An NHS Disease; the rise of the 3LAs – and how YOU can stop it!


“Knowledge is power” – Sir Francis Bacon

I believe ‘language’ can be very powerful. Consider knowledge of ‘language’; a language that can create an air of superiority and mystique. A language that creates a sense of shared purpose, building a community with its own ‘tribal’ communication. This powerful language makes those in the group feel comfort and gives them a sense of belonging.

However for those outside the ‘tribe’ it can result in feeling marginalised. At its worst, it could result in coercive or bullying behaviour making the ‘listeners’ or recipients of the tribal language feel demotivated, less worthy, even stupid. As we know, power can be used to create positive change, used for the common good, but the flip side is that power can be very destructive.

In my opinion, we use ‘powerful’ language too much in the NHS and it’s about time we do something about it. I would like you to join me in my mission!

To help you decide, I will share some examples of ‘NHS speak’. The NHS Confederation has a great ‘Glossary of Terms’ App you can download via the iTunes App Store. I will use this as a ‘Glossary of NON Terms’ to learn as many as relevant, so I can use them in their entirety and not as abbreviations.

I start with 3LA – or three letter acronym, a potential cause of this NHS disease.

Acronyms and abbreviations are scattered across NHS documents, websites and letters. They are used in patient’s records, on information signs and repeatedly spoken in meetings up and down the country. Sometimes NHS staff hearing them will be confused, although they may not admit it.

So let’s start at the top, with the Department of Health or DoH. Now due to the popularity of a certain Homer Simpson we MUST use the acronym, DH.  Think about it ?!…..DOH!

Some 3LAs, are ‘words with two meanings’ …Zeppelin fans, we will come back to this! Routinely we use acronyms that have multiple meanings and we wonder why people get confused?  In a general practice meeting, I recall a male GP talking about ‘challenging PMS’. My first thoughts were that it was inappropriate to be talking about such a delicate matter. I soon realised he was talking about Personal Medical Services, not Pre Menstrual Syndrome! Nowadays though it could be PRIVATE Medical Services.

Do you get effective PPI (patient & public involvement) and PPE (patient & public engagement) in a PPG (practice participation group)? A point to discuss maybe?  And don’t confuse DNA (did not arrive) with DNR (do not resuscitate) – could be tricky!

There are also 2LAs – but is IP and in- patient or an information prescription? Guess it depends on circumstance but this could be awkward at best, risky at worse.

Acronyms or abbreviations are used to describe job roles and organisations. Hopefully we won’t confuse a HCA (health care assistant) with a HCAI (health care acquired infection) or an ECT (enhanced care team) with ICT (information and communication technology) or even and ICU (intensive care unit).

Theres some very dubious team names too. Who really wants a Fast Action Response Team ( thanks Mandy for that example) and what about the Health Improvement Team (HIT) who  considered adding the word Strategic to their team name title …. they didnt!

The new landscape of the NHS has given rise to new organisations. For example CCGs   (clinical commissioning groups) , PCTs (primary care teams NOT primary care trusts). We say goodbye to the NHSI and now have NHS IQ (NHS Improving Quality). We  lose lose  LinKs (Local Involvement Networks) but gain HWBBs (Health & Well Being Boards. Emerging are AHSNs(Academic Health Science Networks), SLETBs (Local Education & Training Boards), SCNs (Strategic Clinical Networks), LATs (local area teams) and RATs (say nothing) which are REGIONAL Area Teams. We have CSU (Commissioning Support Units, which support the CCGs and PCTs. However when I worked in the local hospital, or the FT (Foundation Trust) as it is known today; CSUs were Clinical Service Units, Clinical Support Units or Clinical Supply Units! I am now confusing myself.

They are also Royal Colleges; the RCN for nursing, RCGP for general practitioners, RCP for physicians, RCM for midwives and RCS for surgeons. Keeping up? But what’s the RCT? The Royal College of Therapists…no! …. no such thing, it means random controlled trial.

And when it comes to patients, there are some horrible acronyms. One of the worse is H2R which is a ‘hard to reach’ group. I was once told, there is no such thing as ‘hard to reach’, its just the NHS not ‘reaching’ in the right way. Another horror is BME (black & minority ethnic groups), not to be confused with AME ( annually managed expenditure) or BMA (British Medical Association).  

Now I apprecaite that medical acronyms are often useful, but not when communicating to patients. There’s not the time to detail medical diagnosis acronyms, or diagnostic test acronyms, but suffice to say, a CAT is not  a fluffy pet but a computerised axial tomography scan , or is it ‘crisis assessment &  treatment?

STOP!  Are you convinced? I hope so.

There is a need for change and the time is right. I’m looking for others to join me in my crusade. My ‘ask’ of you is to PLEASE consider dropping the 3LAs.  The clever ones amongst you will realise that was a call to action or ‘C2A’. I want YOU to think; really think about the language that YOU use and how you can ‘de mystify’ it, simplify it. Lets join together to get a movement of like-minded people to use ‘plain English’. The vision is we will really understand each other  make our communications with patients clearer and be ‘as one’.

Next time I will tackle ‘Management Speak’ …a whole other ‘ball-game’ on a ‘burning platform’!


After all that I need some Zeppelin and the perfect track is ‘Stairway to Heaven’ , with the line “Cause you know sometimes words have two meanings”. Well put , Robert.

Now if you can stomach it, there is a little story made up of a number of acronyms. There’s a prize for the first person to successfully decode it. Contact me via the blog or Twitter @michaelafirth8

In my role as a HCA in a FT A&E, I saw a BME patient arrive by SAS to the CDU. They had been seen by a CCP, or maybe it was an ECA as they’d been in a RTA. The patient was admitted to a RTT and the SHO then got them moved to ITU. The IP was then referred for a CAT scan as per the EBH and EBM. After a few days, they were moved to a DSU in a DTC but had a DTOC to the PCO. But at least it was a FCE! Good job there was an EPR for the ETP. But a question is, was there SDM or even PPI or PPE in this case?



About Michaela Finegan

Passionate about the NHS and making it better; for patients and staff. An avid fan of social media with the belief that, along with social marketing, social media the potential to positively affect how we use the NHS and how it provides services to us. First love is music, spending as much time as possible at gigs and festivals. Enduring, everlasting love for my two beautiful sons. All views my own.
This entry was posted in call to action, communication, management speak and tagged , , , , , . Bookmark the permalink.

4 Responses to An NHS Disease; the rise of the 3LAs – and how YOU can stop it!

  1. Excellent points here – the importance of effective communication cannot be overstated, for the benefit of both staff and patients. The most effective communication is always the most simple.

  2. Michaela Firth says:

    Reblogged this on Michaela Firth.

  3. Robert Ferris-Rogers says:

    you know how much this drives me mad too!

    • Michaela Firth says:

      I do indeed ! I love the way you challenge this behaviour.
      But together we can change things …. A day at a time x

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