Duncan F
@dgfull
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General Medical & Respiratory NHS Consultant | Dad of 4 | Lungs & Cancer | PhD | Failed mountaineer |🚴♂️🥾🏳️🌈 🫁
United Kingdom
Joined April 2012
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@SarahBSmithVA
The WHO works to expand basic healthcare, support vaccination & sustain weak & stressed health systems in the poorest countries.
I am dumbfounded & shocked that the President of one of the richest countries in the world does not see this as valuable.
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15
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@DrSimonHodes
@redcellemma
@deb_cohen
@trishgreenhalgh
I am with
@carlheneghan
. Evidence is not strong enough (not equivalent of a parachute) It’s a complex intervention. They have negative & positive effects, impact on patient experience alot, are dehumanising & they’re annoying to wear for 8hrs. Plus the horse bolted 3 months ago!
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The elephant in the room is pay. Relevant discussion about scope, regulation, accountability, training opportunities. But it is wrong that somebody does the same job, with no prescribing or ability to request radiology, and earns more money & has less debt. Fix this
@RCPhysicians
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@AntheaTurner1
Can I suggest Anthea that you listen to
@GilesYeo
& inform yourself about the complexity of obesity rather than spreading nastiness & bile?
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I am increasingly troubled by
@PHE_uk
advice re: PPE. Supply is not the (current) issue....
@BBCNews
@BBC_NWNews
@mancunianmedic
has appropriately suggested that now is not the time for recriminations - it perhaps should be the time for a change in policy?...(1/7)
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Tobacco dependence should be treated as a chronic, relapsing & remitting disease (one that often begins in childhood). It has evidence based treatments that we should all be trained to use.
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@MidCheshireNHS
‘s Covid19 response is absolutely fantastic - All staff members. Consultants, cleaners, research team, porters, nurses, executives, health care assistants, junior docs, domestics & senior leaders; I am incredibly proud & lucky having such great colleagues @ MCHFT
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Very grateful for the work that’s gone into this! It’s taken ~3yrs to get
@CureProjectMCR
Crewe across finishing line
Many thanks to all that have helped incl
@Mcguiganemma
@garethjones08
@wellyfreak
@claire_glazzard
@DrJonGriffiths
&
@CMCaAlliance
&
@MidCheshireNHS
for funding!
@dgfull
brilliant day of engagement
@MidCheshireNHS
@CCICPNHS
@CureProjectMCR
@NurseHarleyJ
@StephanieBeres5
@Pip_wise
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I believe current
@PHE_uk
guidance on the use of FFP3 masks to be wrong
@OutbreakJake
@pash22
Over the last four weeks I have seen 50% of the acute medical/respiratory team catch covid19.
We have not caught it at the supermarket...
@mancunianmedic
... (5/7)
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Our
@MidCheshireNHS
estates team are awesome!! Not just bigger oxygen pipes but negative pressure siderooms!
#UnsungHeroes
Huge shout out to
@MidCheshireNHS
Estates dept, what you have delivered is staggering! Increased oxygen flow on wards, built more isolation pods than I can count & today making 8 negative pressure side rooms.....Thank you so much🛠
@jamessumnerNHS
@Mcguiganemma
@julie_tunney1
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@DaveSThompson
@devisridhar
It seems very strange that we are encouraging people to eat out & yet schools remain closed with teachers reluctant to offer more virtual or actual face to face time with pupils.
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Solutions to stopping transmission to staff that can be implemented now?
- Use 3-4 FFP3 masks per shift?
- Adopt SPACES
@RCPLondon
- Ask infection control teams to critique work spaces?
What do others in positions of power & influence think?
@TheBMA
@OutbreakJake
... (7/7)
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Raise the smoking age to 21🚬 You are right
@sajidjavid
(on
@BBCr4today
) - Smoking is one of the key drivers of health inequalities. If you are serious about
#LevellingUp
then adopt a New Zealand 🇳🇿 public health policy on smoking now!
@felly500
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10
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Really helpful, sensible, clear & level headed statement from the
@BritSocGastro
president
@andymveitch
. It articulates really well some of the discussion around PAs in General Medical specialties like resp & gastro. Excellent leadership - Thank you!
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2
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@RussInCheshire
It might start before this... Health & Social Care Act and changes to Public Health? Nursing student numbers & changes to bursary making nurse training difficult to access for many candidates?
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2
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@Cray_tweets1
@DrLindaDykes
Yes. I am concerned that there are significantly more medical students than 10years ago but seemingly no more specialist training by posts to meet the increased numbers. None of our F2s have got a specialist training program next year 😢
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Quitting smoking halves hospital mortality & re-admission rates. In Crewe for every £1 invested in Tobacco Addiction treatments the health economy would save at least £5.
@CureProjectMCR
are doing an amazing job. Let’s get investing elsewhere!
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I’ve really enjoyed the first 2 episodes👇
It’s great exploration of the complexity of weight gain. Dr Chris & Dr
@xandvt
are insightful, honest, intelligent & witty.
HPF is a new 3 letter acronym to me thats really worth knowing about. Give it a listen!
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Absolutely this. Thankfully
@NHS
does not have a no visit policy for patients at the end of life. 🙏
Problem is diagnosing dying is not easy (philosophically or practically) & so many have not even able to visit 😔
Hard no. Loved ones should be able to decide if they wish to see loved ones in person before they die w/ gown & mask & goggles.
Inflexible bans are a human rights violation. Loved ones can then agree to quarantine after for 10 days... (Thread)
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@MidCheshireNHS
is recruiting ~20% of all covid19 patients to
#recoverytrial
. This is >65 patients which is fantastic. Great work research team!
@clairegabriel71
@Kate_Pagett
@carolinedixona
It is great to be able offer our patients the Recovery Respiratory Support trial too!!
6 hospital sites have opened to recruitment today for
@recovery_rs
. Welcome on board
@bedfordhospital
@WestSuffolkNHS
@QEGateshead
@MidCheshireNHS
@ESHTNHS
. Thank you for being involved in this urgent public health
#COVID19
study
#ClinicalTrials
#whywedoresearch
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@doctorcaldwell
@ingridbrindle
@Shlambie
@amirhannan
It is easy... if you were seeing a consultant about a health problem - would you want a copy of the letter? Fundamental & key. Open & transparent. Why on earth wouldn’t you cc patient in? Or better still - write the letter to the patient & cc the GP?
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@KateBurkeNHS
Interest & engagement by exec team would help. Because of rotational nature of doctors in first 10+ years of career exec team rarely met or spoke with us during this phase of our careers
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A great piece about a personal experience on Critical Care by Dr Shan Ramachandran from
@MidCheshireNHS
. Really helpful insight to those of us looking after patients who have been to critical care.
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There is a real opportunity for the UK government to make an enormous difference to peoples lives by being bold and adopting the
#Khanreview
#SmokeFree2030
@theresecoffey
@HistoryMakersGM
@BTSrespiratory
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7
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@Cray_tweets1
@DrLindaDykes
Our PA workforce is great & contribute enormously. They are increasingly experienced and knowledgeable and as pointed out already offer excellent continuity care which helps greatly with patient safety
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In 2015 I was issued with this 👇mask for H1N1- Swine flu.
H1N1 has approx same mortality as influenza virus. The associated mortality of Covid19 (SARS Cov 2) is much greater.
I don’t use the below mask in solidarity with all members of staff & because it is not policy...(3/7)
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@mancunianmedic
@townfieldfox
@rupert_pearse
@DrSimonHodes
It’s all quite worrying.
@DrSimonAshworth
(&
@SachaBaronCohen
) are so right.
I challenge you to find a better speech on social media…
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Covid. Floods ... I am not loving 2021 either! 🌧 🦠
At least Trumps gone!
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Another Friday = Another decision made on the hoof. No consultation & no strategy.
We value visitors so much that prior to March we had (almost) open visting to the ward.
Hospitals are currently the outbreak within the pandemic.... To change visiting now is extremely unwise.
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@Parody_RCGP
@DrLindaDykes
We have 4 excellent PA’s in the Resp dept at our DGH. They offer great care & support our patients really well in a variety of ways: out patients & inpatients including doing procedures. It is all very open & transparent. You are welcome to visit & see the benefits.
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As always thanks to
@clairegabriel71
&
@Kate_Pagett
for getting this off the ground
@MidCheshireNHS
The trial asks important questions that are relevant to lots of people. Sadly we still have quite a few patients that can be invited to take part
Welcome to Leighton Hospital
@MidCheshireNHS
and North Tyneside General Hospital
@NorthumbriaNHS
both of whom opened to recruitment for HEAL-COVID today!
@NIHRresearch
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Coughing aerosolises virus...
At the beginning of SARS Cov 2 outbreak we used gowns, visors, gloves & FFP3 masks.
Within a week of 1st case
@PHE_uk
PPE policy changed - related to future predictions about supply? We now only use plastic pinny, gloves & surgical masks... (4/7)
1
5
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This is an important myth to shatter... eating healthy food is more expensive.
You can get your data about healthy food costs from the Daily Fail, or from the Harvard School of Public Health. Palatable healthy food is more £$ per calory. And if you are in the poorest decile, eating healthy basically takes out your whole expendable income after housing.
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Struggling to believe that this is true. Its enough money to give every one of 650k nurses a £45k bonus & £20 to 5.6million on Universal Credit. It is incompetence on a massive scale. Please challenge & scrutinise
@Keir_Starmer
@BBCNews
@guardian
1
3
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Great to hear from
@NHSEngland
that there will be £150million available for treating patients with tobacco dependency in NHS organisations. Is it enough?
#SCAHconf2020
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This program contains some important wisdom for practicing clinicians & was an enjoyable listen. Good reflection. Thank you
@sophharrison
&
@MichaelRosenYes
and
@BBCRadio4
for a great program
Another gem from
@MichaelRosenYes
As a new Speech and Language Therapist thinking a lot about how I explain things to patients!
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This looks really interesting: Inhaled corticosteroids might prevent deterioration from Covid19. Definitely worthy of more attention
@PCRSUK
(Thanks to
@jengleruk
for highlighting)
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@davidbelldr
Hi David! It is fair to say it is complicated. There are multiple reasons behind our secondary care perceptions. Simon,
@mgtmccartney
& our GP colleagues care enormously about the same things as we do. We are all on the same side...
@HelenRSalisbury
@Azeem_Majeed
@gpdiarist
@ChristmasRowena
@Jochurchill4
please do see this too for some useful facts below
@Helen_Whately
@Keir_Starmer
@JonAshworth
@MattHancock
@DrShanHussain
@KailashChandOBE
@ProfDonnaHall
@AllysonPollock
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Bears & Unicorns & Palliative Care. This is a great read. It would be great to see it in one the big 'bear publications'?! Well done
@JoeHawk75825077
1
6
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@krakent007
@clairegabriel71
@MidCheshireNHS
@NIHRCRN_nwcoast
@richlowsby
@DrRyanHum
@Kate_Pagett
@carolinedixona
@Sallysm89820077
@MchftCAE
Great work! I love this image: “Each Heart is one of our Covid19 patients who has contributed to research”. Brilliant!
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6
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Always great to hear
@MatthewEvison1
talk about
@CureProjectMCR
. There is a long way to go nationally but
@NHSEngland
plan is a massive help. Great work Matt.
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7
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@Jo_McGinn
@AlisonGeorge10
@veggieequallife
@Dr_Done_
@BMA_James_Steen
A lot of the debate around the PA workforce has been made worse by the debt accumulated by medical students and the antisocial hours that junior doctors currently work. This is not Physician Associate’s fault.
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So many more people need thanking & acknowledging!
@MidCheshireNHS
Ann Dingle,
@ChrisOliverNHS
& Denise Frodsham,
@jamessumnerNHS
&
@mulu10luckas
@ CCG
@DrAndrew_Wilson
&
@jamaila_tausif
. On ground now
@proflead481
Jack Gillard &
@Pip_wis
. So many to thank - not enough characte
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ICU’s not full in first wave? Patients ventilated in operating theatres, staff drafted in from all areas, elective activity postponed?!
It is fine to question lockdown as a strategy but to deny the impact of SARS CoV 2 is dangerous and misinformed
@allisonpearson
The Coronavirus is NOT “out of control” in the East, the South East, London, the South West, Wales, parts of Scotland.
Nor are most ICUs overwhelmed. Nor were many during the 1st lockdown.
Respiratory deaths are normal for autumn.
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Fantastic to see this becoming normal practice. As
@MatthewEvison1
has said: We are moving from negligence to excellence in our routine treatment of tobacco addiction.
@CureProjectMCR
was a trailblazer!
@JackGillard
@proflead481
Our new report recommends that smokers should be routinely provided with help to stop smoking
The recommendation is one of a raft of measures designed to put an end to tobacco smoking in the UK.
Read more here: 👇
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Impressive stuff. A readily available, safe & well tolerated medication. Well done
@SanjayResp
&
@MonaBafadhel
- great work!
Probably needs rolling out & adding to guidance quickly.
@DrSimonHodes
@PCRSUK
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3
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Great video here from
@CureProjectMCR
. I cannot think of a waiting room in the NHS that shouldn’t play it. Watch it, advocate for
@OttawaModel
in your organisation & get animation playing in waiting areas
@ChrisOliverNHS
@DrJonGriffiths
@Spuff_78
Our new
@CureProjectMCR
animation on tobacco addiction & treatments that can cure this disease. Coming to hospital waiting rooms in Greater Manchester soon....
@StopSmoking_McR
@freya_howle
@HistoryMakersGM
@drloubrown
@dgfull
@MFT_PatientExp
@MFTnhs
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@laramitchdr
@openchangeuk
Great image to help with difficult conversations. Thank you!
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Me too...
I would like the hamster wheel to stop now. 🐹
0
0
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Nicotine & surgery: I’ve seen the data related to smoking & wound healing - it is defo helps to not be smoking. What about nicotine? I can’t find good evidence that patients either vaping or using NRT are at risk of impaired wound healing. Is this is surgical old wives tale?
8
2
14
I do not know much about the economy - I am a Chest Physician. I care a lot about the misery that comes with COVID-19. However I know that if the economy tanks poorer people will suffer disproportionately & both the
#NHS
that I love & work in will not have funds & people will die
1
3
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I want to be a hedgehog
A quick update: Bubble and Moss have joined the others in hibernation. Pogo's on his way there too. Dilly is beginning to show signs of hibernation. Flute went into the cool-down cabin this morning. Berry and Cubby are still slow to thrive. Echo Plum and Goose all have hay sacks.
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Fantastic work by The CURE team. You are the role model & lead the way. Hopefully with collaboration, investment & vision we can achieve the same!?
@MidCheshireNHS
@NHSSCheshireCCG
@NHSValeRoyalCCG
@PHE_NorthWest
@DrAndrew_Wilson
@DrJonGriffiths
@ChrisOliverNHS
@OttawaModel
Wow! New smoking prevalence data Greater Manchester smoking at a historic low 16.2% from 17.5%. Manchester down 22% to 17.2%. I truly believe
@CureProjectMCR
has been one component of this success & one part of whole system change led by
@HistoryMakersGM
. Congratulations everyone
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Mrs F went to
@StoryhouseLive
this rainy afternoon to watch film. She had a great time with kids. Sadly there were only 4 others in the theatre. 😐
#supportlocaltheatres
before we loose them!
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The RECOVERY Respiratory Support (RS) trial
@recovery_rs
is important.
The UK
@NHS
Respiratory & ICU community are ideally placed to help answer some important COVID-19 ventilation questions.
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There are not enough GP’s; capacity outstripped by demand. Drs in training r more likely to choose GP if they spend time in their training in GP practice. Not enough GP’s to supervise Drs in community. Any solutions to this catch 22?
@AndyWilliamsNHS
@DrJonGriffiths
@DrSimonHodes
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4
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A progressive & sensible national policy from New Zealand. This is something we should be advocating for & delivering in the UK
#SmokeFreeby2030
🇬🇧
@sajidjavid
@BTSrespiratory
@felly500
@RCPhysicians
@NHSEngland
@LeicesterLungs
@zaheerzaheer
1
2
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I am struggling to believe that the government followed the scientific advice over Christmas lunch. The after effects are significant. It was not VE Day 😞
2
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@Em_Lickspittle
@trishgreenhalgh
@patrickgcox
@JillYGld
I am sorry but it is not like climate change. Last nights
@BBCNewsnight
was balanced & appropriate.
The science is a lot less certain.
@carlheneghan
views are no less valid than
@trishgreenhalgh
. I don’t think that stifling the debate is the solution.
@deb_cohen
did a good job.
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This looks a great idea
@Mcguiganemma
#admissionavoidance
The first day of the new Winter
@LHCHFT
@NWAmbulance
Respiratory Rapid Response car today.
@C_MPartnership
@CM_Respiratory
initiative to manage more patients with Respiratory problems at home. Rolling out over
@Knowsley_CCG
@HaltonCCG
@StHelensCCG
@dave_physio
@MarkBillyCooper
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@trishgreenhalgh
We've been randomizing patients to Colchicine in the
#RECOVERY
Trial (Oxford) for >3 months. >31000 UK participants so far in this brilliant real world RCT.
@MidCheshireNHS
@clairegabriel71
has recruited >320 patients😀
Results published in due course
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@proflead481
@CureProjectMCR
@MidCheshireNHS
@CCICPNHS
@NurseHarleyJ
@StephanieBeres5
@CMCaAlliance
Excellent! I am wearing mine with pride too. Thank you!
It is truly fantastic work especially given the difficulty of covid 🦠
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@pefteammchft
@missnellyash
Here is a really helpful suggested protocol how to do it in awake patients.
@SepsisUK
Thanks to
@Davetarpey
@WirralU
- thank you for sharing!
0
7
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@HelenRSalisbury
Stories of clinical negligence are always worrying. I see examples of sub-optimal care by multiple different HCPs most months. We all live in glass houses. Encouraging the Daily Mail to take on this issue is unwise. I do not see a lot of positivity from it directed towards GPs
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@dr_ianjackson
@Parody_RCGP
@DrLindaDykes
Our PA team are excellent communicators and regularly (daily) phone patients families with up dates after ward rounds. Because they are a stable and are a consistent work force. They have really grown in their skills in doing this.
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This is hopefully a important document to help progress tobacco dependency treatment services in the UK
#SmokeFree2030
Comments welcome!
0
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Well done! Hopefully we will be successful in persuading Cheshire's health economy that
@CureProjectMCR
is worth investment later this week...
Great day today welcoming
@NHSEngland
Prevention Leads to discuss
@CureProjectMCR
& all the other brilliant work going on in GM as part of the
#TobaccoStratgey
Talking about how we can best deliver the treatment of tobacco in secondary & primary care. Thank you all 🤝
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#OMM
Fresh & moist underfoot this morning. About to get going... It was a lot easier when our combined age was 65 & not 97.
#gettingold
is not easy; I ache & we haven’t started yet! 😬
@theomm
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1
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@DrRJWebb
@emmdechen
It would make it much more efficient but there would be much less opportunity for ‘learning to make decisions’ which is probably the key educational benefit of clerking as well as Reg reviews of more junior colleagues clerking
0
0
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This is great work. We have to change our policies to achieve a
#SmokeFree
#NHS
. Vaping is a really good short acting nicotine supplement to help patients with tobacco addiction give up
@proflead481
@Heather14516900
@MidCheshireNHS
. Well done
@MatthewEvison1
&
@CureProjectMCR
Very pleased that from today our
@CureProjectMCR
team include a Vaping starter kit as part of the tobacco dependency treatment offer for patients that smoke attending the Manchester
@LungCheck
service. Working towards a Vaping offer in every tobacco dependency service we provide
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@LeanneHPatrick
@missbikerni
Having reflected on this over the last few weeks I think it is primarily a Twittersphere thing. In most work places there is not the negativity. It is primarily the same accounts that are actively trying to create more of an issue than there really is 🤞
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Palliative care colleagues continue to be the completely unsung hero’s of the pandemic & healthcare generally.
#dyingmatters
.
Really valuable commentary by
@doctor_oxford
- thank you.
For 12weeks, day after day, conversation after conversation, phone call after phone call, this 👇is a fair description of that bit of my job - I’m lucky & share the burden with lovely colleagues in acute medicine, respiratory medicine & palliative care
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#Tocilizumab
: It now seems extra complicated, a bit messy & in danger of being an unanswered question.
Shouldn’t we just continue with the RCT & ignore the announcements of politicians?
@VPrasadMDMPH
4
0
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A great piece. We are very grateful for
@DrJonGriffiths
coming & learning about some of the problems in secondary care - thank you Jon
3
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“It’s a big assumption that patients who are selected to be enrolled in a virtual ward or a hospital
@home
scheme would otherwise have been admitted. Perhaps in many cases they would’ve still been sent home”
Great piece by
@mancunianmedic
🙏
@DrSarahSibley1
0
3
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20% Covid deaths were tragically related to hospital acquired infections.
Infection Prevention Control strategies can’t fix old hospitals where 6 people are in a bay.
Recognition that virus is airborne & investment in ventilation strategies (as per
@CathNoakes
) = quicker wins
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How do you make a hospital truly Smoke Free? This is a really positive & innovative example. … By using the
@CureProjectMCR
model of tobacco addiction treatments & support for patients, relatives AND staff we can make NHS hospitals beacons of health!
0
2
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An NHS New Year resolution for 2024 would be to institute this policy tomorrow. I can see no reason why it should not happen.
@ShaunLintern
@KateBurkeNHS
My gen drs had the same treatment, but rarely complained. Society has changed. They rightly won’t put up with it anymore.
BTW, NZ hospitals now have to reply to leave requests within 14 days otherwise it’s deemed approved.
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Tobacco dependency is responsible for more deaths than traffic accidents & HIV combined.
We should be providing some patients who smoke with a vape as part of their treatment, similar to how condoms are provided in a GUM or family planning clinic
0
2
10
To be welcomed: Royal College of Physicians
@RCPLondon
report supports the role of electronic cigarettes.
Nicotine without smoke—putting electronic cigarettes in context | The BMJ
1
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@diwan_vinod
@Microbedoc2
TB is neglected but increase wealth & the incidence does reduce. As medics we inevitably focus on medical treatments but often these are only part of solution.
Malaria is another example; there are treatments that are effective but accessing them is often more difficult
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Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial - The Lancet Respiratory Medicine
1
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@ClareGerada
Sorry Clare you’re wrong: They did not takes intubated & ventilated patients. Not enough staff. Miles from patients home, no ability to sort out ‘packages of care’ locally etc. We tried to identify patients for 3/12 but v few were appropriate. Did not pass friends & family test.
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Well done
@DrSimonHodes
&
@NikkiKF
! Great interview on
@BBCr4today
at 0736h today. Very professional, calm, informative, optimistic & positive!
I hope the roll out of vaccine in General Practice today goes really well. Good luck!
#doctorsforvaccine
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It is not all about PPE...
Social distancing is not possible in most ward environments. We use the same case notes, phones, computer keyboards & mice (that cannot be wiped).
We certainly don’t have a computer per bed space
@KieranMullanUK
@elinlowri
... (6/7)
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@dremmaw
@BMA_JuniorDocs
This is shocking & worrying. The salary is not significantly greater than when I started in 1997
#SupportBMA
✊
A significant complexity is related to the no. of doctors & hours worked. In 1997 we were fewer & worked longer hours but we felt more part of a team & more supported
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Achey but we did it. 100 miles & 2700metres (for Community Action in Nepal) 😀⛰🏴🚴♂️
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@PBSherren
I’m sure these messages are getting through.
@ClareCraigPath
will row back from her position &
@MichaelYeadon3
will stop throwing stones.
Both are the go to ‘experts’ that journalists like
@JuliaHB1
use so maybe
@talkRADIO
will have a show discussing how wrong they’ve been?
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