Shammy
@Shamz_141
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Medic ⚕ Full-time hater & accomplished gatekeeper Like/Retweets ≠ endorsement
London, England
Joined June 2018
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I asked a very valid question that everyone is wondering, and instead of getting an answer, I get blocked. Is nobody able to give an explanation/justification?
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Day 1097837 of me asking what it is that PA school got so right where med school is failing. If they share the secret we can make MBBS 4/5 carbon copies of PA 1/2 and then everyone can graduate at reg level. Then no need for FY or IMT. That would save everyone so much time/money.
If you bottled a single PA's confidence and sold it, you could cure all the low self-esteem in the world twice over.
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Why do PAs have less supervision than a GMC regulated F1 doctor with an accredited degree that was externally audited? Shouldn’t every single PA be in tier 1 because they don’t have any tribunal system or medicolegal accountability? Am I missing something here? Is this safe?
@LukeAmos__
I just want to know why ACP ED consultants are a thing despite not featuring in the sacred tiers.
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The concept of a “locum PA” contradicts 2 of the key tenets that FPARCP championed for PAs:
1) how can you have an impact on the locum market if you are not directly replacing a Dr Instead for that role?
2) what “continuity of care” does a locum PA provide?
@IncogAssociate
???
Steve "locums are only OK when PAs do them" Nash, founder of UMAPs.
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@theSamMorrow
@jjz1600
But they found no tunnel system and only a bag of Kalashnikovs in an mri room that shouldn’t have any metal in there. Also even the BBC admitted that the evidence is tampered/manufactured.
🚨🇮🇱 BBC proves that ISRAEL is staging weapons caches in civilian buildings!
They also stated ISRAEL has not yet produced evidence that Al Shifa was a “Hamas HQ.”
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@user27282991672
@rehnvma
I’m not sure if the word “good” immediately references or directly correlates to wealthy. They don’t always need to go hand in hand. But I mean you jumped straight to the word Brokie before good. Also ultimately the man will have to judge if you are good & worthy of committing to
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If Drs were able to work on PA rotas (the way we’ve seen many PAs infiltrate Drs rotas) and the same “PA” shift was reimbursed by ARRS, would the PA in that “competitive market” still secure that shift, or would the trust assess the options and take the IMT3 instead? Who knows?
Once again, the whole point is that it *isn't* a market. Doctors are prevented from working as PAs or even doing the training. Specifically not allowed to be employed under ARRS money. PAs are specifically protected by govt from market effects in order to make the role work.
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@parthaskar
Can confirm my generation is not here to make friends in the burning building. We’re here to either put the fire out (sort out pay), or safely evacuate the premises with everyone we can (Drs + patients) and let it crumble under its own weight (poor decisions by senior management)
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What a loss of time/efficiency/efficacy.
Instead of:
Nurse -> Dr -> ABx
We have:
Nurse -> PA -> Nurse -> DR -> ABx
If it were any other system, you’d say cut out the middle man. If you say that here, you’ll be accused of a pile on and bull you bullying by the BeKind Brigade.
A PA told a nurse that antibiotics are not needed for a patient because they are in neutropenic sepsis.
So the immune system is non existent.
And let’s give it no help to fight the infection
🤔
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@GMCharlatan
When the public see the cost of one blue light ambulance trip, they’ll very quickly realise they’ve been forsaken.
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@eleezxh
It’s a lot of chronically single women who I’ve seen talking the most. “She’s better than me, I wouldn’t accept this”. There’s nothing for you to accept. Bigger or smaller. You have no meaningful options. And there’s nothing to suggest they’re worthy of such effort. Shame is free
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@Dr_Done_
No one will ever be able to justify to me why an fy3 who did a gp rotation 2 months ago can’t locum in the same gp practice, but a PA can on day 1 and have their own clinic list. There’s just so many failings and double standards in every direction I look. Very bleak outlook.
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@yaaraaa_
Hospitals have been calling for us to stop using “politically motivated” pins/stickers on lanyards when in practice. Never saw the same when it was ukraines turn but that’s another story…
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@guidelinexpert
I remember this exact question. Would always set the group chat on fire. That’s the thing with medical exams, “single best answer” denotes that atleast 1 other may similarly be correct. PA exams seem to have “only best answer” and thats why the pass rate is so high, you cant fail
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@IVfacts
And something WILL go wrong, and you’ll be hung out to dry. The trust and GMC will make an example out of you.
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@YasminSamuels1
@NotOnTwirra
It gets written off after 30 years, or if you die. Never gets passed on to anybody.
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@medicalmodelbri
And what is the scope set by the FPA/RCP? There is no formal guidance document that I’ve seen. “We will leave it up to trusts” isn’t really guidance is it. It needs to be black and white, but I suspect they won’t do that because it can’t be safe and also economically viable.
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@Dr__Sarmy
Aren’t experienced SAS Drs akin to CCT consultants? By extension are they arguing that an AA is akin to a CCT consultant?
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@ItsnotrightUK
@IncogAssociate
can you suggest what in PA training (you mentioned to me you’re involved in PA education) allows a PA to work at reg or consultant level in half the training time? Whatever module it is I’ll implement it throughout the rest of med school, for my own competence.
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@DrEilidhMaria
@D__Melb
@mmamas1973
I think the elephant in the room that’s missing is they don’t know the basic guidelines. Even by second year I had learnt “over 50 with unexplained bowel bleeding” is immediate 2ww no questions asked. It’s not about my DDX being right, it’s about cancer being wrong. Foolishness
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@IncogAssociate
@medicalmodelbri
@ClearThinker66
@InvCoriolis
@VishwajeetP4t3l
If you cost the exact same amount as another GPST, there needs to be a unique reason why you wouldn’t go for someone who has a longer, more accredited and externally audited training pathway. It’s not about marketing, it’s about viability to justify cost and service to taxpayers.
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@IncogAssociate
@makepumps666
@TheSooperCynic
Drs tend to say their name (x), role (Dr), rank (foundation, reg, consultant).
PAs are not specific enough with their role (some seen even swapping to associate physician) to draw false equivalence to gain legitimacy and authority. The public dont know a PA≠Dr so specify it pls
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@DoctorYemula
“No I don’t think that is safe for me to do so and as such I cannot take responsibility. Please escalate to the appropriate consultant, and in future endeavour to fill the post well ahead of time. Yours.”
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@Dr_Done_
@VishwajeetP4t3l
Vish are you able to produce a screenshot of an instance where old boy Done has posted patient identifiables or intimate data without due consent? I’ll be amazed if you can.
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@KhyjaMccalla
Hi you seem quite knowledgeable so please explain:
What act is it that a PA distinctly provides to the MDT that no other member cannot already do?
Also what can a PA do that another SpR cannot do? You cost the same
If you need constant supervision how much time/money is saved?
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But I thought they weren’t replacing GPs? How can they offer more availability without also replacing a clinic that another GP or GPST couldn’t fill instead? Bear in mind, without ARRS (a pot of ringfenced taxpayers money) a PA costs the same as a GPST.
Not only does this practice employ 9 unregulated PAs to see vulnerable patients. They also accuse the public of having “too high expectations from the NHS” for asking to see a doctor. This has gone too far. Leave a review and let them know.
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@DrGoblin3
It’s worth mentioning that for medical schools such as mine we only do 1 year preclinical of intense physiology, anatomy, immunology, genetics etc. years 2-3 are clinical with further pathophysiology for about 300 diseases. 4-5 are clinical with specialty placements and more GP.
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@CheekyClackers
Imagine if doctors made it so that PAs were categorically banned from entering medical study or our hospital learning time. The bekind brigade would be up in arms, and yet, a doctor or med student is banned from entering their study or touching their rota because overqualified…
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This is why I urge all Drs as a collective to just follow the BMA guidance. PAs and their advocates would sooner blame a naive mum than the PA in question for working beyond their competency and provided incorrect medical care/advice. Dont be a liability sponge anymore and say no
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@BMA_James_Steen
They can’t work out of hours or on call, because every act needs their hand held. It would’ve been cheaper and more efficient to have another specialty reg trainee for the same salary cost and everyone can share the OOH burden, but instead there’s a wider backhanded agenda here.
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@user27282991672
@rehnvma
Let’s hope you’re not waiting too long for it to fall out of the sky then 👍🏽👍🏽
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@DrEilidhMaria
Why do they get so offended when it’s quite literally an unaccredited course, which is half as long as the clinical portion of many med schools. The biomed years don’t all count towards clinical or physiological knowledge that med school provides you with. 5yrs =/= 5yrs medschool
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@IncogAssociate
@UniofNewcastle
Surely only senior PAs should supervise and sign off PA students, because only PAs are taught in PA studies? Like a Dr is not taught PA studies or their curriculum so it wouldn’t make a whole lot of sense for an fy1/2 to have someone shadowing them with different academic needs?
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@InvCoriolis
I hope
@VishwajeetP4t3l
and
@IncogAssociate
are able to engage in good faith and explain this paradox. For a role to be so essential and integral, why does it need an innate financial incentive. Without it would they still be integral, or would a second GPST become more integral?
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@Thingsnstuff33
@tparsi
What about the strikes in Nablus as late as 16th August 2023. Is that part of the ceasefire you’re referring to on 06/10??
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@ayeshx22
Funny thing is, if you spoke to a vegan now they’d still try and push their moral high ground onto you now. In fact they’d probably say “animals aren’t terror*sts”
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@WorthWords
@ReddicalMedge
@gmcuk
PA-R means they put themselves on the voluntary register that the faculty of PAs has set up. It’s supposed to mimic pseudo-regulation, but it’s not like the faculty of PAs is a full governing body or holds tribunals against those registered with them for malpractice etc.
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@TheBMA
@BMA_James_Steen
Is it an option for the BMA to create some sort of badge/pin or card to attach that distinguishes MBBS medical staff from other “medical” staff. That way patients are rest assured with exactly who and what rank is treating them, so as to maintain full informed consent at work?
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@Ask_foradoctor
You know what’s funny. I didn’t care much for HF before. Now that I’ve spent a whole year doing cardiovascular medicine and properly learned the neurohormonal axis M Packer hypothesised, and learning all my trials and pharmacology, it all makes sense, and HF is very interesting.
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@Ask_foradoctor
If they get made independent prescribers the NHS might just end up spending all of their perceived savings on medical negligence claims.
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@TheSalariedPA
Hi you seem knowledgeable so please explain:
What is it that a PA distinctly provides to the MDT that no other member cannot already do?
Also what can a PA do that another SpR cannot do? You cost the same
If you need constant supervision how much time/money is actually saved?
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@Xeon4f145d96s1
@iDrSunny
I’m antibiotics is the ONLY treatment plan because the patient is clearly immunocompromised and cannot possibly mount their own response? I actually need to have a look at their curriculum. Anyone got a copy of that matrix thing cos this is just a howler, and that’s being civil.
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@NoamBitton5
@Humanityclouded
@EylonALevy
Your leaders and their statements do not suggest this (insinuating a 2nd nakba, and there will be no peace until all of Gaza is gone). The actions of your troops do not suggest this, and clearly if you were not committing it beyond reasonable doubt, it would have been withdrawn.
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@NatashaAght
They need to be regulated. The problem is who is meant to regulate. It’s an easy thing to say let the GMC do it l, but they’re not true physicians. They need their own governing body to lead their own tribunals etc. And a change of name might help too. “Associate” is confusing.
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@TheYootopian
@jakeshieldsajj
Because chrome comes for free on your phone and a 30 second Google search gave me the article as the first suggestion. Most normal people if they wanted to do further research would be able to do this fairly easily. As you can’t, here I’ve done it for you
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@armz_korleone
Do you realise that if you're bicep curling what mandem deadlift with more effort than that you're allowed to come into anyone's house and take whatever you want interest free 😂😂😂😂. I rate the grind though 💪💪. Soon me too
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@user27282991672
@rehnvma
I’m sure you won’t. I just said let’s hope Prince Charming comes round sooner rather than later and that you’re worthy of such a stone when he does find you
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@Dr__Sarmy
If both the ARRS and legal responsibility for doctors to supervise was lost, the house of cards would very quickly collapse. I just want to know what justification there is to maintain the facade of this structure the gov/trusts insists is correct, so special even a doc can’t do.
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@Statsjamiefact
@Fehmida90715738
Advocating for accredited training frightens patients? I believe a PA with 2yrs training holding the consultant neuro/stroke bleep should more than frighten patients. The GMC was meant to represent us. So was RCP. Theyve all shown theyve been sold out now. BMA taken over for them
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@Dr_BellaR
How the GMC can continue to have a 10% mortality statistic as a workplace regulator will always be beyond me.
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@DrAsifQasim
@gmcuk
@drcolinm
If the GMC are admitting that they do not set or regulate scope for Drs, then they should see no problem in SAS & IMTs going into GP practices. After all theyre better generalists than PA and already have some specialism too for free basically. Such value for money compared to PA
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@Xeon4f145d96s1
Let’s say we all banded together to agree never to sign a prescription for a patient we hadn’t yet seen as a concrete rule, how much autonomy would be left behind??
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@JoOgidi
One can be ruled down to an accident or a mistake (forgetting to log out), and one is an active crime that puts a patient at risk through overconfidence and lack of competency. It’s not a rabbit hole. It is literally a crime trying to get swept under the rug. Keyword: ILLEGAL.
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@DocAnonX
(Not-a-real)DocX enjoy your journey in the land of maple syrup. I always used to think CCT is enough. I thought PhD was a guarantee. You’ve just shown me that it isn’t, which has completely reinforced my growing notion that I owe no loyalty to the NHS. I’ll be acting accordingly.
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@Xeon4f145d96s1
@RBNHSFT
@MedReddit
@thatsnotmine125
this is a serious patient safety concern and represents more instances where trusts cannot by relied upon to define and govern scope/rollout.
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@19870830N
@hannahmillana
The BMA rate card recommends about £100/hr ish for someone of that seniority for those kinds of hours. Hourly rate is determined by your specialty training level, what hours you’re doing (day time or out of hours), and if it’s a weekend or not. This shift will not be taken.
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@Roddy_Neilson
For people with a unaccredited course, an unfit for purpose national exam, and 0 post graduate exams, they do love to call equivalence to doctors a lot, purely because a ladder pulling consultant is moulding them into technicians rather than giving that training time to their Reg
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@ExplosiveEnema2
@UMAPsUK
A locum Dr is still a Dr. So does this confirm that PAs are replacing a Dr. Is this true
@UMAPsUK
?? Is this in line with GMC, RCP and FPA guidance? Please respond.
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@munday_d
Have you considered the alternative hypothesis that instead people have given up working hard because of how long they’ve been paid less?
You’ve got the right dominos, you’ve just put them in the wrong order.
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@veggieequallife
You’ll never catch my signature or gmc number on there. I’ll always turn away and refer prescriptions for drugs/ionising radiation to their direct supervisor (cons/gp). I outright refuse to become future liability sponges for gov/trust malpractice. Patient safety > BeKind OneTeam
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@zadameera
I saw a clip where she was crying because someone on her child’s Roblox server already showed them exactly how mummy got so famous. It will always come round full circle. She was naive to think she could hide her history in the internet age.
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@Meghpai
@Leedsviv
Why is a PA even reading the referrals. A referral is made when one clinician needs specialist input -> someone more knowledgeable and competent in that domain, for further guidance. The PA isn’t as knowledgeable as a 3rd year medical student let alone the initial GP. So backward
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@nas_vascular
@medicalmodelbri
@ClinOncDoc
@ExplosiveEnema2
Hey doc. I believe the clown emoji was used in an inflammatory manner, and feel as though they are undermining all of your hard work and attempts to include them in the team despite. On next conversation it may be worth asking what role they believe they occupy in MDT for clarity
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@DrrDentist
It has to be something amazingly special because the government thought it wise to include a whole new funding scheme, which has contributed to IMT becoming 4:1 and GPST becoming 3:1 regionally. If the ARRS was scrapped I can almost promise uptake would be very different. Strange
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@SaraTon08500527
Can I ask what is it a PA can do that an SpR doesn’t or can’t. Also what distinct value is brought forward to the MDT that doesn’t already exist in a pre-existing role?
This is of course to justify the need for ARRS as opposed to just acquiring another trainee in that same place
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@ExplosiveEnema2
@InvCoriolis
@rcgp
Explosive enema really CCT’d in keeping receipts. What a guy 😂😂😂😂
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@TheYootopian
@jakeshieldsajj
The picture has the article title and date which means you would be able to perform a simple google search independently to do the further research in your own time.
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@IncogAssociate
@KadeFlowers
@VishwajeetP4t3l
As I understand it, PCNs are mandated to allow you to see undifferentiated patients if they are to benefit from the lucrative ringfenced ARRS. Without it, what could you do that another GPST can’t do is the question you’re avoiding here. You cost the same to the taxpayer patients
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@Silvershanafox
@RedDevilae1323
@timecaptales
@Morbidful
Your body gets tricked into thinking you are drowning every time you are stimulated by fluid. Hence the “hydrophobia”
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@Westsaeed10
@Suburbanbella
@ColumbiaSurgery
@pppforpatients
@TakeMedBack
My definition of surgeon is an accredited doctor who does post graduate training in surgery. Specifically a “lead” surgeon would be a senior surgeon (consultant/attending) who leads the procedures. Does the PA in question fall within the confines of any of these criteria doc?
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@ExplosiveEnema2
@gmcuk
That option relies on coming to terms with the sunk cost fallacy. How likely do you think that is for any of these parties involved? Especially the government?
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@junaayd
Youre doing amazing. Just ignore them. Loving the solidarity between the rest of us gym lads against this absolute injustice.
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@BikeNurseRN
@thatsnotmine125
@IVfacts
Whatsinaname ever the skeptic…
First they’ll say where is the proof.
You give the proof plus cite it, then they’ll say how/why did you get it, rather than addressing the proof itself.
How tiresome.
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@KamilaRCGP
@Keir_Starmer
@wesstreeting
Do remind them that promising “more GP appointments” means more appointments with actual MBBS GPs, and not just more appointments at the GP surgery building. This is the critical miscommunication that all of the parties keep trying to fool the public with. We need more GPs STAT.
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@thirst4dodgers
@omaiirrr
@karanbirtinna
You better lower your volume rn 😂😂😂😂😂. The assistant nurse might find out.
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@fehmihf
Half of the things they’re injecting into you won’t even stay in the circulation long enough for meaningful effect. 30,000 ui of Vit D? What the hell is the body going to do with that as a one time bolus. That’s like injecting pure whey protein and expecting muscles immediately🤣
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@dave_maroni
1) PA are not functional as they can’t prescribe drugs/radiation/oxygen
2) not cheaper as cost more upfront than up to an st6 doctor
3) reducing doctors will not improve any quality as they have the most clinical reasoning through longer study
@Dr_Done_
care to chime in pls?
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@thesourie
@theSamMorrow
@jjz1600
Jackson Hinkle is not my source. That screen recording is not his property. It comes directly from the BBC night time news. They are my source. Jackson simply posted it.
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@TomStocks1982
@NHSHandSan
@rcgp
Only a matter of time until independent prescribing licenses are awarded and then the flood gates really do open. I wonder if the royal college of physicians will ever allow a similar vote to how the anaesthetists recently had. I reckon that’s not a poll they want an answer to 💀
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@VirtueOfNothing
@ELHT_NHS
@Dr_Done_
@Xeon4f145d96s1
@BMA_James_Steen
An f1 can’t get a locum shift at £62 an hour, so I struggle to see how this is “paid in line with the rate of a junior doctor”. They get paid more salary, and more locum than the doctor itself, while only licensed to do a quarter of the doctor’s responsibilities. Leave it out
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@sujhurta
@ether___
@jmgrimwood
@babadookspinoza
Can we also see please, head or the body. Old boy Biden had to put out a statement saying he himself hadn’t seen any real footage of beheaded babies. If you’ve got it at hand send it to us here and you should direct it to Bidens official account aswell just in case.
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@InvCoriolis
At this stage I think more supervising consultants and GP just need to get called up to tribunal for poor supervision
Maybe that will be enough to convince other supervisors that ARRS is not worth risking their license over
Or MAPs need to have their own tribunals from now on
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@mariamichle29
@drmattuk
@Xeon4f145d96s1
@potsy70
Hi you seem knowledgeable so please explain:
What is it that a PA distinctly provides to the MDT that no other member cannot already do?
Also what can a PA do that another SpR cannot do? You cost the same
If you need constant supervision how much time/money is actually saved?
0
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@iDrSunny
@unwizemonkey
This issue is exceptionally exacerbated in an acute A&E setting. Even in a well-equipped trust, 4hrs is still a long time to wait. If you get pulled into a consultation room by an MAP and refuse their service they threaten to send you to the back of the queue again. I’ve seen it.
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Hi
@parthaskar
, given that Jamie Saunders (CCT lanyardologist) has quite a questionable and arguably illegal fitness to practice considering he contravened FPA/RCP/GMC guidance in masquerading as a Dr in arrest calls, he doesn’t understand his own limited scope so can’t write it.
Woken up to gazillion notifications 🤪
Seen this document
Fed back my views that it needs a rewrite
Supervisory stuff good
Scope stuff yikes -needs a start from scratch
(Did Not Know Jamie Saunders was an author 😮)
Ah well, till it’s rewritten?
Scope is the
@TheBMA
one
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@Cray_tweets1
@IncogAssociate
An equally important question is:
Is it ethical for someone to allow someone who isnt a consultant to complete such procedures without confirming the exact same skill level while also establishing fully informed consent beforehand?
The trust hasn’t answered re informed consent
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@Parody_RCGP
As a medical student I’m not yet allowed to see undifferentiated patients until 5th year and even then must report every case to the supervising gp. I’m also not legally not allowed to do an A-E assessment at most trusts because an actual doctor has to score it and write it up.
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@Ask_foradoctor
@rojaha58
I’m perfectly happy being called a protectionist. I believe what we signed up for is to protect the patient from non-evidence based care. Seems like a compliment no? “Look at this guy, always protecting the patient so much”. Awww fanx
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@Statsjamiefact
@Fehmida90715738
Has it potentially occurred to you that the attitude is secondary following a number of lies and much deceit from the royal colleges too? The PA project is riddled with contradictions and the PA leaders aren’t stellar examples either (see Jamie Saunders, CCT lanyardologist).
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