I’m going to sound a bit mad here. But I’ve been warning everyone about this, and no one has been listening to me. It’s nearly too late. They know where you live. And they’re coming to get you – the PCN, the CQC, the GMC.
It’s that shared decision-making thing. It’s there, in the PCN DES: ‘By 30 September 2022, a PCN must ensure all clinical staff complete the Personalised Care Institute’s 30-min e-learning refresher training for Shared Decision Making (SDM) conversations.’ All clinical staff: that means us. So when I read the DES I told everyone.
You won’t believe me, I said, but we’ve all got to do something called training for Shared Decision Making (SDM) conversations. I tried to convince them that we should run, run for our lives. But they said no, that’s ridiculous, that’s insane: shared decision making conversations are what we’ve done every day, for years, in literally every consultation. We have nothing to learn. No one’s going to make us do that. It’s like insisting politicians do a refresher course in lying. Bonkers.
Then the emails started coming. Reminding me that I had to do it, and that the deadline was drawing near. And the more I realised it was real, the more deranged I got. Partly because general practice really is increasingly a place where you don’t have to be mad to work here, etc. But mainly because I find the concept of mandatory Shared Decision Making Conversations Training for a GP with 34 years’ experience arbitrary, insulting, deprofessionalising, patronising, infuriating, demoralising, demeaning, timewasting, unrealistic, pathetic and potentially hysterically funny.
I decided that the only way I could cope was to subvert the whole thing, perhaps by giving away the answers to the five pre- and post-assessment questions through this blog, in coded form. But I wouldn’t do that because:
1 That would be a) puerile b) dangerous c) unkind e) immoral
2 The idea that sharing (ha!) it with readers would be a delicious irony is ‘False’
3 It’s as easy as a,b,c,d anyway
4 The idea that it might be hysterically funny, as suggested above, unfortunately proved also to be ‘False’
5 I thought I should just let it be (b)
And we’re left with the delicious perversity that the concept of shared decision making training must be in the PCN DES because of imposition rather than mutual agreement.
Never mind. I’ve got a sustificate now, I understand there is software available that can edit pdfs, and you know where I live. If not, just follow the mad laughter.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs here
READERS' COMMENTS [12]
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Deranged and derailed.
Completely concur with Paragraph 1.
The matrix is getting stickier, and most of the sheep are penned for the slaughter. They can’t even see the web, because their faces are glued to their screens and they’ve forgotten their own worth and mortality. Keep sharing. Keep been monitoring. They’re watching you you know. They’ll soon share your whole appointment book, that’s what they want. Then you’re stuffed. The October slots are just a trial, and you’ll be seeing Tom Dick and Harry from down the road. Tasty sign-up. The same shared decisions that strike you off at tribunals and rate you as inadequate for not testing your thermometer and doing an audit on whatevers trendy at the moment. Share a decision about taking the flack for all the decisions and share the passing of the buck back to your ugly over-regulated lap. Even (scape)goats don’t share a decision, they just run off individually when they see danger, or jump off a cliff.
That’s what you get when you let faceless bureaucrats run the health service. “getting the BCDs to tell the AAAs what to do” is how someone I respected once describe it.
Appreciate the article for getting awareness out there, Copperfield, and hope you’re also voting to reflect your frustrations.
Well said people, well said. The pen pushers are justifying their jobs assuming they are making a difference and most are like the Emperor’s new clothes until they come to read Pulse. When BCDs make decisions, this is what we get.
BCD seems a little generous don’t you think Or as a 3 B’s offer I am clearly now an old fart and would consider at lot odf these people 2 E’s at best
Where’s AC12 when you really need them!
I costed this at about £1million for England. Less is you underpay your staff.
Fag packet sums:
England headcount of clinicians in GP, Nov 2021 = 88k.
88k*0.5 hours =44k hours.
Assume we pay them all 30mins of national living wage =
44k*£9.5 = £418k
The pilot actually calls for 2 FULL DAYS of STAFF TIME –
https://www.hee.nhs.uk/our-work/learning-disability/oliver-mcgowan-mandatory-training-learning-disability-autism
so calculation is (again, an underestimate)
88k* 14hours = 1232k hours (1.2 million hours)
Paid at national living wage =
1232K*£9.5 = £11704k (11.7 million pounds)
My apologies, the link clearly refers the last instance of imposing a 30 minute course on every clinician in England. Hard to tell these apart sometimes.
That came from CQC, in their 1st July update –
“All CQC-registered providers to ensure their staff receive training on interacting with people with a learning disability and autistic people”
i thought this was made up until i realised there is such a programme. Add this to the cqc new plan of statements and aspirations .
Who is driving this??? As a semi retired shall I stop or carry on GP worrying about my clinical safety I realise i live in a different world than those running the NHS. And they are worried about GP retention??
They are certainly not worried about GP retention. Indeed, they might be quite hurt if you suggested that what they are doing was stripping away whatever small shreds of enthusiasm anyone might have left for the job. Making GPs jump through new hoops is the gift that keeps on giving.
34 years is a good shift Tony, same as me, I left today.
Yes, there does need to be more shared decision making, but online tick box learning is not the answer. Investment in increasing GP numbers is what is needed.
When patients are seen mostly there is a shared decision. Looking broader – should patients receive test kits from their GP “your GP would like you to have a kidney test” It’s abnormal – what test is it, I don’t know – what are they looking for, I don’t know, I repeated it – and they want it repeated in 3 months, why, I don’t know. No diabetes, thinks kidney function ok – but does not know. Well and active and feels fine.
This is not shared decision making, but this patient has the advantage of asking family what it means.
Is this GP land trying to up their qof before another cqc?
Fundamentally the answer is not tick box learning for clinical staff.
I trust that the PCN managers have done this learning.
The answer is to invest in Primary care, more clinicians are needed, and enable them to do their job, not more tick box learning.
Box ticking is essential. If there is no box ticking, there is no CQC jobs, NHSE jobs etc. They need to generate paperwork at your expense to keep them in their jobs. It does not matter if you have less doctor-patient consultation time. Some regulation is essential but this is way too much nitpicking and it is detrimental to general practice.