🧵 THREAD on @TheBMA report on medical staffing in England which did not get much airtime last week:

bma.org.uk/advice-and-sup…

Whilst the numbers are increasing, we just don't have enough doctors, esp GPs. #NHS #medtwitter

Here's the evidence:

@sbattrawden
@ShaunLintern
2/

We have some the lowest number of doctors per population in Europe. Image
3/

Whilst the number of hospital doctors is rising, the numbers of GPs has not despite record numbers of new trainees.

With more and more work being diverted to primary care without resourcing and funding, can we be surprised? Image
4/

🗣️ "Due to these workforce shortages, on average, each FTE doctor in the NHS currently does 1.3 FTE roles.

That is an additional 11-12 hrs extra per week per FTE doctor.

This is 1-2 hrs above working time regulations cap for average weekly hours." (I think it's more) Image
5/

We are falling short of doctors - but this is a local, national and global problem. But compared to the world we are falling short and will continue to do so at this rate.

@lizzie_toberty @wanderingwelch ImageImage
6/

– Compared to September 2015, there are:

⬇️ 22% GP partners

⬆️ 24% salaried and sessional (locum) GPs

⬆️ 42% GP trainees

⬆️ 22% increase patients / practice

⬇️ fully qualified GPs per 1000 patients in England from 0.52 (in 2015) to 0.46

@DrSimonHodes @DrNeenaJha Image
7/

💡 We have 1,307 (4.4%) fewer fully qualified FTE GPs than we did in September 2015 - the reason you can't see your GP is not laziness. 💡

There is a trend to more flexible working as workloads escalate.

The real question is whether GP trainees will stay working as NHS GPs. Image
8/

On the flipside in secondary care, numbers of hospital doctors is increasing

"Since 2010, there has been an average annual increase of 2.34% in the secondary care medical workforce."

BUT ... Image
9/

... Since 2010, activity in NHS hospital and community services has increased by 26% Image
10/

Similarly for doctors who:

🧪 make research breakthroughs (academic)

🛡️ keep the population safe (public health)

🧷 treat other doctors (occupational health)

⚠️ We don't have enough ⚠️ ImageImageImage
11/

➡️ "3.5 million more people live in the Midlands than the North West, but they have 4,000 fewer hospital doctors to treat them.

➡️ Not a single area in the country meets the OECD average of 3.7 doctors per 1,000 people." Image
12/

➡️ "The medical workforce is ageing.

➡️ 13% of secondary care doctors and 18% of GPs will be reaching minimum retirement age in the next one to 10 years.

This could equate to a combined loss of 25,494
doctors through natural attrition alone." Image
13/

➡️ 1/3 secondary care doctors in England alone are international medical graduates

➡️ nearly 1/4 GPs gained their Primary Medical
Qualification outside the UK. Image
14/

➡️ "The UK has one of the highest levels of overseas doctors in the OECD

➡️ International recruitment has been, and will remain, an essential pipeline for medical staffing in the NHS." Image
15/

Economic / political decisions as well as higher rates of disciplinary action and being less likely to secure consultant posts all act as deterrents to attracting international graduates to work in the UK.

@RCGPJIC @BAPIOUK
16/

Not forgetting that some doctors are opting to do private work probably as working conditions/pay is much better. Image
17/

Overall we need politicians to listen to this because after this pandemic we will more doctors.

We have not even talked about the rest of the NHS yet.
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More from @DipeshGopal

25 Jul
I read all 288 pages @food_strategy, and this is what I learnt

🧵 THREAD

1/

TL;DR - our food system needs multi-level intervention to improve our health, healthcare systems, biodiversity and climate emergency

14 recommendations and the govt has 6 mths to respond.
2/

Deforestation, climate change and overfishing is all linked...to food production.

Food production contributes to 33% and 20% of UK of global greenhouse gas emissions.

(air travel = 3.5% global emissions)

There is a huge biomass of farm animals for food production. ImageImageImage
3/

Diet has huge implications for human health.

In 1980, on average, 57% of a household’s grocery budget was spent on ingredients for home-cooked food.

By 2000, this had fallen to 35%, while the share of processed foods which required little preparation rose from 26% to 45%. Image
Read 17 tweets
2 May
1/

🧵 THREAD on critiquing lifestyle medicine from

article from @dnunan79 @dnblane @mgtmccartney just published in @BJGPjournal: bjgp.org/content/71/706…
2/

🗣️ "... we focus on the unintended consequences of uncritical endorsement and application of lifestyle medicine including the infiltration of pseudoscience, profiteering, and the potential for widening health inequalities by a continued focus on the ‘individual’."
3/

🗣️ "We have two main concerns here:

1⃣ the opportunity taken by some to link alternative medicine practices to lifestyle medicine

2⃣ the association of some ‘lifestyle medicine practitioners’ with commercial opportunities" Image
Read 11 tweets
21 Mar
🧵 THREAD on BIAS in MEDICINE #MedTwitter #FOAMed

1a/

BIAS:

➡️ is integral to how we see people/make diagnoses: can't be removed

➡️ affects research questions that get asked, who gets funded, what gets published and in which journal

@FutureHealthJ: rcpjournals.org/content/future…
1b/

Bias training:

➡️ increases bias awareness

➡️ doesn't decrease biases (no evidence base)

➡️ bias training ignores communication, provides no debiasing interventions, doesn't measure motivation

➡️ doesn't address structural problems

Read: ncbi.nlm.nih.gov/pmc/articles/P…
2/

Shoutout to the amazing team:

@UlaChetty

@patrickod9

@returnofcam

@jodieblackadder

And Prof @damienridge who shaped the manuscript.

Hundreds of papers, hours of lectures/books, many drafts to get here.

Thank you 🙏🏽
Read 26 tweets
20 Mar
🧵 on #COVID19 in Pregnancy / Breastfeeding

1/

Prof @thangaratinam:

Pregnant women at increased risk of severe COVID (ITU admission), thus earlier delivery

Risk factors: obesity, advancing maternal age, non-white ethnic origin #GlobalPregCov

🔗: bmj.com/content/372/bm…
2/

Animation here:

Read more about the research here: birmingham.ac.uk/research/who-c…

#GlobalPregCov
3/

Prof Paul Heath @StGeorgesUni

Efficacy in slide in general population:

Pfizer/Moderna/AstraZeneca/Gamaleya from clinical studies.

Novovax, Janssen, Sinovac, Bharat Biotech from press release.

#GlobalPregCov
Read 12 tweets
19 Mar
🧵 THREAD on "good men" #NotAllMen #MeToo

🗣️ What is the pass we give ourselves when we call ourselves "good men"?

Full video from @wayfarerstudios @justinbaldoni:

feat. @TonyPorterACTM @acalltomen @jameyjaz
🗣️ The language used to objectify women is problematic.

Full video from @wayfarerstudios @justinbaldoni:

featuring @TonyPorterACTM @acalltomen
🗣️ What should men do? (watch from 56 mins)

Listen
Believe women
Don't use assumptions
Interject in the locker/boardroom

Be intentional about educating boys/young men

Set an example

Look inwards

Full video from @wayfarerstudios @justinbaldoni:
Read 4 tweets
3 Mar
🧵

1/

THREAD on @BMJLeader study: bmjleader.bmj.com/content/early/…

➡️ Gender and racial CONFERENCE PANEL KEYNOTE SPEAKER representation at Royal College conferences 2015-2019

➡️ Publicly available data: 20 of the 70 conferences
2/

At 60% (n=12) of conferences in our sample, there
was a predominance of male speakers.

Median percentage of female speakers: 35 - 46%.

In 15% (n=3) of conferences, there were an equal number of male and female keynote speakers.

No #manels detected! 🤯 @medicalwomenuk
3/

At 20% (n=4) of conferences examined, none of the keynote speakers were from ethnic minorities.

Median % ethnic minority speakers 9 - 18%.
No increase from 2015 to 2019.

@crageshri @RammyaMathew @Dr2NisreenAlwan @DrRakN @DrJessPotter
Read 10 tweets

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