James Steen
@BMA_James_Steen
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“Just a union rabble rouser”✊🏼| BMA Head of Region, London | “BMA-Officer-James” on Reddit | London Irish ☘️| Chelsea | Dog lover | Views my own
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Joined October 2022
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For those in any doubt.
I am not a doctor.
I am indeed “just a union rabble rouser” who works for the BMA.
And I’m proud of it too.
✊🏼
@FullFact
@BMA_James_Steen
Just asking - is James Steen actually a doctor or just a union rabble rouser for the BMA?
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Ok, I’ll bite;
1. As has been well documented, there’s a workforce crisis in the NHS, so we don’t have additional doctors to work weekends, so if you wanted them in, you’d have to give them days off in the week, delivery zero additional capacity.
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For the record:
New PA salary: £43,574
Core hours: 37.5/week
Newly Qualified Doctor salary: £32,398
Core hours: 40/week
Disparity:
£11,176 (34.45%)
Plus 2.5 hours/week
Hourly rates
New PA: £22.35
Newly Qualified Doctor: £15.58
True Disparity (inc. core hour diff):
43.45%
'They are there to work alongside doctors not instead of doctors.'
Health Secretary Victoria Atkins reiterates 'regulations' on physician associates after the death of 30-year-old Emily Chesterton.
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For the record:
My fellow
@BMA_JuniorDocs
negotiating team members and I can be at
@DHSCgovuk
building within a couple of hours.
We’re happy to meet today, tomorrow, over the weekend, Monday, and in fact all of the above. 🤷🏻♂️
But they won’t meet us.
It’s in their hands.
The Government says we walked away from talks - but it was them who walked away.
Ministers can’t even explain why they won’t talk to us while strikes are planned, like they did with barristers.
Come back to the table with a credible offer and we can end this now.
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So the PA examined and took the history of a patient.
And the tribunal determined that the doctor failed in their duties for not examining the patient or taking a history themselves and in addition to the PA.
What exactly is the purpose of a PA in this medico-legal context?
A fitness to practise tribunal (MPTS) determines that a PA's history should be repeated by a doctor and a PA's examination should be repeated by a doctor too.
DAUK's report in Pulse explains more 👇
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£66.55 for 3 full qualified and highly skilled doctors to save yours or a loved one’s life is an absolute disgrace!
With pay restored this would be:
10yr doc = £37.88
7yr doc = £33.09
1yr doc = £19.06
TOTAL = £90.03
We’re not asking the earth!
#JuniorDoctorsStrikes
✊🏼
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And there it is.
The GMC was created for the sole purpose of protecting patients from unqualified pseudo doctors by facilitating the safe identification of qualified doctors.
Today they boast of their wholesale abandonment of this core purpose.
A complete dereliction of duty.
🧵The updated
#GoodMedicalPractice2024
uses the term ‘medical professionals’ as a collective term for doctors, physician associates (PAs) and anaesthesia associates (AAs), rather than listing out each individual role for every reference. We haven't removed doctors from the…
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For context.
£9.9bn is circa 9 times the value required to restore “junior” doctors pay in full and in one hit.
The govt also cut national insurance earlier this month at a cost of another £9-11bn
Doctors - Don’t ever let anyone tell you there’s no money to restore your pay.
The government has written off £9.9bn of the £13.6bn it spent on personal protective equipment (PPE) in the pandemic due to the gear being unusable or having lost its value
Read more 🔗
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Genuinely baffled by this. 🤔
A BBC journalist has blocked me.
What for you might ask?
Well my only interaction with them is shared below.
I asked a perfectly legitimate journalistic question in relation to a news story they had covered.
🤷🏻♂️
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2. Wanting to protect “work life balance” isn’t a bad thing - doctors are human like you, and trust me when I say you don’t want to see the studies on the impact of fatigue on medical decision making - would you want a shattered pilot flying your plane, no, so why risk a surgeon?
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A doctor has to pay circa £750 for 2 DAY course of this type.
A Physicians ‘Associate’ gets 2 WEEK course completely free.
A new doctor earns >£11,000 / 35% less than a new PA.
Make it make sense.
Current priorities for surgical training in the NHS/UK need an urgent overhaul.
Why is
@RCSnews
✅Training of
#PhysicianAssociates
in
#Surgical
Skills ?
@TMitchellFRCS
@AoMRC
@RCSEd
@rcpsglasgow
@TheBMA
@ASiTofficial
@bota_uk
@asgbi
@BritOrthopaedic
@the_mdu
@MPS_Medical
@AvMAuk
@PatientsAssoc
@whichuk
@bmj_latest
@bbchealth
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So now both Sunak and Starmer have or will pledge to “doubling” medical student numbers.
Yet neither have committed to restoring doctors’ pay/retention.
Result & translation:
UK government commits to train thousands more doctors for Australia, Canada and New Zealand 🤦🏻♂️
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This is key.
The government is feigning its desire to negotiate.
There’s no law of nature or in statute that prevents them from talking to us with strikes called.
They talked to barristers on strike 15 months ago.
Nothing is stopping them from talking to us except themselves.
“It's still not too late. The Secretary of State - or anyone from the Government - could still come to us today, and if that offer is credible, and if we can resume talks and build on that credible offer, then we can stop our strike action for the rest of this week." [3/3]
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So all in all, this is as idiotic, flawed, and shortsighted an argument as it is disingenuous and manipulative in its presentation…
Want a real solution? Commit to full pay restoration now and invest in the future of the NHS workforce - anything less is a dereliction of duty!
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Problem is, they’re not being paid even what you were.
They’re on approximately 25-30% less than what you got; what you describe as “not well paid”.
So why are today’s “junior” doctors worth 30% less than you were, Patrick?
We’ll park the military doctor disparity for a sec.
When I was a junior doctor I wasn’t paid well, but I accepted I was an ‘apprentice’ and thus couldn’t expect a massive salary.
Our junior colleagues need to realise that they are simply doctors in training whose priority should be their patients not income.
#JuniorDoctorsStrike
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Are you not CEO over the weekends?
Because doctors are still working and they still need a quiet space to work safely.
Do you not have a site manager out of hours?
Perhaps, as an interim measure, doctors can use your office and the offices of your executive team until Monday?
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Before the NHS, only the wealthy could access an actual doctor.
Working people had to make do with “quacks” and fake doctors, who were untrained or undertrained, and often made things worse.
Working people deserve access to actual doctors.
We can’t let this go backwards.
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This is lunacy.
Patients everywhere report difficulty in securing GP appointments.
Yet this practice deems GPs surplus to requirements in a GP service?! 🤯
The replacement of doctors, particularly GPs, is a false economy and is a danger to the public.
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“It’s outside the BMA’s remit!”
This assertion is as ignorant of unions as it is inaccurate.
1. MAPs deployment is directly related to doctors’ working conditions.
2. Anything our members care about is within the remit of the union.
The BMA is a real union for real doctors✊🏼
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Raising legitimate concerns is not disrespect.
Disrespect is starting a newly qualified doctor on >£11,000 less than their alleged “associate” grade who;
🔹works less hours
🔸has less responsibility
🔹works less unsocial hours
🔸is not regulatory accountable
🔹doesn’t rotate
GMC calls for ‘multi-disciplinary respect and courtesy’ towards non-doctors
#physicianassociates
#PAs
#ARRS
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Two things here;
🔹The government’s position of not talking to us with strikes on is clearly indefensible and untenable.
🔸Mr Barclay finally recognises we’re only asking for Full Pay Restoration - not a pay rise.
Well done
@GMB
, first media outlet to ask the right questions.
Susanna Reid presses Steve Barclay on why the Tory govt refuses to negotiate with junior doctors while strikes have been called. Barclay flounders and blusters and finally resorts to claiming the strikes are politically motivated
#JuniorDoctorsStrike
#GMB
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“it is clearly wrong that a newly qualified doctor… is paid over £11,000 less per year than a newly qualified PA, while the Dr role, remit and professional responsibility is far greater… this is a 35% differential, which is manifestly unjust.“
We move. ✊🏼
🧵Read our position statement on physician associates and anaesthesia associates which aims to clarify the confusion over roles, supervision and what patients should expect: [1/2]
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Blimey.
I know I can be hot headed and a bit of a firebrand at times, but take a beat…
Also, FYI:
🔸Doctors are the BMA.
🔹Doctors are MAPs supervisors.
🔸GMC, NHS England, RCP and your FPA have had 20yrs to produce a patient safety focused definitive scope and still haven’t.
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Doctors,
I’m no regulatory lawyer, but I’ve represented many healthcare professionals facing allegations.
This seems to me to be incredibly dangerous practise.
Are you really ok with being accountable for and your GMC registration being reliant upon a PA’s clinical judgment?
Oh here is also the list of jobs I was given by the reg level PAs when I was busy on call holding the bleep. So they can go to theatre/clinics ASAP.
I had seen none of these patients. And I had to prescribe all these. Not from a consultant or a doctor but a PA.
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Yes, the following doctors are now in a dispute with Govt:
🔸“Junior” Doctors
🔹Consultants
🔸SAS Doctors
🔹General Practitioners (GPs)
Govt appears to want a war with doctors on all fronts:
Pay / funding 💷
Patient safety 🚨🤕🤒
Replacement by PAs 🔄
Training numbers👨🏼⚕️👩🏿⚕️🧑🏽⚕️
So is that every major group of doctors in dispute with the government?
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I hadn’t seen this before today.
This is the Royal Australian College of General Practitioners (RACGP)’s assessment of the risks and position on the use of PAs in general practice.
This is what professional medical leadership looks like.👇🏼
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For the public.
A lumbar puncture is also known as a “Spinal Tap”.
It involves the delicate procedure of inserting a needle into your spinal canal.
It is terrifying to me that unregulated, under-trained and under-qualified “associates” are doing these.
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Except that we did have both, literally just 14 years ago.
Kate alleges our pay claim is unaffordable at just over £1.1bn
Kate also advocates for scrapping inheritance tax for the wealthiest 4%, which costs £8bn
Pay is a metric of value, this has always been a pay dispute.
Focus on pay is understandable. In different health systems, doctors rightly get paid more. But the BMA demands salaries closer to mixed health systems while also demanding the NHS stick to its socialist structure.
You can't have both.
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Unaffordable?!
Govt has spent over £2bn trying to ignore the dispute and strikes.
That’s much more than the cost to fully restore doctors’ pay.
We’re happy to meet Govt any time, anywhere.
It’s Govt’s self imposed precondition of “no talks with strikes called” stopping talks.
Doctors know that a 35% increase in salary is non affordable but refuse to sit down with the Health Secretary to negotiate an increase which is. Apparently putting their patients lives at risk is more appealing to them than talking with the Government to agree a settlement.
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“Don’t strike in summer, people are on holiday”
“Don’t strike in winter, the health service is under too much strain”
“Don’t strike when it’s sunny, it’s a heatwave”
“Don’t strike when the weathers bad, it’s too dangerous”
So when Nigel?
There is no ‘good’ time to strike.
The trainee members of the
@TheBMA
striking for 5 days over the summer when consultants are likely to be on leave and unable to
cover them is running the risk of loosing the support of the consultants and severely endangering our patients and loosing public support.
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23 doctors from the UK. 👨🏾⚕️🧑🏼⚕️👩🏿⚕️👨🏾⚕️🧑🏼⚕️
For just 2 hospitals in Australia. 🏥🏥
Over just a 4 month period. 🗓️
The mass exodus of UK doctors is real.
Time for
#FullPayRestoration
✊🏼
🇬🇧💷 🧑🏼⚕️👨🏾⚕️👩🏿⚕️ ➡️ ✈️ ➡️ 🇦🇺💵💵💵
Excellent news that 41 more junior doctors will be joining
@RoyalAdelHosp
and QEH between August and November this year - including 23 doctors from the UK.
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In case you needed a stronger argument to scrap the House of Lords, I present to you Hereditary Lord and literal Baron
@JimBethell
Attempting here to speak with authority on a subject he clearly has no grasp of, and which he will never personally suffer the consequences of.
Shaking right now!
The PA debate in the House of Lords-
@JimBethell
said:
“We have to find people from somewhere (to do GP appointments) & they’re going to be some people (Physician Associates) that don’t necessarily go through the 10 years of qualification TO BECOME A GP”
🚨
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I don’t have words for this.
This is beyond the pale.
Give me the name of this Trust, and the name of the person who sent the email.
Via DM and or anonymously if need be.
Just give them to me.
What would happen if I sent an email to “all managers” showing them any number of daily mail articles hating on managers even more than they hate on doctors 😳
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🚨“Junior” Doctors🚨
Do not sign prescriptions or ionising radiation scan requests for MAPs as the norm - MAPs should go to their named supervisor.
If you’re ever confronted with such arrogance when challenging them - Make sure you document it and contact us for support.
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🚨Junior Doctors of England🚨
Longest strike by doctors in NHS history announced:
START: 7am Thursday 13th July
END: 7am Tuesday 18th July
5 day / 120 hour strike
#JuniorDoctorsStrikes
#JoinStrikeWin
#PowerInAUnion
#TellThemAgain
#TellThemLouder
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Insult after insult for actual doctors.
A new actual doctor earns over £11,000 (35%) less than a new one of these pseudo doctors / “medical associates”
Now this slap in the face.
And FYI, actual doctors’ pay doesn’t catch up with them until 6/7 years into their career.
So we heard today at the select committee debate
@gmcuk
will be charging £221 per annum for PA/AA registration.
Why do I as a doctor have to pay £433?
I would much rather pay £221 as well, and come to think of it, I just might cancel my direct debit right now. 🙂
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If you’ve spent any time around “junior” doctors, you’ll know it was never in doubt.
We go again! ✊🏼
BMA junior doctor members in England have voted by over 97% in favour of extending our mandate for industrial action, and to provide us with a mandate for action short of strike (ASOS).
A huge thank you to all of those who voted.
Read the full results 👇
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🚨📣Consultant Anaesthetists📣🚨
This is what they plan for you and your patients.
They intend to spread you as thinly as they think they can get away with.
Whilst you maintain ultimate accountability for everything these pseudo doctors do.
It’s time; stand up and say no.
As government passed registration of PAs/AAs by the GMC today one particular clip really intrigued me:
@theresecoffey
here talks about having 1:3 supervision for AAs 🤔
We have to also remember she was health secretary - she’s seemingly marking her own homework here.
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If the King end up requiring surgery, who do we think will administer the anaesthetic and perform the surgery?
An anaesthesia associate or a consultant anaesthetist?
A physician associate learning the procedure on the job, or a consultant surgeon?
🤔
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Huh?
I always thought the named supervisor, a senior doctor, would be accountable for alleged failures in supervision.
But here we see the registrar being suspended?!🤯
Couldn’t be more important for doctors of all grades to stick to BMA guidance on MAPs; protect yourselves.✊🏼
⚠️ For those working with PAs
MPTS case published 2017 where a ST3 Junior Doctor was suspended for failure to adequately supervise a physician assistant’.
The PA was known as ‘Dr G’.
There may have been other issues too - irrelevant. Read the following:
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We’ve seen PA courses that would accept someone like me.
So I could be doing endoscopies in circa 25-36 months.
I have;
No scientific background
No clinical exp
An irrelevant International Relations BA
Oh, but I do have a white coat I got for a cheap fancy dress night at uni!
I started medical school in 1997
Qualified 2003
First endoscopy 2007
10 years
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3. If they’re relying upon the same arguments made by Jeremy Hunt when he was Health Secretary to suggest people die more at weekends, they’ve been fairly comprehensively debunked!
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PAs don’t bring “excellent work life balance” to the workforce.
They take it.
Their cushy hours load a disproportionate burden of unsocial hours on “junior” doctors.
That’s like me saying “I bring my salary to the BMA”.
And how exactly is OOH ED work better for training?! 🤔
Another way in which Drs have been opened up to exploitation by NHS employers. Rather than incentivise Dr workforce to work out of hrs/unsociable hrs with fairer pay, they are being coerced into working unsociable rotas under the guise of "training".
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🚨“Junior” Doctors of England🚨
📣 New strike dates announced 📣
After proclaiming they would meet us within 20mins of strikes ending, Govt burnt nearly a month after our January strikes ending before offering to meet us.
And even then, no new offer 🤷🏻♂️
We go again! ✊🏼
Doctors, we pulled out all the stops to avert this round of strikes.
We asked the health secretary to extend our strike mandate for four weeks so we could keep talking in good faith. But she declined, leaving us no choice but to announce a 5-day full walkout from 24-28 Feb.
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Utterly shameful shilling for the Govt from
@NHSE_Danny
on
@BBCRadio4
.
How on earth could you think it’s appropriate to try to defend the Govt’s ludicrous self imposed restriction not to talk to us with strikes called?!
You’re the CEO of
@NHSEmployers
not a Govt spokesperson.
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Don’t even get me started on the disparity between new doctors and new PAs working in central London.
London Weighting:
All Doctors (FY1 to consultant): £2,162
PA at Band 7: £7,746
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“A PA would not typically go on the tier two rota for about three years.”
🤯🤦🏻♂️
They should never be on the tier two rota whatsoever.
Who carries the risk when a Dr calls this team for advice, the PA issues it and the proverbial hits the fan I wonder?!🤔
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4. And if you still think spreading the existing woefully low number of doctors we have over 7 days is a good idea, you should know it’ll cost the NHS a lot more for no additional capacity - all cohorts of staff attracts unsocial hours payments and doctors don’t work in isolation
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97.6% in favour of strike action.✊🏼
Yet another huge mandate!🗳️
Solidarity with doctors in Northern Ireland! ✊🏼
WATCH: Ballot result announced Chair of NIJDC
@FiGriffin2
gives an update on today's results of the ballot for industrial action for junior doctors across Northern Ireland.
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Let’s look at this decision process:
1. Assesses patient ✅
2. Acknowledges they don’t know ✅
3. Seeks advice from qualified doctor ❌
So close.
This is what you get when you crank overconfidence up to 11, but leave both depth and breadth of knowledge at 3:
Dangerous hubris.
Attempted to hide identities as much as pos. Sent this and found it too damning not to share.
PT presents around 3pm. A doctor doesn’t appear to be contacted for support or help, and instead a Facebook group of PAs (PAAUK) consulted instead. PT in HB sent to a&e not until 6pm.
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Junior Doctors of England - You all absolutely smashed it! ✊🏼
Turn out - 77.49% 🤯
Yes vote - 98.06% 💪🏼
Let’s go…
Junior doctors have voted YES to strike action in England.
This is a giant step forward for junior doctors and
#PayRestoration
. Thank you to everyone who worked so hard for this. Keep an eye out for next steps.
#BMADoctorsVoteYes
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Great turn out at St Tommy’s picket early this morning in the bracing cold wind! ✊🏼
#DoctorsStrikes
#Solidarity
#TellThemAgain
#ThereIsPowerInTheUnion
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After the longest 20 minutes in history (3 weeks, 2 day, 29mins & counting)
Yet another car crash interview 🚗💥
Patronising ✅
Condescending ✅
Infantilising ✅
Lie about who ended talks ✅
Move the goalposts ✅
Pretend pay claims are unreasonable ✅
Are we stuck on repeat?
“I very much hope they’ve had time to reflect and they're able to come back with reasonable expectations”
Health Sec
@VictoriaAtkins
says junior doctors' “unreasonable demands” are stopping a pay deal being agreed
Watch tonight ⬇️
💻 LIVE 9PM
@itvpeston
📺 1045PM
@ITV
#Peston
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The Lords was always a long shot, but thank you to the peers who saw the truth of the matter and spoke up for patients.
Looks like we’re going to have to fix this ourselves then. ✊🏼
Extremely disappointing that Peers have tonight waved through legislation that will blur the lines between PAs and doctors, with potentially dangerous consequences for patients.
We thank Peers who urged Government to heed the warnings of the medical profession.
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So the Irish starting salary of €210k is more than double the starting salary in England, and their top salary of €252k, is circa £98k higher than the top salary paid to NHS Consultants in England…
I wonder why doctors are leaving the NHS and UK?! 🤦🏻♂️
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Hang on.
So not only is it no longer a requirement for the undergrad degree to be in a health science, but not even scientific?!
So me, with my International Relations BA, could waltz into a PA course in Sept, and covering Consultant on-call at your local hospital in 2yrs?! 🤯
@jobbinggasman
@RCObsGyn
@parthaskar
@iDrSunny
@HelenRSalisbury
@carolvorders
@natalieben
@djnicholl
@doctor_oxford
@Dr_BellaR
@Dr_Done_
@Xeon4f145d96s1
@DrLindaDykes
@mmamas1973
The presentation also states that people who have done non-scientific degrees eg law, are accepted onto the two year PA training course. This means two years of clinical training alone produce a PA.
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Over £3bn spent trying to ignore the doctors’ strikes for a year.
A new 6 month mandate for strike action secured, that was never in doubt.
It would cost £1.1bn net to treasury to implement full pay restoration overnight.
And we’re not even asking for it overnight.
The British Medical Association says the Government has wasted £3,000,000,000 on junior doctor strikes — more than double the cost of settling their whole claim.
Failure to negotiate is costly.
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Isn’t it funny:
🔸MP pay review body can get its act together and issue pay rises prior to April.
🔹DDRB, NHSPRB and others never publish prior to June/July.
AND:
🔸MP pay review body is binding on Govt / Parliament.
🔹 DDRB, NHSPRB and others are only “recommendations”.
🤔
MPs awarded pay rise to £91,346 by independent body
Read more🔗
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The arrogance of this policy…
Who the hell are this govt to say how long it should take to study and qualify as a competent doctor or nurse?! 🤦🏻♂️
These are long-standing evidence based professions; their education and training should remain the same!
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We’re happy to meet them today.
Our negotiating team can be at DHSC in no time.
We were happy to meet them yesterday.
We’ve been happy to meet them everyday since May when HMG collapsed talks.
So please stop with the “both sides” nonsense.
It’s HMG who’s not playing ball.
Bosses of leading hospitals in England have written to PM and BMA: “profound concerns at the risks ongoing strikes pose to the care and safety of patients” and each escalation “testing the limits of what can be managed safety” - urging Govt and BMA to restart negotiations
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Minimum role specific education, training and standards for comparison:
Cardiology Registrar (doctor):
🔸5-6yrs medical school to obtain a full medical degree.
🔹Minimum 4yrs postgraduate training and exp.
🔸MRCP passed.
🔹GMC registered
PA (not a doctor):
🔹2yr PA course.
Cardiology registrar - £38-50k.
Cardiology PA - £51-57k.
Make it make sense.
@RobLaurensonD4P
@_VivekTrivedi
@Xeon4f145d96s1
@ExplosiveEnema
@DrEilidhMaria
@dr_benoy_n_shah
@mmamas1973
#NHShatesDoctors
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Wow.
So the reception team, who literally work in the practice alongside both, don’t know the difference between a GP and a PA.
What chance does that give the general public?!
We’re not even in the same ball park as informed consent with this stuff.
🤦🏻♂️
Patient: I would like to see a doctor please
Appointment given with a PA
Patient: this is with a PA, could I have it with my GP please?
Receptionist: ‘they are doctors… they do the same thing’
Other patients also completely unaware
This is a huge problem.
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Shocking tweets.
BMA consultant membership in England isn’t 40%, add another 20% points and you’re closer to the mark.
And do you really want to pull at that thread?!
Conservative share of electorate:
2010: 21.1%
2015: 24.4%
2019: 29.3%
Brexit ref:
37.47% voted leave.
The rejection of the government’s pay offer by consultants is extremely frustrating. Barely more than half of the 40% of consultants who are members of the BMA voted for this but it’s patients who will pay the price as usual. We urgently need both sides round the table. [SB]
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“Onslaught”?!
That’s how
@StGeorgesTrust
responds to the revelation that over 1100 potential criminal acts were undertaken by PAs, seemingly facilitated by the NHS Trust in question?!
🤦🏻♂️🤯
We’ll remember this next time we represent a doctor facing misconduct allegations here.
1/4 It is sad to see the very public onslaught on Physician Associates. We are a unit with a proud history of teaching, training and investing in our junior doctors at all levels. We are an
@RCSnews
accredited fellowship training centre in Robotic surgery (
@IntuitiveSurg
)
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5. What impact do we think demanding arbitrary weekends for no gain will have on a medical workforce already abandoning the NHS due to a ridiculous pensions taxation regime, burn out and being run into the ground?
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If this is what triggered the letter, then we’re well and truly through the looking glass.
This is a perfectly polite and helpful message to colleagues, reminding them of their regulatory responsibilities and confirming the LNC is aware.
Where does the hurt arise from?! 🤷🏻♂️
Said hurtful comments this letter is referring to is just a foundation doctor reminding other doctors about BMA guidance re PAs. Shameful from
@MFTnhs
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Gross false equivalence.
This:
PHYSICIANS ASSOCIATE
🔹Only a 2yr course in PA studies.
Is not equal to this:
QUALIFIED DOCTOR:
🔸5yrs actual medical school.
🔸2yrs foundation rotations.
🔸3-8yrs specialty training + exams
🔸Totalling 10-15 years minimum.
I know which I want.
I can’t even begin to figure out how he thinks that a 2 yr course makes him equivalent to a real doctor because he’s a generalist and doctors are specialists
@djnicholl
@Dr_Done_
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Sorry to hear we’ve lost you.
Although your justification is peculiar.
Are Christmas days & other BH’s unsafe for patients?
Why is BH service ok/safe for the coronation or easter but not for IA?
With 98% voting yes, what did you expect a democratic union like the BMA to do?
I have just cancelled my Direct Debit to the BMA. I cannot remain a member of an organisation that has such scant regard for patient care that they arrange simultaneous strikes by consultants and juniors. Totally in acceptable
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By now, no one can be under any illusions.
The NHS are deploying physician “associates” as substitutes for “junior” doctors.
It’s dangerous for patients.
It’s shortsighted, as we undermine the NHS’s senior doctors of the future.
And it’s an affront to the medical profession.
If you care about the future of the NHS you best buckle in.
I’m a doctor. I’ve been trying to tell you all that NHS/gov intend to use physician associates with two year degrees to replace doctors.
Well I found proof in official NHS documents. A 🧵 (it gets worse)
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We urgently need;
🔹 Full regulation for all non-clinical managers in healthcare
🔹Ironclad protections for whistleblowers
🔹Cripplingly punitive penalties for employers who target whistleblowers
🔹Comprehensive safety management systems
🔹Wholesale review of NHS VSM structures
Due to lack of fear of any consequences, since they’ve no possibility of being struck off or deemed ‘negligent’, management (on a power trip) ignored 7 paeds consultants and let this demon continue to murder babies.
NHS POWER STRUCTURES NEED URGENT REFORM - it’s all connected.
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Fuck me, are
@wesstreeting
and
@SteveBarclay
actually competing on who’s the most out of touch with the reality on the ground in the NHS?!
🤡 + 🤡 = 🤦🏻♂️
#ClownFight
Let’s explore just how this ridiculous claim that the NHS is run for doctors really is…
A 🧵
EXC
The NHS is too often run for the benefit of doctors, not of patients, Wes Streeting warns in
@theipaper
interview alongside Rachel Reeves.
He promises a decade-long reform programme to empower patients to take control of their own care.
Story:
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What the?! 🤯
Only in the Daily Mail is this even a debate?!
By attempting to defend this abhorrent bullying,
@ProfKarolSikora
has demonstrated himself unfit to be trusted with the wellbeing of aspiring doctors.
@UoB_medic
is this the type of culture your university promotes?
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Let’s be clear.
This from
@gmcuk
endorses the continued dangerous and unchecked expansion of the scope of MAPs, whilst simultaneously enabling the misrepresentation of MAPs to the public.
At best, this is a negligent dereliction of duty.
At worst, it is wilful complicity.
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We’re not going anywhere.
We will escalate if needed.
We’re re-balloting to extend the strike mandate to February 2024.
The government should resolve this now - there’s plenty of time to negotiate ⏰
Improving doctors pay by between £5-£10 an hour is fair and affordable! ✊🏼
We won’t give up until junior doctors are fairly paid.
On 13 July, we will stage a 5 day strike, the longest single walkout by doctors in the NHS’s history.
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@HSJEditor
@theRCN
Does the BMA represent nurses?
What about the radiographers and unite who both rejected pay award for 23/24 and I think remain in dispute?
What about unison’s disputes up and down the country on bandings 2/3?
Are we expected to list every dispute in the health service?
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Just a reminder when reading this quoted tweet:
Actual doctors start on £32k.
Actual doctors with the comparable 1 year’s experience this job advert asks for are on £37k
The most senior of “junior” doctors, with 10yrs experience, are on £63k
Make it make sense…
A PA who is not medically trained with a 2 years masters and 1 years "experience" in GP could potentially be earning only £4000 a year less than a NHS consultant who has completed a medical degree, several professional exams, and 10-15 years of medical training and advanced…
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This new, but unsurprising, analysis from
@FT
serves as a stark reminder and warning of the severity of the pay erosion
@BMA_JuniorDocs
have suffered.
If we want access a Dr at those points in life when we need one, we need to find a way to pay them properly.
#payrestoration
✊🏼
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The level of disrespect the NHS throws at new doctors is staggering.
So a new doctors not only starts £11k a year worse off than an associate, whilst working more hours.
But they also now have the indignity of their extra non-contractual work paid at half that of an associate?!
How is this acceptable
@BucksHealthcare
?
Doctors are NOT worth half a Physician Associate.
FY1s, this is how they value you. Look how they value your replacements.
STRIKE.
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🔸£3bn spent in just 10 months trying to ignore the strikes.
🔹£9.9bn spent writing off unusable PPE.
🔸£9-11bn a year spent on their national insurance tax cut.
🔹talk of “fiscal head room” for more tax cuts.
Net cost of full pay restoration for doctors?
£1.1bn
Failure to resolve the strikes is expected to cost the NHS £3bn. Trust leaders are deeply frustrated and anxious that there is no news of any official pay negotiations. It's vital the government and the BMA resume talks urgently.
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Today Govt cut taxes for 27 million people by on average £450 per person.
27m x £450 = £12.15bn
Cost to restore doctors’ pay = £1.1bn
They could’ve ended this pay dispute and still given an £11bn tax cut but chose not to.
Pay restoration is affordable.
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Doctors: we’d like pay restoration please, we did our bit during austerity and put our lives on the line everyday during covid, losing hundreds of our colleagues on the way, it’s only reasonable.
Govt: Can’t afford it, and we won’t borrow or raise taxes to do it.
Also Govt: …
Downing Street is holding talks about scrapping Inheritance Tax as part of a manifesto offering for the next election.
@CliveBull
asks: Would that win your vote?
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This is big risk to the “junior” doctors who would be calling the on-call consultant for advice.
Who has the medico-legal liability if the non-medical consultant gives wrong advice and the “junior” doctor follows?
How are “junior” doctors supervised practitioners in that model?
This is an NHS trust advertising for a non doctor to be employed on the consultant on-call rota.
I’m unclear if this is due to the national shortage of consultants in so many medical specialities, or an attempt to save money, but how can this possibly not risk patient safety?
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The problem in a nutshell.
💵💵💵 Vs 💷
Aus Trainee = £170k
UK Consultant = £88k
Difference = £82k
The UK is woefully uncompetitive in the international medical labour market.
If we want a function health service, we’ve got to pay the going rate 🤷🏻♂️
#PayRestoration
To understand the medical brain drain from UK to Oz, look at my🇦🇺 fellowship payslip.
Fortnightly salary = 12470 AUD = 6528 GBP.
= £170 000 per annum as a trainee.
UK consultant salary = £88 000 p.a.
We will lose our best doctors from the UK if we don’t fix this.
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Utterly disgraceful that Junior Doctors, would be subjected to such coercive and bullying behaviour in an attempt to prevent them from claiming contractually due payment for stat/man training.
@MTWnhs
must repudiate this management statement loudly and publicly to all JDs now…
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This culture of disrespect and infantilisation of a group of highly intelligent, educated and qualified adult doctors must end.
The galling irony being that it’s only the doctors who will have an explicit regulatory requirement to “be kind”.
P.s. thank you Meg.
#BeMoreMeg
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It’s almost as if they don’t feel valued by the UK after 15 years of pay erosion culminating in a workforce retention and recruitment crisis, in turn rendering the working lives of those that remain intolerable.
🤔
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Whilst the rest of the world take steps to attract and reward this highly skilled workforce, the UK instead:
🔸hammers doctors with 6x the pay cut suffered by the rest of the economy.
🔹stretches them on shocking rotas.
🔸pretends £20/hr is an unreasonable request for a doctor.
Imagine working in sunny, warm, beautiful miami as a british doctor?
A new proposal may allow foreign doctors to practice in Florida without repeating specialty training…
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If the consultant surgeon was unaware, what’s the odds on the patient knowing and giving informed consent to the procedure?
Patients have the right to make informed decisions, if they didn’t know the anaesthetist was replaced by an AA, they were not informed when they consented.
Consultants - you can no longer assume the person doing the anaesthetic on your patient is an anaesthetist
And it seems some don’t voluntarily state that they’re actually AAs
Best clarify that before the sh*t hits the fan in theatre
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Train drivers secured their pay and conditions through effective trade unionism; organising, unity and a willingness to take meaningful industrial action.
Nurses have that same power if they would but grasp it.
The alternative is accepting the scraps govt throw them.
That nurses can earn £23k while train drivers can take home £69k is a national scandal.
When did our economy become so skewed, and is there any going back?
@Telegraph
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Doctors,
Protect your patients.
Protect yourselves.
Protect YOUR licence to practise medicine.
Don’t risk all you’ve worked so hard for.
Never rely solely on the clinical judgement or assessment of unregulated, under-trained and under-qualified MAPs.
We will stand with you ✊🏼
Together with the GP registrars committee, we’ve released a new statement setting out our position on MAPs (medical associate professionals). We also cover prescribing guidance for doctors working with these staff.
Read it here:
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The problem:
Currently there is a chronic shortage of paediatric doctors.
Solution:
Train and hire more paediatric doctors.
There; fixed it. ✅
Never accept the lowering of standards by pretending associates are anywhere near safe and or adequate replacements to doctors.
Another cracking read by by HMS Sheffield.
PAs are medically trained generalist healthcare professionals
Aim to train them to be on level 1 and 2 Rotas replacing doctors
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This letter has no force or effect.
Platitudes without effective action don’t address doctors’ concerns to protect patients.
Its time to;
🔹reverse the name changes
🔸nationally define a restrictive scope
🔹ban their use on doctors’ rotas
🔸regulate them elsewhere to the GMC
We welcome this letter from
@NHSEngland
, making clear its position on PAs.
"PAs are not a substitute for doctors; they are trained to work collaboratively with other health professionals as supplementary members of a multidisciplinary team." 1/3
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We should all take a minute to remember what Mr Massey was doing and who for in 2016.
Mr Massey was one of Jeremy Hunt’s hatchet men at the Dept of Health, helping Hunt to impose a contract on doctors against their will.
Now we’re to believe he cares about retaining doctors?!
Today we’ve published our latest research into migration trends in the UK’s medical workforce. The research explores the reasons why doctors have left or may be considering leaving the UK to practise abroad.
Retention is a vital part of any plan to maintain a sustainable…
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Toothless questioning from
@bbclaurak
on the doctors’ dispute this morning.
Didn’t ask PM about;
🔸pay erosion / restoration.
🔹no talks with strikes on.
Also allowed falsehoods to go unchallenged;
🔸consultants and SAS haven’t accepted anything yet.
🔹nurses didn’t accept.
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This is as dangerous as it is shortsighted.
Patients across the country are struggling to access their GPs.
We see GPs facing redundancy and substitution by “physician associates”.
Is the best plan for the nation’s health really to severely restrict your access to a doctor? 🤔
NHS workforce plan relies on 'significant' substitution of qualified GPs, NAO warns
#longtermworkforceplan
#NHSworkforceplan
#NHSworkforce
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Oh damn, would you look at that!
Talking to unions and trying to resolve disputes through negotiation, even with strikes scheduled or ongoing has led to strikes being suspended?!
Who knew?! 😮🤔
#DoctorsStrikes
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I do indeed, quite often in fact;
I’m not a doctor.
I’m not a lawyer.
I’m not an elected member of the union.
And it doesn’t bother me in the slightest, because it’s not about me.
It’s about the person I’m talking to understanding who they’re talking to and what I’m saying.
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@KeeleUniversity
Use of the term “generalist practitioner” for PAs is irresponsible and misleading.
It’s so close to the legally protected term “General Practitioner” (GP) that even the software you’ve used to provide subtitles misheard and misrepresented it.
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Hmm…
A troubling reaction to learning your department has issues to say the least.
The fact you didn’t ask “why has this doctor felt unable to raise this matter via internal avenues” speaks volumes.
Perhaps we need to take a deeper look at the dept’s culture and practices?
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Outrageous on so many fronts;
1. Nursing is a highly skilled and proud profession; to denigrate it like this is disgraceful.
2. It undermines doctors, their training and their role.
3. I’m worried that they may misrepresent themselves as a Dr to patients, undermining consent.
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