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

Joined March 2024
Back for a time limited period only.
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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: nhssugardoc.blogspot.com/202…
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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
President Trump is directly tying waiving Russian sanctions to the release of the freed American Stephen Hubbard, despite denying he gave anything to Putin.
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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!
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
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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
Physician Assistants were first muted as an idea an concept in the early 2010s as a way of alleviating the workforce shortage in General Practice, helping GPs deal with some of the more simple and mundane tasks to allow GPs more time for patients.  A 🧵 rcp.ac.uk/media/ffdai1fx/com…
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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
It utterly baffles me as to why some think that the NHS doesn't obey the basic laws of economics.
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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
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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
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📰 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 🔗 fg.bmj.com/content/early/202… @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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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 /
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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
Today we have started a review of postgraduate medical training led by @NHSEnglandNMD and @CMO_England Listen to @NavinaEvans explaining more. Find out more at england.nhs.uk/postgraduate-…
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📰 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. 🔗 doi.org/10.1136/flgastro-202… @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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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
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Phil Smith retweeted
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: bma.org.uk/bma-media-centre/…
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📰 New review in the November issue of Frontline Gastroenterology Abuquteish et al review lower GI toxicity from immune checkpoint inhibitors and targeted cancer therapies, covering clinical, endoscopic and histological features. 🔑 Anti-CTLA-4 causes earlier and more severe colitis than anti-PD-1/PD-L1, and colitis was reported in about 25% of patients on combined ipilimumab and nivolumab. Rituximab was linked to a roughly sixfold increased risk of developing IBD. 🔗 doi.org/10.1136/flgastro-202… @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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Phil Smith retweeted
It is a basic principle of American democracy that the government can’t selectively target individuals simply because of their political beliefs or what they say. But that’s exactly what the Trump Administration is doing to Congresswoman Ilhan Omar of Minnesota. To understand why this is so appalling, it’s important to know the facts. Congresswoman Omar came to this country with her father when she was 12 years old. Five years later, her father became a naturalized citizen. If Ilhan had been 18 at the time, she would have had to apply for citizenship separately. But because she was 17, she became a naturalized citizen automatically. Congresswoman Omar went on to graduate from college, work as a community organizer, become the first Somali-American legislator elected to public office in the U.S., and win a seat in Congress. There, she has been one of the Trump Administration’s fiercest critics, which has led the president to repeatedly single her out as someone who he believes does not belong in this country. Now the Administration is actively trying to deport Congresswoman Omar, seemingly based solely on the unsubstantiated theory that she was actually 18 when her father was naturalized, and therefore is not a citizen. Federal agents have raided her home, confiscated personal records, and seized her phone — all to try and uncover a nonexistent smoking gun from 20 years ago that will somehow make their case. Think about that. The full weight of the federal government is being brought down on a law-abiding elected official because she has dared to criticize the president. And it’s not the first time this has happened. Under President Trump, the Justice Department has repeatedly gone after those he considers his political enemies — from the Attorney General of New York, to the former head of the FBI, to members of the Federal Reserve. In those cases, the prosecutions either stalled or were dismissed for having no basis in law, and the same is likely to happen in this case. But not before Congresswoman Omar’s life has been turned upside down, her legal bills have piled up, and she’s been forced to spend time fighting unsubstantiated charges instead of serving the people of Minnesota. The fact that any president, or any administration, is willing to engage in such transparent efforts to intimidate someone should outrage all Americans, regardless of how they feel about Congresswoman Omar’s political views. Because if this becomes the new normal, there’s no reason to believe it will stop with her — or that future presidents, in either party, won’t do the same.
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Phil Smith retweeted
If a US politician made fun of Jewish people like this it would be the end of their careers. But Islamophobia is totally fine and normalized.
Trump: "You have Mohammed, Mohammed, Mohammed, Mohammed, Mohammed. Everybody is basically. If you're in doubt about somebody's name from the Middle East, just say 'Mohammed.' You have about a 65% chance."
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I went to Notts Med school in late 90s, early 00s. A&E dept was always packed. But I understood the powers that be decided workforce substitution (rather than more Drs) was the major solution to the issue? I guess that data looks better when that (ironically) has been "doctored"
🚨 EXCLUSIVE: Leaked emails expose rift at scandal-hit @nottmhospitals as desperate A&E staff whistleblew to CQC over dangerous A&E overcrowding and false reporting of waiting times data. Insiders warn of unsafe care being normalised. ​ Full story: thetimes.com/article/867ac5c…
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This will be happening in lots of units - not that this makes it any better. But it looks like this has been reported, proven & verified. Which means it is a probity issue for those in charge of that department. I assume those in charge of this have been reported @ShaunLintern?
🚨 EXCLUSIVE: Leaked emails expose rift at scandal-hit @nottmhospitals as desperate A&E staff whistleblew to CQC over dangerous A&E overcrowding and false reporting of waiting times data. Insiders warn of unsafe care being normalised. ​ Full story: thetimes.com/article/867ac5c…
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Phil Smith retweeted
Truly disgusting what the Republican Party and parts of our media have normalized on this country. Just open naked racism and bigotry and mockery of minorities. Can you imagine a Muhammad or Abdullah in the schoolground getting bullied by kids who heard the president do it first?
Trump on El-Sayed: I’m the president. I can call you whatever the hell I want Muhammad. His name is actually Abdullahalalalala baa ba ba Muhammad El-Sayed. So his middle name is Muhammad. I was right.. almost.
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