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I’ve seen a lot of people say The Leng review recommendation of changing Associate back to assistant doesn’t go far enough IMO it is the single most important change and it blows the doors off the entire project as well as asks some very embarrassing questions This is why 🧵

Doctor pay in the UK is absolutely shocking Home to many of the best clinicians and clinical trialists in the World, criminally undervalued and underpaid

8/ The financial logic here is absurd. Two-year supervised training, enhanced oversight, + higher pay bands - all while refusing full pay restoration for doctors who trained 10+ years. It’s cheaper only if you don’t value safety.

I took seriously the concerns being raised with me about physician associate roles and commissioned Gillian Leng to do a proper review that followed the evidence. Now I will act - starting immediately. theguardian.com/society/2025/j…

PA Stephen Nash I commissioned an independent review led by someone with expertise and, crucially, without pre-determined views to follow the evidence. The review was the consultation. The Leng Review listened to the breadth of workforce opinion and management, too.

I’m doing much-needed self-care at the moment, but I couldn’t resist commenting on one aspect of the Leng Report: the name change. I think this could be far more significant than it at first appears Largely bc of the costs of uni education, recruitment to all types of 1/3

It also confirmed hospitals have used them as substitutes for drs...no surprise there. Hospitals have been doing same with nursing associates for years, as with many other lesser trained roles. This is taskification of care, now Govt policy in NHS 10 year plan #patientsafety

From NHSE. So much for “it’s enshrined into law now, nothing can be done”.

Hundreds to thousands of UK-trained doctors will be unemployed in a matter of weeks as their contracts end this August. Why are we training doctors to leave them jobless? My thanks to The Telegraph for helping me raise this issue. telegraph.co.uk/health-fitness…

Now pay resident doctors more than their assistants, it is absolutely perverse and unconscionable otherwise.

How long has it been the case that someone who isn’t even a doctor can work on a doctor’s registrar rota? And very importantly for patients, what standard would someone in this kind of role be held to in a negligence claim? That of an advanced practitioner, or a doctor?

The whole Physician Assistant saga is giving me strong déjà vu of Brexit: - Bold promises of better outcomes at lower cost! - Critics dismissed as elites with vested interests - Leaders never had to bear the consequences - Believers now left in regulatory limbo #LengReview

theguardian.com/society/2025/j… This is nothing less than a scandal and national disgrace. I struggle to comprehend why this hasn't been headline news on every single national news bulletin and featured on the front page of every newspaper. Unfathomable UK Maternity litigation costs.

We should talk about the the inevitable q of how this mess happened. Prof Leng stated her review wouldn’t dwell on it. This is within her gift - the review is hard enough to land despite sticking to its precise question. But the question of how this happened cannot be ignored 1/

What is the point in going to Med school Wes Streeting Royal College of Emergency Medicine ?

A GP publicly attacking his son’s rape victim, even after conviction and confession, is a serious breach of ethics. It raises real concerns about patient safety and professional accountability. bbc.com/news/articles/…

The erosion of doctors’ pay & conditions is an extreme example of the serious issue of intergenerational inequality. Standards of living are supposed to be better for every generation. Yet the majority of younger people can’t even afford to buy a house (w/out parental help).

The starting salary for a new consultant in Australia is ~£200K a year. My salary as a registrar in Australia averaged £90-100K a year. And this is for working 10 hours less a week as a resident; with generous study budgets; and a system which fundamentally respects the role of

Lord Bethell Hi Jim, FYI….its Prosecco But yes, everyone is entitled to champagne; from the life appointed peers in the House Lords to people like me who were born and raised on a council estate

It takes 20 years for a London dr to earn more than a London PA 🤯 I asked O3-Pro to analyse cumulative earnings from the start of their courses onwards, accounting for the London weighting. Docs cumulatively out-earn PAs 21 yrs after starting med school, 6 yrs into consultancy