Helen Salisbury: Practising at the top of your licence

Doctors in every branch of practice grumble about time wasted trying to fix malfunctioning printers or scouring the workplace for the right blood bottle or pathology form. A well organised health service would have staff on hand to help with such tasks, as it makes no sense to use your most highly trained staff on work that could safely be carried out by someone with less training.The idea of working at the top of one’s licence means just that—spending most of your time doing things that require your expertise. Not surprisingly, it’s an idea beloved of economists: why pay a doctor when a specialist nurse could do the job; why pay a nurse when the task could be undertaken by a healthcare assistant; and so on, right down to offloading work onto the voluntary sector, where no cost is incurred.1 Of course, the economic argument for this concept works only…
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