Nel retweeted
The irony @RoyalDevonNHS . Your emergency dpts are full… so you advertise for band 7 physician assistants that :
⚠️ can’t prescribe
⚠️can’t request X-rays
⚠️need all their work checked by a Dr who is already busy
⚠️ can’t diagnose
Does this make sense ? Like seriously?
Our emergency departments are very busy, with wait times several hours long for those with less urgent conditions.
If its not an emergency, you can avoid a long wait by choosing a service more appropriate for your needs.
royaldevon.nhs.uk/get-the-ca…
ALT Demand for our services is currently extremely high. Think! Am I in the right place?
Nel retweeted
Never say I didn't foresee it.
So..here we go again.
Open letter to @RCPhysicians
@Mumtaz_Patel_1 @OGMustafa @BDChadwick
If you are a Member or a Fellow- join in and sign.
RT/Cascade/Sign as you can or wish to.
The work to move the RCP out from the shadows into the light...continues.
And no- I have zero need to anonymise my name- compared to the contributors of this daft protocol for PAs -post @lengreview
Via @TheDA_UK
@mmamas1973 @djnicholl @doctor_oxford @RobLaurensonD4P @DrSteveTaylor @dr_shibley
dauk.org/rcp-letter/
Prediction time- and a bookmark for those who fancy it.
There will be attempts to fudge the PA protocols and dilute by the pro “PA are just differently trained doctors” lobby.
Absolute lock on that Leng will be under heavy pressure to be part of that
Organisations such as Royal Colleges will try to manage it internally and “find a middle ground”
(Colleges will mostly do as asked- unless the uproar is too much to handle)
They will eventually come in the public domain
There will be uproar and much debate as Fellows and Members see them.
The NHS Long Term Workforce Plan will try- again - to shoehorn PAs in.
The basic strategy?
“Let’s find a middle ground”- based on a belief that people are tired of this and will accept.
And a hope that enough has been given to the BMA - pay structures, IMG sacrifice etc for them to sign up
As ever?
The key sits with the supervisors.
Will YOU as a Doctor- agree to taking lesser trained people on and put your liability on the line.
And will you have the time once METR lands.
Policy is one thing - involves much of politics
Implementation?
Needs wide support.
Ask those who tried to force the whole PA project through first time around.
@lengreview @RCPhysicians @rcgp @gmcuk @TheBMA @AoMRC @AoMRCTrainees @rcpsych @JanetEastham
Nel retweeted
Consultants don’t want to strike, but after 18 months without formal negotiations, they cannot wait any longer.
These strikes are planned to take place on 25 and 26 November, with Christmas Day levels of cover provided. There is still time for the Government to make progress.
ALT Graphic with an orange gradient background and a silhouette crowd holding banners and placards at the bottom. Large white text reads: “Consultants confirm strike action”. A banner at the top says “Consultants in England”. A white box displays the dates “25 & 26 November”. At the bottom is an orange button reading “Find out why” with a white arrow icon.
ALT Graphic with an orange gradient background and a silhouette crowd holding banners and placards along the bottom. At the top, a banner reads “Consultants in England”. Large text states: “18 months in dispute. Still no formal negotiations.” A white text box below reads: “Consultants are taking industrial action after repeated calls for formal negotiations have failed to produce progress.” A white circular arrow icon appears in the bottom right corner.
ALT Graphic with an orange gradient background and a silhouette crowd holding banners and placards along the bottom. A banner at the top reads “Consultants in England”. Large text states: “Christmas Day levels of cover will continue during the industrial action.” A white text box below reads: “Our mandate must now lead to a credible offer that addresses the dispute.” The BMA logo appears at the bottom centre.
Nel retweeted
@benking01 Now 2502 hours - 1.7 days .
They won’t be seen until tomorrow 11:13pm.
Even after waiting 2 days they might not even see a medical Dr but a PA or tACP/ACP.
Disgraceful.
#nhs @YvetteCooperMP @JanetEastham @ShaunLintern @andyburnham @DannyBeales
Nel retweeted
How Can @LukePollard @FredThomasUK Defend
42 Hour Waits
#Plymouth A & E
As @YvetteCooperMP @karinsmyth Continues #DoctorSubstitution ?
@RCEMpresident @RCEMPolicyVP
@JeanetteRCR @CMO_England
@TheBHF @asthmalunguk @TheStrokeAssoc @GMB @BBCSpotlight @Plymouth_Live
Nel retweeted
Nobody can tell me that this isn’t partly due to the 52 tACP/ACPs working in #Nottingham A&E on the ‘tiered’ rota
When you replace @BMAResidents with 52 non-medically qualified nurses, physios , Paramedics, ODPs, radiographers etc playing Dr?
This is the result
@parthaskar
🚨 EXCLUSIVE: Leaked emails expose rift at scandal-hit @nottmhospitals as desperate A&E staff whistleblew to CQC over dangerous A&E overcrowding and false reporting of waiting times data. Insiders warn of unsafe care being normalised.
Full story: thetimes.com/article/867ac5c…
Nel retweeted
Direct result of collapse of clinical hierarchy and rampant Doctor substitute in Nottingham. Of 2 factors, former more significant than latter but feed off each other. Leads to aimless, directionless flow across hospital. Treackle instead of liquid flow. ED (A&E) dysfunctional.
Nel retweeted
A reminder of the letter released by @NHSEngland when they accepted the @lengreview recommendations in July 2025.
This would’ve kept patients safe .
Why is this being torn to pieces now by the Clinical Advisory Group ?
@parthaskar @DrLKVaughan
Nel retweeted
The #NHS also called the “jewel in the crown”
Now- Built on a model of “don’t come to see us”
And if you do?
“Please leave quickly”
Whether it be primary care or specialist care
It’s called demand management
OR not enough resources to deal with the need of the population.
Nel retweeted
#nottingham A&E department has 52 nurses, paramedics , physios , radiographers playing Dr on a tiered rota.
Apparently this is exciting and innovative.
The results speak for themselves
@ShaunLintern
Nel retweeted
I will say this- again.
In a safety critical 'industry' like healthcare?
Lesser trained staff usage-at scale-will cause harm.
You will 'get away with it' a lot of times.
Yet all it needs is 'one miss'.
And the higher training reduces the chance of that 'one' - it's what training is all about.
If you don't understand that?
You fail safety issues
And you fail as an educator and trainer.
Thank you @JanetEastham for continuing to raise the issue.
The irony?
Every single person responsible for such decisions regards 'what the public can have' - reaches out to a doctor when they need help for their loved one.
'Cake for me. None for you.'
Dylan Cope died after an A&E nurse practitioner mistook his abdominal pain for flu, having ignored his GP’s referral for suspected appendicitis. His family thought she was a doctor.
A coroner found he would have survived had a senior doctor examined him.
telegraph.co.uk/news/2026/10…
Nel retweeted
“People with a medical degree should work on doctors’ rotas”
In 2026?
That’s controversial in the NHS.
When you want to see a doctor? You should see one
Not people using titles and alphabet soups to obfuscate their actual training- and hoodwink.
Period.
Nel retweeted
I’m getting DMs from Barnsley GPs telling me that they don’t trust the PA’s assessments and requests for treatment, therefore they rarely use the home visiting service .
#Barnsley GPs and patients DM me . Tell me what is going on please.
@HealthCareBNSLY @BarnsleyHF
Nel retweeted
Serious questions for you to answer @andyburnham @DHSCgovuk @DianaJohnsonMP @PauletteHamilto @JoshFG @YvetteCooperMP @karinsmyth
Would you be happy with this for your own family members?
Nel retweeted
People of #Barnsley
If your Grandad or Nan are sick at home , they could end up being assessed examined and diagnosed by an assistant instead of a qualified GP
@YvetteCooperMP would ask for a Dr for her family members though …
Nel retweeted
Urgent care Psychiatry PAs - Trusts will do whatever they want
The result of your inaction
@rcpsych @subodhdave1
because you’ve refused to set a scope for PAs in psychiatry - (despite Leng highlighting how important a scope is due to ‘ grey areas’ in psych )
Nel retweeted
"It seems to me that a decision has been made to replace doctors and to remove distinctions between doctors and other professions.
It's no coincidence that the NHS continues to struggle with efficiency, productivity, and safety problems while we progress further towards a blended workforce without the necessary training supervision or regulation."
Via @bmj_latest
bmj.com/content/393/bmj-2026…
Nel retweeted
@DHSCgovuk wanting to regulate private aesthetic practitioners & clinics (not a bad idea) whilst NHS Trusts who they themselves are responsible for using medically unqualified & unregulated people practicing Medicine & Surgery in the name of advanced practice @karinsmyth
.@karinsmyth visited Dr Leah Clinics to see how cosmetic treatments being carried out the right way, by qualified professionals in a safe clinical setting.
Meanwhile, our crackdown intensifies on cosmetic cowboys - with new proposals to:
🩺 restrict high-risk procedures to qualified health professionals
🚫 ban cosmetic surgery and other treatments for under-18s
⚖️introduce unlimited fines for rule-breakers
Nel retweeted
If they want further progression & training pathways, they should do GEM. What happens to Medical Trainees when PA/AAs are doing yet more RC credetialled training whilst on the job? What's the point of PA/AAs if they're only using it as a stepping stone to become alternative Drs?
Nel retweeted
Indeed
Imagine if Nurse Owen Dickson is stopped from doing invasive procedures in his private aesthetic practice due to this regulation from @DHSCgovuk but he can carry on doing ERCPs in NHS theatres because neither @nmcnews nor @gmcuk regulate his“consultant advance practice” 🙄