Winston

@nickey_rooke @anaesthetic_spr A Doctoral level qualification confers no clinical gain or equivalence. It is a research qualification. The masters is the clinical qualification.

@anaesthetic_spr Nurse Consultants are highly knowledgeable and educated to Doctoral level. Before making comments at least please research the role. rcn.org.uk/Professional-D…

The nurse practitioner discussed the case with the “stroke NURSE CONSULTANT” 🤡

@pa_StephenNash @TheSnoozeDoctor There are no members of the MDT other than post FRCS(plast) surgeons with the necessary qualifications to supervise and platics surgery specialist registrar.

I know your ego is the single most important thing in your vicinity but to redress the point she's making to be about MDT supervision instead of unsafe staffing, really shows the mental gymnastics you are deploying in order to re-run the stigmatise, dehumanise, isolate, deprofessionalise and enrage script used against PAs but now against nurses. You should be ashamed. @theRCN they're clearly now using the same antiMAP tactics to take out your leaders and advocates. Time to take a stance before your members get picked off. Don't make the same mistakes again of hoping it all blows over. This is going to end up being the antiMDT crisis at this rate.

Consultant Nurse Kate wants to leave the NHS because she lacks a registrar to supervise today: they’re busy with the trauma list at the main hospital! Tough day, Kate? 🙄

@SocialistHB @Neuro_Matt But she is not the senior clinician on shift. A specialist registrar who has completed medical school, house officer, senior house officer posts, and surgical membership exams has considerably more medical training than a consultant nurse.

@Neuro_Matt If she is the senior clinician on shift, why is this ludicrous. I’d assume she isn’t offering clinical supervision, just management for that shift.

Why are Doctors suddenly attacking Consultant Nurses all over this platform!? Horrid! You don’t own the word Consultant!

@ClearThinker66 @Celticwarr71131 @Microbedoc2 @TheSnoozeDoctor There is a big difference. I would caveat what I’ve said that it’s been a few years since I last practised, too! And even long since I worked along side my plastics colleagues. But the above is certainly true to the best of my knowledge.

@Field_Hedgerow @Celticwarr71131 @Microbedoc2 @TheSnoozeDoctor I didn’t expect them to, but I just wanted clarification as it was many years since I worked in hospital medicine. Being fair, there’s a world of difference therefore between the two consultants here, one carrying vast amounts of expertise and responsibility, and the other not.

@ClearThinker66 @Celticwarr71131 @Microbedoc2 @TheSnoozeDoctor That’s not an unreasonable thing to believe, considering what the title of consultant has historically meant. But no. A consultant nurse in plastics will not do plastic surgery. At most they should do nail bed repairs, lacerations, small skin lesion excisions etc

@Field_Hedgerow @Celticwarr71131 @Microbedoc2 @TheSnoozeDoctor If you’re a consultant, nurse or otherwise, in plastic surgery, I’d expect you to DO plastic surgery – the surgery itself. Not just know all about recovery, dressings, vacuum pumps etc. I’ve been trying to find out whether they actually do surgery beyond small lumps and bumps.

@ClearThinker66 @Celticwarr71131 @Microbedoc2 @TheSnoozeDoctor Is they are undertaking nursing tasks, then no one. They are acting at the highest level of competency nursing education allows. If they are acting in a quasi-medical capacity, then a consultant physician/surgeon ought to supervise them.

@Field_Hedgerow @Celticwarr71131 @Microbedoc2 @TheSnoozeDoctor Who supervises the consultant nurse? Anybody?

@Celticwarr71131 @Microbedoc2 @TheSnoozeDoctor Cons nurses cannot be named leads in plastic surgery because they are not plastic surgeons. They do not have the knowledge, training or skills to manage plastic surgery patients. They are experts in nursing, not surgery. Equally a nurse cons cannot supervise a plastics spr.

@Microbedoc2 @TheSnoozeDoctor The consultant nurse if named lead and making clinical decisions within her scope. have you never supervised junior colleagues if reg acts independant or outside of direction reg if pt harm both.

@dave_42 @iDrSunny Neither the MSc nor V300 confers more knowledge of pharmacology and prescribing than an MBBS. Where did you hear this?

@iDrSunny 21 years clinical experience MSc with training in history taking, diagnostics, pharmacology and prescribing (the last 2 more than is given in any medical degree). Clinical competencies to demonstrate that the ANP knows what they are doing and a clinical portfolio same as you

UHL (Leicester) apparently have got ANPs working at the same level as a ‘junior doctor’ (resident) But these guys don’t have to rotate and hence provide stability Hey Trust CEOs, ‘leaders’ in the NHS, AoMRC, RCEM et al… 1) what foundation do these nurses have that allows them to be at doctor medical knowledge? 2) ever thought *why* we have doctors but they are unemployed yet we’re filling *medical* rotas with nursing teams 3) ever perhaps thought about talking to residents to overhaul the post grad education system Ever just thought about delivering excellence to the public rather than this constant downward spiral to the bottom of the inevitable barrel? Or is it perhaps just too easy to have a seat at the table and smile and nod?

@UKGastroDr If nurses/ANPs are able to perform endoscopy I see no reason why PAs cannot. Neither of their training is comparable to that of physicians.

I have been asked my views on this. I don’t even think PAs should be performing endoscopy. To be 💯 transparent, we don’t employ PAs within our department (never have & never will).

@Oskar839556 @DrEilidhMaria Indeed they are the real deal. But they’re not “Doctors” as this article suggests. Why do you think the journalist made that mistake? That, I believe, is what Dr Maria is asking.

@DrEilidhMaria A consultant clinical psychologist is the real deal and is a protected title. Don’t chat about what you don’t know. Get off your high horse. The same isn’t true of a consultant pharmacist etc but is absolutely true WRT clin psych. Any psychiatrist will confirm.

@ianmiles What do you mean returned? Argentina never owned the Falklands. The Falklands were British before Argentina was even a country. Please elaborate?

Should the Falkland Islands be returned to Argentina?

I urge medical students/new doctors to read and reflect on your choice of speciality. An A&E consultant implying that ED doctors have similar knowledge to advanced AHPs. If your sacrifice and academic excellence is not valued by the RCEM, I strongly suggest you go elsewhere.

@HSJEditor I’m unsure who’s going to come out on top; policy makers vs the Royal Collages. But if the suits and seat warmers making policy wish to ignore those with the most real world expertise then shame on them. The fish rots from the head down.

I think this is one of those calls that gets endless plaudits on social media - but just make policy makers shrug and think 'no point in talking to them about the future then'

@theveindoc @ramey999 I have many. Most of which have been re-buffed by management over the years. But on PAs; I don’t object to them. It’s not clever or imaginative, but deregulation of some practise previously reserved for doctors can be done safely. Provided there are limits.

@Field_Hedgerow @ramey999 So what imaginative ways do you propose? Seems to me that any attempts to improve productivity are always knocked back by the “patient safety” argument even though the NHS has a pretty poor record on that front compared to other systems. The medical profession is too conservative

✅️Traffic Light System ✅️3 phase scope based on experience ✅️Induction - 1:1 ✅️ASA3+ cases - 1:1 ✅️Spinal anaesthesia - 1:1 ✅️Remote & Deep Sedation - 1:1 ✅️Max 2:1 supervision for ASA1 & 2 ✅️Supervisor accessible in 2mins Well done to RCoA!

@theveindoc @ramey999 Productivity need not come at the cost of patient safety. Practise limits are needed. I worry that relying on local scope is a de facto green light for AAs to do everything an anaesthetist can. This sort of deregulation is a cheap, lazy, unimaginative way of boosting productivity

@Field_Hedgerow @ramey999 Well again making the role pointless. It would not surprise me if the RCoA has been taken over by political activists . Such protectionism, if allowed to prevail, will destroy any hope of improving productivity in the NHS.

@theveindoc @ramey999 Indeed they broach that topic rcoa.ac.uk/sites/default/… It seems to depend on PA experience. If junior, they must revert to RCoA guidance and stop. If senior (5 years +), they must be supervised at least 2:1 and a few other requirements.

@Field_Hedgerow @ramey999 Presumably many AAs are already employed working beyond that suggested scope. I havn’t read whole document as you might imagine but is there anything in there about existing staff carrying on as were?

@pa_StephenNash @LittlePersonDoc I worry that you view PAs, not as dependant practitioners who help doctors, but as alternatives to doctors, with comparable training. It concerns me that you and other more junior PAs may think this.

@LittlePersonDoc 3 + 2 makes 5. Come on now. Just because you repeat it enough times does not make it true.

Makes it pretty hard to continue the narrative that "THey WerE SoLd As AsSISTants" when as far back as 2011 there is no change in job description and the RCP still went on to absorb UKAPA in 2015. How many lies do you need to be caught in before questions start to get asked about whether the public are being mislead by doctors about PAs? Undoing themselves...

@theveindoc @ramey999 I won’t comment on where or why they’ve drawn the lines of practise, although I have no doubt there is some intentionality. I’m more interested in the consultation process that lead to the document, and in the structure of the document.

@Field_Hedgerow @ramey999 Looks to make the AA role utterly pointless. Maybe that is the intention.

A robust response. This is the level of leadership surgeons should expect. @RCSnews @ACPGBI @Augishealth @VSGBI @BAPRASvoice @RCRadiologists We are waiting.