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Time for honest debate and critical friends. Commentary on … New Ways of Working

  • Paul Lelliott (a1)
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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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General Medical Council (2006) Good Medical Practice. General Medical Council.
Smith, J., Walshe, K. & Hunter, D. J. (2001) The ‘redisorganisation’ of the NHS. BMJ, 323, 12621263.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Time for honest debate and critical friends. Commentary on … New Ways of Working

  • Paul Lelliott (a1)
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eLetters

New Ways of Working: Power, Responsibility and Pounds

Susan Mary Benbow, Consultant Psychiatrist & Professor of Mental Health & Ageing
03 March 2008

We need a debate on new ways of working (NWW) (Psychiatric Bulletin, February 2008, 32, 47-48): good principles are being distorted by a range of conflicting influences. The most powerful is money (Sainsbury Centre for Mental Health, 2003). Doctors are expensive. Financial pressures encourage use of a cheaper member of staff whenever possible: replacing expensive staff with cheaper staff puts us at the cutting edge of NWW! This distorts team structure and working at all levels. Sometimes it mightbe appropriate, allowing highly trained staff to focus skills where needed. Alternatively it might deprive patients and families of access to expertise, and lead organisations to push staff to shoulder responsibilities which they feel are beyond their competencies or for which they are not adequately trained or remunerated.

Other pressures involve power and responsibility (GMC, 2006). Undoubtedly there are people/ organisations who see NWW as diminishing doctors’ ‘power’. Some fear that NWW diminishes medical responsibility, and leaves other staff carrying levels of responsibility that they are uncomfortable with, or worse no-one has responsibility. But is power a finite package that gets cut up and doled out, or by joining together can we become a more powerful force to work in the interests of patients and families?

Paradoxically NWW stereotypes professionals. Organisations describe what different professionals do and how they should be working and, instead of introducing flexibility, enforce rigidity. They lose person-centred holistic care by replacing skilled clinicians with tick-box policies and procedures (Drife, 2006) for people working beyond their competencies.

Drife, J.O. (2006) The history of box ticking. BMJ, 333, 557.

GMC (2006) Management for Doctors. Download at:http://www.gmc-uk.org/guidance/current/library/management_for_doctors.pdf

Sainsbury Centre for Mental Health (2003) Money for Mental Health. A review of public spending on mental health care. Download from

http://www.scmh.org.uk/80256FBD004F3555/vWeb/flKHAL6TJLJ6/scmh_money_for_mental_health.pdf
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Conflict of interest: None Declared

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