Of all the petty-minded bureaucracy, idiotic tick-boxing and counterproductive diktats handed down by our ivory-tower dwelling managerial colleagues in the NHS; the one thing that really blows the mercury through the top of the tube for me (or would if we were allowed mercury sphygmomanometers) is the constant changing of referral forms.
Let us imagine, hypothetically, you have a brightly coloured form. Let’s say, for argument’s sake, it is yellow and let us further suppose any health professional who qualified since John Major was PM were aware of its very specific function: for the prescribing of controlled drugs to dying patients.
Fast forward to Friday afternoon, you are the only doctor on duty and you get an urgent call from the palliative care team to say the yellow form you diligently completed the previous day, in anticipation of the patient’s decline, is no good as they have now switched to a new form. You argue, quite reasonably in your view, that as the patient is dying and in distress, could the team not just issue the medication using the old form and perhaps we could sort the paperwork out later.
After all, you implore, surely the patient’s pain relief is all that really matters. You may find yourself smattering the last part of your speech with silently mouthed obscenities, but then we are only human. You are politely informed by an individual whose job is clearly not as valuable as the colour of a medication form, that no, you must complete the correct form or the drugs cannot be administered.
There then follows a stream of very naughty Anglo-Saxon expletives and a desperate search through the endless list of online forms. After much searching you find the latest version which, to your delight, turns out to be a 12-page document with one paragraph relevant to the prescribing of drugs in end of life care.
Needless to say the form does not work and the palliative care team end up having to bring a paper version of the new form in to the surgery for you to complete by hand.
Unfortunately, this account is a not a hypothetical scenario written in the second person, but as you have probably guessed by now, how my working week ended recently.
‘Replacing things that do not need replacing with things that work less well than the original and being bloody minded about it’ may as well be emblazoned as a mission statement on lapel badges and issued to all NHS management.
Dr David Turner is a GP in west London