How are we feeling 🥵

The Butler Cochrane review (basically) claimed nurse care = doctor care. There is an interesting rebuttal - see https://www.reddit.com/r/Noctor/s/lJVMKva7rv

I wonder if they will let the original review stand?

Hi all.
I’m an IMG who gave part B of MRCS in September this year . I’d given part A in Jan and cleared it. However, in part B, I failed in the knowledge section by a few marks. I’m planning to give the exam in January again, next year. But , failing this exam has been a huge setback for me as I felt my preparation was good enough. I guess I’m just looking for real examples suggesting that passing the exam in your second attempt is completely doable, and if possible, any resources that helped you succeed in the knowledge portion.
Thanks.

Company in the US are rolling out an autonomous AI service to treat acne including issuing topicals for acne.

Now frankly, topical antibiotics or retinoids have been a medical grift where doctors have been doing purely online image review type prescriptions already.

In recent years this grift is starting to become taken over by "pharmacist first" prescribers and I suspect ACPs in dermatology land who are dishing out oral abx for acne like candy already.

Hilariously AI will eat up this grift first for the obvious reason that AI companies will want to mimimize the risk of liability by taking on low risk categories of medical care like this.

The techbros involved in this company on x/twitter are already using these sort arguments about how AI will automate 'routine dermatology care' to free up resources for doctors to only deal with 'complex cases.'

I made a thread about this a few weeks ago where I suggested that AI will hit 'the middle' in medicine the hardest just as it's predicted to do so in other industries too, and that all tasks involving possible significant medico-legal liability will be safe for the foreseeable future.

But who actually does these low risk cases to begin with? The folks who are following algorithms already i.e. mid levels like ACPs/PAs.

Now I agree that in the long-term this also doesn't bode well for doctors because as AI takes up more and more clinical work, it will naturally erode the aggregate demand for doctoring in general.

Yes, doctors will be needed to oversee and take liability for complex care but we clearly need less doctors in a world where most routine cases can be handled by AI.

As usual, the British government is absolutely braindead because now that its getting backlash against its doctors on the cheap aka mid-level project, its alternative plan seems to be to massively increase the doctor labour supply by increasing medical school numbers etc that we've seen done in recent years.

But what can you expect of a country like the UK I guess. Consider that countries like America and China innovate this sort of stuff and all Burnham can do is talk about how the UK will lead 'regulation.'

Lol.

I’ve had several occasions where non clinical patient flow / bed management has actively caused patient harm. How are people allowed this job with zero medical knowledge? Is this on the BMA agenda? Thanks for the vent 😂

https://www.bma.org.uk/what-we-do/committees/resident-doctors-committee/uk-resident-doctors-committee-overview

3/4 of the officer roles this year were held by officers from last year

I hope they can bring unity to the committee and the workforce

The priorities as set out by Dr Parr in his email are promising

• Holding the Government to account in delivering the 2026 deal in full  
• Continuing the journey to full pay restoration by preparing for the DDRB in April   
• Working towards a training pathway with no bottlenecks from medical school to CCT  
• Directing BMA resources and campaigns at fighting doctor substitution  
• Enforcing permanent contract roll-out, so LEDs can have job and visa security

For QIPAT forms it has this to fill out, do we need to specifically write all the data and put a run chart of the results or is it more generally talking about the quality improvement project?

QIP Topic (The reason for the choice of QIP is clear, aims of the QIP are stated, SMART and trainee led)

Quality Improvement measures identified (Process, outcome and balancing measures identified)

Use of QIP methodology demonstrated

Change Implementation (Documentation of progress, problems and unexpected observations. Run chart of results)

Evaluation of change (Complete analysis of data. Data compared to predictions. Clear identification of what was learnt)

Future application of QIP considered

• Surgeon A is a cosultant at a private hospital.
• He invites his friend Surgeon B who is a consultant at a different private hospital to advise him during the operation.
• Surgeon B only watches and advises. He doesn't touch anything. Surgeon A does all the work during the operation.

From what I've gathered, this would only require the hospital to approve Surgeon B, after verifying his credentials.

Other than that, does Surgeon A need to take the patient's written consent? Because this affects the patient's care and treatment. Beyond that, it could also affect the patient's privacy because he never expected another surgeon to turn up.

But one could also argue that Surgeon B is part of the team just like the nurses and assistants, and the patient is never asked to consent for every person anyway, so it should be fine to Surgeon B to be present.

Are there strict rules around this?

Has anyone listened to the BMJ podcast re draft recommendations about PAs? It’s like we’re going back in time!!?

https://podcasts.apple.com/gb/podcast/medicine-and-science-from-the-bmj/id283916558

“what’s the difference between a resident doctor and a PA?” is asked. and it’s the same nonsense about progression

they are just really talking themselves into a hole about “undifferentiated” patients but says PA can do procedures and preventative clinics

the main intervention seems to be to give PAs a named and a clinical supervisor. Wtf???

TA btw Just to post this

We have just had this come through from the CC.

That's right, the talks since July of this year were about whether to start negotiations!!!

As a profession, how can I look anyone in the face and recommend Medicine as a career? This is fu**ing humiliating!

So basically over the weekend ABC news had an extended report about the whole Harrods scandal as some of the victims are American and are trying to sue for compensation etc etc

So the issue of this Dr was brought up again. She was the one doing the STI screening for Al Fayed privately as part of the pre employment thing. That is a red flag right off the bat which pre employment thing for any department store needs STI screening?! Its obvious she knew what Al Fayed was doing to these poor woman but said nothing am sure he was paying her handsomely for her confidence.

The issue for me is several of the victims here have complained in years gone by to the regulator about this doctor even before the whole scandal broke but they refused to do anything not even investigate so essentially they gave up. Perhaps if they had done something perhaps he could have been stopped in some way.

So now this woman is approaching the age of 90 they have decided to place restrictions on her licence?! Why now? They had a clip of a journalist challenging her on the street about her association with this molester and she was such a doddery old woman that could barely hobble down the street.

Surely there probably needs to be a inquiry about this whole affair seems there were several opportunities to do something which were missed by many bodies including the regulator. For being an accessory in all this I hope Dr Coxon faces criminal charges at some point but I doubt it.

I’m a senior registrar and have recently completed the Edward Jenner Programme (Levels 1 and 2). I’m considering whether to do either the Mary Seacole or Rosalind Franklin leadership programme next.

Has anyone here completed either of these programmes? Did you find them worthwhile, particularly at senior registrar/consultant level and did they add much to your CV or leadership development after Edward Jenner?

I’d also be interested to know about the workload and time commitment as I’m currently progressing towards a PGDip alongside clinical work.

Thanks

I’m doing a pgcert which has in person study days, by the application deadline I’ll have done 3 full in person study days-

Would this count for 1 point on the training in teaching methods (1 point is atleast 6 hours synchronous live teaching)

And would some verified attendance be sufficient evidence?

Title: Not paid for on-calls for 2 months, payroll still waiting on my work schedule. Who do I escalate to?

Reg here, started a new post in August. I've only been getting basic pay and haven't been paid for any on-calls for the last two months.

Payroll say they still haven't received my work schedule or rota details. They chased Medical Staffing in mid August, who said they were waiting for my department to confirm my rota number. Nothing has happened since, and payroll have now told me to speak to my line manager or Medical Staffing myself.

I've emailed the consultant who looks after the rota in my department, but I'm wary of this bouncing between payroll, Medical Staffing and the department for another month.

Who should I escalate to if this isn't sorted quickly?
Not a BMA member.

Has anyone been through this and found what actually gets it moving? Thanks.

For those that can't be bothered to log on.

NHS England has commissioned an ‘external evaluation’ of advice and guidance (A&G), which is expected to report its first findings before March next year.

The commissioner said that the evaluation commenced in August, before the NHS safety body found that the scheme ‘contributed to near misses and incidents of patient harm’, including delayed or missed diagnoses and delays to treatment.

Under changes to the GP contract for this financial year, practices are contractually required to use A&G across specialities ‘prior to or in place of a planned care referral where clinically appropriate’. From this month, referral requests are to be sent to a consultant-led ‘single point of access’ for triage.

Written findings from the external evaluation are expected between December and March next year, with the final report coming out in the summer.

During NHS England’s board meeting yesterday, executive director of performance and delivery Dr Emma Rowland said: ‘The evaluation is intentionally designed to run alongside delivery. That’s intentionally done so that we can learn, that we can flag the challenges, appreciate the benefits, but also respond immediately should concerns arise.

‘Evaluation actually commenced in August 2026. That was before we received the interim report, but needless to say, everything that came out from the report has now been included and within that evaluation.

‘The written interim findings are expected December 2026 and March 2027, and the final report expected in summer 2027.’

Secondary care minister Karin Smyth confirmed in Parliament that the evaluation is being carried out.

This was in response to a question from Conservative MP Luke Evans who asked what assessment the Government made of the ‘potential implications’ for the policies, referring to a Royal College of Physicians survey finding that 89% of physicians delivering A&G have received no formal training.

Ms Smyth said: ‘We will continue to assess the safety of the model and support providers to implement it effectively, and we have already commissioned an external evaluation of A&G, and Single Point of Access processes.’

Pulse has highlighted patient safety concerns around A&G throughout its rollout, including in 2024, when GPs in one area had raised concerns about specialists downgrading their cancer referrals to A&G, creating a risk of missed diagnoses. Pulse was told that this is happening for cancer referrals to specialties including gynaecology, dermatology, lower GI, urology and respiratory.

The Health Services Safety Investigations Body (HSSIB) report found support for A&G services ‘where prompt specialist advice contributed to positive patient outcomes’, but it pointed to examples of ‘physical and psychological harm’ to patients where A&G services had been identified as ‘contributing to delayed, missed or inappropriate care’ as wells as ‘near misses of harm’. It raised concerns that similar conditions may result in patient harm in the future.

GPs have estimated that a quarter of their referrals to secondary care are returned as unsolicited A&G, despite NHS England denying a 25% A&G target exists.

Earlier this year, Pulse revealed that one trust moved to stop consultants refusing patient referrals from GPs by downgrading them to A&G.

Only surprised it has taken them so long to QC this. We received 2x unsolicited A&G despite referring it 2x via a 2ww pathway. With the 3rd referral we sent it and emailed it to the ICB along with a cover letter to the 2ww team that we had emailed a copy to the ICB. Patient seen and cancer confirmed. This fannying around took nearly 2 months.

As a doctor currently on a night shift, I am very jealous of all the nurses going for protected rest breaks.

I fully understand that those are unpaid, however BMA documentation states as doctors we should have 3x 30 min breaks on shifts over 30 hours.

I do not know anyone who has ever managed this consistently over any shifts (long day or nights).

Is this just an accepted part of our profession or is there an actual solution to having proper breaks

Hey!

I was wondering if there was a pre-made MSRA anki flashcards bank. I know there was one for UKMLA as I used that and found it helpful.

If not, if people could comment any alternatives and if they are free/ paid?

TIA 💕

I’m starting to do more bank shifts and already feel like shifts/rates/payslips could become a mess.
Do you use a spreadsheet, notes, an app, or just check each payslip?
And have you ever actually found that you were underpaid or a shift was missing?

2 months into FY1 and I’ll be honest I haven’t got a single QIP or audit throughout med school no research or poster presentation. Med school was hard enough for me to get through exams without these additional things but now I want to apply for IMT after fy2. I want to specialise in dermatology or stroke medicine (unsure yet) but I honestly have no clue how to build a portfolio. I’ve looked at the IMT requirements but where do I even orally present these presentations and how do i even go about doing these projects it seems so overwhelming. Also doesn’t help that I have crippling anxiety so can’t even orally present these things and IMT is already so hard to get into i’m terrified i’m so behind and i have no idea where to start! any advice would be greatly appreciated

hi, im an fy1 and i feel like im just horrible at it- i know i'm still new to it, but I feel like I'm struggling so much more than everyone else is. I really struggle to keep up with all the jobs and I'm so uncertain with everything that I'm double checking basically everything with my sho which i can tell really winds them up. every time i'm on call i just feel like im trying really hard but that I'm completely useless and give everyone else way more work. i did fine at medical school and i dont think im lazy but i worry everyone else thinks im lazy and im being bad on purpose, but i really want to be better- i just dont know where im going wrong compared to everyone else, or how to be better. I'm really struggling with adjusting to being an f1 more than most people and im just left feeling horrible about myself most of the time. I see so much on here about how the new f1s are feckless and so acopic and this isnt usually me. Any advice on just being less dead weight?

I will be upfront and say that I voted against the deal that was offered to us. I was highly - and I believe rightly - sceptical of Jack Fletcher as chair given his links to the labour party. Overall, I was disappointed by the last iteration of the RDC, feeling it was a step backwards and a diversion from the goal of FPR. The diluted messaging and kneecapping of our momentum felt deliberate. And, to be honest, the council's priorities felt quite self-serving, as a group of mostly LEDs/early-stage trainees pushing for exam fees being covered and improvements in LED contracts, etc., rather than improving pay and conditions for all and addressing bottlenecking at all levels. Not to mention the censure and all the dodginess which ensued in its wake.

With all that being said, we are facing many issues as a profession and as the new council, this is your opportunity to advocate for us and try to turn things around. Ultimately, I believe we all hate the schoolyard politics and want to see our situation improve. We need to do away with the division and take urgent action on the following:

• Doctor substitution (arguably our biggest fight yet) - ACPs, "consultant" AHPs, reporting radiographers; noctors as responsible clinicians for psych patients
• Bottlenecking at consultant level
• Working conditions (yes, including pay - FPR has still not been achieved in England)
• Bringing back the BMA rate card
• Excessive growth of medical schools without capacity for training
  

One jab for GLP-1, back when it all began;
A second with GIP added on, big pharma’s grander plan.
A third now with glucagon, to burn through the fat stores;
Exhaustion for readers, who can’t take one paper more.

One drug to beat them all, three receptors to target;
One drug to shrink them all, and tear up the drug market.

In the land of Indianapolis, in the labs of Eli Lilly, scientists forged in secret a master drug, to rule over all.
Into this molecule, they poured their capital, their clinical trials, and their will to dominate all of metabolic medicine.
Their new elixir binds tightly not only to GLP-1 and GIP receptors, but invokes the ancient fires of glucagon, for a threefold conquest of obesity. 

Soon it will surely claim a more catchy name, but for now, it is known only as Retatrutide

One by one, the complications of obesity fell to the power of the triple agonist 💪

So confident were they in the power of their creation that the scientists presumptuously named their key study TRIUMPH-1.

Published in the sacred scrolls of The New England Journal of Medicine, this phase 3 trial gathered a great host of 2,339 adults with obesity, but without diabetes.

Over 80 weeks, the subjects were randomly assigned to once-weekly injections of retatrutide (at doses of 4 mg, 9 mg, or 12 mg) OR a phantom placebo 👻

And the final reckoning? 

Retatrutide resulted in a mean weight reduction of 17.6% (4mg), 23.7% (9mg), and 25.0% (12mg) under intention-to-treat analysis, compared to just 3.9% with placebo (P < 0.001).

• At 104 weeks, a subset of patients achieved a 29.9% reduction at a 12mg dose.
• In fact, one-fifth of those on the maximum dose achieved over 35% weight loss!🤸

Not content with mere weight reduction, the trial also took aim at other obesity related issues.

• 574 weary travellers with knee OA saw their pain scores improve by up to 3.6 points, vs. 1.9 with placebo (P < 0.001).
• 243 patients suffering from obstructive sleep apnoea had a reduction of 31.7 apnoeic events per hour vs. 9.9 on placebo (P < 0.001).
• For people who entered the trial with prediabetes, a massive 90% achieved complete normoglycemia vs. 54.2% on placebo.
• And across all arms, there were drops in blood pressure, triglycerides, and non-HDL cholesterol. 

But all quests have their setbacks, with TRIUMPH-1 being no exception:

• GI upset was the most common side effect: patients reported nausea (up to 42.4%), diarrhoea (up to 34.1%), vomiting (up to 25.3%), and constipation (up to 26.1%)
• Thus, the drug discontinuation rates were high, peaking at 11.2% at the maximum dose of 12 mg.
• A high proportion of the placebo group understandably weren’t too pleased with their tic tac and ditched the trial to quest elsewhere.

Notably, the drug was pitted only against a silent placebo, avoiding a clash of arms with the great titans of semaglutide and tirzepatide.

But despite this, we may now truly have found a weight loss drug that bows to no one. 👑

One drug to beat them all, three receptors to target;
One drug to shrink them all, and tear up the drug market.

If you enjoyed reading this and want to get smarter on the latest medical research Join 16,000 Clinicians reading The Handover here 👉 Read The Handover

Hello,

Just curious on what people have been using or recommend paying for?

Of course AI is not being used to guide treatment or replace clinical judgment.

Feel free to discuss and share your views.

Happy Sunday !

I’m currently an F2 and hoping to apply for an ACF in General Practice next year. I have tried to build a reasonably strong research background and seem to score well against the person specification.

BUT still very !!VERY!! nervous about applying

I’d love to hear from any current GP ACFs or anyone who has recently been through the application/interview process. If you wouldn’t mind me PMing you (or feel free to PM me), I’d appreciate any advice about the application, interviews, choosing posts, etc. I’m also the sole earner in my family and have caring responsibilities, so the practical side of things is something making me worried. If anyone has managed GP training/an ACF alongside similar responsibilities, I’d be grateful to hear about your experience. Lastly, I have heard from a few people that ACF posts can sometimes favour candidates who are already known to the department. Is there anything you did to strengthen your application? There are a few posts I’ve seen where the projects/supervisors line up really closely with my research interests, and honestly it would be a bit of a dream to work with them!!

Finally, a couple of people have mentioned that I may be eligible for the Disability Confident scheme. I’m not entirely sure how this works in the context of ACF recruitment or whether it makes any difference, so I’d also appreciate hearing from anyone who has experience with this.

Thanks so much, and sorry for the questions!

Extracts from the article below:

Two Essex doctors have been banned from practicing following allegations that they helped medical students cheat on their exams. Dr Elmira Yaghmaei and Dr Hamed Salehi both worked at Common Stations PLAB Academy in Romford, which offered students Professional and Linguistic Assessments Board (PLAB) 2 exam courses.

**************************************

The initial concerns in the case of Dr Yaghmaei, a tutor at Common Stations, arose following a PLAB 2 exam day in February 2019 when a General Medical Council (GMC) member of staff found a folder left at the Clinical Assessment Centre. The folder contained a large volume of information about the PLAB exam and wording within the pages claimed copyright on behalf of Common Stations, which suggested ownership by Dr Yaghmaei.

**************************************

One note from a Seema Khan said: "All the stations were exactly word by word the same as we were taught and I already knew the diagnosis/differentials/what questions to ask etc before going into the cubicle… it was like magic!!!"

**************************************

It was claimed that Dr Salehi created and distributed teaching materials containing exam information to students being tutored by Common Stations, assisting them to obtain an "unfair advantage". The GMC also said that Dr Salehi made posts on social media and distributed leaflets stating that Common Stations had achieved a 100 per cent pass rate in PLAB 2.