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Today, a devastating report from the @theRCN, based on the testimony of over 5000 NHS nurses, has rightly catapulted the national shame that is NHS 'corridor care' into the headlines once more. (1/n) This winter, nurses describe being forced to give care in corridors, cupboards, toilets, car parks & hospital gyms on a daily basis – locations without lifesaving equipment such as oxygen & bedside monitors, meaning that patients are “routinely coming to harm” or dying. (2/n)

Misleadingingly contextualised piece, @NickTriggle, which relies, predictably enough, on those infamous anonymous NHS senior sources.

The crux of the issue is not, as you claim, 'the speed at which [PAs] are being recruited". 1/n

bbc.co.uk/news/articles/… Rather, it is the replacement of doctors with PAs in multiple different safety-critical settings, despite their radically shorter & more superficial training (a 2 year course, not a 5 year medical degree; no post-grad medical training). 2/n

What troubles me most about ⁦@kimleadbeater⁩’s bill is that it places a legal obligation on the Secretary of State to ensure that assisted dying is available to patients for whom he’s under no such duty to provide adequate palliative care. 🧵 bills.parliament.uk/bills/3774/pub… Her bill, she says, has world-beating safeguards to prevent coercion of vulnerable patients to end their lives prematurely.

But “existing palliative care provision” is not “excellent” as she claims. Far from it. We are desperately underfunded & struggle to meet patients’ needs.

🧵 This week - under a Labour government - NHS community services for the entire population of Wilshire (half a million people), were handed to a private equity backed company, @HCRGCareGroup, formerly known as VirginCare. 1/n A consortium of NHS, local authority & charities also made a bid to run the community services - as they were already doing. But no, the contract was awarded to an outfit whose owners celebrate realising 'significant tangible wealth' via, for example, 'corporate carve-outs'. 2/n

🧵/

This is, I believe, unprecedented in the history of UK medicine.

28 eminent UK doctors have written publicly to @LaylaMoran, the new chair of @CommonsHealth, to report something nothing less than scandalous.

Read their letter here (1/n) 👇

bmj.com/content/386/bm… The signatories, all Fellows of @RCPhysicians, believe that their College, the @gmcuk & @DHSCgovuk essentially colluded to mislead parliament in claiming that the College approved legislation going through Parliament this year to regulate physician associates (PAs).

(2/n)

I’m simply horrified to see @NHSEngland now literally breaking the law in how it misrepresents physician associates & other allied health professional - who are NOT doctors - to the public.

These posters are from the Bradford District & Craven Health & Care Partnership. 1/n

I downloaded the posters from their website, here:

“Physician” is a title that’s protected in law - to protect you, the public, from the dangers of fake doctors masquerading as the real thing. 2/nbdcpartnership.co.uk/download/96/gp…

Well, I’ve read the @Conservatives manifesto on health so you don’t have to.

Aside from the expected unfunded nonsense on those 40 fictitious new hospitals, cutting managers & using AI to ‘free up’ doctors & nurses etc, here’s a stand out out example of its vacuousness. 🧵 What even is this verbiage? A ‘plan’ to prevent cancer from occurring, but also to give patients the best possible care? When over 235,000 cancer patients have had their treatment delayed in the last 3 years?

Come on, @Conservatives, this is offensive.

BREAKING/

This is a scandalous moment in UK medicine.

Over 80 Fellows of @RCPhysicians have just declared their lack of confidence in the College.

Why?

Because they believe its stance on physician associates (PAs) is recklessly failing patients.

Pls read - this matters. 🧵 The Fellows - over a quarter of whom are professors - are appalled by @RCPhysicians' role in in enabling the government's project of replacing doctors with cheaper & less well-trained doctor substitutes (PAs) in an extraordinary array of medical jobs across the NHS.

The GMC have tweeted this in response to widespread alarm from doctors at a video showing an 'AA' (anaesthetic associate) openly bragging about using "local governance" to get away with less supervision by doctors.

I find the GMC's position deeply concerning.

Here's why. 🧵

https://twitter.com/gmcuk/status/1795822703624028178

The video in question was recorded at a GMC conference in 2022.

AAs, like PAs (physician associates), are not doctors.

They have neither a medical degree nor anything like the depth & breadth of doctors’ training, yet are being used increasingly as doctor substitutes.

Astonished to see @timspector doubling down on his reckless comments re: boosting 'cancer immunity' by stopping using SPF year round.

The study on which he bases his claim is in mice, not humans - & one of the study's own authors has publicly disputed Spector's conclusions. 1/3 As a doctor, how can he possibly imply we should use less sunscreen in order to reduce cancer risk?

Vit D deficiency from lack of sunshine can be addressed by diet.

But fatal skin cancers, as I know all too well in palliative medicine, cannot. 2/3

🧵 Whatever your views on assisted dying, one thing I’d hoped we’d all agree on is that the topic is ethically fraught & complex.

Not so Matthew Parris.

For him, it’s simple. Old & frail people *should* be killed - to save society the cost of looking after them. 1/n In no sense am I twisting Parris’s words.

Here he rehearses an argument often used by opponents of AD to fight legal change - that with time, it will lead to people feeling pressured to end their lives prematurely (for it would be socially irresponsible of them not to). 2/n

Dear 🇬🇧,

The current state of UK medicine - a brief 🧵

Exactly 1 week ago, I felt I had no choice but to resign from giving a keynote speech at this year's @RCPhysicians annual conference.

The behaviour of the College leadership left me no choice. 1/n

https://twitter.com/doctor_oxford/status/1768180726732620165

The @RCPhysicians had been forced by its Fellows to hold an Extraordinary General Meeting - the third ever held in its >500 year history.

Fellows were appalled at the College's key role in driving through the government's plans to replace doctors with cheaper substitutes. 2/n

Dear UK public,

Yesterday, hot on the heels of widespread concern among doctors at the govt’s project of replacing NHS doctors with doctor substitutes, @gmcuk released a blog about its future intentions.

It left doctors like me reeling.

Here's why 🧵

gmcuk.wordpress.com/2024/03/12/dev…
@gmcuk First, a reminder of what the GMC is.

Founded 166 years ago, the GMC protects the public by maintaining a register of drs in the UK, controlling entry to the register & suspending or erasing members if necessary.

It sets standards for all UK doctors.

Weighty, vital stuff. 2/n

Dear 🇬🇧,

Please read - this NHS scandal potentially affects you all.

🧵 Having studied the data, just released, from the @RCPhysicians members' survey on PAs, I couldn't be more disgusted by the lack of probity, honesty & fairness of those who lead my Royal College. 1/n Last week, @RCPhysicians leaders were forced, against their will, by members & fellows to hold an extraordinary general meeting: only the 3rd in the Royal College's >500 year history. 2/n

🧵 Doctors are depressingly used to being smeared by govt ministers.

But likening us to intimidatory "drug dealers" is a new low from @JimBethell.

He's trying to delegitimise our genuine patient safety concerns about @DHSCgovuk's roll out of PAs as doctor substitutes. 1/n

https://twitter.com/JimBethell/status/1766153034353021286

The crux of the issue is this.

The government (reasonably enough) looked at ways of reducing the NHS staff bill.

Physicians assistants - less qualified & cheaper than doctors - would assist doctors in admin/straightforward tasks, freeing them up for more complex work. 2/n

"Staff members were buying rain ponchos from Amazon because they offered better protection than what we had."

Please read this devastating interview with Dr Nathalie Macdermott, who caught Covid after being denied PPE by her hospital. 1/3
thesun.co.uk/tv/26011843/br… Nathalie, a former runner, is so severely disabled by Long Covid, she has to use a mobility scooter.

Like so many NHS staff, she was treated like cannon fodder - even as the government told the public (dishonestly) there were no problems with PPE supplies.

It's scandalous. 2/3

🧵 Underlying the govt's decision to replace doctors with doctor substitutes in a huge variety of roles (including, incredibly, putting PAs on senior registrar on-call rotas), is something deeply concerning that we need to address.

Namely, the devaluing of a medical degree. A 5 year medical degree (4 years, at a push, if you are a grad entry student), is a gold standard, a benchmark, an assurance to the public that the NHS doctor treating you has an vast breadth & depth of knowledge & expertise - right from day one of their clinical practice.

Tomorrow evening - thanks to the generosity of @BAFTA & @ITV - over 100 members of NHS staff will arrive at BAFTA for the UK premier of BREATHTAKING.

3 years in the making, I can hardly believe we've reached this point. Feeling so nervous!

Being on set was extraordinary /🧵 We built a three storey hospital from scratch inside an old, disused higher education college in Belfast!

Every detail needed to be utterly, authentically NHS.

The scuffs, the stains, the scrapes, the shabbiness - nothing would be sanitised nor sensationalised at all.

🧵/ The government doesn’t want you to know it, but it is currently conducting a massive, un-evidenced, cost-cutting experiment in the NHS, replacing doctors with so-called physician associates. 1/n

theguardian.com/society/2024/j…
PAs were originally termed physician assistants. They were introduced here - or so we thought - to support doctors with simpler tasks, in order to free them up to use their expertise to perform more complex ones.

Sounds sensible, and it is... 2/n

Many thanks, @wesstreeting.

Have to say I really didn't have "stop exploiting those patients you see dying in corridors in horrifically overwhelmed A&Es" on this year's Christmas list.

Please consider reading this short thread in response to your Sunday Times interview. 1/n First up, where we agree. Yes, of course the NHS needs to innovate. Better & more creative use of tech, logistics & patient-centred approaches are vitally needed.

And some of the ideas you outline in your interview, below, are fascinating. 2/

thetimes.co.uk/article/wes-st…

🧵1/ This week, as @borisjohnson fights for his political legacy, he will be watched by 1000s of people whose loved ones fought Covid for their last breath - and lost.

Johnson's strategy will be to apologise, yet insist he got “the big calls right”.

But did he?

Facts matter: 2/ Both Prof Neil Ferguson & Prof Graham Medley, who sat on SAGE, have already told the Inquiry that by Feb 2020 they worried the NHS would be overwhelmed by Covid.

Yet Johnson missed the first 5 Cobra emergency Covid meetings & didn't chair his first meeting until 2 Mar.