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Louella Vaughan Profile picture
@DrLKVaughan
Feb 28 • 12 tweets • 3 min read • Read on X
Events unfolding in Australia re PAs and workforce substitution.

Brace yourself for a tumble down the rabbit hole! 🧵
Last year, @qldhealth laid the groundwork for the expansion of PAs in Queensland.

Frameworks were put in place that would allow PAs to prescribe + order ionising radiation despite NOT being recognised by the super-regulator APHRA.



2/health.qld.gov.au/__data/assets/…
No PA courses currently in Aus. So where were the new PAs going to come from?

Overseas recruitment? Or were the universities gearing up to roll out new courses??

So the tweet above regarding the reorganisation of Medicine/Health Sciences at UQ piqued my interest.
3/
The UQ Med School has always been the Jewel in the Crown and the Med Faculty run almost semi-autonomously.

Well, it's all been reorganised. Medicine smoushed together with everyone else vaguely health-related. New super-Dean over the Medical School Dean.
4/
The new Dean has a mission.

To shape future health workforce, tailored to the needs of the community and generating evidence to guide its function.

Sounds great!

Except where have I heard this before? 🤔

Oh that's right. NHSE/HEE introducing PAs and other forms of
5/ Image
new roles aka workforce substitution.

Virtually WORD FOR WORD.

Further, they actually have a WHOLE department dedicated to this task - the Centre for the Business and Economics of Health. Devoted to reshaping workforce.
6/ Image
A recent output from the CBEH was this travesty of a article, purporting to be an analysis of the evidence for PAs. But really just a puff piece.

No mention of the problems in the UK. The patient deaths.


7/theconversation.com/what-are-physi…
They went so far as to lift words directly from a piece Martin McKee wrote, but not provide the context NOR the reference. Nice.
8/
It is striking to me that the UQ Med degree is also in the process of being revamped. No indication of into what.

To summarise:
- the Govt puts frameworks in place for the expansion of PAs
- hospitals put business cases together
- the leading Medical School +
9/
Health Sciences reorganises, including a new Dean
- purpose of above is to enable workforce reconfiguration' and 'innovation'
- paid advertising promoting the 'evidence' to back the plan (when there is none).
10/
I feel like my tinfoil hat is showing!

But we have seen this all before. Straight out of the NHSE/HEE playbook.

I predict PA and other 'new role' courses announced by the end of this year, with intake next year.

The UK was a practice run. Brace yourself Australia!
@ama_qld @ASMOFnsw @brookmanknight @RACGPPresident @KangarooBeach @rahttled_doc @archiecurium @DrSteveRobson

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More from @DrLKVaughan

Louella Vaughan Profile picture
Jul 22, 2024
A take from Someone Who Was There about the PA Project.

FWIW, @mancunianmedic is mostly right. But I disagree with him on a few points (natch!).
🧵
1/
1. Workforce substitution within the professions was/is an explicit plank of Blair/Brownite reforms to make public services cheaper and (coughs) the professions more tractable.

The first PAs were brought over from the USA in the early 2000s as part of this.
2/ Image
2. PAs were actively promoted by a small handful of senior clinicians most of whom had been to the USA. Most of them worked with various forms of non-medical staff and liked it.

We know this because they talk about it.

3/
Read 10 tweets
Louella Vaughan Profile picture
Mar 20, 2024
Because I am a woman of my word, here is a look at GMC Colin's blog about proposed changes to UG and PG medical training.

It is a tough gig, as it is unhappy reading.

1/ gmcuk.wordpress.com/2024/03/12/dev…
Starts with a preamble about changes to medical practice.

Usual stuff about demographic change. Older, more complex pt population with complex needs.

The really points to a solution that involves more Generalism. I thought was what Shape of Training was about? 🧐 Image
Then there is blurring between lines of primary and secondary care.

Well, that is considered to a population health approach.

Both Generalism and population health approaches probably DO merit different approaches to aspects of training.

Let's have a look.
2/
Read 15 tweets
Louella Vaughan Profile picture
Mar 17, 2024
Because the RCP is a large, complex and rather opaque organisation, here is a thread about how it is organised and functions.

And some of the ramifications that the current goings-on are shedding light on.

So buckle up punters, for a Vaughan mega-nerd 🪡
1/
At the most basic level, the RCP has a government-style structure.

A leadership team (some elected, some appointed), an elected Council and then various Committees. This is the doctor-facing bit most familiar to the profession.
2/
There is the organisational side, which actually runs the show day-to-day.

CEO, various Directors and 300+ staff.

Most doctors are only dimly aware of this. But it is a large and complex organisation. OR of ~£45M Pa.
3/
Read 22 tweets
Louella Vaughan Profile picture
Mar 14, 2024
There has been lots of discussion about Scope of Practice recently.

I spent several months trying to understand concepts of scope and regulation for a piece of funded research.

So here is a bit about what I learnt.
1/
Scope can be 'set' in several ways.
1. By custom and practice
2. Through legal precedent (the Courts)
3. Via training and assessment of competence
4. Explicit limitation as set out in law, standards etc.

As a rule of thumb, the older the profession, the more likely
2/
scope is set via 1-3 (in combination) and these things influence each other.

So scope for doctors is set via:
1. Doctors and the public having a good sense of what it is that doctors do
2. Training and exams (lots of them!)
3. The Bolam test for medicolegal negligence
3/
Read 8 tweets
Louella Vaughan Profile picture
Mar 30, 2023
As a clinician, I am only dimly aware of the built environment of the hospital. And usually only when annoyed (door/lift/sink rage).

3 days at the European Health Property Network workshop opened my eyes to a few things.

🧵of interesting snippets.
1/
Firstly, there are phalanxes of people who DO care about the built environment - architects, engineers, academic, manufacturers, estates people.

They are all deeply dedicated to health care. Just in a different way.

I salute them all!
2/
Research in this field is REALLY difficult. The research-implementation-assessment cycle is often decades. By which time, much of the stuff is obsolete anyway. And so the research doesn't have the impact it ought.
3/
Read 9 tweets
Louella Vaughan Profile picture
Mar 30, 2023
The world's largest experiment in the delivery of Emergency and Acute Care has been quietly happening in Denmark.

Massive reconfig of ALL acute care.

The European Health Property Network meeting this week informally assessed the outcomes.
🧵
1/
The Danish Super Hospital programme is ambitious.

Closure of HALF of all hospitals. Reorganisation of care within hospitals. Reconfig of admin.

PLUS 6 new hospitals. 10 refurbs/extensions. Cost E5Bn or so.
sum.dk/Media/0/2/TheD…
2/
The programme started back in 2007. Builds mostly complete.

So did it work???

The verdict was that the build programme probably went better than expected. The new hospitals are staggering beautiful. Built mostly on time. No major scandals.
3/
Read 11 tweets

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