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New Ways of Working: time to get off the fence

  • Christine Vize (a1), Stephen Humphries (a2), Janet Brandling (a3) and Willm Mistral (a4)
Extract

New Ways of Working is about developing new, enhanced and changed roles for mental health staff, and redesigning systems and processes to support staff to deliver effective, person-centred care in a way that is personally, financially and organisationally sustainable. It is about developing capable teams attuned to the needs of their users, supported by good systems (particularly information systems) and adequate resources, embedded within a values-driven organisational culture with leadership and effective team working modelled at all levels. New Ways of Working is what it says – new ways of working – rather than a single service model or structure that has to be adopted. It recognises that services catering for the different types of needs of service users across their lifespan and differing demographics and geography will need different configurations to manage their task most effectively. However, the underlying principles relating to using the skills of the workforce in the most productive way are common. It is about achieving cultural change; a shift in the way teams think about themselves, the skills of the individuals within them, and the reasons they are there. However, cultural change is difficult to achieve and it is difficult to measure the extent to which it has been achieved.

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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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Care Services Improvement Partnership (2005) Joint Guidance on the Employment of Consult ant Psychiatrists. Department of Health.
Care Services Improvement Partnership (2007) Mental Health: New Ways of Working for Everyone. Department of Health.
Care Services Improvement Partnership National Institute of Mental Health in England, Changing Workforce Programme, et al (2005) New Ways of Working for Psychiatrists: enhancing Effective, Person-Centred Services Through New Ways of Working in Multidisciplinary and Multiagency Contexts. Final Report. Department of Health. http://www.lincoln.ac.uk/ccawi/publications/NWW%20Psychiatrists.pdf.
Kennedy, P. & Griffiths, H. (2001) General psychiatrists discovering new roles for a new era … and removing work stress. British Journal of Psychiatry, 179, 283285.
National Institute of Mental Health in England, Changing Workforce Programme, Royal College of Psychiatrists, et al (2004) Group Guidance on New Ways of Working for Psychiatrists in a Multidisciplinary and Multi-agency Context: National Steering Group Interim Report. Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4087352.
National Working Group on New Roles for Psychiatrists (2004) New Roles for Psychiatrists. British Medical Association.
Pajak, S., Mears, A., Kendall, T., et al (2003) Workload and Working Patterns in Consultant Psychiatrists: Project Report June 2003. Royal College of Psychiatrists Research Unit.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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New Ways of Working: time to get off the fence

  • Christine Vize (a1), Stephen Humphries (a2), Janet Brandling (a3) and Willm Mistral (a4)
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eLetters

New Ways of Working - Time to abandon the phrase

Martin A. Gee, Consultant Psychiatrist
11 March 2008

Christine Vize et al (Psychiatric Bulletin 2008, 32, 44 - 45) advise us against any loss of momentum in this revolution of our working practice.

The ensuing other commentaries by Peter Kennedy and Paul Lelliot echorecent debates on community care and home treatment. In these previous debates however, what was being proposed was clear and based on significant background information. NWW is unclear what it is about (otherthan the abandonment of traditional out patient clinics) and is not supported by evidence.

It would be easier to join this bandwagon if it was clear where it was coming from and heading to. The movement originated from recruitment and retention problems in psychiatry but has moved on to attempt to optimize functioning of multi-disciplinary teams. The real stress in adult psychiatry never came from dysfunctional MDTs but emerged from unrealistic expectations about our ability to curb violent patients. Nothing in NWW will address this.

The term has become divisive with its denigration of previous patterns of service and its unwillingness to let the evolutionary processes that have worked well over the last 20 years continue to take their course. I do not agree that the body of the profession has been “one of the biggest single drivers” of NWW which is about changing professional roles on a wide scale. The College will not be able to control NWW either. It is time for a more cautious approach to the change incompatible with such a phrase as “New Ways of Working”.

Declaration of Interest – Dr Gee has been a General Adult Consultant Psychiatrist for 14 years.

Yours sincerely,

Dr Martin Gee FRC Psychm.a.gee@doctors.org.uk
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Conflict of interest: None Declared

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New Ways of Working: fences and cuckoos

David J. Jolley, Consultant Psychiatrist/Hon Reader
28 February 2008

There is a clue in the capital letters: ‘New’ = old, Ways = one way, Working = work avoidance. It is NewSpeak.It did not occur to me when responding to the histrionic outpourings of oppressed General Psychiatrists (Jolley 2002) that their despair would spawn a quasi-religious management sect. I drew attention to practices within other specialties which maintained morale and positive service profiles and suggested that a more equable spread of manpower would reducethe difficulties.In semi-retirement I have experience of General and Old Age Psychiatry reconfigured to the model commended by Vize and Kennedy and questioned by Lelliott (Opinion and Debate 2008). Every device is deployed to separate patients and families from consultants: to fragment patterns of care and to divert (‘Signpost’) expectations and responsibilities elsewhere.This is not the work of thoughtful, caring, clinical innovation which sparked and sustained my enthusiasm, confirming that we are available, with knowledge, skills and wisdom for people wherever they are in need (Jolley 1976 ). Community Psychiatry, including Old Age, demonstrated professional humanity and superbly efficient use of resources. Let us return to the lessons of the recent past and set aside these ugly New Clothes. Those who have been led astray are not to be blamed, but understood and thanked for the challenge they have given to us. There is always something to be learned: we can do better. Taking down fences rather than sitting on them or jumping from them might be a good idea. 247 words

References:

Jolley D (1976) Psychiatrist into Psychogeriatrician British Journal of Psychiatry News and Notes November 11-12

Jolley D (2002) General Psychiatry: Cuckoo. Psychiatric Bulletin, May, 26, 197

Opinion and Debate (2008) New Ways of Working: time to get off the fence. Psychiatric Bulletin, February, 32, 44-48
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Conflict of interest: None Declared

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New Ways of Working: Trainees View

Shalini Agrawal, Speciality Registrar in Psychiatry
14 February 2008

Christine Vize and colleagues are of course encouraging psychiatristsacross the country to embrace New Ways of Working in a big way and to comeoff on the right side of the fence! This may sound a bit of a hard sell tosome psychiatrists who have not yet experienced the kind of working being advocated.

As a psychiatric trainee and having had first hand experience of working in New Ways of Working in South Essex Partnership NHS Foundation Trust, I can certainly speak out for those who have embraced this way of working and encourage trainees to gain more experience in this.

There are concerns about lack of continuity of care (Gee, 2007). These were overcome by having a joint multidisciplinary meeting (MDT) of in-patient and community teams for effective hand over of care. Both teamswere aware of the management plans and could offer better follow-up. Also,with two consultants in the MDT meetings, opportunity for ‘second opinion’was always present.

The in-patient consultant was able to dedicate more time on the ward.Better and easier access to consultant opinion was available which was much appreciated by the nursing staff, patients and the junior doctors. With the advent of teams like Crisis Resolution and Home Treatment, more unwell patients are now being admitted. Therefore, it is vital for expert opinion to be available more readily. In all the surveys conducted, patients were very satisfied with the care they received.

From a trainees’ point of view, it was much easier to conduct work place based assessments. With increased availability, the consultant was able to observe more of my assessments, interviews and procedural skills, with the advantage of immediate feedback. This is very relevant for futuretraining needs.

A unique feature in the unit where I was working was daily risk assessment meeting. These replaced the traditional nurses handover. Doctors were part of these meetings where risks related to each patient onthe ward were discussed and management plans made to minimize such risks. This helped in better patient management and in improving my risk assessment and management skills.

Overall I felt that for whatever criticisms, and there will be criticisms, new ways of working is the right way of working if we have to keep patient interest at heart.

Reference:

Martin Gee, New Ways of Working threatens the future of the psychiatric profession. Psychiatric Bulletin (2007) 31: 315. doi: 10.1192/pb.31.8.315a

Declaration of interest: None
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