Posted by: Witch Doctor | October 16, 2008

NHS algebra

The Jobbing Doctor gets fed up waiting for letters from hospitals about his patients.

“This is important, guys. You have been managing the patient on my behalf, and when you discharge out of hospital their care is now with me and my colleagues; when patients come out of hospital they are often at their most vulnerable or illest, and I need the information. Not in 6 months time, not next week, but straight away.”

Quite right too!

Communication skills. Communications skills. Communication skills.

The Oldest Sage Witch is sick hearing about Communications Skills!

When something needs improvement you sort out the basic elements first.


Why should it take weeks for a discharge letter to reach a GP regarding a patient who has had a stay in hospital?

Why should it take weeks for a letter to reach a GP following an out patient consultation?

These are the most basic communications relating to patient care.

The answer will be that secretarial staff are overloaded. Case sheets lie on great piles on the floors of NHS offices up and down the land waiting for letters to be typed by secretaries who are effectively not there. They are are not there because they are not replaced to cover holidays, maternity leave, sick leave. They are also not there because the waiting list initiative (or some other intiatitive) takes priority, so the secretaries are bombarded with managerial e-mails and phone calls regarding “potential breachers.”

Managers cannot solve the waiting list problem – they can only manage hassle those who can – secretaries and consultants.

Secretaries are easier to manage hassle than consultants – and so the typing lies on the floor.

If the typing lies on the floor, the conscientious secretary feels inefficient and creeps back into her office in the evenings and weekends to get on with the typing at a time there are no interruptions. No-one knows she’s there. She gets no thanks for this. She may seem efficient but she gets stressed out. She goes off sick and the cycle recommences.

For the less conscientious and perhaps less stressed secretaries, the typing will lie on the floor until there is a Discharge Letter Initiative or a Clinic Letter Initiative.

It is called NHS Algebra.



For every action there is an equal and opposite reaction

Where is the consultant in all this?

The consultant who has had a GP’s patient in his/her care and who needs to communicate with that GP?

The consultant can say – this is not my problem. It is a managerial/administrative problem.

Or the consultant can take overall responsibility.

If a consultant takes overall responsibility for letters of communication between consultant and GP, then these letters will be typed in a timely manner.

Believe me.

They will.

This is an important aspect of “A Consultant Delivered Service”

Something the NHS does not, or chooses not, to offer.

Something the consultants and patients seem not to be fighting for.

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