Richard Marks - London Anaesthetist
@LondonAnaesth
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Anaesthetist in London. Co-founder of Anaesthetists United.
London
Joined January 2011
@RishiSunak You have brought shame and disgrace on the country and the electorate will teach you a lesson you will never forget.
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"The reaction of actual doctors to an unqualified manager with a history degree telling the medical experts what they should and should not be demanding was unequivocal'.
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@gmcuk Until relatively recently the doctors sitting on GMC council were elected, not government appointees. Perhaps your archivist could add that, to highlight the change in culture which that signifies.
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@Dr_Done_ Interesting how the GMC doesn't have the expertise to set scope. yet does have the expertise to comment on what the experts say. And why is their CEO taking such a personal interest and involvement in this, rather than delegating to the appropriate Director? More expertise?.
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@Councillorsuzie Making the overground lines easier to navigate is not pointless virtue-signalling, nor is it mayoral PR. It is making public transport easier to use and more accessible to use, especially when the current overground map is so confusing.
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@Conservatives @RishiSunak Ready to hold labour to account from day one, say the conservatives on day 4.
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Anaesthetic Recruitment 2021. The one where they told people they had jobs, then told them they didn't. The one where they got the 'rank' and 'score' values muddled up on a spreadsheet. We found out how it happened.
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@GMB Thank you for the opportunity to raise this issue. There has been a huge expansion in the numbers of Associates, which makes it even more important to clarify their exact role. Legal action seems the only way to get this, but it's proving to be very expensive.
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@NHS_HealthEdEng Greatest achievement of HEE is that they look like an employment agency, they act like and employment agency but they don't adhere to the laws governing employment agencies.
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NHSEngland didn't want to wait for new guidance from RCoA and wants to restart training AAs. If you're an anaesthetist in London your department will be asked if you wish to participate. So make sure you convey your views to your clinical lead.
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@NHSE_WTE If we really and truly wanted to take the crisis in medical manpower numbers we'd look at retention of the staff we currently have.
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When I trained - in the 1970s - the overriding priority for both junior and senior surgeons was to be in Theatre. Because thats where the learning takes place. Both on surgical technique and surgical pathology. ". [PAs] role in theatre frees up time for other activity.
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@veggieequallife When I was an FY-equivalent, in 1979, I was expected to be present in theatre whenever any of our patients were being operated on, and I had my own minor-ops list once a month. Because surgery is all about surgery. Something has gone very wrong.
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The GMC is a registered charity, and its charitable objects are 100% tied to registered medical practitioners. Yet for several years they have been spending money on activities for non-medical practitioners. Astonishing, really.
Does regulating physican and anaesthesia associates breach the @GMCUK charitable objectives?. We are writing to them to seek clarification. Co-sign the letter here: .
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Recruitment for doctors-in-training - impersonal, centralised, anonymous, miserable. Recruitments for Associates-in-training - parley with our mateys and see to it they land the job. Why the inconsistency @NHSE_WTE ?
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It could be Game Over for national recruitment, following the Department of Business and Trade decision that, in their view, ANRO must comply with Employment Agency legislation.
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As a matter of fact, Physicians Associates are not actually doctors-in-training . @FBMH_UoM .
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"Doctor of the week" certificate awarded to Physician Associate by a Head of School Of Medicine, Associate Dean and Director of Training for @RCPEdin . Not wishing to criticise the award recipient in any way, but does @RCPEdin accept a PA can receive 'doc of the week'?.
Eau doctor of the week, Hannah, our physician associate. Extremely competent, good independent decision making, dependable and very well respected @NTeesHpoolNHSFT @MADEinHEENE
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An amazing night for UK anaesthesia. Especially pleased that the motion I proposed on regional recruitment were supported, thank you to all the members that voted for it.
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@LordPhilofBrum The NHS has placed two groups of workers alongside one another with overlapping roles but very different backgrounds, and after 20 years it still hasn't defined their working patterns. Absolutely dreadful people-management by those at the top.
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@Dr_Done_ @SheffieldHosp @MajorKirsten1 Everyone better behave, they're watching us; but once they heat is off its back to business as usual, me hearty lads, says Captain Pirate on his 'plucky little sailing ship'. Back to unsupervised practice? . Where are the CQC when you really want them? @CQCpressoffice.
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Surely the reason that this issue has become more heated over the past 2 years has been the decision to expand the numbers of Associates before demonstrating their value.
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Lancaster University part-time diploma to become a qualified Anaesthesia Associates. (PGDip AaPOS). Cost per year Ā£6,500 funded by the NHS. Why is the NHS funding this?. What's going on?.
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The difference between a doctor and a technician is that the doctor looks at the whole patient not just the submucosa.
Family of film make-up artist call for inquest after treatment by physician associate which led to death. @JanetEastham @TheDA_UK @TheBMA.
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@TheBMA @NHSEngland @Channel4News @DrPhilBanfield That's six Medical Royal Colleges in that letter - how many does it take until we reach the tipping point for the Academy of Medical Royal Colleges?.
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@JimBethell @rcgp What is even more shameful is for an employer to place two groups of staff with vastly different backgrounds and experience into the workplace, and expect them to work together, somehow, with no clarity of their differing scopes of practice.
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@ShaunLintern Would you say that creating an entire cohort of healthcare workers without first defining their role, and creating ambiguity as to whether they are autonomous practitioners or fully-supervised assistants was reckless?.
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This must one of the fastest crowdfunding cases ever - which just shows the depth of feeling amongst doctors and the public. What's the difference between a Doctor and an Associate, other than the wording on their name badge? It needs to be spelt out.
Thanks to your generous donations, we've rapidly reached our initial target of Ā£15,000. We can now get started on the legal case. A stretch target of Ā£100,000 will allow us to fight this in court. Please keep donating. Time to #telltheGMC.
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@Assoc_Anaes Association of Anaesthetists . "believes that AAs should be supervised on a 1:1 basis. guidance should take account of those who are not content to supervise AAs". Is this the beginning of the end? Surely with 1:1 supervision they cannot be economically viable.
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Seems to be a lot of confused excitement over whether or not PAs "study medicine". As though somehow this is really important. But really it isn't. Lets look at an analogy. Imagine an essay by a GCSE student on 'the causes of the First World War'. Their essay will be different.
May I add my personal apology for the confusion and/or distress and note the message below is the GMC position. @parthaskar @doctor_oxford @ollieburtonmed @TheBMA @BMA_JuniorDocs @mmamas1973 @DrLKVaughan @UKGastroDr @DrAsifQasim.
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@mark_toshner Placing two groups of workers side by side with radically different backgrounds and unclear demarcation of roles is something that only a particularly rotten employer would do. NHS senior management should hang their heads in shame.
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@BMA_JuniorDocs @TheBMA Excellent statement from BMA juniors. Could the BMA Consultants and SAS doctors also issue their support for this initiative.
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This thread nicely summarises the wrong that has been done to our trainees by the introduction of Associates. Undermining them, undercutting them and giving them a professional identity crisis. What sort of an employer would do this to its valued staff?.
My perspective on AAs; a š§µ . I was an ANP before medical school and am now a specialty doctor in anaesthetics. I work with 2 qualified AAs who are excellent, . I am often asked for my opinion given my background, so here it is a long thread including my own story.
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@DrMattThomas1 Rotational training is a historical relic from a time when there was free doctors accommodation. Now itsju st part of a depersonalised and harsh recruitment system, with very little clinical/educational benefit (except in a few subspecialties), and is a major source of stress.
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@zoenora6 @politicshome Two groups (Doctors and PAs) with very different backgrounds, educational targets and starting salaries placed together in the workplace, with no clear distinction over their roles. What sort of senior manager would think that's a smart way to run the NHS?.
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@natalieben @medicalmodelbri @PeterStefanovi2 @thatginamiller @doctor_oxford @JanetEastham @AnaesUnited @TheDA_UK The RCoA called for a pause on recruitment of new AAs earlier this year. Time that other Colleges/specialties followed suit, pending results of Leng. Very unkind to recruit/train people for a job that won't exist or will be different to expectations.
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The role of PAs and AAs needed to be defined before they started recruiting applicants who were led to believe the job was "like a doctor but without going to medical school". The current expansion, before regulation and scope planning, is badly judged.
There's a place in the NHS for the PA role but not at the expense of fully trained, specialist medics. Bringing PAs to join the NHS now is like trying to train firefighters in the middle of a Californian wildfire.
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Failure to define what PAs should be doing is central to our current dilemma. The recent @RCSnews statement said they must be 'implemented appropriately' then failed to define what that means. More clarity needed asap. #MedTwitter.
Physicianās Assistants should to the following jobs, and the following jobs only:. - Discharge letters.- Cannulas.- Bloods/NGs/Catheters.- Create patient lists.- Scribe on ward rounds . That would really assist the physicians.
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The lack of clarity on what Associates can and cannot do is astonishing. How have we allowed this to happen?.
Did you know that on Thursday the govt is to legislate for Regulation of Anaesthesia Associates without even defining what they can and cannot do?. Did you know that they're using a parliamentary wheeze to avoid any awkward questions?. Does your MP know?.
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What is especially concerning in this paper is the reference to Trusts paying higher salaries to Associates than NHS Health Careers suggests. @PeriopMedUCL are mentioned as an example Where is this money coming from? Is the magic money tree being used
The current working model for Anaesthesia Associates is not financially viable. To make economic sense either the level of supervision by Doctors needs to be reduced, likely to compromise patient safety, or the AA programme itself should be terminated.
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BMA and AU joining forces on getting the terminology right for Physician and Anaesthesia Associates. Who will be next to join? The Academy of Medical Royal Colleges? @AoMRC
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@ShaunLintern @wesstreeting Did Wes say what the role was?. Or did he say "there is a role, I just don't know what it is yet?". #LabourConference2024.
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@LeylsTurk The cardiologist probably thought he was cracking a very witty joke and would have been totally unaware of the impact of his comment. Seniors and people in positions of authority need to recognise how seriously their juniors take throwaway criticisms like this.
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An extraordinary general meeting of the Royal College of Anaesthetists (RCoA) held on 17 October looks like the start of a revolution in UK medicine. Or, more precisely, a counter-revolution. And while we're all waiting for regulation to start, is the CQC hiding in a fridge?.
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@Dr_Done_ Its not just that PAs are nice people (as are most doctors). They have the crushing advantage that they are permanent and not endlessly rotating. So they establish professional and inter-personal relationships much more easily. Short-term rotational training is very damaging.
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@mmamas1973 @steven_hassel @Jamesbr42538384 Makes it much harder to train doctors if PAs assess the 'easy' acute cases in A&E and only call the Reg if they're difficult. Medicine is all about pattern recognition; you need to examine a lot of patients before you can recognise the outliers.
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Of all the allegations and claims made in this article, here's the one that worries me the most. They acknowledge their statement contradicts the views of the College, but they're saying it anyway. How do you deal with people like that?
EXC: āAnaesthesia associatesā recorded claiming NHS trusts let them ābend the rules' to carry out complex procedures normally reserved for doctors & give anaesthesia āunsupervisedā. @RCoANews "do not support" assistants āenhancedā roles @AnaesUnited .
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Maybe its not about the money (as you say, they aren't cheap). Its not the quick workforce fix either. Maybe the motive for expanding them is retention. They're underqualified to go to Australia or Canada. And insufficiently trained to quit the NHS and work privately.
Both topical and interesting from the analytical mind of Prof JJ Pandit at @RCoANews updates ā economic proposition of AA vs SASā¦ do the NHS workforce plan numbers hold up?
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I'm not sure the general public really understands what the lack of a defined 'scope of practice' really means. It means that somebody who is not a doctor can do whatever their employing Trust ask them to do. Voila. All manpower shortages solved.
Open letter to @RCRadiologists regarding the proposed GMC regulation of AAs and PAs. Co-signed by an astonishing 617 members and Fellows in <24hrs!. This overwhelming call for action simply cannot be ignored. @halliday_kath @DrStephenHarden @tomroques @OliverReichardt
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A Court ruled 8 years ago that, by changing a surgeon at the last moment, the patient's consent became invalid. Court ruled that patients have a right to make an informed choice, based on who would be operating on them. Act quickly, @NHSEngland - current consent forms need to.
@gmcuk advise that the names and roles of the key people who will be involved in their care are shared with patients. Consent for anaesthesia must be modified with this advice in mind.
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Adding staff who are not doctors . to the GMC register brings into question the competence and qualification of the whole medical profession. Is this not, in the most broad and abstract terms, bringing the profession into disrepute?.
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@parthaskar @bmj_latest @RCPhysicians @trishgreenhalgh @mmamas1973 @DrLKVaughan @UKGastroDr @RowanHarwood @doctor_oxford @RoshanaMN @MRCPandFRCPs @AntonEmmanuel2 @OrthopodReg The RCoA has called for a pause in recruitment of AAs - here's their formal statement. Surely if the anaesthetists can do it then the physicians can too.
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Anaesthetic National Recruitment Office under investigation by Department of Business and Trade over workers rights.
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@MedRegoncall1 @enherts Surely posting identifiable xrays is a breach of the terms of employment.
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@gmcuk And yet a court upheld a GMC decision not to take FtP action against the architects of MTAS, because their action in running a flawed recruitment system was deemed too far removed from their job as doctors. The lines seem very grey.
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Online version of the film includes a statement from me, explaining that the overarching duty of the medical regulator is to protect the public. The public would be shocked to find that not only are there no national rules saying what associates can and can't do, but that the.
BMA backs family suing regulator over the role of NHS physician associates, @BeccaBarry reports
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@bbchealth Nowhere in that statement does it say the @AoMRC back the rise in numbers of PAs. It says they need to restricted and supervised. Was there a separate statement saying that medical leaders back the rise? Or is that bit made up?.
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@VictoriaAtkins Would be helpful if you clarified whether, in your opinion, PAs and AAs should always be acting directly under the supervision of a doctor, on a case-by-case basis; or whether they are permitted to act autonomously and unsupervised.
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Hello, my name is [Forename Surname] and I am one of the physician associates working in [specialty]. Physician associates are commonly referred to as PAs. I work alongside the doctors, but I am not a doctor.
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@wesstreeting The blurring of the distinction between PAs and doctors dates back to when Labour first introduced them to the workplace.
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Separate registers for doctors and associates is a clear requirement of the Draft Order, and distinguishing AAs from PAs additionally specified. GMC have spent over Ā£5m on this so far, you think they'd've read the spec first.
@DrDLittle Talking to GMC workers itās intentional. We need to be clear about the problems this will cause and the undermining of medicine.
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Lancaster Uni have pulled the video. For those that missed the original, it seemed to be 2 hours of AAs talking openly about how they 'bend the rules' and have extended their scope. Seems like someone somewhere has woken up to the implications of what they're saying.
"I think they assume you're the anaesthetist. I don't say I'm an anaesthesia associate.". Patients are being deliberately misled. If this is considered acceptable, so much so that @LancasterUni even published it online, just imagine what is done and said behind closed doors.
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@DrJPGannon @PhilipBrayshaw @SandipP64097927 @ponteepon @trentconsultant There are also some very senior clinicians, who have had successful careers, that have expressed concerns over the current problems with PA regulation. For example, the clinical vice president of the RCP, who recently wrote this.
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Royal College of Anaesthetists continues to deliver on EGM Motions; with a letter sent today to clinical directors in anaesthesia calling for a pause in recruitment of new AAs and a pause in development of AA enhanced roles.
Following our Board of Trusteesā meeting last week, we have written to the Clinical Leaders in Anaesthesia Network regarding EGM resolutions 1 and 2. We have published the letter on our website:
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@JimBethell Its the same in anaesthetics. Most interactions are incredibly straightforward, except for the ones where it isn't. Which, if I may say, is slightly less than helpful.
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Extremely strong statement today from Royal College of Emergency Medicine on Physician Associates, with clear indications about scope of practice and supervision.
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@FrankCoffey26 @Caesarnots96696 @mouseter_chef @First_Neptunian @GMCharlatan @PepperNutty @iDrSunny @parthaskar @JanetEastham @drmattuk @doctor_oxford @implausibleblog @Xeon4f145d96s1 @AnaesUnited @medicalmodelbri @chriscraigCCC Frank you're making a valid point. Physiotherapists, speech therapists, midwives, and many other professions, make huge contributions to health care and are very skilled at what they do. But difficulty with Associates stems from lack of clarity over their role and supervision.
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@AnaesUnited That NHSE letter to the @TheBMA reads to me like:-. We created the job of Associates before we worked out their job description or their regulation. Now we want to create 12,000 more of them and everyone is getting all upset. And its all your fault šššš.
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This is precisely the problem with Physicians Assistants; because the concept of an everlasting FY1 completely ignores human nature. Most of us, in our working lives, hanker after promotion and additional challenges. So Assistants want to grow into Associates.
@Jo_McGinn @iDrSunny And yes, I think one of the biggest problems with the whole PA concept was the idea that anyone would want to be an āeternal FY1ā, which is how the idea was sold to doctors.
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@JackTeh96 Is this for real? Moonlighting by setting up a for-profit non-medical business is the way to progress your career as a doctor? Has someone lost the plot?.
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The 7-digit GMC registration number for PAs needs to be reconsidered.
Following Faculty Board on 2 November, we have released the following statement regarding physician associates:
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Surely regulation of Associates should define in some way what it means to be an Associate. If the GMC cannot do this then they should formally delegate that to some body that can, and not just leave it to market forces and the whim of the rota writer.
We call on the @gmcuk to clarify unambiguously that scope of practice, levels of supervision and training should be set by the Royal Colleges/Faculties, and not by the employers. To protect the public, and to protect the Associates themselves, this needs to be crystal clear.
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Ā£25k raised yesterday to challenge the GMC over Physician Associate regulation. This morning its up to Ā£40k. How much will it be this evening?.
Anaesthetists United is pursuing a legal case against the GMC, claiming the PA/AA regulation process is āblurring the distinctionā between doctors and associate professions.
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Meanwhile, Ā£500k might end up going to lawyers, not into patient care, to get an answer to a very basic question. Can individual hospitals override the scope of practice determined by a Royal Medical College?.
The issue is not that Associates are working in hospitals but that what they do is so completely undefined. Our court case is about setting limits on their responsibilities, as well as establishing what consent patients have to give and what level of supervision is required.
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@mancunianmedic @pointlesslettrs Aside from the salary, the letter describes the job of a junior doctor as 'a rewarding life of service to be enjoyed'. The 'life of service' phrase is an interesting choice of words and perhaps describes the culture and perceptions of work-life balance in 1958.
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Ā£30,000 donation to the @AnaesUnited legal case. Wow. Wait until that sinks in.
2/6 We have today committed Ā£30,000 to this vital case, emphasising the deep concerns shared by the medical profession over patient safety and professional standards.
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Possibly the one thing more headline-grabbing than an unregulated non-medical associate administering an anaesthetic is an unregulated non-medical associate carrying out brain surgery.
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The doctors that other doctors call in a crisis. World Anaesthesia Day #WAD2023 is a way to remind people of who we are, what we do, and what a vital contribution we make. And the sax player is fantastic.
For World Anaesthesia Day on Monday 16th let us be proud of what we are and what we do. And at our Team Brief in the morning let us all sing, dance and cheer to our collective anthem - The Gasman's Shanty. Hoorah! The Gasman's Come. #WAD2023.
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@pa_StephenNash @ExplosiveEnema2 @UMAPsUK @BMA_GP @rcgp I'd encourage people to listen in full to the podcast to hear exactly what I said about the evidence. Small numbers of serious incidents, and small numbers of AAs, make statistical significance hard to demonstrate.
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@AnalysisDrawer The RCoA, who are actively pursuing a pause in AAs, have interpreted it to mean a pause in all further recruitment of new, student AAs.
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@parthaskar @FrankCoffey26 @iDrSunny @isitsleepytime @Caesarnots96696 @mouseter_chef @First_Neptunian @GMCharlatan @PepperNutty @JanetEastham @drmattuk @doctor_oxford @implausibleblog @Xeon4f145d96s1 @AnaesUnited @medicalmodelbri @chriscraigCCC Doublespeak like this doesn't help; these are mutually exclusive. Yet House of Lords never seemed to question it.
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My Opinion piece in the BMJ on the growth of anaesthesia associates, why I have awoken from my indifference, and what I hope will be achieved at the RCoA EGM next Tuesday.
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How much of this has arisen because of the change to random scoring? When there was a 'reserve list' in the past then this was for the weaker candidates only who were left to await their turn. Now there are strong candidates who for no reason have been left on the bench to sweat.
Hundreds of UK final year medical students have been told by their foundation schools that they could only get three weeks notice of what hospital and city they will start working in. š§µ
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@ShaunLintern @wesstreeting Presume that those individuals that held key decision-making roles in organisations that are 'unfit for pupose' and 'cannot be trusted' will hang on to their Awards and thumping Excellence payments.
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Recruitment of junior doctors. Coaching an international sports team - 6 points.Hold a national managerial role for a year - 6 points.Family settled in the area - Nil points.
Are we really selecting doctors by whether they have competed nationally in a sport, play a musical instrument to a high standard or have set up a business on the side? Is there a risk of indirect discrimination in this?
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The Royal College of Anaesthetists call for a pause in the expansion of Associates is starting to have an impact. Why are other Colleges so slow to pass the necessary resolutions?.
The RCOA calls for a pause on recruitment of new student anaesthesia associates while it investigates safety concerns:.
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@RCSnews RCS statement on PAs all hinges on the phrase "implemented appropriately" but doesn't give any definition, guiding principles or worked examples of what is or is not appropriate.
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All the talk of 'regulation' misses the point. This is all about de-regulation and liassez-faire. Its about how the checks and balances that have governed training and practice in healthcare have been conveniently bypassed and evaded. Open your eyes.
Reforming medical training and employment is cumbersome, restricted, and full of vested interests. This government wants to sidestep the rules and cut corners by making up 'different professions. Or as they call it, "New ways of working".
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Why are @AnaesUnited taking legal action against the GMC? . Listen to my conversation with James Catton, who runs the Physician Associate podcast, to see how much we agree with one another.
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@ELHT_NHS @Doctors_Vote @ELHT_CEO As the GMC puts it:- . You must treat your colleagues fairly and with respect. You must not bully or harass them or unfairly discriminate against them. Was this form assessed before it was introduced?.
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@parthaskar Its in Good Medical Practice 2024 edition very explicitly. Time to see the end of "Hi I'm one of the anaesthetic team".
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So now we're asking applicants to ST4 to demonstrate they've got previous exposure to anaesthesia including taster days, and the role of a core trainee. #anro.
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"We will discuss with the General Medical Council how they plan to reflect surgical specialty scope of practice in their intended regulation of physician associates". Because at the moment the regulators aren't regulating.
Congratulations to @RCSnews for their new statement on PAs which highlights the concerns over proposed MAP clinical leadership roles that overlap those that should be reserved for doctors, and emphasises the importance of defining scope of practice.
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There's that phrase. Medically Associated Professionals. Where did that come from? MAPs used to stand for "Medical Associate Professionals"; so the syntax was like Medical Secretaries.
Here is an extract of recent evidence given by Prof Mangat, ironically, at an inquiry into a national scandal: Infected Blood Products. Apparently, āpostgraduate training in Medicineā also includes MAPs: people who havenāt studied a single day of Medicine in their lives.
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For we doctors, scope of practice narrows after completing training and becoming a consultant. I no longer do neuro, cardiac or obstetrics even though I trained in all 3. Why is it the other way around for Associates? Why are we saying that after they have trained their scope of.
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