In 1995, learning to type using two fat fingers, I cursed the fact that I hadn’t taken secretarial studies. Since then computers have transformed primary care with online systems, scanned letters, electronic referrals, and searchable databases. Paper is dead. And as a consequence we have dispensed with secretarial support. I type all my own referrals and reports, I answer emails on the go, and I use my phone as my diary. Communication is easier and quicker. Technology is both revolution and revelation. So why has the NHS as a whole been so slow to respond to the changes in how we communicate?⇑
The health service is a large, hierarchical bureaucracy, and senior members are resplendent with badges of office—a glass office, a secretary (sometimes two) for correspondence, and also a personal assistant to keep the diary. Status and power are measured by the size of our entourage of administrative bodyguards. This administrative muscle is purportedly to improve communication, but in reality it is a barrier that enables senior staff to become detached from the frontline.
It is time to call time on the bling-bling of secretarial support that trust executives and senior managers enjoy. What about also phasing out the traditional medical secretaries in NHS hospitals and general practice surgeries while we’re at it? Most doctors and managers can type as quickly as they can dictate. Voice control and recognition software is getting better, and mobile computing means we are always contactable. And experience shows that when we are responsible for typing our own letters they become shorter and more direct, with fewer poorly punctuated, rambling, unreadable monologues. And patients would receive letters sooner if the communication process was simpler and more accountable.
Many doctors are already seeing the withdrawal of secretarial support. But the process is ad hoc, chaotic, and often inequitable. A proper review and a universal policy are needed so that change can be implemented throughout the NHS in a systematic way. As for personal assistants, there seems to be no justification, in my opinion, for any at all within NHS structures. But calling time on this function can only be achieved with improvements in information technology in the NHS. These systems are overcomplicated, clunky, with multiple ever changing passwords, difficult and slow to access at best. There is also the rise of the online, five-page, tick-list referral protocol, designed by the computer illiterate. These are the product of poor commissioning and a distant, hierarchical, and unaccountable management. It’s time for a communication revolution in the NHS. Savings can be made, communication improved, and hierarchy broken down.