Nicholas Pegge

Consultant Cardiologist, musician & writer

[Nicholas Pegge @nicholas_pegge]

LNER train stationary not quite at Peterborough!!
Everyone being good natured despite frustration

[Nicholas Pegge @nicholas_pegge]

Superseded?

[Nicholas Pegge @nicholas_pegge]

#TGRLive having fun at Twickers

[Dr Phil Hammond 💙 @drphilhammond]

Thank you for asking me this question

I generally refrain from comparing medical scandals because they are all tragedies in their own way.

The Bristol heart scandal arose because the unit had demonstrably worse results for paediatric cardiac surgery than other units, but was telling parents the UK average mortality rates rather than the unit’s actual rates. To compound matters, the problems in Bristol were widely known amongst the profession, the Royal College of Surgeons, the Society of Cardio Thoracic surgeons, the Department of Health specialist commissioning group etc. Everyone knew apart from the parents, until a very brave whistleblower called Steve Bolsin spoke up. The public inquiry, which finished nine years after I broke the story in Private Eye, concluded that around three dozen babies might have survived if they’ve been operated on elsewhere over a set period. Over a longer period, Professor Bolsin puts the number at around 170. The real tragedy of Bristol is that it made 198 recommendations, many of which have been subsequently repeated in all the other health scandal since, most notably the Mid Staffs inquiry and more recently the infected blood inquiry. The UK is a world leader in public inquiries, and then we ignore the findings so we can have another public inquiry.

The physician associate scandal may not progress to a public inquiry because so many people have raised concerns early, both here and elsewhere. Various Royal Colleges and the GMC have egg on their face and are reversing, or may shortly be reversing, their positions. Far more NHS staff are speaking up for patient safety and, with a new government in charge, constructive changes are more likely to happen and people will continue to speak up if they don’t.

There have been some well publicised disasters where PAs have either voluntarily or forcibly been put in positions that were beyond their competence, and serious harm and death has resulted. However, this clearly doesn’t just apply to PAs. In the Bristol Inquiry report, it was estimated that around 25,000 people die every year in the NHS from either substandard care, or failure to access care. More recently we seem to have settled on a number of 11,000 avoidable deaths a year. Only a tiny fraction of these will have anything to do with PAs.

I guess what I’m saying is that we need to look at patient safety in the round, and speak up forcibly about every aspect of it. My big lesson from Bristol was that how you raise concerns matters as much as the concerns you raise. I did it in a very aggressive way, that made people pull up the drawbridge and probably delayed constructive change and adversely affected the mental health of surgeons trying to do the hardest operations on some of the sickest children. There are plenty of competent PAs out there doing their best in very difficult circumstances, and suicide rates are high enough amongst NHS workers without making things worse.

If we see everything through the prism of patient safety, safe staffing and skill mix levels, it gives us something to unite around as healthcare workers. As Steve Bolsin famously said about the Bristol case, “if you want to prevent future scandals, never lose sight of the patient.” And the lesson from Bristol for PAs out there is that you have to be very explicit and honest with patients about who you are and what your levels of expertise are. If you give misinformed consent, there is no defence. And hospitals and professional bodies that misrepresent the expertise of PAs are equally culpable.

Does that answer your question?

[Nicholas Pegge @nicholas_pegge]

@ShivaniM_KC Hourly. In fact many times per hour.
Post COVID, most patients are surprised that a Dr still examines them…

[Nicholas Pegge @nicholas_pegge]

@majesticwine dear Majestic wine, where is my delivery please

[Nicholas Pegge @nicholas_pegge]

The Gov, despite opposition from doctors, is pressing ahead with regulating PAs & AAs under the GMC. @pbottomleymp, as my MP, please oppose the draft Anaesthesia Associates and Physician Associates Order 2024 to protect patient safety

[Sam Ghali, M.D. @EM_RESUS]

Hi, ER Doc here.

RT if you’ve ever done CPR on someone and they survived.

Trying to prove something.

[Mike Henley 🤨 @trentconsultant]

@TomStocks1982 Yes, House *Officer*, *Senior* House *Officer*, *Registrar* and *Senior Registrar* didn’t have the same issues.

[Mia Hughes @_CryMiaRiver]

There's a saying in medicine that goes, "when you hear hooves, think horses not zebras." Meaning always opt for the most plausible explanation first.

So let's apply that to the enormous surge in adolescent girls identifying as transgender in the past decade.

Option 1:

All throughout human history, there have been girls who showed no sign of gender distress during childhood who suddenly at puberty realised that they were actually boys, but modern medicine had yet to be invented so they had to suffer the lifelong agony of being trapped in the wrong-sexed body. Curiously, not one ever gave voice to this pain.

Then, only when the caring, benevolent medical industrial complex invented the concept of transsexualism and out of the goodness of their hearts made puberty blockers, cross-sex hormones and surgeries available were these tortured souls able to embrace their true authentic selves.

As well, miraculously, the modern trans rights movement began in 2014 and achieved immediate and complete societal acceptance of transgender people, so all of these boys trapped in female bodies felt comfortable coming out en masse starting in 2015.

Or, option 2:

It's an internet-fuelled social contagion on steroids.

Incredibly, in gender clinics all over North America, doctors are still opting for zebras.

[Nicholas Pegge @nicholas_pegge]

Timely…

[Mamas A. Mamas @mmamas1973]

The fact that we are having to state that someone with a two year's masters degree is not an appropriate substitute for someone with a 5-6 year medical degree, post graduate exams and 5+ years of clinical training shows the depth that UK medicine has fallen.

I feel like I'm in a parallel universe having to state the obvious. You cant play at being a doctor without compromising pt safety. There are no shortcuts.

[BMA Consultants @BMA_Consultants]

Once again @SteveBarclay repeated the claim that consultants receive an annual pension of £78,000 – despite NHS BSA data showing that retired consultants receive on average 40% less. Listen to the clip on BBC Radio 4 Today Programme 🧵1/🎧

[Tim Lane 💙 @MrTimLane]

NHS senior managers’ pay has risen by 65pc in a decade. … they always tell us we’re in the same storm … but we’re definitely not in the same boat! Oh for the Exec corridor and the Buxton spring mineral water and Exec car park with electric charging 🙄 https://t.co/rlAGS26ZYV

[Fraser Nelson @FraserNelson]

Cartoon from Isabel Hardman's Evening Blend email, which has just gone out. Sign up for free: https://t.co/zUPZMdFD7Q

[Dr Done @Dr_Done_]

❌ @BristolUni Med School joins effort to undermine doctors

❌Doctor WHO ACTUALLY HAS THE DEGREE + 2 YEARS CLINICAL PRACTICE deemed unsuitable to sign off med student

❌PA with 2 year course deemed suitable

Pathetic.

Show them what you think

@Brms_Research @BristolUniBMERG

[Dr Asif Qasim MA PhD FRCP @DrAsifQasim]

So many issues with PAs following F1/F2 and on to GP / specialist training

If their training is the same they should to take MB BS to prove that

F1/F2 shouldn’t be used as a test of capability - it’s training

Medical schools and Royal Colleges are very particular about their curricula and standards. Have they been getting it wrong all this time?

What we can all see is this government creating a medical workforce of non-doctors whom they can train quickly with qualifications that won’t be recognised overseas.

Until these issues are resolved doctors, @TheBMA and Royal Colleges should not support these non-doctor programs

@BMA_JuniorDocs @TheDA_UK @dr_barrett @parthaskar @trishgreenhalgh @djnicholl @TomStocks1982 @Parody_RCGP @DrSteveTaylor @goldstone_tony @Existential_Doc @drmattuk @DrAmirKhanGP @mmamas1973 @DrEilidhMaria @EmergMedDr @dr_irfan_malik @ShafiAhmed5

[Sue💚 @SueTaylor_]

“Ideologies don’t have human rights. You can criticise, oppose and even ridicule ideas without infringing on anyone’s rights.” @RickyGervais

[Martina Navratilova @Martina]

Brava Anna!!!

[Adam Bienkov @AdamBienkov]

More than half a million people were sanctioned last year after breaching conditions of their benefits claims, yet when the Prime Minister breaks Parliament's own conduct rules it is dismissed as an 'inadvertent' breach and he's let off scot free

https://t.co/hMPudmADIN

[A C Grayling #FBPE #Reform #Rejoin #FBPR @acgrayling]

A resigning issue,
Don't hold your breath.