as prescribe drugs - and then we will not need so many of them.
Sounds good - in my patch it means a 50% increase in work-load on top of what has already proven itself to be an unsustainable catchment area of 50,000 - now its up to 80,000 plus taking over half of another teams case-load (an assertive outreach team inc 15+ community supervison patients) - it is dangerous and will lead to a severe reduction in quality of care. (A team psychologist, with a case load of 6-7, comments how we will manage. My case load is 250 so its difficult to take the comment seriously.)
The good thing is it gives me permission.
Permission to fail.
I have worked myself into the ground for 15 years, and on occasions had to stand in a coroners court to support the organisation.....that burden is removed. If the employer clearly cares so little for the service, why should I ? There is something liberating about psychopathy.
