No time for noctors

Jobbing Doctor returns from his holiday to an irritating letter regarding one of his patients

Holidays are very important. I've just had my first proper one for six months, and it was badly needed.

When you get back off holiday, the work piles up waiting for you, so the first day back is pretty grim. The first task is to check if anyone has died or has become acutely ill. I defy any GP to say that they don't do this when they return from leave: it's a defensive thing where you are worried that you have made an awful mistake causing the death of a patient.

This time there was nothing, except a very old Irish man who died of natural causes.

Then there are the problems left behind that your partners can't deal with, and this time the biggest problem I am finding is with an increasingly irritating group of healthcare workers - the noctors.

Noctors are essentially people who are now doing some of the roles that doctors used to do, but they are not medically qualified - 'not a doctor' or noctors, for short.

I have a patient who is dying at the moment. The details are unimportant, but essentially I have discussed with the family of this patient - at length - the fact that it would be best for my patient to be managed within a residential environment. I have made a clear note that the patient should not be sent to A&E, but they should contact me, and the family have my mobile phone number and my house number (I'm still in the phone book - albeit as Mr Jobbing Doctor). I am visiting daily. This is what we do.

Cue the noctor. This is a nurse who is the 'leader' of the Community Learning Disability Team. No, I don't have much idea what they do either. But he sends me a pompous letter saying that they need to be involved in the care of my patient, and requesting that I convene a meeting with him, the family, the residential home staff, some consultant who I've never met and a social worker. This is what he recommends.

It's a good job that I was in a good mood when I returned from holiday. I dictated a reply. Then I deleted that and dictated again: this is the 24-hour rule of letters. If you are writing a stroppy letter, leave it for 24 hours before you send it - particularly important with e-mails, I find.

I wanted to write to him and ask him who he was, what authority he had, who did he think he was talking to, and so on. In the end, I was diplomatic - I thanked him for his input, politely declined his offer of a meeting, explained the arrangements I had put in place, and left it at that. Fortunately, the nuance of the wording will be such that he will not realise the gently subliminal message.

That message is to bugger off and leave it to the clinician who has been looking after the same lady for 31 years.

This example is one of many where we have noctors feverishly clutching their protocols and guidelines, and muttering phrases such as 'current best practice is.....' or 'it is recommended by Organisation X that....'.

There is a role for people who wish to have extended clinical roles within management of clinical issues, but they should not seek to undermine or replace the appropriately qualified individual who has been doing the job well for many years.

If the noctor wants to do my job, well fine: I suggest 3 A-levels at A* grade. Five years at medical school, another seven or eight years postgraduate training.

Then he can tell me what to do.

The Jobbing Doctor is a general practitioner in a deprived urban area of England.