Many years ago Nottingham was thought of as a decent medical/scientific centre. It had a good medical school, the major hospitals had a strong reputation for high quality care. Things have clearly changed. Another scandal in another specialty. These are not isolated problems.
🚨 EXC: Nottingham hospital launches urgent investigation into hip fracture deaths as its mortality rate hits 50% more than national average - the problem is linked to long delays for emergency surgery according to internal documents.
Full story: thetimes.com/article/b5bc397…
Simply saying this is a failure of our orthopaedic surgeons is not right. It's a failure of their entire system of emergency/urgent care. It reflects incredibly badly on the entire hospital, and in combination with the other scandals we have seen it points to a failed institution
It seems strange that there is such warranted concern about staff access to records and breaches of confidentiality, yet totally random people looking to profit from patient data have full access to patient records even if patients explicitly state they refuse Palantir access
This statement means that there will be nothing that PA/PAAs cannot do. It will also be the same for any 'advanced' practitioners. There is absolutely no point anyone in the UK going to medical school. Why bother with all that work when you can bypass it all?
This is crazy. Out of hours the med reg and ICU reg are a team caring for the sickest patients in the hospital. Their consultants are usually at home. If neither of them are medically qualified who provides senior medical opinions on sick patients? Are consultants in house?
Doctors make mistakes. Doctors miss things. None of us are perfect. A child who has been seen by a senior doctor who sends them to the ED for further assessment should not be discharged by someone who is not a doctor. Where are the senior EM and paeds doctors condemning this?
Doctor substitution is being championed at the highest levels yet anyone with a grain of common sense or integrity knows it’s nonsense
I wonder what platitudes @theRCN or @RCEMpresident would offer these parents given their involvement in enabling this scenario?
Seems pertinent to point out that in the tragic case of a child dying after being discharged from the ED reported by @JanetEastham the ANP involved tried to place responsibility for the discharge on an EM resident doctor. So sad and totally avoidable
Burnt Toast retweeted
GP refers child to hospital appropriately
Nurse doing a job they should never be doing, ignores referral, misses the diagnosis a third year medical student would make & inappropriately discharges child to worse possible outcome
Dropping professional standards causes harm : FACT
The refusal to identify who wrote this document shows that there remains a lack of honesty and integrity at the very heart of the UK PA project. Nothing has changed.
Comments on the protocol for PAs:
Regards the people who have done this.
It's no different to what I saw when RCP was making their interim document of scope.
A few of us stopped it from a complete slide at that point- and this panel doesn't have a dissenting voice- so it's mostly an echo chamber IMO.
FWIW?
I respect Gill Leng- and she has been-IMO- bench pressed by a skewed group.
It is why she is asking for as many people as possible to comment on this.
If we-as doctors- we want to support her and @lengreview recommendations, we support her through organisations as best as we can.
First the good news:
1. With the @TheBMA having put the PA protocol document in the public domain?
The @RCPhysicians is saved the hassle of mulling over whether to open it up formally.
Now that it's open, let Members & Fellows decide whether they want to take this level of supervisory responsibility.
Let the wider democracy give their views
2. It's a national scope work- so we are finally moving away from the nonsense of 'local scope'
Now the rest:
1. My personal view?
It's a flat No from secondary care perspective
No one has that level of supervisory capacity as stated in document due to job plan constraints.
And we have the 'Medical Education & Training Review' yet to land @DacreJane
Which means- we will have lesser trained people seeing undifferentiated patients- and cause harm.
2. In my opinion, it should be rejected by RCP et al- but I don't speak for all.
Write to your College.
If you- as a Resident Doctor- or Senior- feel this is ok?
Write too.
That is my view- and I will not want any of my loved ones to be seen by a PA as per this protocol.
I have the privilege to avoid that.
Question is- do you.
This document goes nowhere without support of @TheBMA @RCPhysicians @rcgp et al
I can guarantee you that @DHSCgovuk will not take on a pitched battle if all doctor organisations- the ones being asked to be the liability sponge- says 'No'
Over to all of you.
I know it feels tiring sometimes- battling the machine- while trying to improve patient safety
Yet- You only lose when you give up.
@mmamas1973 @djnicholl @Mumtaz_Patel_1 @OGMustafa @VictoriaTzB @SwordsFrankie
Burnt Toast retweeted
The consultation on clinical protocols for PAs to see undifferentiated patients is published below⤵️
These are loose and unrestrictive, raising safety concerns
Worse, the burden of supervising falls on ST4s+
Doctors, reach out to your royal college and ask them to reject this.
Wait, there was no formal representation from bodies who represent doctors on the panel that wrote these guidelines? The BMA should have been at the front and centre of this. Looks like they need to bin these and start from scratch. @lengreview this is embarrassing.
The proposed protocols, if enacted, would effectively enable the NHS to continue to dangerously use PAs. We are clear - PAs must not assess, diagnose, or manage undifferentiated patients in any healthcare setting. Read the proposals here:
cdn.intelligencebank.com/eu/…
The decision to change their name from assistant to associate was made unilaterally with no input from the people they are supposed to assist. It was done to con the public, now real physicians have spoken up, the assistants are unhappy their title reflects their qualification
A trade union has been granted permission by the High Court to bring a judicial review challenging a decision to rename physician associates and anaesthesia associates as “assistants”
bmj.com/content/395/bmj-2026…
I think UK residents will find tiers like the RCEM system introduced in all specialties with progression through training linked to rising through tiers and supervision of PA/ACPs as part of higher tiers being formalised and forced onto residents over the next 5-10 years
@DHSCgovuk @NHSEngland @lengreview stop using ‘ supervision ‘ as a cover for allowing dangerous non-medical staff to see undifferentiated patients .
The supervision of a PA /ACP is different to that of a resident Dr
bmj.com/content/bmj/389/bmj.…
For ACPs: will you relieve doctors of all supervisory responsibilities? If you’re not replacing doctors there should be no need for supervision from doctors. Same if you are autonomous. Should medical supervision be removed and the risk assumed by ACPs?
How many people think that, to practice medicine, a medical degree is the most basic qualification the public should demand? If this is a polarizing view then lets polarize people, why should we pander to people demanding to lower standards?
The UK is debating whether to replace healthcare professionals with people who lack the required qualifications. Bizarrely, every other professional group's leaders will claim it is unsafe to replace them, while at the same time actively supporting their members replacing doctors