Saturday, 7 July 2012

Aftermath of NHS Walk-In Centre closure

I've written earlier about the death by attrition of an NHS Walk-In Centres (WIC) in the United Kingdom. The concept of a nurse led WIC is to provide primary health care to patients who walk in off the street without appointment. The nurses are highly skilled, highly trained and carefully selected. They are examined in physical assessment skills, their work is routinely audited for best practice. They work to careful designed medical protocols which allows them to assess and manage the majority of minor illnesses. The nurses are also trained to recognise conditions which should be referred to specialist medical practitioners. The senior nurses in the team usually posses Master degree level of medical training and take separate training and assessment to be allowed to prescribe medicines.

I'm keeping track of one WIC which was closed down and the team transferred to a local A&E department of an Acute Hospital Trust. The highly skilled primary care Matron who had led the WIC nursing team was within a few days forced out of the job and was replaced by a less senior A&E nurse who had no training in primary care.

In the past 6 months the skilled WIC nurses now working under A&E management have been subjected to a programme of bullying and repeated comments that they lack the competence to undertake primary care work. The people harassing the nurses have little or no primary care knowledge/experience. There have been arbitrary bans on the WIC nurses performing the role they'd practised many years before in an autonomous way. Note that the WIC team previously had a very low rate of complaints of medical mistakes. Make no mistake, the Acute Care A&E management is trying to force the WIC nurses out of their jobs while retaining the budget funding for their primary care work.

This may all sound like internal politics, but it has a serious impact on service to the local public. The WIC in question used to have about 400 visitors a day. Some of those would be streamed away without medical treatment, but most patients were seen in less than an hour.. The local A&E now regularly breaks the four hour rule for treatment and has a much higher error rate. Skilled Nurse Practitioners like this person are the type of experienced nurses being forced out.

Edit 27th Aug 2012: Or look at Suffolk NHS who posted on their web site: 'Only visit A&E if you are dying' a few months after the decision to close their minor injuries unit and transfer the staff to A&E.

10th Sept 2012: I lose no tears over Andrew Lansley getting the sack as the Health Minister. Sadly the NHS will continue to suffer the effects of the chaos he's caused for many years.

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