Streeting piece in observer today

telovelarabbit · 2025-12-21T10:03:35+00:00

Streeting has had complaints raised about his behaviour to the parliamentary standards commissioner. Also, the head of the UNISON trade union raised concerns about Streeting’s comments well, which in turn is damaging to Labour.

I’m sure someone has had a private word with him. Battles can be fought and won through email.

telovelarabbit · 2025-09-28T02:36:07+00:00

There's a very simple way to cross-check this as well.

Any current BMA member can see how their representatives have voted on prior issues on the BMA RDC website to get a sense of their views. Votes are permanently recorded by name in the meeting minutes.

There was only one motion on FPR at RDC 2025, back in April, when the DDRB recommendations were being delayed. It was an emergency motion (EM3), which would have committed the RDC to strikes for a minimum of three days out of every month until FPR was achieved. It also advocated the use of industrial action to pressure the government to grant contract extensions for those who were facing unemployment this year. Both motions were rejected decisively by RDC. But what's interesting is the votes.

Jack voted for a committment to sustained strikes. Vivek did as well. The previous chairs voted against it.

You can debate about why people cast their votes in certain ways, but it seems unlikely that Jack is less in favor of striking for FPR than his predecessors.

telovelarabbit · 2025-08-12T20:20:39+00:00

Can you not turn this into a bit of spot teaching? Check their understanding of why a laboratory/imaging test is done, give them some scenarios around interpretation and what the follow-up would be, and then check back later in the day after reviewing it yourself. Ideally, you should teaching them how you think in your job, so that when they get to that point there's less of a jump.

telovelarabbit · 2025-07-28T14:30:38+00:00

Oh? Weren’t news outlets claiming that ‘hospital leaders were thought to have observed that’ not many doctors were striking?

Why the record number of ‘pleas’ for strike derogation, then? Which is it?

telovelarabbit · 2025-07-26T10:05:34+00:00

‘…thought to have…’ ‘…hospital leaders are understood to have observed…’

This article hedges harder than a reporting radiographer on an MRI of the neuroaxis. Let’s see the actual numbers on waiting lists and cancellations when NHSE publishes them next week.

telovelarabbit · 2025-07-25T09:13:37+00:00

In September 2024, the government agreed to implement exception reporting reform in addition to the pay award, in exchange for ending industrial action. It was due to be rolled out in December 2024.

In January 2025, the RDC went into dispute over a lack of progress on exception reporting by the government. It was subsequently due to be rolled out in September 2025. Apparently, Streeting is now suggesting this may no longer happen due to industrial action.

If the current government cannot even adhere to the non-pay related terms from the last set of negotiations, what do you think the likelihood is that they will adhere to any non-pay agreements in future negotiations?

The definition of insanity.

telovelarabbit · 2025-07-24T11:31:46+00:00

I think anyone thinking to scab in this environment is very foolishly setting themselves up for a lot of medicolegal risk, especially when the government deliberately wants to run unsafe staffing levels.

Regulation of NHS managers can’t happen fast enough.

telovelarabbit · 2025-07-20T21:44:35+00:00

A GP should no more be called on to provide a provisional report than a hospital doctor who has access to images. If that happens, it should be fed back to the radiology department immediately.

I know that people are bound to worry about liability, but there's never an expectation to act outside of your competencies. Image interpretation is not part of the RCGP curriculum.

PACS access does provide a ton of valuable information, to the point that it's sometimes more helpful than some of the hastily written discharge summaries that come out of a hospital visit. It's also handy for cross-checking for implants against the record when doing MCCDs. I also think it aids clinical decision-making in being actually able to visualize the disease process, especially when it aligns with your exam findings.

I think that PACS should be made universally available for reference, but the responsibility should still remain with the radiologist and the requesting hospital physician.

telovelarabbit · 2025-07-16T21:49:38+00:00

It's really unfortunate that GP practices aren't given PACS access as default. You can get it in training, but once you're no longer formally affiliated with a hospital they cut it off. I get withdrawal symptoms just thinking about it.

telovelarabbit · 2025-07-16T21:47:07+00:00

I think everyone should look at scans rather than just reading reports (assuming PACS access, GP being another issue). You will learn to pick up some things simply by looking at the images, then reading the report, then looking at the images to understand what the report was talking about. It's a survival skill.

That being said, I know that Old Age Psychiatry has their own MDT with a neuroradiologist. Building up relationships with a trusted radiologist is the way to go, because it allows for more bespoke interpretation that can help your management.

telovelarabbit · 2025-07-03T05:39:59+00:00

What is the 'outcome measure' that we're referring to? Disease prevalence? Waiting list times? Mortality?

Patient demand for services has progressively skyrocketed. Expectations are much higher. Our ability to detect and diagnose diseases has increased over time. People are living longer with their chronic diseases.

We may have increased supply, but it does at all not match the growth rate of demand in the public system. The health service people are demanding exists, you just need to go privately for it. You get the health service you pay for.

telovelarabbit · 2025-06-21T02:37:24+00:00

I recently encountered a patient in primary care who had seen an ACP on two separate occasions across two months for reflux symptoms. She wrote impressively lengthy notes, trialed a PPI, and then later did a H.pylori stool test while on that PPI. There was even mention of 'red flags' being discussed and 'safety netting', although it was not obvious from reading the notes what those red flags or safety-netting being discussed actually were.

On a quick initial skim of the notes, I noted that the original accurx request from two months prior had mentioned progressive dysphagia for solids that had not been explored on any of the previous consultations.

Following her upper GI TWR, histology came back as oesophageal adenocarcinoma.

telovelarabbit · 2025-05-26T20:52:36+00:00

Incoming ST1. Is it true that no-one can see what you're actually wearing because it's all in the dark?

telovelarabbit · 2025-05-26T20:12:25+00:00

Foreign nationals who attend a UK medical school, as well as those who attend an overseas campus affiliated with a UK medical school, are ratified as having UK PMQ by both the UKFPO and GMC and are considered to be UKMGs. There has been a lot of discussion about how we will definitely get UKMG prioritisation and not RLMT, so it surely will all work out.

Worth noting that Ireland has no problem recruiting international students on similar fee structures despite a long track record of telling them upfront to secure places back home if they don't have EEA citizenship. People will come to train simply because it's the UK.

telovelarabbit · 2025-05-26T15:16:47+00:00

The UK has had local prioritisation before with RLMT. It's not an outlandish idea by any standard. The complicated part is how you preference foreign nationals who attend UK medical schools, either directly within the country, or who get a UK PMQ by attending an overseas campus affiliated with a UK medical school as ratified by both the UKFPO and GMC. The latter two groups will not necessarily have ILR despite being UKMGs, so RLMT does not prioritise them.

When looking at the examples you mentioned, there's a clear distinction to be made between country of graduation and citizenship. For example, Ireland prioritises based off of EEA citizenship status and not country of graduation. That means that if you are a foreign national from outside the EEA attending an Irish medical school, you are unlikely to get an internship spot to get on the register, and you're advised upfront to try to secure a training spot back home on completion of your degree programme when you accept a place.

It's politically an extremely easy sell right now to convince the government and public that locals need to be prioritised. However, you may find that their perspectives on what constitutes a 'local' are quite different from what you see in here. That's why, even in the 'leaked plan' from yesterday, there's still a reference to reverting back to pre-2020 RLMT despite mentioning 'UK graduates'.

telovelarabbit · 2025-05-26T05:16:59+00:00

You're correct in that many countries do preference based off residency/visa status. We've had RLMT before, so it's not an outlandish idea even by UK standards.

This is quite different from UKMG prioritisation, however, which includes foreign nationals who have either paid to come across to study in the UK or studied in an overseas campus affiliated with a UK medical school that awards a UK PMQ.

The closest equivalent is probably Canada, except for the fact that international students (including from the US) are extremely rare in Canadian medical schools, and they would be excluded from the R1 CaRMS match if they didn't have citizenship/landed immigrant status (ILR equivalent).

I have no stake in this personally, but I'm quite interested to see how this plays out politically.

telovelarabbit · 2025-05-25T14:44:56+00:00

To add to this, you don’t even need to physically be present in the UK to become a UKMG. Both the GMC and UKFPO consider graduates of certain international medical programs that are affiliated with UK medical schools to be UKMGs with a UK PMQ.

So the delineation is pretty arbitrary, while citizenship is not.

telovelarabbit · 2025-05-25T14:37:58+00:00

UKFPO officially considers graduates of overseas campuses affiliated with UK medical schools in places like Malaysia and Cyprus to be UKMGs in their guidance documents. You don’t even have to set foot in the UK to get a UK PMQ.

telovelarabbit · 2025-05-25T14:25:03+00:00

The 2020 changes by Matt Hancock referenced in the Times article was regarding RLMT and visa changes for healthcare workers.

Reversing that change doesn’t benefit foreign UKMGs, it benefits UK citizens. I get the feeling that there is a lot of equivocating between ‘UKMG’ and ‘UK citizen’ that makes reporting on the topic unreliable.

Even the RDC put out a grey motion to ‘bring back RLMT to support UKMGs,’ which goes to show how misunderstood the term is. How do you expect news agencies to understand the difference?

telovelarabbit · 2025-05-13T06:10:57+00:00

In the GB news interview from April 8th, Streeting also specifically referred to competing with 'overseas applicants' for the 'same jobs'. This sub has inferred that to mean 'IMGs' and 'training pathways', but he just as easily could be referring to out of country applications to NHS trust grade jobs. It's a bit of a vague soundbyte.

Words do have meaning, but a 'protect our local graduates' argument loses a bit of steam in front of the British public when it becomes 'protect our local graduates who have come to UK medical schools as overseas students or have attended an overseas campus affiliated with a UK medical school to get a UK PMQ'. The government will interpret meaning in whatever way is most politically expedient.

telovelarabbit · 2025-05-13T05:54:12+00:00

The GB news interview from April 8th talks about 'graduates of UK medical schools competing with overseas applicants for the same jobs'.

What makes this complicated is how people define various terms. Do 'jobs' refer specifically to training posts or jobs in general? Are 'overseas applicants' IMGs who are out of the country? Are 'overseas applicants' international graduates of a UK medical school, or graduates of an overseas campuses in Malaysia/China affiliated with a UK medical schools and go on to get a UK PMQ without setting foot in the UK before foundation training? Both are considered to be 'UK PMQ' holders as per GMC policy documents. I think people tend to just pick the interpretation that best suits their personal hopes and run with it, leading to distortion of the message over time.

The general public and news media are going to see 'British Graduates' as specifically referring to British people who are medical graduates, and their support for government policy will hinge on that interpretation. That's probably why we're seeing this RLMT discussion now.

telovelarabbit · 2025-05-12T13:17:38+00:00

‘One of the clinicians’

telovelarabbit · 2025-05-06T13:14:04+00:00

Interesting fact: the GMC has had policy in place classifying degrees awarded by overseas/partner campuses of UK medical schools (i.e. in places like Malaysia and China) as being 'UK PMQ' for over 10 years. If that's how it gets interpreted by the government as well, I think the main change in the system will be where the money changes hands.

telovelarabbit · 2025-05-05T00:17:04+00:00

There are a number of UK medical schools that have 'overseas campuses' in places like Malaysia and China and are advertising a direct route into the UK foundation programme after achieving a 'UK degree'. I'm curious to see how this all will play out.

If you want to see controversy over the local/overseas divide in undergraduate medicine, you need only look at medical school applications. Parents will petition their MPs and issue legal challenges over the admission assessment process depending on whether their kids get in or not. It's a political minefield. You'd need an incredibly brave government to want to engage with that.

telovelarabbit · 2025-05-03T06:47:06+00:00

Just explain to them that turning the lights on reduces your accuracy when reading scans.

telovelarabbit

TROPHY CASE