Iona Collins.DOCTOR.
@Doc_IonaCollins
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Actions speak louder than words. BMA Cymru Wales Council Chair 2022-
Cymru Wales
Joined January 2011
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Pinned Tweet
I think I will pin this post.
@physicianassoci
@TheBMA
@DrPhilBanfield
Awful lot of doctors about to be hauled in front of the GMC for insufficient supervision 🤦♂️
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@NatashaMDay
I’m betting that your post has supported a ton of people who haven’t yet spoken out and I thank you on their behalf.
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You qualify as a doctor.
You find out that while you've been studying to be a doctor, the NHS wages have significantly stagnated.
You look at adverts in English-speaking countries and work out that the NHS provides the lowest income of them all.
You leave the NHS.
The End
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There is somebody out there, in the UK, who worked out that quitting their job as a doctor in order to work as a dog walker at £15/hr made financial sense. We are not just losing doctors to other healthcare employers, folks.
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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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I think I will pin this graph.
It's the NHS doctors' pay dispute in a nutshell.
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@SteveBarclay
@BMA_JuniorDocs
@Telegraph
Dear Mr Barclay,
Please can you explain the phrase “come to the negotiating table”? The BMA understands this as being physically present at a table, in a room, at a specific date and time, to negotiate. Which should have happened yesterday, when you didn’t turn up.
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I am a BMA rep.
I am employed to work in Morriston Hospital, Swansea, as a consultant orthopaedic spinal surgeon.
I am open to all doctors, regardless of BMA membership, to DM me or contact as they wish regarding any workplace issues.
Actions speak louder than words. I act.
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Severed hand reattached by a surgeon somewhere in the NHS. Surgeon paid £50/hr.
Just saying.
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I often wear scrubs in work and I wear this badge for as much clarity about my job as possible. I also have a few scrub caps, all with my name and job title on them. I think this helps in theatre. Finally, we have scrubs for the wards with "Spinal Surgery" written in large print.
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@Xeon4f145d96s1
A newly-qualified nurse starts at band 5. A newly-qualified PA starts at band 7. A newly-qualified doctor starts at the equivalent of band 5, a fully-specialised doctor at the end of training is offered band 6-7. There is no point being an NHS doctor. We must leave this abuse.
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@pulsetoday
When doctors are responsible for supervising PAs, doctors define the PAs’ scope of practise.
If PAs are wholly independent of doctors, then doctors do not need to determine scope because doctors are not responsible for their actions.
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Just thought I'd remind us all of Wes highlighting how inflation-matching pay was important to retain staff...in politics.
Wes Streeting admits that MPs pay has gone up from £65k to £82k to keep in line with inflation.
Why aren't junior doctors and nurses given similar pay rises to keep in line with inflation?
#BBCQT
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This is an example of how doctors are treated these days.
Pay deducted on the assumption that breaks are taken during a shift, but also with the expectation that the locum doctor is available for 100% of the shift.
The NHS is broken.
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Junior doctors should be ashamed of themselves
Ashamed of themselves for what,
@AllisonPearson
? Would you rather the doctors keep their heads down and soldier on, despite the NHS, as you correctly report, being no longer fit for purpose? Really?
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The medical profession is doctors.
The End.
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This makes sense to me.
eg
"Hello, my name is John Smith. I am not a doctor. I am a Physician Associate and my supervisor is Doctor Iona Collins."
Physician Associates are Dependent Professionals.
The supervisors, on whom they depend, should be named.
Complete transparency.
In the spirit of
#HelloMyName
is….all that needs to happen is ALL PAs state
“Hello my name is Jo Bloggs & I am a physician associate to Dr X”
Ie a NAMED doctor ….then the patient knows who they are, that they are part of a named team
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There is no way that I could make clinical decisions on my own after two years of clinical training. I would run absolutely everything past a doctor.
I speak for myself.
Does anyone else think that they can make clinical decisions after two years of clinical training?
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£35k minimum salary for a visa? How are we going to recruit all those healthcare workers that other countries have trained up? The NHS salaries are often less than this. Is the NHS exempt, given that it’s a calling/vocation rather than a job?
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I could be accused of stating the bleeding obvious in this interview, but it seems that government gaslighting is so effective that headlines like this are necessary.
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@gmcuk
Doesn't "Good Medical Practice" mean the same as "Practising Medicine Well"?
If Doctors alone practise medicine, then, why include AAs and PAs in this guidance, when they are not doctors?
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Trust Chief Physician Associate.
Band 8b for a 37.5hour working week.
How does this compare with what's involved with reaching this salary as a doctor? Why train as a doctor when the PA route is available, unless doctors choose to avoid the NHS?
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@DrLou83
@CUH_NHS
This is a symptom of resource constraint. We end up in-fighting. It’s so sad to witness. Why do we keep working in the NHS? Are we setting ourselves on fire to keep others warm? The BMA must keep the pressure on, to change all this. Let’s begin with pay and take it from there.
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So, the AAPAO has passed in the House of Lords.
At least the dissent is now accessible for the public record.
The medical profession has been ignored, despite the medical profession being currently required to supervise MAPs.
Let's see how history looks back on us.
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Who has more clinical expertise and experience?
A Consultant or a Senior Consultant Nurse?
Can a Consultant treat patients independently?
Can a Senior Consultant Nurse treat patients independently?
How about a Physician Associate? (Clue:PA pay starts at £43,742 vs Dr= £32,300)
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That was an eye-opener. >13 hrs, virtually non -stop, trainers necessary for the step count, Cisco phone like an inconsolable baby needing constant attention. STRIKE HARD!!!! You are the most amazing people, delivering so much with so little and we are at breaking point.
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Between 1996 and 2007, I always had an on call room when I was resident on call.
How many NHS hospital doctors can say this now?
Have on calls been changed to shifts in all acute specialties?
PS I do 'on calls' as a consultant surgeon ie on standby
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I think that many training doctors are feeling frustrated by the fierce competition for training places on the one hand and the reported lack of training doctors on the other hand, which justifies fast tracking new roles, used as their substitutions in the workplace. 1/2
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Junior Doctors supervise PAs, yet their pay is significantly less than those who they supervise.
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This is not an isolated experience. I know of PAs from different UK locations reporting that they have been told they are having a crash course in medicine, condensing everything Drs know into 2 yrs, like a super-intense medical degree.
Say it often enough and it sounds true.
@LittlePersonDoc
@RCPhysicians
Yeah, pretty much. We were told we were covering most of the same clinical content and sitting exams from the same question bank. I now know this clearly was not the case.
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@timricketts_
Hang on- Physician Associates can assess medical students, but doctors in their first and second years post-qualification can't? But doctors in their first and second year of post-qualification supervise the Physician Associates, check X Ray requests before signing, prescribe...?
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I worked my first junior doctor job over half a lifetime ago. I had hospital accommodation, I had access to food and drink, the mess was well-equipped, there were so many of us working together, we had well-staffed solid teams, or firms. It was hard work, but today- it is harder.
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“Some of our patients tell me that they have chosen to pay for an appointment because they know they will see a doctor, as opposed to seeing a physician associate for free on the NHS”
Two tier system already developing in General Practice?
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PAs are substitutions. The GMC (2015) explains why it needs to regulate them here 👇
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Assistants do not supervise their supervisors, they assist.
Can someone at
@NHSHighland
please explain why PAs are now supervising doctors at Raigmore Hospital? Is this a joke? Job advert posted 14/12/23.
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This Wednesday will mark an historical milestone: the beginning of the end for doctors in the NHS.
From Wednesday onwards, associated professions will share the same regulation as doctors and we will all work together according to the medical model, with associates earning more.
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Supporting the junior doctors in England today . Strike day 3.
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Regulation doesn't make two years of clinical training automatically sufficient to place PA into general practice, making clinical decisions which may have life/death consequences.
PAs are not Drs, so please stop substituting Drs for PAs. It's not fair on PAs or safe for patients
'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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In 4 days’ time, NHS Wales doctors identified as “Junior Doctors” ie sub-consultants will strike.
Consultants and SAS docs will vote on IA in 11 days.
I’ll replace a night shift SHO and donate all net pay to the BMA strike fund.
@WelshGovernment
@Eluned_Morgan
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Physician associates make job harder, not easier, say thousands of NHS medics
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And so it begins.
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If Physician Assistants/Associates are not Doctors' Assistants, but instead, medically-trained professionals who work alongside doctors, then what is the specific role of a PA in the NHS?
Are PAs substitutes for doctors or are they doctors' assistants?
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Really? GPs getting sacked as too many in the surgery?
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In 1980, the roles which supported doctors were paid less than doctors. Clinical Assistants and Hospital Practitioners helped free up doctors to focus on work which specifically needed a doctor's clinical expertise. BTW, doctors had a 30% pay rise in 1980.
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@SheffieldHCP
“Prescription issued by ourselves and signed by a GP”.
Is this happening in Sheffield?
GPs’ signatures used to sign off PA prescribing?
PAs cannot prescribe- it’s illegal.
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I would like to walk you through a very big and controversial annual report which advises how NHS hospital doctors and dentists should be paid.
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Listening to a spinal surgery lecture does not equate to stating that one has been trained by a spinal surgeon, has been taught spinal surgery by a spinal surgeon, or is highly skilled in spinal surgery.
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Who wants to study for 3 years after school and get a starting salary of £28,407?
Who wants to study for 4 years after school and get a starting salary of £43,742?
Who wants to study for 5 years after school and get a starting salary of £32,398?
3 A levels ➡️Nurse/PA/Doctor.
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Twitter has discussed this article already.
The Telegraph Online has 534 comments linked to this piece so far.
I hope that PA= Physician Assistant legally and the regulator ends up as HCPC- we can then all get on with our respective jobs without overlap.
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The British Medical Association is an association of doctors who work in the UK, along with medical students who are studying to practise medicine.
The General Medical Council is soon to be the Generally Medical Council, as MAPs become regulated by the same regulator as doctors.
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A recognisable doctor, in a prominent position, is asking the UK's medical professional community for help in reporting unsafe (and illegal) activity within the NHS.
The medical profession appears to be responding, but only as anonymous accounts, to avoid personal repercussion.
Request to Med Twitter- can someone kindly collate & send me the name of the Trusts where-allegedly-PAs have requested ionising radiation or been prescribing?
Since no one else seems to be taking it on?
I will raise it formally to relevant orgs
On grounds of safety
Thanks
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The BMA has published a document which clearly states how a PA can support patient care with specific tasks and work collaboratively within the medical team. This should enhance clinical care and provide clarity to all, including employers.
Thank you, BMA 🙏
"Patients must know who is treating them and the skills and abilities that clinician has."
Today, we have published new guidance on the scope of responsibilities for Medical Associate Professionals (MAPs).
Read more here:
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This paper, published in June 2023, shows that despite PAs being introduced to the NHS in 2002, there is still confusion regarding a PA versus a medically-qualified doctor.
Why must an ambiguous job title necessitate constant clarification of one's role?
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A PA’s clinical qualification is gained at the end of 2 years’ clinical training.
Why is a PA the on call consultant?
Following on from the most recent example of a stroke consultant bleep being held by a PA (someone who isn’t a doctor at all), is the gastroenterology on-call bleep again being held by a PA.
Who is legally responsible if any incorrect advice is given by a non-doctor to doctor?
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Only doctors practise medicine.
.
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While most settle down for the evening, the night shift prep begins for doctors, nurses and other front line workers up and down the country. What value do we put on this?
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How do we value professionals? Doctors are undervalued, literally, on account of annual pay erosion since 2008.
So- who is hugely valued these days in the NHS?
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Q: Are Physician Associates medically trained?
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Is the supervising doctor hiring the PA or is the doctor tasked with assuming liability for the PA? Who’s doing the hiring and what are the T&Cs for a currently unregulated role? Who is indemnifying these PAs and do doctors need to declare their extended liability too?
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Is it possible to learn science in school until the age of 14yrs old and then not touch another science book until at least 5 years’ later, when undertaking a 2year PA course, followed by working as a fully qualified PA anywhere in the NHS?
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At the end of the day, dependent professions depend on the medical profession. Doctors are the professionals that dependent professionals rely on. There’s a professional hierarchy, based on training, expertise and experience. Letters after the name reflect the expertise level.
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When the NHS and social care pay less than other employers, the workforce migrates to where they are better paid. This is the reason why the NHS and social care now has a workforce crisis. Conditions also a major contributor. Pay and conditions in this order.
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“There’ll be a situation where those with private insurance will see a senior doctor and those without, increasingly, will see individuals with no medical training”.
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RCGP red lines-
1. PAs REQUIRE GP SUPERVISION.
2. PAs DO NOT SUBSTITUTE FOR GPs
@SecretPhysician
In a WhatsApp group of dozens of PAs, not one of them thought it was odd that there was no doctor available
This is the norm
Stop burying your heads in the sand
@rcgp
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"Physician associates are medically trained, generalist healthcare professionals, who work alongside doctors and provide medical care as an integral part of the multidisciplinary team"
Same words, repeated across multiple sites.
So, how are PAs different to doctors?
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Physician ASSOCIATE. Associated with a physician. Like a doctor. Medical model training.
Confusion or Deception?
The BMA calls for renaming of the role to Physician's Assistant.
The 2 years' clinical training should allow for the role to assist effectively.
@thesalariedGP
@TheDA_UK
We do know she thought she saw a doctor.
We know doctors are more likely with their expertise to recognise serious pathology.
Whether preventable or potentially preventable, it was suboptimal care by virtue of a lack of qualification to make the diagnosis.
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All 15 professions regulated by the HCPC pay the same fee, but 👇
PA GMC fees could be half of doctor rates
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Please consider writing to your MP. This draft order, which legally protects the titles “physician ASSOCIATE” and “anaesthesia ASSOCIATE” is set for December.
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@nhscaroline
@LeeJone61350125
@AnjanBa91282506
@veggieequallife
I'll leave this here.
You, my friend, are an NHS colleague, yet you behave in a way that invites others to believe that you are medically qualified, while simultaneously admonishing actual doctors when they make reasonable requests about their workplace.
Please reflect.
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@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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This is what we're up against, folks.
Deliberate devaluation of the medical profession if employed specifically by the NHS.
We either want a fair-paying NHS, or the NHS can keep pushing doctors away.
@Doc_IonaCollins
Hi Iona
NHS Digital updated their quarterly data on Thursday (to Sept 23) so this now included 6 months of DDRB 23/2. See new charts (version 4) and thread below
Still *shocking* pay erosion - not “fair and reasonable”
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@SaraTon08500527
MAPs are dependent roles. I believe that they are the only roles that require specific supervision by a different profession. The different profession is the medical profession, with the BMA being its representative association. The BMA publishes this document to enable teamwork.
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Communication matters.
A medic, in court, is defined as a doctor or medical student.
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If PAs are dependent roles, with the role mandating supervision, why is it seen as “resistance” when supervision is queried by others? Does overcoming resistance translate as no longer checking whether supervision is in place?
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@TheBMA
"This is an assistant role to doctors helping with simple practical procedures, administrative tasks, and working with patients in a supportive and specified role"
The BMA's definition of a PA, in a nutshell. Supporting patient care, helping doctors to treat the sick. Teamwork.
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BMJ July 11th 2023.
Opinion piece.
Conclusion: NHS attempting to solve its workforce crisis on the cheap.
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Back pain. A simple diagnosis, or a symptom with a broad differential diagnosis? So-called “mechanical back pain” is a diagnosis of exclusion, with reassurance= serious potential diagnoses confidently excluded.
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"Medically trained, Physician Associates (PAs) are generalist healthcare professionals, who work alongside doctors and provide medical care as an integral part of the multidisciplinary team."
Statement by a major teaching hospital on a social media platform to educate the public
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F 1, F 2, F flee is a well-known cliche, thanks to growing opportunities outside the NHS and ever-decreasing incentives to remain employed by the NHS. But, is CCT then Flee becoming normalised too? Internally quitting(⬇️hrs) and early retirement, sure, but is post-CCT ✈️ ⬆️⬆️?
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@Dr_Done_
I have no doubt that dog walking is better for that ex-doctor's health than the healthcare service was for that ex-doctor's health.
We're good for the NHS, but the NHS isn't good for us, in other words.
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@nhscaroline
@AnjanBa91282506
@veggieequallife
Hi Dr Leach.
Sorry to ask, but are you able to clarify your job?
Are you an MBBS doctor, going by the title Advanced Practitioner, or are you a nurse going by the job title Dr?
Feeling a bit confused by your Twitter handle!
Thanks.
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This fast-tracked PA workforce is put into the clinical setting after 2 years of clinical training.
When PAs earn more than doctors, how is this creating efficiency savings?
When PAs learn less than doctors, how is this creating a safer NHS for patients?
@DHSCgovuk
And I’m not particularly sure it’s the safest of affairs.
However there does seem to be some real bizarre pushers at play. It seems to have a hint of personal gain.
Look through my tweets and you will see they ARE planning to replace doctors.
Credit to
@ExplosiveEnema2
for…
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Who practises medicine?
Who is a medical practitioner?
If a doctor fails their duty of care, their fitness to practise (medicine) is investigated.
Are PAs also medical practitioners practising medicine, who can be investigated via a Fitness to Practise (medicine) process?
#AAPAO
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In 2005, there was no intention for Physician Assistants to be registered alongside doctors, because PAs are not doctors.
Care was also taken to ensure that the Physician Assistant title did not cause confusion.
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How many years of raising concern are required to instigate change? The physician associate issue remains, despite reports like this 👇
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4 yrs training, with half done with medical students, equipping the qualified professional to make decisions about patient management as generalist medical practitioners.
Explain to me how this isn't a doctor.
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Quote from this tragic event below. When somebody is indistinguishable from a doctor and also fails to seek help from a doctor.
There is also the problem of the title of the role, which Marion Chesterton told me sounds
“extremely grand, even grander than a General Practitioner”.
The cost of cheapening our health service by rolling out under qualified PAs and AHPs to play doctor. Always demand to see a doctor. RIP.
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@ShaunLintern
Angry NHS workforce- yes.
Toxic Med Twitter- no.
Angry Med Twitter-yes.
Med Twitter lashing out- no.
Med Twitter publishing evidence to support significant concerns- yes.
Med Twitter speaking truth to power anonymously to avoid incrimination - yes.
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Another predictably busy on call. This evening, the SpR takes me around all the referrals that she’s seen along with proposed plans. I later realise that her shift finished 2hrs previously but she wanted continuity of care. This is what additional discretionary effort looks like
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This is how to confirm:
1. That the doctor you are seeing is medically-qualified.
2. Year of qualification
2. Check your GP on the GP register
3. Check your consultant on the Specialist register (there are many different jobs with the title "consultant")
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Lots of different people now working in the NHS.
This is how you find out whether they are a medically-qualified doctor, whether they are trained as a GP or whether they are a specialist in the specialty that applies to your condition.
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How can PAs, with two years of clinical training, be expected to meet the same regulatory standards of fully-qualified doctors? PAs are not doctors and should not be compared with doctors. It’s unfair to both PAs and doctors.
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This talk sounds impressive. How many exams have been passed to gain this level of expertise and what was the pass rate?
A plastics PA
Fortunately the PA podcast comes to the rescue to describe exactly why they won:
- consenting
- taking complex referrals including 3°
- on call
- carrying bleep
- theatre & clinics
@DrSarahClarke
- is this replacing doctors? Is this safe for patients?
2/🧵
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This is what newly-qualified PAs are going to be expected to do by the GMC when they are regulated, with the onus on them to seek supervision when they think it's necessary. The responsibility is with the PA, in other words, not the supervisor.
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@Xeon4f145d96s1
If you are a medical student or a doctor working in the UK, please join the BMA and please wear your BMA badge or lanyard with pride, please use the BMA pens, please show that you are a part of the British Medical Association. This is your representative professional body.
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@JaneGr01
Please do not consider the solution to be removing the locks.
This picture is evidence of workplace deprivation, IMHO.
Please consider furnishing the NHS estate with appropriate equipment to permit rest, rehydration and healthy eating.
Staff investment = high-yield.
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MBBS.
All doctors, who treat sick people as a profession, have this qualification.
Here is the link to apply 👇
.
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