New Ways of Working: are we prepared?

We completed an audit on New Ways of Working to compare the 60 most recent histories taken by junior doctors (STR1-3, including general practice trainees) and nursing staff in an out-patient clinic. The audit was done in Lymebrook Centre, which is one of the resource centres that caters for adult psychiatric patients in North Staffordshire Combined Healthcare NHS Trust.

All histories were assessed for 108 variables. In addition to assessing whether the relevant variable was reported, we also graded the information reported on whether it was comprehensive or only partially obtained. The data were collected on hard copy and analysed on SPSS version 13 for Windows.

This audit showed significant differences in histories taken by junior doctors and nurses. Doctors documented comprehensive histories for 52% of variables; they took incomplete histories for 8% of variables and did not ask for 39% of variables. Nurses have taken comprehensive histories for 32% of variables; they have taken incomplete histories for 13% and did not ask about histories for 55% of variables. There were statistically significant differences (P < 0.05) between the two groups in 44 out of the 108 variables, with doctors generally taking a more comprehensive and detailed assessment. The audit was presented within the Trust; nurses’ representatives were asked for their views. They stated that history-taking, physical examination and pharmacology are not part of their nursing training, therefore they are not confident in these aspects of patient care (e.g. physical, pharmacological). They have identified difficulties in differentiating physical symptoms because of functional and biological causes. Torn & McNichol ¹ found that 96% of nurse practitioners did not feel that their training adequately equips them to treat people with mental health problems and 83% did not feel adequately equipped to assess people with mental health problems. No other independent studies have since been completed and there is no other evidence available which would support New Ways of Working.

It is certain that psychiatry needs to change to provide better patient care and to overcome difficulties posed to the psychiatrists, but are we ready for it?