Thursday, June 7, 2012

Will you....or shall I?


Cattle class..evidently that's the term used for Economy Class nowadays..and you do start to feel it on a long haul flight sometimes. Especially when the movie options are so utterly rubbish too...well, there's only so many times one can watch Mark Wahlberg sleepwalk
through yet another movie or Denzel trying his utmost to make a Ryan Reynolds flick look half decent.3rd option was some movie about a skinny chap ( the teenaged girl next to me squealed something about R-Pat)..evidently he is some sort of heartthrob...tell you what, don't know about his dashing looks, but that fella certainly needs his haemoglobin checked. Anyhow, I digress..in short, the movies were utter rubbish and with 3 hours to go till touch down in the city of Rocky, it certainly was time to have a crack at putting some thoughts down in a blog.

Just before boarding the plane, I was having a conversation with a very dear friend of mine, Mayank ( you should all meet him....he's sort of like the son my mum never had; someone I aspire to be but never will; Clark Kent to my Bruce Wayne..you get the drift..) and we were discussing how a recent job advert in Southampton had attracted candidates of "average" quality. Had an identical conversation with another colleague from Bath who mentioned how 11 candidates had applied but of them 7 hadn't even bothered contacting the department, same conversation a few months back from a job advert in Norwich..and then you read and hear how jobs are scarce, our trainees are all going to join the dole queue, workforce planning is shocking etc etc...and you have to wonder how in a market of such apparent lack of opportunities, the posts being advertised are not having candidates applying in droves, falling over each other to get that job.You ask Consultants around the country doing teaching programmes, educating and you can sense their palpable sense of worry about the quality of trainees coming out.
Don't get me wrong, there are some fantastic trainees out there, on the verge of doing something big, becoming the new stars of the system....but their numbers are a handful. Those stars of the future will be fine, there will be no problems for the Roselle Herrings and Paul Grants in their desire to get jobs, if anything, they will be head hunted...the question is what about the vast majority? I don't know about other Deaneries but in ours, the ones you look at and go "yep, would love to have him or her as a colleague" seems to be far less than previous. Something's missing, there seems to be a general sense of apathy amongst many....it seems that turning up for your work and going home is enough..it's just a job, isn't it?Ask the folks who do annual assessments of specialist trainees...and the general theme is of a few sparkling diamonds and a majority of folks who do as they are told, do as their rota suggests.

Is it because we are attracting the wrong folks? Are we failing to energise our bunch of trainees or is it simply because the bleak picture of job prospects by all of us is just having a demoralised effect on all concerned? Maybe all of the above but maybe a solution could be provided. Or at least tried. My motto in life has always been to look at solutions...do they always work? Of course not...but it's still tons better than just sitting back and moaning about it. Case in point, in 2004, I went to Diabetes UK annual Conference and attended the Consultant-SpR session...god..a more soul sapping, morale destroying session I have yet to see. Figures were shown, bright piecharts screamed back at the audience...there were no jobs, we were all screwed. 8 years later? the same refrain continues...and one is yet to see any position papers, national guidelines from anyone as to what a Consultant Diabetes specialists responsibility is.

The question is whose responsibility it is to do so. As per their tag line, the Association of British Clinical Diabetologists (ABCD), professes to represent the interests of Specialists..fair enough...in that case, why don't you do one? if you want to protect the future workforce, get present trainees to energise themselves, paint a brighter picture, why not a position paper on Consultant Diabetes roles? We all seem to bristle with indignation when GP colleagues question what our role is...why can't we put it down on paper? A position paper on Metformin and Vitamin B12 deficiency, as attractive as it is, is not, honestly, going to change an individuals perception. I will be honest, if I want to make my mind up on the relationship between Metformin and Vitamin deficiency, I am not going to look at ABCD position statements, I will be doing an online search, go through PubMed, weigh it up and make my decision. Similarly for topics such as analogue and non analogue insulins. However, if ABCD come up with a position paper on the role of Diabetes Consultants in the modern NHS, fellas, I am listening.

So..if you want to listen to someone who has never cared for reputations...here's a suggestion or two. Sit down with the YDF, listen to what the SpRs would like to do in a job, talk to Consultants around the country, listen to the frustrations, engage with GP organisations such as PCDS or even political ones such as NAPC, NHS Alliance, find out what they think Consultants should be doing and most importantly sit down with patients or patient groups to hear their views. Listen to all and then come up with a position statement on role of Consultants, what their role should be win an acute Trust, what they should be doing in the community, how their educator role can be used to improve patient care etc etc. Come on guys!! it cannot be that difficult, can it?
In previous blogs, I have mentioned what Consultants should be / could be doing within an acute Trust and within the community. How difficult can it be to create a 10 PA Diabetes Consultant job template?? As regards Direct Clinical Care sessions,think of the sessions one can do using the super specialist skills in areas such as pregnancy, foot disease,pumps...think of the sessions needed to provide leadership to the service, develop it, think of the sessions one can devote to community.As regards Supporting Professional Activity or SPA sessions, think of the sessions needed for educating juniors, primary and specialist setting, leading on audits to assess performance, personal revalidation.......does an ideal 10 PA job sound too difficult to construct? I say again...come on guys!!! You still think we need to flounder around having to do more General Medicine to justify our existence? Let's stop being the poor cousin..we have much to do!!

Once done and all parties have agreed to the position statement, then use publicity appropriately. Engage with the NHS confederation, engage with the media, the NHSCB, send out the statement to Acute Trust Execs, get departmental Clinical Directors to use it for job planning discussion...what have we got to lose? The media is crying hoarse over how poor diabetes care is...who doesn't think this is is THE ideal moment to showcase what a Diabetes Consultant should be doing.
So, my colleagues at ABCD, If you are who you profess to be, if you do genuinely believe that you represent specialists, present and future...then this is the time for some bold leadership. It's not about being worried what others will think of us, about us being perceived as being brash. That doesn't involve saying we can do it better, it's about saying that there're some things we are trained better, have spent taxpayers money to be trained and we should be leading care in such areas of diabetes. it's about saying we will be there to support our primary care colleagues, not do it all ourselves.

Bu then again, what if ABCD feel they can't or shouldn't? Our trainees will love some clear direction on their future, would appreciate the fact if national bodies approve it and jobs are appropriately placed and created using this document as a template It may just be the catalyst for those rare jobs being fought over, improving the overall urge for trainees to do something extra in their careers...something to look forward to, not the looming possibility of staring into the abyss of joblessness.
So if not ABCD, who then? Shall I? Should I talk to colleagues, similar minded folks, do all that I have suggested, use my links with the GP groups, NHS Confederation...or should I for once pause before taking on another challenge? I probably will answer that in my own mind very soon....but till then, I wait to see whether ABCD pick up the gauntlet..or not.

Remember this... if someday somebody analyses that the lack of clarity of specialist roles have harmed patient care, then the onus for not raising that will be upon us...and there won't be a single patient who would understand or care to understand the politics that stopped us from doing so.
So...my colleagues in the ABCD Executive team...will you...or shall I? Clocks ticking...:-)

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