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having clinical responsibility for all of the
patients within the team, instead of this
being devolved to the respective care
coordinator. Further research could
establish what happens with the
information gathered at this time to
establish whether risk information adds
to the care coordinators management
plan in an appropriate manner.
Appointments offering reassurance and
support have remained at a low level
throughout the assessment period this
shows that despite changes to the service
there is an appropriate level of this that
should be offered by the psychiatrists.
The authors believe that were this to be
eliminated from their role then this would
be to the detriment of patient care and
job satisfaction.
A reduction in the DNA rate over the 3
periods of assessment could be seen to
be a sign that patients appreciate the
change in the nature of appointments
that has occurred over time. The authors
recognise that this surrogate marker for
patient satisfaction may not be a true
reflection of patients’ views. Future audits
of this nature within the team will include
more direct measures of patient
satisfaction.
Changes within the team that have
facilitated this evolution are sometimes
hard to pinpoint. As the population
covered by the team have not changed
and neither has the demographics of the
people living in the area so the change
has been within the team. The authors
believe that increased and more effective
supervision of the MDT has been a major
factor and resulted in requests for fewer
outpatient appointments.
Conclusion
Debate in the psychiatric literature
continues about how the NWW
movement impacts upon the
psychiatrists’ role, job satisfaction and
even recruitment 2,3,4,5 This literature has
undoubtedly uncovered strong feelings
that the majority feel that this process
acts to the detriment of the psychiatrists’
practice. The authors believe that the
audit shows that an evolutionary change
in the service need not be a tremendous
upheaval if managed well, and could
improve psychiatrists’ working practices.
The authors recognise that the process of
change can only be attempted if others in
the team are willing to take on new
responsibilities. We believe that more
effective and regular supervision from
medical staff to non medical staff in the
team has facilitated this change within
our team. We are aware that our audit
does not take into respect their view
points and further work will address this
as well as more direct measures of
patient satisfaction.
References
1. Department of Health; Final report
from the National Steering Group. New
ways of working for psychiatrists:
Enhancing effective, person-centred
services through new ways of working in
multidisciplinary and multiagency
contexts. Department of Health;
31 October 2005 67.
2. Craddock N, Antebi D, Attenburrow
M-J, et al. Wake-up call for British
psychiatry. The British Journal of
Psychiatry 2008 July 1, 2008;193(1):6-9.
3. Dale J, Milner G. New Ways not
working? Psychiatrists' attitudes.
Psychiatr Bull 2009 June 1,
2009;33(6):204-7.
4. St John-Smith P, McQueen D, Michael
A, et al. The trouble with NHS psychiatry
in England. Psychiatr Bull 2009 June 1,
2009;33(6):219-25.
5. Vize C, Humphries S, Brandling J, et al.
New Ways of Working: time to get off
the fence. Psychiatr Bull 2008 February 1,
2008;32(2):44-5.
Research and Audit
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