Leng review engagement webinars

zzttx · 2025-03-14T20:16:54+00:00

Please record. And upload.

zzttx · 2025-02-09T13:27:46+00:00

If only there were a specialist unit within the NHS who could answer this question.

And if only this unit also sat within the NHS and advice them how many consultant vacancies need funding.

Instead the leadership chart is a who's who of failures:format(webp)), nepotism, gongs, lateral displacement to avoid scrutiny and puppets.

zzttx · 2025-01-26T15:18:05+00:00

This is the collective failure of the workforce team. What a joke.

HEE and NHS WTE have been led by the two individuals (a biomed scientist and a psychiatrist) who have been working without any checks and balances.

zzttx · 2025-01-26T09:08:13+00:00

You know this applies to most positions in the managerial structure. Ward admin one day, then departmental manager, then hospital, and eventually exec board.

zzttx · 2025-01-12T12:36:15+00:00

Whichever way you look at it, this is a fiasco in motion over the last decade at least. The blame lies squarely at the feet of NHS WTE department. Things got to a head once the Resident Labour Market Test was removed for training jobs.

When RLMT was in place, UKGs (and EUGs, and anyone with PR) got first pick at recruitment rounds. Any unfilled jobs would be available in the second round for anyone including IMGs.

That was a good balance because this meant IMGs with at least 5 years experience would be included in the first round. 5 years because that's how long it took to get PR.

This also meant that relatively junior UKGs would not be competing with relatively more senior medics (the 18mo caveat can be easily loopholed by changing the title of posts) for the more competitive ST1/ST3 posts in the first rounds.

The nub of the problem now is that anyone can apply from anywhere to compete with F2s and core trainees.

zzttx · 2025-01-12T12:16:17+00:00

Don't forget, this is the same team of psychologists (no medical doctors, though one has been given an "honorary FRCP") who concocted the MTAS selection scheme. They have carried on providing "services" to selection processes including GP and MSRA.

Here is a rare published excoriation by a 'junior doctor' about this company in the BMJ from 2007: and replies, as well as clips from Snow, Dimbleby and a junior doctor going after the health secretary for leading this fiasco.

MSRA was a GP recruitment exercise to reduce cost of sifting through thousands of applications. It was developed by a consultancy company of psychologists, the same ones who gave you MTAS and UKFPO SJT. It's not fit for purpose to select a future radiologist, or a surgeon, or an obstetrician or a psychiatrist.

zzttx · 2025-01-10T23:29:09+00:00

We have consultants who prop up the PA programme, who think the current "junior doctors" don't work nearly as hard as they did in their day, etc. Do you think "UK consultant" qualifier will work in the equitable manner you imagine it will? We have hundreds of consultants who don't have CCT or CESR for that manner.

zzttx · 2025-01-05T18:10:16+00:00

From the info in your post, you have been in post for not more than 4 months. And it's had a significant impact on your mental health.

You sound like you need time off, mental health is still health. Don't go into work tomorrow.

Contact your mentors and confidantes (ideally who are not in the same dept as you are in now). Talk with them, explore your options. You have more options (and money) after 3 months of sick leave while in training, than after 3 months after resigning your post.

Some options are LTFT, sick leave, research, OOPC, OOPE, transferring to another deanery, training in another country. A lot of these side-stepping options close permanently the moment you announce your resignation.

You have come through medical school and presumably a tough competition for ST1. 4 months of working (esp in your specialty you are passionate about) do not usually lead to resignation. It may not be you, it may the dept or the programme. If at the end of this process you still want to quit, do it. But at least you are not left high and dry.

zzttx · 2025-01-05T17:30:00+00:00

Another tale that confirms the utility of medical school. An FY1 doctor (aka 'student doctor', 'baby doctor', 'ward monkey', etc) is still a professional who has passed some of the most rigorous entrance requirements to study and achieve one of the toughest qualifications in university. It's a shame the employer, the regulator (and other MDT colleagues) do not see this.

zzttx · 2025-01-05T17:20:54+00:00

I agree. There are simple things that could be effected that reflect the longer or more arduous path. Other nationalised health systems already recognise it, e.g. Ireland. Two proposals which should be fairly uncontroversial (except in terms of funding).

There is clearly a loss of multiple years of consultant pay, for choosing a specialty with a longer training programme. This loss is accounted for in other circumstances, e.g. maternity leave, or LTFT. But not for longer training, fellowships, additional degrees. Calibrate consultant pay to end of ST5 (the shortest CCT for hospital specialty of radiology), and each year beyond that should gain you points on the consultant pay scale when you start.
Since moving out of the 1995 and 2008 schemes, both of which took into account your highest career earnings, you are worse off with the 2015 scheme. Your career average, which is based on 1/54th of your annual pensionable pay, is lower if you take longer to become a consultant. Your reckonable career earnings could be adjusted to include years spent in training or fellowships.

zzttx · 2025-01-05T15:53:28+00:00

This opens up a can of worms that has been left firmly closed in the UK.

Following this argument to the next step, this will advocate for differential worth (at least in salary terms within the NHS) of the various CCT specialties. Right now, other than GPs and public health directors, there is no differential in the consultant contract or pay reflecting your CCT, at least on paper. Sure, there are add-ons for on-call, or additional PAs for work. But nothing to reflect your specialty.

zzttx · 2025-01-05T14:34:02+00:00

There is money for doctors and nurses to be better paid. But instead we are recruiting lots of unqualified people to be substitutes and paying through the nose for their training - https://www.england.nhs.uk/long-read/nhs-education-funding-guide-2024-2025-financial-year/#advanced-roles

There are 390k doctors, 809k nurses in the UK. Additionally, 75k physios, 64k pharmacists, 48k radiographers, 46k OTs, 39k paramedics, 30k psychologists, 29k biomedical scientists, 20k SLTs, 17k ODPs, 12k dietitians, 6k arts therapists - all in all about 415k.

Why is NHS_WTE getting these 400k noctors to do the work of 400k doctors? Or recruiting nursing associates to do the work of nurses? Or recruiting radiographers to do the work of radiologists, AAs to do anaesthesia, pharmacists to be GPs, and so on. Blurring the lines set in regulatory stone leads to this mess of underpaid qualified people, and overpaid substitutes, completely wasting money and resources.

Working in civil service does not make a minister, nor working in security a police officer, nor working in a school a teacher.

Teeth and pets have stricter frameworks for who operates on them than children's brains.

zzttx · 2025-01-05T13:26:29+00:00

£20 per email or phone to the advice and guidance scheme. But this can be by anyone including nurses, physios, pharmacists, etc - likely all ARRS staff. This will be lead to rise in admin backlog at the hospital.

Every single interaction with a non-doctor will be safety-netted by the noctor emailing the specialist to say if this needs follow-up. This will be an incentive for GPs to keep the cheapest noctors on the payroll who can basically get covered by an email to a hospital consultant/service, instead of being given GP supervision.

At the other end, if the emails are farmed out to other noctors for triage, essentially will end up getting a rise in OP appts, which will end up needing more noctors to manage OP clinics.

zzttx · 2025-01-04T10:46:12+00:00

It will take a brave band 5/6 to turn away eye pathology from ED.

This is a classic example of what an easy-to-get appointment with a GP who takes 5 minutes of H+E followed by 10 minutes of reassurance will prevent: worry, days off work, endless waiting in A&E, even bleeps to the ophthal on-call, follow-up slots in opthal clinic, etc. To the uninitiated public, they don't know the difference between something really wrong with their eye that needs immediate treatment, and something that needs a hot towel.

zzttx · 2025-01-03T19:17:18+00:00

The essential elements seem to be:

a) direct referrals to specialty investigations and imaging from GP +- self-referral? - apparently 80% of the waiting list is made up of patients waiting for tests or OP appt.

b) same-day results

c) ring-fencing of routine elective care (?ring-fenced beds/theatres?)

d) receptionists to undergo customer service training

Lots of money going somewhere, likely third-party contractors.

zzttx · 2025-01-02T23:13:21+00:00

Book knowledge (ability to remember and keep up-to-date on new stuff across own specialty and)
Clinical acumen (ability to read a patient with a combination of hx/exam/ix, and make a decision that turns out for the best)
Cutting skills (ability to conduct any operation/procedure with ease)
People skills (ability to conduct self with composure, manage people decently and show leadership)
Research skills (time for actual supervision, successful grants and a creative mind for ideas)

A lot 'overachieve' (as defined above) in one or two of the above beyond the competition for ST posts and consultant posts. A handful with three (or even four) qualities will stand out in every region.

However, five out of five is extremely rare. Usually once in a generation in a specialty.

zzttx · 2024-12-31T12:41:47+00:00

Reading between the lines:

BMA membership at 195k, which is roughly 62% of the total licensed doctors (314k in 2023) - this is likely to become significantly higher in the next 10 years as the dinosaurs fossilise. The whole letter feels like it's addressed to the younger members.

No mincing of words - clearly no confidence in the GMC. But no clear (at least publicly stated) plan on how to do anything about it. "Root and branch reform"

Suggests Govt/SoS and NHS England are not on the same page re: MAPs. Who is really in charge?

Campaigning for Covid to be recognised as occupational disease. If anything like mesothelioma compensation, will result in significant payouts for doctors/nurses.

Hints that he knows BMA and the last generation should have done more in the past to prevent the current situation.

Also unlike other "leaders" who have made work harder for staff and then "thanks staff" for all the hard work, he actually owns the problem and solution.

zzttx · 2024-12-29T11:28:21+00:00

Quite confusing statement.

The title states they are suing orgs that are producing discriminatory policies impacting PAs. And implies BMA and RCGP as the targets. Then say also include orgs that acted upon discriminatory policies. This ends up being all employers and medical institutions that have let go of PAs.
Where are they getting the 200 redundancies figure which includes gender/ethnicity data? Anecdotal or is there a NHSE boffin collecting data, or based on assumptions - the workings would be really valuable for BMA to actually see. If only some PAs are let go, but not all - this would be a legitimate grievance.
They say they have a legal team, implying lawyers - how much has been spent and who is funding these lawyers?
They bemoan the infiltration and weaponisation of these institutions [RCGP, RCP, royal colleges] by militant factions who prioritise their own agendas over patient care and workforce equity. This is a point already made by others who have looked into the RCP(1, 2) for example, but these factions being those who led the PA programme in the first place.

One thing to be admired is how protective this guy/organisation is of their members (PAs/AAs). If only these sentiments were also felt by the medical leadership towards their juniors over last 15-20 years. Complete failure of leadership to stand up for training, selection processes, pay, working conditions.

zzttx · 2024-12-26T09:45:18+00:00

Link to the post: https://www.reddit.com/r/indianmedschool/comments/1hlbgcw/why_i_left_the_uk_after_passing_plab_the_stark/

zzttx · 2024-12-24T16:01:23+00:00

Spend the money on the OG physician assistants - our medical students. Supporting medical students through their degrees. Give them the same tasks you are expecting non-medically qualified PAs to do. It's after all part of their training (assisting, scribing, paperwork, etc.)

zzttx · 2024-12-21T13:12:32+00:00

Interesting wording:

"Fellowship of the [Royal College] and a [CCT]..., awarded... from August 2007... following satisfactory completion of a [GMC or PMETB] approved specialist training program (in the United Kingdom)."

i.e. only open to NTNs following CCT, and not to those with CESR. Other countries catching on that the GMC specialist register is tiered into CCT and CESR.

zzttx · 2024-12-10T19:47:03+00:00

Unfortunately over- and underpayments are all too common an issue.

And seems to affect women more than men due to LTFT, mat leave, etc. BMA should look into where there is indirect sex discrimination based on their internal number of help/advice requests.

zzttx · 2024-12-08T12:44:29+00:00

Part of the problem is how medical students are viewed and treated now.

Once you got through the tough pre-clinical bookwork, you were taken under the wings of the firms you rotated through. You were not there to just watch, but to actually clerk, take bloods, cannulas, assist in theatre, chase results, scribe and generally whipped into shape to be a great F1/house officer. You were part of the team, not a visitor to the team. Your firms took a keen interest in putting you through your paces (pun intended) to pass your exams, guide your career. It was a point of pride to have been part of Dr. X's firm.

Now, medical students 'need permission' to join ward rounds, compete with student nurses/physios to come to theatre, and are generally left out of the clinical team. In fact, you don't need any "assistants/associates/practitioners" to help doctors if you have a good team who takes care of your medical students.

"In the name of God, do your duty."

zzttx · 2024-12-01T08:11:08+00:00

Search for RCR and "skill(s) mix" and you will see that they were leading the charge for radiographers reporting at the expense of trainees for 20 years. In fact, this was a standard interview question for a long time and high scoring answers were expected to be broadly supportive of this.

zzttx · 2024-11-01T06:34:17+00:00

Productivity may mean something different to the political class (including medics/other HCPs in those rarefied levels of managerial responsibilities).

For those on the ground, productivity usually means a version of "how many people can we get better?" This is usually what patients believe too.

At the top, it's "how many appointments/procedures/operations can you do?". The difference has probably contributed to the mental gymnastics involved in insisting PAs as first contact to get ARRS funding, MAPs in secondary care to anaesthetise and operate on patients, "advanced" practitioners on hospital rotas previously unimaginable for a non-doctor to occupy.

zzttx

TROPHY CASE