Phil Smith

Views entirely my own and do not represent anyone else. RT does not mean agree. Apologies for typos.

[Phil Smith @PhilSmithIsBack]

Back for a time limited period only.

[Frontline Gastro @FrontGastro_BMJ]

🎥 Captured something special on your last list? Share it with Frontline Gastroenterology!

We're looking for endoscopy video articles featuring new techniques, practical tips, unusual findings and creative solutions in GI endoscopy.

Get started today 👇
https://t.co/h7QCARREhb

[Frontline Gastro @FrontGastro_BMJ]

🚨 🚨 New article in Frontline Gastroenterology

Srinivasa et al linked national cancer registry and HES data for 56,827 people diagnosed with oesophageal cancer in England between 2018 and 2024. They asked how many had their oesophagus dilated for a stricture in the 2 years before the cancer was diagnosed.

🔑 Key findings:
1️⃣ About 1 in 80 (1.2%) had dilatation before diagnosis, and in 36.4% this was more than 3 months before
⚠️ Dilatation was more likely in women, in squamous cell carcinoma and with more comorbidity
💥 3.9% had a perforation, with higher risk in women and after 4 or more dilatations
🔁 51.7% had no endoscopic follow-up after dilatation, and follow-up was linked to less advanced cancer at diagnosis

�� Characterise strictures with image-enhanced endoscopy and adequate biopsies before dilating. Re-biopsy strictures that respond poorly, and build follow-up into stricture pathways.

Read the full paper 🔗
https://t.co/4yh1Yw72Sl

@BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman

[Frontline Gastro @FrontGastro_BMJ]

🚨 🚨 New in Frontline Gastroenterology

Machta et al compared diagnostic yield for first diagnostic paediatric endoscopy at a London tertiary centre across three eras: 2014, the COVID-19 restrictions, and 2022–23. COVID-era capacity limits forced stricter patient selection, and that shift persisted afterwards.

🔑 Key findings:
📈 Histological abnormality rose from 36% to 66.4% (194 procedures in 137 children)
🔬 For OGD alone in children with negative coeliac serology, it rose from 16% to 54.9%
🩺 For OGD plus ileocolonoscopy, it rose from 47% to 75%
🛡️ There was no observed evidence of harm from more selective referral
🔎 Endoscopic impression had a PPV of 83.8% but an NPV of only 57.9%, so routine biopsy still matters

💡 The authors propose diagnostic yield as a national benchmark and quality standard for paediatric endoscopy services.

Read the full paper 🔗
https://t.co/0V0pyWXLsg

@BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

Response to @RCPhysicians ask re @lengreview clinical protocol done- as a Fellow of RCP.

I believe in transparency- so here are my views on some of the key questions.

In summary?

Needs a rejection on key areas of PAs seeing undifferentiated patients.
And certainly not lean on Gen Next to be liability sponge.
And let @rcgp make their own decisions regards primary care- no need to interfere.

NB:

Don't like it, give a counter view.
Don't abuse or be snarky. It's a democracy- it's my view. You are welcome to give yours.

@mmamas1973 @djnicholl @Mumtaz_Patel_1 @OGMustafa @BDChadwick

Link:

https://t.co/oJAazzAkYq

[Phil Smith @PhilSmithIsBack]

He can't handle @kaitlancollins because she is v intelligent, fearless, articulate, holds him to account & crucially, is female. A complete misogynist (as well as many other things). Keep going Kaitlan, I wish your colleagues across the media would hold him much more to account

[Kaitlan Collins @kaitlancollins]

President Trump is directly tying waiving Russian sanctions to the release of the freed American Stephen Hubbard, despite denying he gave anything to Putin.

[Phil Smith @PhilSmithIsBack]

It is hugely frustrating to see the person who was the longest serving SoS for Health @Jeremy_Hunt paraded out on almost every media channel as a bastion of patient safety - from maternity, to pandemic preparedness etc. Many of the issues we currently have started on his watch!

[Dr Steve Taylor @DrSteveTaylor]

Unregulated expansion of PAs started in 2015

It took 10 years to finally get the Leng Review

15m after being published it is still not being followed, sadly there are some who are still pushing for undiagnosed (undifferentiated) patients to be seen first by PAs in GP practices0

[Dr Steve Taylor @DrSteveTaylor]

Unregulated expansion of PAs started in 2015

It took 10 years to finally get the Leng Review

15m after being published it is still not being followed, sadly there are some who are still pushing for undiagnosed (undifferentiated) patients to be seen first by PAs in GP practices0

[Phil Smith @PhilSmithIsBack]

It should be a privilege and honour to do it for free (or poor pay) innit? Oh wait, how much did some in management get for redundancies recently? How much are paid to the management consultancies? Only frontline staff get guilt tripped into poor pay

[Louella Vaughan @DrLKVaughan]

It utterly baffles me as to why some think that the NHS doesn't obey the basic laws of economics.

[Louella Vaughan @DrLKVaughan]

It utterly baffles me as to why some think that the NHS doesn't obey the basic laws of economics.

[Frontline Gastro @FrontGastro_BMJ]

Many congratulations to Dr Chris Black @DrCJBlack and Dr Nuru Noor @Y_ECCO_IBD on their #UEGRisingStars2026 @my_ueg awards. Chris and Nuru are exceptional clinical academics and we are very proud that both are excellent @FrontGastro_BMJ Lead Associate Editors!

@BritSocGastro @Gut_BMJ @BMJOpen_Gastro @PhilSmithIsBack

@dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman @alex_ford12399 #UEGweek #UEGWeek2026 #UEG2026

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

A reminder to @RCPhysicians about what Fellows voted for in an EGM IN 2024

And how data was presented- with it's subsequent fall out due to data manipulation- resulting in resignations

Lessons from the past:

1. Don't manipulate responses to suit a narrative.

2. Don't ignore Fellows and their views by use of 'process'

Yes- standing by that narrative cost me- yet I haven't budged an inch from that philosophy.

Less Chicanery, More Leadership.

I repeat:

The @lengreview clinical protocols for PAs should be rejected -if nothing else- on grounds of presumed COI by contributors.

Also- PAs should NOT be seeing undifferentiated patients.
Full stop.

@Mumtaz_Patel_1 @OGMustafa @HilaryWMedic

[Frontline Gastro @FrontGastro_BMJ]

📰 New article in Frontline Gastroenterology

Ngu et al report LivR Well, a randomised controlled trial from Monash Health in Melbourne. It tested a 28-day multidisciplinary, home-based programme for people with hepatic decompensation. The programme included home nursing and physiotherapy, plus hepatologist, dietitian, pharmacist and addiction medicine input. It was compared with enhanced standard ambulatory care.

🔑 Key findings:
👥 105 patients were randomised (54 intervention, 51 control)
🏥 30-day liver-related emergency admissions did not differ: 24% vs 25% (IRR 0.92, 95% CI 0.39 to 2.16)
📉 MELD improved in both groups, by about 3.4 to 3.9 points
💬 Quality of life improved similarly in both groups
💰 The programme wasn't cost-effective (modelled ICER A$145K/QALY vs an A$50K threshold)

💡 Both arms had a liver nurse, a direct mobile line and day-ward access. This enhanced "standard care" may explain why no difference was detected.

Read the full paper 🔗
https://t.co/HJQ9vAR6LH

@BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman

[Phil Smith @PhilSmithIsBack]

@pistol147 I am not a huge snooker follower, but saw your interview yesterday and wanted you to know that I desperately hoped that you were being supported. I am glad this is the case. You can see how many people care about you. Keep strong, you will get through this.

[Phil Smith @PhilSmithIsBack]

@Megsenmumdr @PhilipSteart @Jean_Jeannie1 @lengreview @DHSCgovuk The baton has been passed on... it a club. Complete and utter blatant cronyism

[Louella Vaughan @DrLKVaughan]

Interesting admission from one of my least favourite accounts.

Back when I first heard about ACP, it was the older, battle-hardened nurses who were obtaining extra skills and making a difference.

I was shown examples of where this really augmented team working. I kind of
/

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

You have to love the fact that it's been 18 months since this started @NHSE_WTE

And there are still focus groups running on this...

While we await a report which will confirm that the Pope is indeed Catholic.
And lots of things will be said, asked and pontificated over.

But without any funding- thus based on love, vibes and prayers.

Incoming...soon.

Then again, it comes from the stable of those who categorically stood against Motion 5 of the @RCPhysicians EGM passing.

Evans, Powis, McLeod, Dacre, Whitty et al.

Reminder of that motion 5:

"Demand of a formal pause or slow-down in the deployment and recruitment of PAs until wider medico-legal issues, regulation standards, and exact scopes of practice are legally resolved"

History is such a lovely thing.

@djnicholl @mmamas1973 @Shr_Nottingham @dieracg @Dr_Done_ @PhilSmithIsBack @G_D_Phillips1

[Phil Smith @PhilSmithIsBack]

@jim_crawfurd @Davewwest @emilyltownsend Yep, exactly right. I want to be proven wrong on this. I bet I am not as the MPs for Hampstead, Surrey etc will carry more weight than those in Boston, Cumbria and so on. Hence, inequalities will continue to increase.

[Frontline Gastro @FrontGastro_BMJ]

📰 Out now in the November issue of Frontline Gastroenterology

Danso et al give a practical guide to managing fatigue in IBD, designed for clinicians without a full multidisciplinary team.

🔑 Fatigue affects 72% of patients with active IBD and 47% in remission. A 5-step algorithm covers screening, reversible causes, sleep and activity, and alerting medications. Modafinil looks promising in refractory cases.

🎧 Listen to the related #FGPodcast via the FG homepage.

🔗 https://t.co/Qdtk8NG5ZF

@BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

Working on the feedback as Fellow to @RCPhysicians - regards the @lengreview protocols for PA working

Unless I have read it wrong?

The RCP has included a few questions on primary care, whether it’s ok for PAs to see undifferentiated patients, what exceptions should apply - and asking for views of RCP Fellows.

In my view?

1. The @rcgp have stated PAs have no role in primary care. It is up to THEM to change that and decide what’s right or wrong in primary care

2. It’s not the business of @RCPhysicians (I think) to interfere in primary care working - we should focus on what we can influence - eg: Should PAs be doing Lumbar Punctures & Peritoneal drains.

Or seeing undifferentiated patients with mythical levels of supervision

@Mumtaz_Patel_1 @OGMustafa @djnicholl @mmamas1973 @Azeem_Majeed @trishgreenhalgh @VictoriaTzB @BMA_GP

[The BMA @TheBMA]

Cutting doctors’ pay won’t keep them in the NHS.

The DDRB must show its independence and recommend what patients and the NHS need, not what the Government is prepared to pay.

Full statement: https://t.co/qPdGQ8HXPO