The Relentless NHS, the Prescribing Paradox, and Becoming the Doctor You Once Chased

Disclaimer

This blog reflects personal views and experiences only. It is written in accordance with the NMC Code and social media guidance. No patient-identifiable information is included. The content is intended for reflective, educational, and professional discussion purposes and does not represent the views of my employer, colleagues, or any organisation. Any resemblance to specific individuals, teams, or situations is entirely coincidental (although NHS colleagues may recognise the general atmosphere).

Half-term

For most families, this means rest, recovery, and perhaps a trip somewhere involving overpriced coffee and soft play.

For NHS staff, it usually means one person is on leave while the other is holding the clinical front line together with caffeine, professional resilience, and the faint hope that the triage queue will eventually end.

My wife, for example, is currently stationed in the Surgical Department assessing patients — a role that can best be described as operationally relentless and emotionally athletic.

The public perception of NHS work often underestimates the cognitive load, pace, and constant decision-making required. It is not simply busy. It is sustained intensity, day after day, with very little margin for error.

My own role brings different pressures. Unlike acute triage environments, I work within a relatively stable Upper GI team. Doctors rotate, but the core nursing structure remains consistent. Stability, however, brings its own unintended consequence: performance becomes the new baseline.

If you successfully arrange imaging yesterday rather than next week, that quickly becomes the expected turnaround. If you walk to radiology, speak to interventional colleagues, and coordinate the pathway yourself — that level of service quietly becomes “standard practice”.

Success, in the NHS, has a habit of normalising itself.

The same principle applies to endoscopy access. Things get done because someone puts the legwork in. Relationships help, of course. Knowing who to speak to, understanding system pressures, and communicating clinically rather than transactionally makes a difference.

However, this is not simply a matter of personal style — it is a matter of system function.

Legwork is not an optional extra. It is an essential clinical activity.

Modern healthcare pathways may be digital, protocol-driven, and process-heavy, but the reality remains that complex systems move when professionals actively navigate them. Walking to a department, having a clinical conversation, clarifying urgency, and building professional trust frequently makes the difference between a request sitting in a queue and a patient progressing through their pathway.

Increasingly, however, there is a perception that if a form has been submitted or an electronic request has been sent, the job is complete. The unintended consequence of this shift is predictable: delays, duplication, and the familiar phrase — “I thought someone else was dealing with it.”

The absence of legwork does not create efficiency.

It creates inertia.

From a professional perspective, I consider this aspect of the role both necessary and appropriate. Patient care does not end at the point of request submission; it includes actively ensuring that the system responds.

In many cases, the difference between average and effective care lies not in clinical knowledge, but in system navigation and professional ownership.

The Prescribing Bottleneck

Another recurring feature of my working life is the steady flow of outpatient prescription requests — predominantly for bariatric patients.

This is not an “issue” in the negative sense, hence the quotation marks. It reflects a wider structural tension between primary and specialist care that many services across the South West will recognise. The practical outcome, however, is that a significant proportion of prescribing activity is redirected back to the hospital team.

Within our Upper GI service, I am currently the only Non-Medical Prescriber (NMP).

Accessibility is a double-edged sword. When you are known, available, and responsive, requests naturally gravitate toward you. At times, this creates a curious professional identity — part of the bariatric service when prescribing is required, somewhat peripheral when strategic or workload discussions occur.

The landscape has changed significantly over recent years. Historically, bariatric prescribing was often framed as “just vitamins and minerals” — not necessarily seen as sufficient justification for advanced training. That perception no longer reflects clinical reality. Patients now require more complex pharmacological management, long-term optimisation, and careful governance.

Healthcare roles, like biological species, must adapt to environmental change.

Otherwise, extinction is not theoretical — it is organisational.

From a workforce perspective, expanding prescribing capability across the team would distribute workload more equitably, enhance resilience, and represent appropriate professional development.

Advanced practice is not about role expansion for its own sake; it is about aligning capability with evolving patient need.

The Communication Gradient

Within the team, the nature of requests varies.

When nursing colleagues approach me, the interaction is usually contextual, immediate, and clinically grounded. We share an office, discuss patients regularly, and there is an implicit understanding of the clinical background. The legwork has already been done.

Email-based requests, particularly when the patient cohort is less familiar to me, require a different approach. Safe prescribing demands adequate information, clinical rationale, and traceability. This can lead to several rounds of clarification — not out of reluctance, but out of professional accountability.

This reflects a broader point:
Non-medical prescribing is not simply a technical skill. It is a governance responsibility.

The NMC Code is clear. If you sign the prescription, you own the decision.

And I am rather attached to my registration.

Perspective (and a Touch of Professional Karma)

Perhaps the most interesting part of this half-term reflection is the shift in professional empathy.

Years ago, as a ward nurse on night shifts, I remember asking doctors to prescribe fluids. Their cautious questioning occasionally felt… unnecessary. Why all the detail? Why the hesitation?

Now, sitting on the other side of the prescribing decision, I understand.

Every prescription represents clinical risk, professional accountability, and regulatory responsibility. The “shifty” questions were never avoidance — they were due diligence.

It turns out that career progression has an unexpected side effect:
you gradually become the person you once chased down the corridor.

Conclusion

So yes — half-term is a welcome pause.

But the reflection is this: healthcare does not move because systems are well designed. It moves because someone walks to radiology. Someone speaks to endoscopy. Someone asks the extra question before signing the prescription.

In other words, the NHS runs on legwork.

And if that legwork ever disappears, we may finally discover the true national waiting list — the one where every request is technically “done”, but nothing actually happens.

Which is why, next week, I will once again be leaving my desk, walking down a corridor, and politely asking someone if something can be done.

Because in the NHS, progress is rarely digital.

It’s usually measured in steps.