Posted by: Witch Doctor | July 21, 2007

A witch’s take on “Agenda for Change”



1. Start with this:

What is an “Advanced Practitioner – Level 7”

“Advanced Practitioners’ are experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high-level clinical decisions and will often have their own caseload. Non-clinical staff at Level 7 will typically be managing a number of service areas”

2. Now think about “Agenda for Change”:

There are now mainly two employment branches within the NHS – the Medical Branch (small), and the Agenda for Change Branch (large). Agenda for Change lumps almost all workers within the NHS into a single group. Sure, there are dietitians, secretaries, scientists etc etc among them, but competency based training has the ability to blur these margins until they are almost obliterated. Indeed, with the passage of time, the necessity for a specific background could disappear almost completely for most staff. Except for a few “obedient experts.” This is what will happen if and when the “Skills Escalater” really kicks in.

At the moment medical staff are the only group apart form very senior management who are not included in the Agenda for Change structure.

3. Now have a look at “The Secret NHS” located above, under “My Black Cat”

This gives the future “Career Framework for the NHS”

Do you see responsibilities generally considered to be those of a doctor?


Do you see the word “Doctor” there? Do you see the word “Consultant” in the context of “medical consultant?”

You don’t?

The Witch Doctor thinks medical consultants will eventually be hidden in Level 9. But they are not there yet. The “doctors” and “consultants” are still sitting in the wings – in the separate medical branch. Too hard to integrate the medics at this stage. There is not much to offer them except, as a preliminary, a new modern but malleable competency based career structure for the juniors (MMC) and a well paid but very malleable and less professional contract for the seniors. Much easier to integrate the nurses by giving them a new status, though. Practitioner status. Advanced Practitioner Status. Consultant Practitioner status. Flattering. Ultimate responsibility. Confusing? Sure. It’s supposed to be confusing.

It’s so damned confusing, most of you didn’t notice it happening.

Did you?

And patients won’t have a clue who’s treating them.

4. Now consider what’s next.

Where will most doctors sit?

Anywhere, depending on a competency profile. Relatively cheap to employ.

Where will the consultants sit?

Level 9 – like puppets on strings. Well paid, highly trained, experienced, obedient, unprofessional medical consultant puppets who are too few in number, too busy and too downtrodden to question anything very much. Puppets who will be wheeled in to take the blame if anything goes wrong. And maybe to plug some holes.

Let”s call it all “Modernisation”

Let’s call part of it “MMC”

Let”s call it all “Competency Based”

Let’s call it “The Great Leveller”

Let’s introduce MTAS and PMTB as the “medical” tools to make it happen. Yes, introduce them fast in spite of rumbles of dissent from the great and the good. The rumbles will never crescendo to screaming pitch. They seldom do! Introduce them before the implications are fully understood.

This looks like a deliberate plan approaching the end stage of its fast evolution.

It does not look like incompetency.

Is this witch’s take OTT?

Of course it is!!!

This couldn’t be happening!

Could it, My Black Cat?

The Witch Doctor – Link to a random page






  1. […] Considering the other agendas in “AGENDA FOR CHANGE” […]

  2. […] Considering the other agendas in “AGENDA FOR CHANGE” […]

  3. […] mean The Skills Leveler, My Black […]

  4. […] This would exacerbated by the predominance of women in medicine. We reckoned The Leitch Report, Agenda for Change, The Skills Escalator were all attempts to address the imbalance. We thought MMC, as conceived by […]

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