I’m doing some book keeping as a diversion for the next time someone tries to talk to me about basic science. An #anaesthesia 🧵 of 🧵’s regarding some of the things I think about during my day job. (Thank you to everyone that has contributed to the discussion) 1: Alfentanil

I’m going to speak freely Ranking Trusts is disastrous Meaningless measures are targeted for ease over relevance with profound and perverse consequences If you want to know why, read this 👇

20 years ago the only real difference between going private & NHS was choosing your consultant, waiting a little less and getting a nice ☕️ The 10 year plan makes it pretty clear you might not even see a Dr in the NHS now, let alone a consultant Two tier … … is here 🤷‍♂️

It seems like they might have their objectives rather too aligned with the DH for an independent regulator??

And as a final thought I can’t shake the unease of the GMC saying in court safety is an objective not a duty and that they didn’t want to set scope because of the impact it would have on the employment prospects for PA’s / AA’s

The only conclusion I foresee now is avoidable harm from people working locally outside of unenforceable boundaries and this issue being settled after very expensive, sad and unnecessary negligence suits?

And this is the crux The RCoA can write scope but has no way to enforce it The GMC can enforce it but has no interest in doing so? So what’s the point of the college and what’s to stop Trusts relying on totally inappropriate staffing??

Now we know some trusts are clearly over reliant on their AA’s Sheffield replied to the RCoA scope consultation with the below 📷 If a department is this beholden to non medical AA’s I fail to see how it can be safe?

And this has been the scenic route to the❓with no answer…… The RCoA can rightly set scope as the experts but they cannot enforce it The only body that can enforce a scope across all healthcare sectors is the GMC That’s what we asked them to do and that’s what they refused?

It’s a very fair document that was produced transparently and although almost half of anaesthetists that replied thought it wasn’t restrictive enough, let’s just assume it’s agreed and fit for purpose

And here it is: https://t.co/qEdtpFYgRy

So I’m going to stay in my anaesthetic lane now After a slightly shaky start to life with AA’s the @RCoANews , to their immense credit, listened to their concerned membership which culminated in them writing, formally consulting upon, and then endorsing a scope document

We never even touched on what scope should actually look like, this just seemed like a safe plan in the current vacuum?

With the above in mind it seemed reasonable that the experts in each speciality, The Royal Colleges, consulted their membership and set a reasonable scope In turn the GMC as the overarching regulator could see to enforcing that scope

Now, I always assumed a, if not the, primary goal of the Royal Colleges and @gmcuk would be to advocate for and plan policy around patient safety Do no harm etc etc I’m left wondering how incredibly naive I’ve been but anyway, I’ll continue

What we never said is there isn’t a job for PA's nor that they couldn’t be incredibly useful if deployed in a safe role commensurate with their training

Saying it seems sensible is actually rather charitable as we know many trusts have been enabling wholesale doctor substitution be it PA’s working on registrar rotas or AA’s running their own lists So as I say, perhaps not charitable, but essential for safe guarding patients 🤷‍♂️

The reason this is appropriate because Senior doctors are independent (unsupervised) clinicians after years of selection and training And PA’s and AA’s will by definition always need supervision so it seems sensible to provide agreed boundaries for the latter

For context this is what I’m talking about 👇 We contended that there should be a nationally agreed upon and universally enforced scope of practice for associates, or assistants in this post @lengreview era https://t.co/DHRq2CExWn

This week was a beat down but you win some & you lose some One thing this court ruling won’t stop me doing is raising concerns & asking questions about patient safety And for me, this is the biggest one that no-one seems able to answer….. 🧵🤷‍♂️

Now we know some trusts are clearly over reliant on their AA’s Sheffield replied to the RCoA scope consultation with the below 👇 If a department is this beholden to non medical AA’s I fail to see how it can be safe?