Thread by @PhilSmithIsBack

Way back in 2015 when Twitter/X and social media was not as big a thing as it is now, back in 2015, there were lots of concerns how #PAs where being pushed forward by @RCPhysicians whilst junior doctor strikes were on the horizon 1/x

Doctors were pretty apathetic then, Anons didn't exist but there was a growing disenchantment with how doctors were treated, paid, deprofessionalised etc. The learnt behaviour was to 'shut up and put up' with a very paternalistic approach from the medical leaders of the day 2/x

Apparently the way to deal with the above was to tweet out #medicineisbrilliant - something the then PRCP @DacreJane did. I am not suggesting this was the only intervention, but certainly the most visible. At that time the word 'gaslighting' was not commonplace, despite this 3/x

Disillusioned, and having been in a senior trainee role with @BritSocGastro, I was elected to the @RCPL_trainees trying to represent doctors concerns. However, I was soon disillusioned with that. Why? Because effectively the @RCPL_trainees really acted as a tick-box exercise 4/x

For the the @RCPhysicians hierarchy - they undoubtably wanted a trainees voice, but that voice was only able to speak when spoken to. It had no freedom to release statements saying what really were trainees concerns, and any meetings with PRCP @DacreJane et al were carefully 5/x

Stage managed - you had to submit questions in advance of any meetings, if the PRCP spoke and you disagreed politely you were not able to air that at the time. It was really poor and I articulated this, politely - consequently I was labelled a 'troublemaker' @parthaskar 😂 6/x

At around this time it was clear bottlenecks were being produced - less and less NTN positions available, with similar issues in FY and CMT years. But, a new "innovation" was on the way - physicians assistants (helping with bloods, cannulas, TTOs) were being renamed 7/x

As physicians associates - with this group of NHS worker being expanded massively - one @RCPL_trainees email explained by 754%! In addition, #PAs would be apparently seeing A+E patients and the like and 'helping with the medical take' - @DacreJane explained to @RCPL_trainees 8/x

At one @RCPL_trainees meeting that they would see "the easy Asthma patient in A+E" - I remember pushing back on this point explaining this was a misnomer in itself - any asthma patient in A+E is usually a patient to worry about! I did wonder how often decision makers using 9/x

This example actually saw patients in A+E, but decided to keep that thought to myself! Remember, I was labelled the 'troublemaker'.

In addition #PAs would do a 2 year course only, have a science degree before (?astrophysics I asked) and soon be prescribing once regulated 10/x

My jaw dropped to the floor - what was this? I and a few others asked about pay, career progression and importantly for me why PAs were needed when a FY/CMT etc could do so much more. It did not make sense at all. So much so I spoke to @DacreJane at a @BritSocGastro meeting 11/x

That she had agreed to talk at invited by the late Ian Forgacs. She repeated the same information to me. She also pointed out that by having @FPARCP "in house" the @RCPhysicians was in the driving seat effectively going forward & financially - money was an issue to consider 12/x

as the @RCPspaces (although location not chosen at that time) was coming in the next 5 years and others costs at @RCPhysicians meant money was paramount. She also explained that being at the 'table' with @DHSCgovuk was crucial as @Jeremy_Hunt was known to freeze people out 13/x

I still was unconvinced, and became further concerned after online conversations with two #PAs called Teresa Dowling and Jeannie Watkins. It was clear they were hugely ambitious - Teresa stated she lead consultant ward rounds in geriatrics and Jeannie fully supported 14/x

The idea of Consultant, Professors etc #PAs. When I asked about how could she lead ward rounds making decisions whilst the doctors following her ward round decisions took the responsibility for them, I was called a dinosaur 🦖 - I have been called worse! 15/x

It also struck me there was no insight into how a doctor has done 5-6 med school, 2 years FY, 2-3 CMT and then ST posts with ARCPs, exams, hurdles galore, to lead ward rounds, do procedures etc, but somehow a #PA could achieve the same level of competency after any science 16/x

degree and a 2 year course. It was a frustrating conversation to say the least and I could see then what the future held. It was clear that vested interested mattered more than common sense. Moreover, it was clear to me that @RCPhysicians had taken on the tenancy of tenants 17/x

Who had very different ideas of what their tenancy agreement was at the @FPARCP, and in fact the @RCPhysicians had no control over the tenancy agreement in the first place - that was @DHSCgovuk and @NHSEmployers and @gmcuk - it seemed like a mess 18/x

Thankfully the @RCPL_trainees pushed to do a #PA position statement to sent urgently to the likes of @DacreJane @bodgoddard, Prof David Black and others. For balance, there were some members of the @RCPL_trainees who were not bothered by #PAs (they would be consultants when 19/x

They became a bigger issue in the #NHS), a small number were pro-PA (mostly non interventional specialities) and some were disengaged as in any committee. The majority were concerned, a few like me, were perplexed - not because I had any issues with the #PAs as people 20/x

But because I could only see this playing badly in the future (which it has, and for the record, I find no pleasure at all in being right).

Anyway, a position statement was written - it was not as strong as I wanted it, but here is is 21/x:

We never got a written response from @DacreJane @bodgoddard to this (as far as I am aware) but did from these two people - Prof Black and the then Chair of the New Consultants section of the @RCPhysicians 22/x:

Well that was us told - we had nothing to worry about and it was overblown. "Patronising" was the exact phrase the @RCPL_trainees chair stated 23/x

So this was how the @RCPhysicians responded to its future FRCPs and MRCPs. Metaphorically, patted on the head. That's how it felt. However, THEY WERE WARNED. The highest powers we could reach in the organisation we were elected too HAD been told. 24/x

BUT, crucially THEY did not listen to us ........

and 10 years on a group of Anon accounts such as @Xeon4f145d96s1 @ExplosiveEnema @Dr_Done_ and others and the irrepressible @DrEilidhMaria @drmattuk have pushed this matter to the fore in a way that was not possible in 2015 25/x

Please be kind to the good, nice #PAs who have been sold a lie. Please hold those who made this disaster happen, despite warnings, accountable. I am sadly retired now. Keep fighting for your patients, even if they try to discredit you as 'troublemakers'

NB: A few of you have asked what convos were going on in the @RCPL_trainees - there was some apathy, some muted support for introducing #PAs and then my thoughts (backed by a few others). One example from Feb 2015 - the lingo was so new it was easy to get mixed up! I was worried

I had just had major surgery