Intended for healthcare professionals

Rapid response to:


Senior UK researchers campaign for sensible guidelines on regulating trials

BMJ 2009; 339 doi: (Published 08 September 2009) Cite this as: BMJ 2009;339:b3671

Rapid Response:

Asphyxiation due to paper requirements

Dear BMJ

I felt that I had to write to the BMJ with a cry of anguish about the
madness that passes for administrative necessity in the NHS. This pervades
both the clinical and the academic sectors of the NHS, hence my rapid
response to the recent article in the BMJ about research ethics committee
applications (Senior UK researchers campaign for sensible guidelines on
regulating trials, DOI: BMJ 2009;339:b3671).

I left my job as a consultant psychiatrist over a year ago and since
then have been filling occasional locum posts. When I first began to do
this, I was overwhelmed by the pieces of paper that I had to submit to the
‘compliance department’ of my locum agency. I can’t be the only NHS worker
who remembers the days when locums seemed to walk in from the nearest bus
stop and commence work. By contrast, the current situation means that all
qualifications, references, immunisation results, (to name a few
instances) must be provided on headed notepaper, otherwise they are
unacceptable. I can’t help but ask ‘unacceptable to who’? While I can
understand the need to ensure that references, for example, are authentic,
is there really such a necessity for one’s vaccinations to be presented on
headed notepaper?

The latest delight that I have been confronted with is that I’ve been
told that I cannot take up locum employment in a particular North London
trust unless I have an up-to-date Basic Life Support certificate. I am
simultaneously stunned and disgusted. I wonder which idiot in this trust
(and I’m sure it’s not an isolated example) decided that as a doctor, I
wouldn’t be safe with patients unless I had another piece of paper in my
hand that said that I am competent to shout “Are you all right?” at a
rubber dummy and press it’s chest/blow into its mouth in a suitably
concerned charade. The piece of paper in question needs to be renewed each
year. I am tempted to suggest to the relevant authorities that I should
perhaps also demonstrate my psychodynamic skills with said rubber dummy,
as these would be more relevant to my speciality.

Equally, a recent locum post was spent in front of a computer for
over 80% of the time, filling in forms and updating the electronic patient
record. Of the remainder of my time there, about 5% of that – which is
probably an overestimate - was spent on face-to-face contact with
patients, actually doing psychiatry.

How did this crazy state of affairs come to pass? I can’t help but
think that the glut of administration that we are all forced into is
purely to justify the jobs of administrators. It makes no difference to
patient safety and says nothing about one’s competence. All that it
demonstrates is that one can fill in forms, or obtain the correct ones.
I’m sure that Harold Shipman obtained and completed all the necessary
forms within the requisite time.

I think that this is an indication of the general de-skilling of our
profession. Sadly, it’s not confined to medicine. I know that teachers are
another example of a trained occupation that is being suffocated by paper.
(And I suspect that there are several other examples.) I also suspect that
any attempts to remedy this situation, however noble they might be, would
involve multiple meetings, which of course have to be thoroughly minuted.
And so an unsatisfactory situation continues…

Yours in despondence(!)

Dr Jacqueline Conway

Competing interests:
None declared

Competing interests: No competing interests

11 September 2009
Jacqueline L C Conway
Visiting Research Fellow
MRC SGDP Centre, Institute of Psychiatry, Maudsley Hospital, Denmark Hill, London SE5 8AF