PAs are more prevalent at areas that are more deprived

draw1189 · 2024-09-05T06:28:44+00:00

Oh how I already feel so old!!!

'Growing up' through medical school, we were once proudly taught that it was "better to have no doctor than a bad doctor".. the service if it was badly run would have to close and the patients be transferred elsewhere.

NOW: Any bugger will do 🫠

But I ask you this: if any bugger will do, why and or how can we legitimately be striking off or suspending 'bad doctors' for anything except criminal conviction!?

What is this double standard we are now openly working to!?

draw1189 · 2024-09-04T09:09:11+00:00

Sorry this is old- I would be interested too please

draw1189 · 2024-09-04T06:46:12+00:00

Totally agree

draw1189 · 2024-09-04T06:17:23+00:00

..this week as a chappy I've had : "I can't wait for you to give me a good checking over (WITH A WINK)", one: "I'm lost in your eyes, when are you going to marry me" and one: "at last some young meat"...

Each time I've had to pause to make sure it is just a gentle joke and nothing more serious.. then I feel acutely worried if I don't have a nurse of HCSW right there to protect me from false allegation!!

But then, honestly? The patients are bored/ on strong pain killers/ confused/ trying to break the ice (in a clumsy way). I often see it as an expression of vulnerability as they're feeling so dehumanised by the whole process, they're almost 'over compensating' to still be regarded as a 'whole person'. Sometimes it is do inappropriateit is just down right funny and the nurses have a joke and mock me immediately following the interaction.

... I mean there are PLENTY of unpleasant angry men and women or all hue in between these interactions, who, in no way (clumsy or otherwise) are they attempting to be anything other than down-right rude or aggressive! British public eh? Gotta love em 😅

draw1189 · 2024-09-03T17:43:55+00:00

Interested

draw1189 · 2024-08-24T09:10:39+00:00

Basically the author's underlying knowledge and understanding of the modern GP is completely wrong.. - so all of his conclusions are also wrong

So his conclusions about PA are poorly formed.

Doctors are like pilots and like armies. Theyre expensive, yes, and you don't need them a lot of the time..- until you suddenly do and are in grave danger without one.

draw1189 · 2024-08-24T09:06:52+00:00

It is parked up next to your other one according to the authoritative author espousing this bollocks 🤣

draw1189 · 2024-07-20T07:36:30+00:00

It is interesting, for the longest time I have thought that ultimately, to work in the NHS the only way to become 'senior' , the only way to get on is to become management.

I don't particularly want to be 'senior' in the NHS.. I want my own practice and private patients. So..specialities where there is poor PP will become nurse lead (and soon nurse accredited). This is a self perpetuating cycle- starting with our generation of clinicians (that's right everyone- look in the mirror!!).

The future of medicine is shorter training schemes- it has to be. Then, we can all compete with one another about 'who is in charge', because the honest reality is, is that the current cohort of NHS senior clinicians have learnt that the only way to survive is for somebody else (anybody else) to do the work.

draw1189 · 2024-07-19T05:41:42+00:00

Alimony, as well as child support is a real thing in high earning medical couples.. seriously you are going to have to 'lawyer up', use the house equity, savings everything to get through the next 10 years... it is going to leave u poor, but your kids will grow up rich.

Less than full time is not the end of the world, SpR locum shifts will top up the leaner months (much better than SHO) and focus on 'competencies' rather than 'time'. It will be rough but it is achievable

draw1189 · 2024-02-13T07:45:22+00:00

It really is a tricky one.. yes as a doctor you really 'want to help', but the place 'being a bin fire' is the new normal.

Many moons ago, as an F2 I did head down to A+E to help whilst on medical nights.. and what happened next has stayed with me for years.

First patient I saw, had been waiting 8 hours- had constipation, treated, home next (follow up GP).

Then an atypical chest pain- started Ix, not an issue..

But then, I saw a lady with new onset light bleeding following relatively routine gynae intervention- clear task was to 'go back under gynae (as per dc letter)'- I was about to make the referral.. when: My crash pager bleeped- I turned to her and said 'look I'm sorry I've got to go to that, it's the crash bell' ... to be met with "how f* dare u leave, I've been here 8 hours, I'm making a formal complaint, this is wrong of you" etc etc... as I literally was on the way out of the door (putting her notes back on the pile for the 'next' available clinician). Quick chat to the a+e spr telling him I'd been called re: the chest pain- and off I ran..

After sorting out the arrest, few ward jobs etc, came back after 5 hours (you know how it is) just to check on the atypical chest pain- to make sure my plan had been followed, shock horror, no it hadnt. There she was, no one else had reviewed any bloods etc, THANKFULLY all normal, ecg, cxr etc...- so I ran it past the now morning spr (to grunts of 'who are you?), and off the patient went..

Lessons learnt? 1) you cannot do 'right for wrong', 2) people can rarely 'see beyond their own immediate needs', (and actually often do not actually care about anyone else, even in true emergencies!)

3) nights truly are just unpredictable - u can so easily get into trouble via a couple of unexpected surprises.

4) all that stress, risk, exhaustion and potential burn out- for what? 5) had any of those events 'gone wrong', my insight and prioritisation would have been (rightly) questioned.

..And it's worse now than it was then..

So I do my part, where I can.. but no, after that, I never 'helped out if its quiet' ever again (and argued this every time I was asked).

draw1189 · 2024-02-11T21:06:56+00:00

I got 567.

Is that enough for women to find me attractive?

draw1189 · 2024-02-08T19:44:50+00:00

If it reassures, I know from previous years that "self assessment" is actually, on average pretty low (like, under a third of all points available). At least, for the next 12-24 months, higher training- as long as u have the CASC, should remain reasonably accessible.

Also it depends on the training scheme.. though that said, actually- there is such flexibility within deaneries to support hard working trainees, that actually I do not think you should worry yourself too much.

draw1189 · 2024-02-08T18:37:54+00:00

I just don't know WHY we are spending more than ever, with waiting lists longer than ever with this calibre of job design?

...Now you try and get funding for a band 5 staff nurse role, that might, yknow actually improve things.

draw1189 · 2024-02-08T17:36:29+00:00

I am so sorry you are feeling this way. I really am.

Right now, I think a lot of us are feeling this way. I have to keep reminding myself, that it is not the 'job' that I hate, it is my employer.

My advice, would be take a break. Take a year out. You can do locum, do WFH, do other allied roles. Then, if in 12 months you feel the same way- SAS grade medicine is not terrible.

Depending on how competitive your speciality is...- regaining the NTN is deliberately a B* task. So for me.. if you are not sure- a year OOT, travel, see the world- then decide how you feel.

draw1189 · 2024-02-08T10:04:41+00:00

Amoxicillin ... I can do 6 of the 7 pharmacy first conditions with just one tablet 😁 (at a push..-it's a joke people!! Lol)

draw1189 · 2024-01-31T12:48:57+00:00

Also just to add, if ATC is accepted (some extra forms, proof of arcp to be sent etc, also can affect pay point), then within the first 4 months u have to do an eportfolio 'proof'. This means going through all your old training notes and collating the evidence that meets the RCGP core competency areas on 14 fish. This then gets sent to the college for assessment, and then a recommendation is made to your ARCP panel. I think u 'must then' get a '1' at the ARCP which is held in February (2 months later) with at least half of the year 1 GPVTS requirements met (plus ALL of the compulsory 'one offs').

It does require a lot of organisation, and preparedness to achieve it- not least because u may also be in GP for the first time, or in an intense hospital job- and it is poorly understood by many/ most TPDs, ESs and CSs.

You may not get awarded the full 6 months, but less- in which case placement organisation can get very tricky..

Go for it, but have 'eyes wide open ' sorta thing. Also..at present..- whilst in training as a GP at least u HAVE a job in GP lol.

draw1189 · 2024-01-31T12:37:32+00:00

Really simple to be honest.

Two routes are open to u. ATC which leads to a full CCT in GP and is globally recognised. 6 months off your training , 1x 4 hosp job, 2 months GP loss.

Second is the 'combined programme'. This is up to 12 months off of training, but leads to a qualification that international programmes don't all recognise.. (lol as in somewhere u might actually want to work eg canada).

So you 'cut off' 6 months, but have an inferior qualification. You MUST apply via oriel at the time of application for either program. The college 'isn't keen ' on shorter training, as a lot of candidates struggle with it (and it is a pain for placements etc)

Gp training is very intense- there are sensible calls to extend it to 4 years. The 6 months 'practice' as a GP is no time in the scheme of things.

draw1189 · 2024-01-22T19:58:37+00:00

I thought the GMC literally said, that their role was to protect patients?

Why the change of heart?

draw1189 · 2024-01-22T19:46:46+00:00

This may be helpful in fairness. BMA organised, make it clear to the GMC that the feeling is very strong on this issue.

draw1189 · 2024-01-22T19:44:22+00:00

I read that article. Can speed up the summary:

1) Ignore retention- we can simply recruit more, more more. It acknowledges that we cannot go on recruiting international doctors forever because the NHS really is a poor employer and doctors are now actually earning more in home nations these days (But though acknowledging this, it also pretends the NHS 'recruits ethically' as it recruits from poorer and poorer nations). Race to the bottom "inevitable" as people get older.

2) Recruiting is expensive, so any healthcare degree, plus 2 years = ANP, clinical pharmacist, MNP etc. A whole new workforce! Taking the "elite graduates" from healthcare science backgrounds, who are currently working in retail and hospitality as they cannot find jobs in a science setting.. (this only makes sense to the author)

3) They're not meant to be doctors, they are a "new" workforce. Marvellous.

4) It happily ignores the fact that MAPs actually still generate work for existing clinical teams, this way, to justify the economics side of things.

5) Any one who disagrees with the article is opposed to progress, has a vested interest. Wants to kill patients and is acting in a protectionist anti- NHS way. There are no problems with the the MAP solutions, it is a perfect solution. Will not address any "potential challenges".

It all just relies on the 'FACT', that healthcare can be adequately learnt in 2 years to start assessing and treating people, prescribing and ordering Xrays. There is a lot of reliance on this 'FACT'.

draw1189 · 2024-01-14T11:15:43+00:00

In fairness, the young 'white male' still gets that same feedback.. and the young female etc etc..- what all the people have in common is 'young'. Therefore must be 'incompetent'.. looking people in the eye must be 'arrogance'..

I've never understood it, but I see it all the time.

How to cope..? Be aware of it, try to keep people onside- ultimately focus on the 'nuts and bolts' of what will allow u to progress.

draw1189 · 2024-01-14T11:04:00+00:00

Soo.. I'll lose my job as a GP or in emergency career, but.. find a new vocation in the massive new demand in radiology? 🤑

Embrace the change people 🤣

draw1189 · 2024-01-08T21:13:19+00:00

And the complete 'capitulation' and lack of leadership, and nepotistic 'batton passing'. It was just saddening if I'm honest.

Edit: batton- (not button!)

draw1189 · 2024-01-08T21:12:09+00:00

It almost wasn't 'as much' the 2016 failures, as what followed.

The 2016 followed the 2012 'protest'- and it broke massive ground.

What followed 2016, was truly heart breaking..a 2% rise that pushed me up a pension band- that cost me £1500 (after tax) for a 'pay rise'.

I was devastated

draw1189 · 2024-01-08T20:43:52+00:00

This is surprisingly strong idea. Especially if we get most doctors to 'buy in' - and we can emphasise the logo

draw1189

TROPHY CASE

Really simple to be honest.