24/7

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I’ve been musing something about services ( yes my brain did hurt a little). These are some thoughts out loud (written) and no semblance of a plan of how to manage this.

We’re told that the NHS is a 24 hour, 7 day a week service. But that’s not true for a lot of it. Community services both physical and mental health tend to be Mon-Fri 9-5. GPs are similar with walk in centres sometimes covering weekends.

There’s been a lot of media flimflam controversy coverage on the NHS for the past couple of weeks or so.  We’re told that A&E is at breaking point, more money has been promised (AGAIN) to mental health services and GPs have been told they need to work 7 days a week.

Now let’s examine that last one. I don’t think it’s a bad idea. I’d also be happy (though I’m sure a lot of people wouldn’t be) if community resources stayed open at the weekends. I will put a disclaimer here: I think our GP colleagues are doing a fantastic job, they get a lot of stick for the service they provide sometimes but there is always a way to improve.

I can talk of my experience in a Community Mental Health Team (CMHT). I’ll use CMHT as my framework of 9-5 services. CMHT is another underfunded, under appreciated, under pressure teams working hard with the resources they have. They too do fantastic work. But when it was coming up to the weekend, things would start becoming busier due to service users becoming anxious about how to cope over the weekend, wanting to ask questions that they needed answering before everyone ran out the door at 5pm. Whether consciously or unconsciously they knew part of their support network wasn’t there for the weekend. Then they get distressed and worried and if they’re unwell, or believe they’re in danger they’ll refer to their care plan; in which it will say that if they are distressed call 999, the out of hours team or go to an overloaded A&E in distress to be seen by the RAID (or MH liaison team). Then comes the flood of calls that come Monday morning, probably filling care co-ordinators with dread about what happened over the weekend and Monday is sometimes spent dealing with this fallout.

Should it be this way? Could those 5 days they work be rota’d over the full 7 days. But if someone familiar who knows you, your history can talk to you about concerns or if there are visits booked over the weekend? If there is a relapse then referral to the Home Treatment Team can be made or an admission directly to a ward could be enacted missing the anxiety and distress of having to attend A&E and discuss your entire history with a person you don’t know…several times. Surely this will be better than the current model. It’d mean some big changes but if it’s in our patient’s interest surely this is better than wringing our hands saying something must be done.

This can be applied for GPs too I believe. Those not under secondary MH services, or physical health complaints that could easily be dealt with at GP level rather than no contact, and be easily reassured or correctly signposted to A&E or onward referrals made. Rather than the worried well turning up at A&E at a weekend because it’s the only thing they know to do and know they will at least be heard by someone caring and compassionate.

Even so this is not a fix to a system that is under so much pressure. Better Smarter  Different people from me, who can see the bigger picture need to look at this. Is the NHS fundamentally broken? Staggering from problem to problem, being patched up, short term interventions which often end up back where we start. Is it beyond fixing? I’m not sure yet but what the NHS needs a change at it’s very core. Throughout my health care education, governments have tried to implement changes in it’s structure. To my mind this is inconsequential. Cooking up changes off the top of their heads like May’s call for the 7 day GP ( I didn’t say it was a baaaad idea..).

This isn’t a political football to be played with. Those concerned need to sit down and really think about what the NHS needs to be and come up wth a plan of action…that isn’t going to change again in the time it takes for the next election to come around and then to change the direction yet again.

 

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