Estimated reading time at 200 wpm: 14 minutes

This publication outlines the secretarial support required by Consultant Forensic Psychiatrists (CFPs) to function effectively and safely. In recent years, widespread NHS cost-cutting measures have led to a systemic downgrade of administrative roles, with highly skilled medical secretaries often being replaced by ‘admins’ of lesser competence.

This strategic ‘re-banding’ pushed by central government, has created a significant skills gap, forcing consultants to spend valuable time on administrative tasks rather than on the critical clinical work. As a result money has been saved by what is euphemistically known as ‘workforce reprofiling‘. Any savings made in respect of ‘secretarial’ was made meaningless by increased inefficiency costs. But the ‘spreadsheets’ are not well contected, so no-one really knows.

The assertions made in this article are not based on research or audits. There have been no national audits on this topic or any of a robust nature relevant to CFPs, to the author’s awareness (having searched for such). The contents here are based on 30 years of experience across over 20 different health services mostly in the NHS and HSCNI. It draws on knowledge of how CFPs and other psychiatrists work through interacting with them, and listening to their difficulties.

Table of Contents

• The Fundamental Role of a Secretary
• Core Competencies of Secretaries to CFPs
• Limitations of AI and Technology
• The Categorised Framework of Needs
• The Systemic Challenge: Why Support Fails
  • Line Manager Support
  • Lack of Competence and Consequences
• Examples
  • Real examples of admin incompetence
  • Real example of secretarial competence
• Conclusion: The Indispensable Partner

The Fundamental Role of a Secretary

The role of a secretary to a Consultant Forensic Psychiatrist (CFP) is not merely administrative; it is a specialised, multi-faceted position that is crucial for the efficient and safe delivery of patient care. A competent secretary functions as a vital non-clinical partner, managing operational work so the CFP can focus on clinical and professional duties.

Contrary to ideas held by many ‘managers’ most CFPs do not need as much typing or transcription of dictation compared to years ago. This is because speech recognition is now easily available – and of reasonable quality – directly from within MS Word. Secretarial support is better spent polishing any obvious typographical errors from electronic transcriptions and other draft documents created by the CFP, or some from team members that the CFP will sign off.

Health Service Managers tend to argue that the role and competencies described here are those of a ‘Personal Assistant‘. Persistent erosion of the job specifications of secretarial roles into ‘admin roles’ has caused ‘managers’ to believe that something much better than ‘admin’ is a PA. All in this publication is basic and what would have been expected of secretaries, 20 years ago. Times have changed but the needs for such roles haven’t.

Many managers do not possess detailed knowledge of what psychiatry is or worse yet what forensic psychiatry is. They therefore do not understand the demands of the job. I can say that based on rich experience of interacting with a range of managers over the last 20 years.

Core Competencies of Secretaries to CFPs

The effectiveness of a secretary in this role is determined by a specific set of skills that fall far outside of basic administrative duties. The following table provides an overview of the competencies required to provide a high level of support, categorised by their importance to the role. These skills have often been overlooked in the transition to more generic ‘admin’ roles and are a key reason for the documented decline in support quality.

Vital Competencies	Essential Competencies	Desirable Competencies
Professional Writing & Grammar: High-level command of UK grammar, spelling, and punctuation. The ability to finalise professional, legally defensible documents by direct co-working with CFP. [This is not inappropriate delegation of a secretary to do clinical work. CFP always takes lead and final responsibility for all documents ]	Complex Diary & Scheduling: Expertise in managing a busy schedule involving clinical, medico-legal, and academic appointments.	Academic and Research Support: Experience in formatting and proofreading academic papers, presentations, or organising academic meetings.
Information Governance & Confidentiality: A deep understanding of GDPR and the secure handling of sensitive patient and medico-legal information, crucial for all communication and documentation.	Liaison & Communication: Professional, tactful, and effective communication with a wide range of individuals, from patients’ relatives to court staff. Liaison experience and skills with legal teams regarding administrative matters.	Problem-Solving Skills: The ability to identify and resolve issues independently, such as sourcing difficult-to-find records or navigating bureaucratic hurdles.
Proactive Judgement: The ability to make independent decisions within their role, anticipate needs, and manage conflicting priorities without constant direct supervision from the consultant.	Documentation & Transcription: The ability to take accurate minutes and transcribe dictations, with a good working knowledge of medical and legal terminology.	IT Proficiency: Advanced skills in a range of software and systems to streamline workflows and increase efficiency beyond basic word processing.
Typing Speed: High typing speed (>60wpm) for efficient transcription and document production, crucial for polishing up any documents and correspondence.	Information Gathering: The ability to chase and collate comprehensive records from a wide range of organisations.	General Management & Administration: Competence in handling administrative tasks related to service development, team management, and inter-departmental projects.
High level of competence with Office 365 applications: Including MS Word, Outlook, OneDrive, Sharepoint, and Excel.	Legal & Court Preparation: Competence in preparing documents for Courts, Tribunals and Managers’ Appeals. [Preparation here, does not mean writing the reports. It means skills to format documents to a high standard.]
	Forward-thinking & Anticipatory Planning: The ability to anticipate the consultant’s evolving needs and take proactive steps to streamline workflows based on the nature of the work.

Limitations of AI and Technology

While AI and other technological solutions are useful for some text-based tasks, they cannot replace the core competencies of a highly-skilled secretary. Typing is not the big issue, though some skills are necessary.

Current AI models cannot perform the crucial interpersonal and proactive duties essential to this role, such as making phone calls, arranging meetings, or exercising the judgment and proactivity necessary for effective liaison.

Furthermore, due to strict UK information governance and data protection policies, AI’s role in handling highly sensitive patient data is significantly limited, making it a poor substitute for a trained human with an understanding of these protocols.

The Categorised Framework of Needs

The requirements for secretarial support can be broken down into three core, interlocking categories. A high-quality secretary or “admin” functions effectively across all three.

Core Clinical and Administrative Support

This covers the essential day-to-day tasks that underpin clinical practice. A lack of expertise here directly impacts a CFP’s efficiency and ability to manage their caseload.

1. Proactive Diary and Agenda Management:
   1. Proactive scheduling of clinical appointments, team meetings, and supervision sessions.
   2. Coordination of multi-disciplinary team (MDT) meetings and case conferences.
   3. Scheduling patient assessments, follow-ups, and visits to external units
   4. Booking and managing travel arrangements for clinical duties.
2. Effective Communication:
   1. Acting as the primary point of contact for internal and external stakeholders.
   2. Triaging calls, managing correspondence, and liaising with team members and relatives of patients.
3. Accurate Documentation:
   1. Taking professionally worded and legally defensible minutes for all meetings and case conferences, ensuring precise and clear language.
4. Medical and Patient Record Management:
   1. Securely handling sensitive patient records in compliance with GDPR.
   2. Populating forms with accurate data, and ensuring records are up-to-date and easily accessible.
5. Medication and Prescription Management:
   1. Organising and preparing repeat prescriptions for the CFP’s review and sign-off.

Medico-Legal and Report-Specific Support

This is a unique and high-stakes area of forensic psychiatry that demands specific skills not found in general administration.

1. Production of Medico-Legal Documents:
   1. Transcription of dictations, formatting, and proofreading complex medico-legal reports, risk assessments, and psychiatric summaries.
2. Information Gathering:
   1. Requesting and collating comprehensive records from a wide range of organisations (e.g., police, prisons, courts, other NHS Trusts) under the correct legal frameworks, and tracking these requests meticulously.
   2. Court and Legal Liaison: Coordinating with legal teams and court clerks, and managing administrative aspects related to a court appearance.
   3. General Management Support: Handling administrative tasks related to service development, team management, and inter-departmental projects.

Academic, Managerial, and Professional Development Support

This is an often overlooked area. A CFP’s work extends beyond direct clinical care, and this support is necessary for professional excellence and career progression.

1. CPD and Training Logistics:
   1. Managing the administrative side of Continuing Professional Development (CPD), including booking training, tracking hours, and organising attendance at conferences.
2. Academic and Research Assistance:
   1. Assisting with the formatting and preparation of presentations, articles, and research papers.
   2. Organising teaching sessions or academic meetings.

The Systemic Challenge: Why Support Fails

The decline in the quality of secretarial support is not a matter of individual competence but a result of systemic changes driven by NHS cost-cutting.

• Downgrading and Re-banding: The downgrading of secretarial roles from a higher pay band (e.g., Band 4) to a lower one (e.g., Band 3) led to a change in job titles from “medical secretary” to a generic “admin” or “pathway assistant.”
• “Workforce Re-profiling”: This is the official term for the process of re-evaluating job roles to justify these downgrades, even when the core duties remain the same. This strategic practice, part of broader NHS efficiency drives, has been implemented across multiple Trusts.
• The “False Economy”: By forcing CFPs to spend valuable clinical time on administrative tasks—such as correcting “social media-style” minutes—the system creates a “false economy.” It saves money on a lower-paid administrative role but wastes the time of a highly-paid specialist, which leads to inefficiencies, delays, and potential risks to patient care.

Line Manager Support

‘Some line managers’ have instructed ‘admins’ “not to touch clinical documents” and that they must not cut and paste anything into them even if the CFP takes final responsibility for documents. This means that the CFP must manually cut and paste background history into certain reports. But strangely ‘admins’ are allowed to ‘touch’ ward round minutes which is a ‘clinical document’. The way that works apparently – is that the ‘admin’ is ‘touching’ but not cutting and pasting anything. Such ‘directives’ reveals a fundamental lack of trust in administrative staff and a profound misunderstanding of their role. Those managers are attempting to protect themselves from some perceived risk by creating blanket rules, but they’re doing so without considering the practical consequences. They do not demonstrate knowledge of what responsibility means. The distinction between a ‘clinical document’ for a report and ‘clinical document’ for minutes is entirely arbitrary and only serves to create more work.

As this is my blog I can say what I think. Such line managers are incompetent. But incompetence ‘always’ lives in an ‘envelope’ arising from a higher level.

Lack of Competence and Consequences

The practical impact of this systemic failure is serious.

When a highly-skilled medical secretary with a grasp of vital competencies like professional writing, information governance, and proactive judgement is replaced by a less experienced ‘admin’, the workload doesn’t disappear. Instead, it is shifted onto the consultant.

A lack of competence in documentation means that a CFP must spend hours correcting minutes to make them legally accountable. A deficit in liaison skills forces the consultant to personally chase records, arrange complex meetings, and manage communication with external bodies. Using support doctors to substitute for such non-clinical activities is a waste of resources and clinical time.

This diversion of effort from clinical care to basic administration represents the core of the ‘false economy’ and is a direct consequence of a staffing model that fundamentally misunderstands the specialised needs of CFPs’ practice.

Ultimately safety, quailty and efficiency of patient care are negatively impacted.

Examples

Real examples of admin incompetence

‘Incompetence’ is used in the sense of someone who is not suited to the role. This is primarily a managerial and leadership issue. Because the author has not won the Euromillions Jackpot and has a need not to be struck-off the GMC register, only vague and anonymised examples will be given spanning the last several years.

1. Profoundly deaf secretary – this is not a joke – it was confirmed by HR as a known problem about which they had no solution.
2. Admin tells CFP “You need to send the court document (via XXXX)” after receiving a clear instruction. Nope – there was no potential breach of process or Information Governance procedures. In this scenario the ‘admin’ is the boss of the CFP.
3. Social media type wording in professional minutes.
4. Typing speed that is less than 40 wpm.
5. Missing important reference points as to who said what in minutes of meetings.
6. Words without quotation marks in important parts of patient interaction with teams.
7. Spelling and grammatical errors that would be expected of a 10-year old, left for the CFP to correct.
8. Spelling of medications that made them unidentifiable or unrecognisable.
9. Loss of syntax that makes minutes meaningless.
10. Cluelessness about what ‘decision-making’ means, it’s utmost importance in forensic psychiatry, and hence failure to capture key issues balanced in decision-making.
11. Failures to capture important legal issues because ‘they became confused’.
12. Totally missing the context of what happened in Ward Rounds.
13. Massive blanks in minutes – where nothing is documented of important words, CFP then has to fill in.

The high-point of this occurred when manager (not a CFP) in a certain service read the minutes of a high-level meeting with five people, and could not make head nor tail of what was documented in the minutes by an ‘admin’. The said manager confirmed that he had to reconvene the whole meeting.

Real example of secretarial competence

The following is anonymised. It was a recommendation for a secretary who was in an ‘admin role’. She approached me for a reference as she was seeking a better paid managerial role much closer to her home outside of the NHS. D got the job! The best move on and up.

She was one of three such excellent secretaries (even if called ‘admins. The three were at one end of the ‘curve’. The rest were not suited to their secretarial roles – not their fault. Caution: this does not mean that I expect every secretary to be as good as D or the top three.

Conclusion: The Indispensable Partner

The evidence is clear: the decline in highly skilled administrative support for Consultant Forensic Psychiatrists is a critical issue. It’s not an isolated problem but a consequence of a systemic ‘workforce re-profiling’ that has led to a costly ‘false economy’. Well-trained and experienced secretaries are far from a luxury; they are an indispensable part of the clinical team.

The work of a Forensic Psychiatrist is profoundly complex and high-stakes. It requires immense mental focus on clinical detail, medico-legal precision, and patient safety. When a consultant’s time is diverted to chasing records, spending unnecessary hours correcting minutes, or managing their own schedule, it compromises their ability to deliver the specialised care for which they are trained.

AI, for all its text-based abilities, simply cannot bridge this gap. A machine lacks the proactive judgement, communication skills, and understanding of sensitive human situations that a competent secretary possesses.

Ultimately, the quality of patient care relies on the efficiency of the entire system. The secretary’s vital role in managing the administrative complexities of a CFP’s practice directly enables the consultant to do their job to the highest possible standard. It is a partnership where the human element is not only valuable but non-negotiable.

Cost savings on hiring persons with a skill-mix that do not match the needs of CFPs have real implications for costs, continuity of care, patient safety, and recruitment and retention of CFPs. The crazed ‘spreadsheet’ says that ‘It makes sense for CFPs usually paid at over £100,000/yr to spend an hour correcting minutes from meetings, CPAs, cutting and pasting text and formatting it‘. And it makes ‘more sense’ for locum consultants paid at 50 to 100% over that to do the same.