Liam Farrell - Don't turn our district nurses into bureaucrats

District nurses, don't you just love them; if I was in the trenches, I'd want them there beside me.

Even more, I'd happily give them a leg up over the top; greater love hath no man. I can't go over the top myself, you understand, I've got bursitis, and hay fever, the mustard gas would play hell with my sinuses, I'd just get in the way; war is for young people anyway, we old folks would be better off with the more responsible jobs, such as fearlessly guarding the food supplies a few miles behind the front line.

District nurses have always been magnificent and absolutely dependable colleagues. I'm not suffering an excess of nostalgia here; I know there was trend among the Tories a few years ago to yearn for the 50s-style hospital matron, but I'm not pining for Hattie Jacques. It's simply that I've admired and respected every district nurse I've ever worked with, and over the years their advice and support have been invaluable.

Knowledgeable, sensible, practical, never afraid to get their hands dirty and get stuck in, I could go on and on extolling their virtues. So it's been a shame to see this precious and irreplaceable resource being squandered, to see district nurses increasingly hamstrung by the same stultifying and ever more labyrinthine bureaucracy that constipates our own practice.

Everything has to be written down, everything has to be reported. I accept that some degree of accountability is desirable, but there comes a stage when it defeats its own purpose.

It takes so long to explain what we are doing that it significantly affects our ability to do the actual thing that needs to be done.

Middle management, that most proliferative breed in the NHS, just adore accountability. It's the Trojan horse which allows them to construct and justify their vast and ever-increasing bureaucracy.

They are like Lewis Carroll's White Knight: '"Come, tell me how you live!" I cried/And thumped him on the head.'

The raison d'etre of the bureaucrat, however, is nothing to do with patient care; it's looking out for themselves. And I don't need any detailed reports to tell me that they're doing a very good job at that.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Just published

GP consultation

GP practices delivering 150,000 extra appointments per day compared with 2019

GP practices in England delivered 150,000 more appointments per working day in the...

Surgeon looking at a monitor in an operating theatre

NICE recommends non-invasive surgical procedure to target obesity

NICE has said that a non-invasive weight loss procedure should be used by the NHS...

GP trainee

Two training posts deliver one full-time GP on average, report warns

Two training posts are needed on average to deliver a single fully-qualified, full-time...

Dr Fiona Day

How to flourish as a GP by learning from the good and the difficult

Leadership and career coach Dr Fiona Day explains how GPs can grow and develop from...

Unhappy older woman sitting at home alone

Low mood – red flag symptoms

Low mood is a common presentation in primary care and can be a sign of a mental health...


PCN to take on GMS practice contract in landmark move for general practice

A GP practice in Hertfordshire could become the first to be run directly by a PCN...