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New Ways not working? Psychiatrists' attitudes

  • Jenny Dale (a1) and Gabrielle Milner (a2)
Abstract
Aims and Method

A questionnaire survey of general adult psychiatric consultants and specialist registrars in the West Midlands was conducted to examine attitudes towards New Ways of Working (NWW) for psychiatrists; these were measured using a 5-point Likert scale. Participants were also asked about their own experiences of NWW. the data were analysed using Mann–Whitney U-test.

Results

The response rate was 31.2%. Attitudes were generally negative, particularly regarding the effect on patient care, the erosion of the professional role of the consultant and effect on quality of work life. the attitudes of those who did not have any direct experience of working to the NWW models were more negative than those who had direct experience of NWW.

Clinical Implications

There are significant concerns about NWW among consultants and specialist registrars. There is a need for further debate and research with regard to the proposals.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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1 Department of Health. New Ways of Working for Psychiatrists: Enhancing Effective, Person-Centred Services Through New Ways of Working in Multidisciplinary, Multiagency Contexts. Department of Health, 2005.
2 Vize, C, Humphries, S, Brandling, J, Mistral, W. New Ways of Working: time to get off the fence. Psychiatr Bull 2008; 32: 44–5.
3 RCPsych News. Comments received from members to the February e-newsletter 'Diary of a ‘new ways of working consultant psychiatrist’: Dr Peter Kennedy summarises. Royal College of Psychiatrists, 2007 (http://www.rcpsych.ac.uk/member/rcpsychnews/april2007.aspx).
4 Brown, N, Bhugra, D. ‘New’ professionalism or professionalism derailed? Psychiatr Bull 2007; 31: 281–3.
5 Gee, M. New Ways of Working threatens the future of the psychiatric profession (letter). Psychiatr Bull 2007; 31: 315.
6 London, M. New Ways of Working and the patient (letter). Psychiatr Bull 2007; 31: 435.
7 Department of Health. National Service Framework for Mental Health: Modern Standards and Service Models. Department of Health, 1999.
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BJPsych Bulletin
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New Ways not working? Psychiatrists' attitudes

  • Jenny Dale (a1) and Gabrielle Milner (a2)
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eLetters

New ways of losing the art of psychiatry

Dr Cleo Van Velsen, Consultant Psychiatrist in Forensic Psychotherapy
24 June 2009

As a consultant working in a tertiary service I see the results of New Ways of working rather than participating directly myself. What emerges is a loss of diagnosis, let alone any attempt at a differential.

NWW assumes that it is easy to tell, at the moment of referral, whether or not a problem is complex or strightforward. In reality overt psychosis can be relatively straightforward to spot but these go to the psychiatrists. Left undiagnosed are complex personality disorder (borderline pathology reduced to 'depression') and subtle or unusual psychotic states such as encapsulated delusions or thought disorder, described as 'normal'.

I have been involved in an increasing number of cases where there have been serious consequences of misdiagnosis, of the type that used to shame a part 1 candidate for MRCPsych. Diagnosis is still considered a fundamental part of medicine, so why have we, apparantly willingly, opted out of this aspect of our medical discipline. I concur with those who worry about the demise of psychiatry--what is the point of a discipline that seemingly anyone can practice. The loss of differentiation between the disciplines does not contribute to egalitarian practice, it only leadsto non specific and perhaps unhelpfully focussed treatment.
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Conflict of interest: None Declared

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New Ways Can Work

David J Ogden, Consultant Psychogeriatrician
18 June 2009

Much is being made of the negative effects of New Ways of Working, tothe extent that it's future is now seriously threatened despite viable or palatable alternatives not being proposed within an environment of increasing service demand.

Having experienced working in several trusts through the process of adopting New Ways of Working (in working and older age adults), my belief is that the current challenge lies in identifying which factors lead to success, and which do not. The next question is whether the successful factors can be systematized; i.e. are not entirely dependent on individualskill, knowledge or enthusiasm. My view is that the following three factors are of key importance:

1. NWW needs to be clinically lead, and not perceived as being misappropriated by management for their own (financial?) agenda.

2. Strong team leadership to encourage and support care co-ordinators' increased responsibilites.

3. Boundaries between functional teams need to be explicit, without the gaps that GPs hate, and with great emphasis on excellent, protocolled communication standards. Universality and continuity of service delivery are thus ensured.

NWW remains in an experimental phase and shows promise. We cannot allow naysayers whose fear of obsolescence or displacement from power holds back real progress. New Ways can work. Isn't it time for the collegeto canvas members to find out how?
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Conflict of interest: None Declared

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New Ways not Working and the consultoid (1,2)

Claire Hilton, Consultant old age psychiatrist
18 June 2009

Once again, as a consultant old age psychiatrist in my job planning meeting, I was berated for not organising my time effectively. This ignored the real sources of the excessive work load, under-funding and increasing pathology in an aging population.

I was informed that that I need to function as a consultoid rather than as a consultant. This sounded rather sci-fi, perhaps like an androidor robot, and very surreal. Unfamiliar with the word, I suspected a clever neologism used in a very authoritative way. I checked the on-line Oxford English Dictionary; it is not there. I thought that perhaps I might try using it when addressing a patient ‘Good morning Mrs X, I’m Dr Hilton, your consultoid’. But it didn’t sound right. So I searched the internet; consultoid appears to be an imprecise term including people training to be consultants(3), GPs wanting to keep a hand in hospital work (4), and health service developments being made without consultationwith clinicians.(5) Indeed, far from sci-fi it is quite an old word, at least as far back as 1929.(4)

New ways of working with increasing workloads, doctors being removed from the diagnostic, assessment and treatment roles for which they were trained and being ‘consultants to the team’ is perhaps reconstructing a modern, virtual-mental-asylum; relatively few medical staff, risk of inadequate diagnoses, almost all work delegated to lower paid staff, and where possible offering social care rather than active medical intervention. Perhaps somewhere, sometime consultoid work will actually be imposed on us from above. But for the moment, just beware if you are asked to be one. It probably implies lower status, less funding, an android like telepathic sci-fi diagnostic method and mind-reading relationship with the clinical team, plus a super-human effort to keep up with the work load.

1. Dale J, Milner G. New Ways not working? Psychiatrists' attitudes Psychiatric Bulletin, 2009; 33: 204-207

2. St John-Smith P, McQueen D, Michael A. et al The trouble with NHS psychiatry in England Psychiatric Bulletin, 2009; 33: 219-225

3. Dunea G. Consultants and Consultoids Br Med J, 1984; 288: 923-4

4. Lancet. The renaissance of general practice. (editorial) Lancet, 1929; ii: 933

5. ‘Dr Rant’ Would you still trust this lot? May 2007http://www.drrant.net/2007/05/would-you-still-trust-this-lot.html accessed6.6.09
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