Tim CS
@timcs1968
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Consultant colorectal surgeon, husband, dad, keen cyclist, walker, climber & skier. Trying hard to have a low carbon life.
South East, England
Joined July 2012
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@Jeremy_Hunt
@goldstone_tony
@RishiSunak
I am a 54 yr old surgeon. No private practice. Just been advised by IFA to retire or go 1/2 time & pull out of NHS pension due to impending unaffordable pension tax bills. About to breach lifetime allowance too. You said you’d fix it.
61
928
2K
Basically I can no longer afford to work in the NHS & save towards a pension.
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@DoctorMayJay
My wife is a GP and if the have an acutely sick patient & call for an ambulance, they are told that they aren’t a priority as the patient is already in a place of safety. It’s like they think the surgery waiting room is a resus bay! Anyone else have this?
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@doctor_oxford
What the hell is he talking about? We are over 300% of our max capacity at my Trust & are only doing very selective cancer cases due to lack of any HDU/ITU cover. He has no understanding.
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@r1chardf1tzg3r1
@RCSnews
@TMitchellFRCS
@AoMRC
@RCSEd
@rcpsglasgow
@TheBMA
@ASiTofficial
@bota_uk
@asgbi
@BritOrthopaedic
@the_mdu
@MPS_Medical
@AvMAuk
@PatientsAssoc
@WhichUK
@bmj_latest
@bbchealth
I think this needs serious discussion at the
@RCSnews
. What is the aim here? What roles are being envisaged following this very expensive investment that our core trainees would massively benefit from but don’t have access to?
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@r1chardf1tzg3r1
@VictoriaAtkins
@uemo_europe
@EU_Health
@HorizonEU
@CPME_EUROPA
@UEMSEurope
@gmcuk
@rcgp
@NHSEmployers
@wesstreeting
@TheBMA
My wife says she’s been a doctor for 30 years & a GP 24 years & still is amazed by the stuff she doesn’t know & the new things she sees all the time. Who is instilling this misplaced confidence that this job can be safely done after 2 years training?
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150
@ProfGrahamTowl
@LeanneHPatrick
@SaraTon08500527
@thatsnotmine125
@caspertown42
@Erin_Dean_
@ASiTofficial
@ExplosiveEnema2
@RCPLTrainees
@HSJnews
@AnalysisDrawer
@JamesLynchGTC
@keepnhspublic
Nobody is entitled to operate on people. We earn the trust of patients & ask for their consent. The reason they agree (or not) is because we have trained for years, passed exams, done the apprenticeship to learn the craft, then they might risk putting their trust in us.
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@DoctorMayJay
I recall seeing an elderly patient in ED with a saddle embolus obstructing her aorta. Not fit for treatment. Time was short. After difficult talk her son asked me if she could have some white wine. Of course! 10 mins later the family & her enjoyed wine together, died soon after.
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@cruncherwax
@Jeremy_Hunt
@goldstone_tony
@RishiSunak
Indeed. Stopping private practice was perhaps one of the best decisions I have made. I’m not going back to it.
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@ollieburtonmed
@MarkBagnallSurg
I am finding these posts about PAs and their job plans very concerning. An SHO would kill for a job plan as above. The entire reason for taking on para-medical staff was to enable our SHOs & FY1/2 to get to their training. Here it looks like the PA is hoovering it all up.
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@doctor_oxford
@sajidjavid
This is what
@BorisJohnson
said at the very start of the pandemic. They have always hoped the vaccine would avoid a need for proper public health measures & the numbers suggest that covid is following nature rather than being managed. £37Bn T&T: massive fraud
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@DrBenLovell
I knew our EPR was bad but hadn’t realised just how awful it is. Jobs that would have taken me 30 mins with handwritten drug/fluid charts, taking two of us an hour. Massive waste of time. Not designed for clinicians, nurses or patients’ benefit.
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@doctor_katie
Katie, my wife (a GP) told me about this last night having seen it on the resilient GP. So tragic & such a waste. I worry about my wife too. She is part time & easily does a full time working week. I can’t wait for her to give up her partnership. My thoughts with Gail’s family.
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@TheNewsAgents
@AdamWagner1
I am so pleased you highlighted this today. Some of those fines are life-ruining for those people & totally disproportionate compared to the £50 fines levied on Downing St.
#covidfineamnesty
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@ExplosiveEnema
@RCSEd
@parthaskar
@RoshanaMN
@ollieburtonmed
@Xeon4f145d96s1
@UKGastroDr
@Doc_IonaCollins
@gmcuk
@iDrSunny
@MichelePaduano
@JanetEastham
I haven’t read the whole document yet as it’s too hard on my phone, but one part saying PAs have low knowledge in anatomy & physiology & trusts were doing weekly training to address this. This huge effort in training should be directed to the JDs who are so often neglected.
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@ExplosiveEnema2
@iDrSunny
I’d like to correct an aspect of this. There is 1 PA in the surgical dept. They help on the wards: admin, documentation, chasing up results & Dx summaries. They did do clinic alongside me for a few weeks but no longer. They never scrub in theatre. Used as originally advised.
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@mmamas1973
Imagine the excitement of having passed your MRCS, and find an ANP being prioritised to do the ‘easier’ Lap Chloes. This is a criminal waste of training opportunities for core & reg surgeons. 170 lost opportunities to train a future consultant. Is this to crush the demoralised?
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@mikegoulden
It feels like medicine and medical training has somewhat lost its way. There no way on earth I would get a job nowadays. Our surgical SHOs have so many hoops to jump through, but I want to just be able to teach them quality care of surgical patients & the basics of operating.
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1
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@SteveBarclay
You need to stop the exodus of senior medics. Change the nhs pension taxation rules regarding AA limits & frozen LTA which are forcing senior medics to retire early. Follow threads by
@goldstone_tony
& consultant with him.
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@DrVoles
The consultant they are working under. The issue is though, why is an SHO not seeing that patient and the PA helping with the other administrative tasks etc to help them get there? That was how PAs were sold to secondary care: a pair of hands to help take some admin away from Drs
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@mollysmum2012
It is so insulting. I remember trying to operate in full PPE, my assistant wearing a hood as he failed his Fit test. He couldn’t really hear due to the noise of the fans in the hood; me shouting instructions hoping he’d hear. Everyone exhausted.
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@UKGastroDr
Agree. This completely undermines the years of work, experience, ARCPs, MRCP that is required for a gastro reg to do clinics etc. it is not equivalent. Consent is critical here, & as you say this is not following NHSE guidance.
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@RewildScotland
Energy intense destruction of habitat. It could be safely managed to prevent incursion on to the road & still be a home for wildlife.
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@SteveBarclay
@BMA_JuniorDocs
Why have you left it so late to do this? We have spent the last two weeks planning how keep the hospitals safe at the cost of cancelled elective work. Too late to reinstate much of it if strike called off now.
#toryincompetence
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@TomTugendhat
@TomTugendhat
, be honest. This country is crumbling under your failing government. Inflation, crashed economy, poverty, education, NHS, public transport, roads falling apart. The list goes on.
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@LGSpace
no mowing for 6 weeks and we have a small forest of juvenile oaks under the umbrella of a 10 year old oak. 43 in total! Amazing what appears given the chance!
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@wesstreeting
If you allow self referral to secondary care, we will be overwhelmed even more & it’ll be even harder to find those with serious disease. Primary care is the best gatekeeper. It’s not a broken model. It’s under invested.
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@gmcuk
This is too much. We are not a collective. We are those who have done years and a years of training and hold medical degrees and post graduate medical diplomas. There is no equivalence. This is unacceptable.
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@reachimyq
Imran, it can be very easy to forget the impact our words and actions can have on our trainees. As we are all under more pressure than ever we need to keep your wise words in mind.
#kindness
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@KateBurkeNHS
It’s extraordinary. He wants his Thatcher moment, but we aren’t coal miners & the NHS isn’t an industry which we can do without.
@Jeremy_Hunt
&
@SteveBarclay
this is the nation’s health. It is directly linked to economic prosperity. For a god’s sake please sit down & talk.
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@ShaunLintern
@doctor_oxford
It’s not just prioritising one covid patient over another. We have other patients with acute disease for example who have reversible conditions but there’s no ITU care available to help get them through it. This is substandard care but there’s no alternative. We do our best.
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@mmamas1973
Absolutely. 5 years medical school training equips the newly qualified doctor with what they need to start learning how to practice medicine. It is a long long journey that takes time to build up required supervised experience which is then tested with rigorous post grad exams.
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@Doc_IonaCollins
I agree. That’s not it. We as doctors are essentially in control of this. Without us, a PA is completely impotent. Use them as designed. Limit scope. Ours in the dept helps scribe on rounds, chases results & can cannulate. Ensure your friends & family demand care by a doctor.
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@gmcuk
Being a PA or AA is not a profession. It is a new invented role with no expertise & minimal training. Junior doctors could do with help with unskilled & admin tasks, but don’t need replacing with less qualified people. Please see attached characteristics of a profession.
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@AvrahamCooperMD
@SurgicalTutor
Beautiful bronchogram. Call the physio & ask them to help knock back out. Barium not a big deal usually: gastrograffin would be disastrous.
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@_JoelAshton
@BDSdragonflies
@Freshwaterhabs
@LGSpace
@norfolkponds
@EssexWildlife
@WWTLondon
My year old wee pond has also filled nicely. Planning a significantly bigger one as this experiment went well.
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@RoshanaMN
Not only are core training cases & clinics being taken away from our SHOs, the supervising doctors are the ones here taking the professional risk as PAs are unregulated. It’s all on our heads. The Royal Colleges and GMC need to get a grip on this.
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@doctor_katie
If any other business had transformed itself like GP did during Covid & was now delivering 7.8% more productivity with significantly fewer workers, you’d be lauded as business geniuses & showered with bonuses & share options.
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@ShaunLintern
Shaun, are they saying they are on a 1 in 2 rota? That would be sustainable for about a week or two as long as neither went sick or ever wanted a holiday or study leave.
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@EdwinCo94910420
@goldstone_tony
Same position as you guys. When inflation falls though & your pension ‘pot’ shrinks we’d still have paid real money on previous fantasy growth & there’ll be no rebate or carry over. I am prepared to go all out to fight this.
#NHSpensiontheft
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@BenGoldsmith
We took in 3 ex-layer hens in a similar state. Give it 8-10 weeks of decent life and she’ll look fine,
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@DrEilidhMaria
Also, MAPs in clinics or GP surgeries take away the easier more basic cases which often act as a moment of relief to us. My clinics are now a distillation of difficult cases and I am fried by the end in a way that is not sustainable.
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@krishgm
They really need to come and talk to experienced doctors before shouting from the rooftops. We are not impressed.
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@iDrSunny
I have seen their course content. The list of topics may be the same but that’s where the similarity with MBBS ends. If the lake is MBBS course, the PA course is the stone skimming over the surface.
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@parthaskar
@gmcuk
An introduction is not enough. To obtain informed consent to do anything, they need to explain to the patient exactly what their role & training is. I think this rarely happens in a way that patients understand. My mum had her carpal tunnel done by a PA thinking they were a Reg
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@MarkCheetham
I remember him telling us that he was begrudgingly given the afternoon off to get married. I have his job description covering house surgeon, SHO & post-FRCS staff at Westminster hospital on my wall in the office. It’s epic.
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@Jeremy_Hunt
in 2015:
Our pension age was raised form 60 to 67. We accepted it.
Our contribution raised form 6% to 13.5%. We accepted it.
Pandemic: we got on with it.
2022: you are destroying the NHS by stealth by forcing seniors doctors out with punitive pension taxes.
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@ASDGPMe
Yet another tragedy. Coroners inquests and GMC investigations need a massive amount of support for those going through it. All too often it is pitiful or nonexistent. My thoughts with all of you affected,
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@hassantahir786
@souramoo
This is the comparison that is needed, and it the same across the medical profession regardless of seniority. Stagnant/falling wages and appalling conditions is a toxic mix & people will vote with their feet.
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@mmamas1973
@DrSteveTaylor
Nobody seems to believe me when I say that I fear we are heading for a healthcare catastrophe unless pay & conditions are rapidly turned around in the NHS. If our juniors continue to leave en masse we are in massive trouble. I can’t do my job without them.
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@mmamas1973
Medical training is an intriguing thing. My wife is a GP, me a surgeon. She was telling me once about a patient who was worrying her. After a discussion I asked if she thought it could possibly be nephrotic Sy. Lightbulb moment. I was right! Med school is important.
#noshortcuts
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@Dr_Done_
@gmcuk
@LeedsHospitals
I was a radiology registrar many moons ago during the period when IRMER regulation were updated & I clearly remember the Prof telling us that the requests and administration of ionising radiation was now governed under criminal law. That made us sit up & listen.
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@HelenRSalisbury
Surely this cannot be classed as a GP surgery anymore? Isn’t this a place where dressings can be changed, alongside simple health checks. Undifferentiated health problems should not present or be assessed here.
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The president of the Australian Medical Association has cottoned on immediately. How can the the
@gmcuk
welcome this & some Royal Colleges stay so quiet?
"This isn’t an office job. They’re not photocopying the wrong document - they’re killing people."
Utterly staggering goings-on in the UK. 🤯 I struggle to understand why patients aren't up in arms about this. What are they being told?
@TheBMA
#NHSCrisis
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@parthaskar
@NHSE_WTE
@doctor_oxford
@mmamas1973
@DrAsifQasim
@OrthopodReg
@RobJimFleming
@trishgreenhalgh
@DrLKVaughan
@UKGastroDr
@WeNurses
@RowanHarwood
I am just going through he GMC consultation on PA regulation. Still utterly gobsmacked that PAs are embedded in the workforce with:
No regulation
No approved course
No scope of practice
No standards
No unique skill set
please take part.
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@doctor_dru_
It seems trivial, but this sort of thing absolutely does staff in before they even set foot at work. Similarly punitive parking fines against staff destroy morale.
1
0
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@NSoames
Nothing says “thank you” like a 1% pay rise offer after 18 months of a pandemic, 100’s of staff dead , & a 30% real terms pay cut in the NHS over the past 10 years. An imaginary cross doesn’t cut it. Clap…clap…clap
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@SteveBarclay
Steve, ours and junior doctors pay at the start of this year was about 30% down from 2010. It’ll be 40% at the end of this year and 50% down in a year’s time. This has to end and you commit to restoring pay or there will be no staff to deliver the care. They will leave or retire.
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@Dr_Done_
As a consultant I will not support this.
I’ve written to PRCS, GMC & my MP on multiple occasions. Only my MP has replied & that was wholly unsatisfactory.
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@gmcuk
Retention is essential & is easy.
1. Value your staff & treat them well.
2. Pay them properly
3. Ensure they can access training easily
4. Enable career progression/development.
It’s not hard, but it does cost.
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@SteveBarclay
What utter nonsense Steve. GPs and pharmacist numbers are falling. Juniors are flooding to Aus & NZ. You are in total denial about what is going on.
#NHSCrisis
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@Magggicc
@DrHenryMarsh
This is my MP Mims Davies, Mid Sussex. She voted to allow sewage into our rivers Eye and Wreake and onto our beaches.
How dreadful for families taking their children for probably the only holiday they will have to only to be told they can't go into the sea!
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@parthaskar
@NHSE_WTE
@VictoriaAtkin
@BolaOwolabi8
@doctor_oxford
@trishgreenhalgh
@mmamas1973
@DrAsifQasim
@RoshanaMN
@OrthopodReg
@UKGastroDr
@DrLKVaughan
@DrNeilStone
It’s almost as if
@NHSE_WTE
are actively trying to break their workforce.
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@alexanderjbald
This is really important Alex. Few people are aware of the huge financial hardship medical student from poorer backgrounds suffer.
@RishiSunak
&
@sajidjavid
need to provide support if they are serious about addressing Dr shortages and levelling up.
1
1
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@PaulDeehan
@goldstone_tony
@Jeremy_Hunt
@RishiSunak
I think you’re right. Perhaps a career change will do me a power of good?
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@trentconsultant
@FraserNelson
At the peak of the 1st wave we had 30 ventilated patients: usual capacity 10 (8 funded) we transferred out about 5. 2nd wave about 35 ventilated & transferred out another 105 ventilated patients. Hospital utterly done in. Staff done in. What planet have you landed from Fraser?
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I have just been advised to retire at 54 by my IFA. IT IS INSANE. I don’t want to retire or cut my hours, but I can’t & won’t work for free.
Stand by your words and sort this pension disaster, and let us get on with the work.
@goldstone_tony
#nhscrisis
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8
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@Megsenmumdr
UMAPS isn’t a union. It’s a private corporation with a single director/secretary set up in Nov 2023. These legal threats are extraordinary. I’m trying to imagine one of my juniors threatening legal action if I didn’t let them do something that was beyond them…
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@ShaunLintern
@DrSteveTaylor
@ShaunLintern
do you have any data on how many NHS hospitals are remunerated for this? The lack of having to provide critical care back up = giant profits.
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@hlnewey
@chriscraigCCC
This is how my department works too. PA doesn’t have any place being scrubbed in an operating theatre. I am there to treat the patient & impart as much as I can to train our future surgeons.
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8
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@sewateruk
Is that 0600-1000 or 1800-2200? Or both?
Stop paying shareholders until you’ve invested properly in the infrastructure.
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@parthaskar
@RowanHarwood
@CliffJonesGP
@UKGastroDr
@DrLKVaughan
@Trisha_the_doc
@trishgreenhalgh
@AntonEmmanuel2
@mmamas1973
@MRCPandFRCPs
@morefluids
I think the country will look back on the demoralisation of the medical profession & unregulated promotion & widespread deployment of PAs as a huge mistake.
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1
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@medicalmodelbri
@GMCharlatan
@iDrSunny
@ExplosiveEnema
Really worrying. By definition after just a two year course, nobody is an advanced anything.
Yesterday I converted another routine referral from primary care by a PA to a two week rule. Nice letter, but zero appreciation of red flag symptoms & findings.
#notadoctor
1
8
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@drjanaway
I have written to my royal college, GMC and my MP about the inappropriate deployment of PAs with no apparent control on scope of practice, and so far no regulation. No decent responses. Doctors have to stop facilitating inappropriate practice, because nobody else will.
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@doctor_oxford
If the public want a national health service free at the point of use, they will have to fight for it too. We can’t save it on our own.
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@DrVoles
@DrSteveTaylor
@BMA_GP
More worrying is how on earth a GP with their own huge clinical workload adequately supervises a PA. I just can’t see how they can safely deputise like this.
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@RishiSunak
@trussliz
if NHS waiting lists are your priority as
@DominicRaab
has claimed on
@BBCRadio4
then an absolute necessity is to remove the huge problem with the pension taxation rules which are preventing senior doctors from taking on extra work forcing early retirement.
7/ The toxic combination of subinflationary pay awards, defects in the Finance Act (CPI disconnect so AA is measured against last years 3.1% inflation) / negative PIAs & the destruction of lifetime allowance will destroy retention in the NHS.
Waiting lists WONT come down
Pls RT
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@ShaunLintern
@thetimes
@TomHCalver
@Meg_HillierMP
@Ben_Spencer
@NHSBartsHealth
It’s commonplace Shaun.
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@DrEilidhMaria
I’m afraid the
@gmcuk
don’t look as if they are going to protect patients, so we will. I believe there is a role for PAs, but it needs tight scope and supervision. Operating is definitely not part of any PAs remit. If a patient is consented properly, I doubt many will agree to it
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@SteveBarclay
You need to address the annual allowance rules and increase the LTA at least in line with inflation. These changes won’t stop senior doctors and nurses from having to reduce hours or retire early.
Please read what
@goldstone_tony
has written to you about this.
0
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@codingbrown
@101dnarg
It’s more moral injury which I suspect is most acute in ED. I’m a general surgeon & know we aren’t offering anything like the service we were 5 years ago. I admit, I avoid ED if I can. It’s like a Dickensian scene of human misery. I don’t know how you guys do it day after day.
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@drcolinm
@davidianpyle
@drdernial
@wendyburn
PAs should not be regulated by the GMC & should have registration numbers issued that clearly define them as different from qualified doctors. There is already a lot of confusion in patients who think they have seen a doctor, this will add to it.
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@ExplosiveEnema
@BWC_NHS
@DrRaviJ
@LittlePersonDoc
@birmingham_live
@BCFC_News
@PaulBrandITV
@PippaCrerar
@parthaskar
@mmamas1973
@birmingham_bbc
@BWC_MattB
@joelycett
Why are Trusts & some doctors finding this difficult? PAs are not doctors & therefore cannot cover a doctor’s work. Period. Out of hours cover is pure madness. The consultant on call must have agreed. It is their GMC registration on the line.
1
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@miranda_nigel
@chriscraigCCC
Why is this level of investment not being put into medical students & junior doctors? They’re developing some bollocks apprentice doctor training for poorer would be Med students instead of giving them a decent bursary.
#NHScrisis
0
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@trentconsultant
One of my old bosses who retired two years after I joined him as a consultant (2012) went through his old accounts. Indemnity for pp was £400pa when he started, £40,000pa at retirement. Fee for hernia: £400 then. £350 at retirement. (Numbers approximate))
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@GeorgeMonbiot
@GeorgeMonbiot
I think your comment, ‘the ordinary effects of austerity’ captures it very well. The scenes are Dickensian. When you add the likelihood of upto 40% of junior doctors planning to leave this year, we are in huge trouble. Hope you’re ok.
0
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@SteveBarclay
@worcester_uni
@uochester
@Bruneluni
Two problems here
@SteveBarclay
1 you must retain the staff already working & support training. It is a scandalous waste not to.
2. Who is going to have time to train this expanding army of new doctors if you decimate the senior consultant body with burnt out & early retirement?
1
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@Doc_IonaCollins
It beggars belief. Our ST6/7’s wouldn’t have the chutzpah to do this. They understand the experience, knowledge & responsibility that goes with it. These PAs obviously don’t. Consultants must have agreed to it. They are doing the profession & patients a disservice & are culpable.
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@Picss3o
I did private work for a short time, giving up 10 years ago. I was shocked by private insurers. Poor selective cover, shockingly low fees but high premiums for patients. I was often left to chase the patient’s excess that would be deducted from my fee. Profit is all. Period.
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@OrthopodReg
@parthaskar
@RoshanaMN
@ollieburtonmed
@doctor_oxford
@trishgreenhalgh
@AliJaneMoore
@mmamas1973
But MLA is an exam for doctors. Are you suggesting that the GMC will open it up to all comers? Anyone can study to pass an exam, doesn’t mean you’re capable of the job.
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@SecretNHSCEO
@trentconsultant
I agree, it seems that he has no idea about how poor our estate infrastructure is, how dire our IT is & how burnt out the staff are.
Staff don’t need tough love. They need respect, better pay & conditions & more high quality facilities.
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