@docborderless

Skier, Trauma surgeon . Dual qualification: General Surgeon. Obstetrician & Gynaecologist. Humanitarian doctor .FACS.

 London, England
Joined December 2014
  • Tweets5.9K
  • Following1.6K
  • Followers3.1K
538Media
Referrals to secondary care from GPs used to be treated as they were, requests for further support, investigations, and advice from one experienced colleague to another They have now, to the detriment of patients, been treated as merely optional This cannot continue
Dr Dave Triska
@dave_dltOct 20
New Substack 🗒️ Dodging Blows Referral was meant to be a dance between two clinicians. These days it feels more like a boxing match, with the exhausted GP's guard up, protecting their already battered body . Who wins when everyone is fighting? davetriska.substack.com/p/do…
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kc isc@kcisc8 Jul 2025
Not Medicine. This first PA to have a job in IR just so happens to have a doctor parent who is a neuro IR. As mentioned in the podcast, no IR at all on the PA curriculum/matrix, no limits to scope - podfollow.com/the-physician-…
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ITU have clearly lost their way Allowing people without a medical degree to look after the sickest patients in hospital is a total nonsense I’m just happy we’re at the naming & shaming trusts publicly stage I will be avoiding @UHSFT 🫡
TIVA Tim@TheSnoozeDoctorOct 13
Every medical/ICU consultant enabling this practice should be publicly named and shamed! Clearly ‘noctors’ rarely care about patient safety and outcomes, and corporate managers care only about money, but how many more people have to die before we see significant change? Terrible!
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We have qualified doctors struggling to find jobs, yet ACCPs are covering ICU registrar rotas. At what point did we stop asking what level of expertise critically ill patients deserve and start treating medical training as optional?
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“People with a medical degree should work on doctors’ rotas” In 2026? That’s controversial in the NHS. When you want to see a doctor? You should see one Not people using titles and alphabet soups to obfuscate their actual training- and hoodwink. Period.
Luke Mordecai@Shr_NottinghamSep 25
Today I learnt that saying only people with a medical degree should work on doctors’ rotas is an extreme, polarising view 👀 Which is weird because I always thought that should be blatant common sense… …or else what’s the point of medschool? 🤷‍♂️
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Neena Jha@DrNeenaJhaOct 11
1. A GP (senior doctor) urgently referred to hospital documenting suspected appendicitis 2. ANP (nurse practitioner) assessed child in A&E independently 3. They chose NOT to read the GP letter 4. Did not explain to parents that they were not a doctor 2/n
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Burnt Toast@Burnt2020Oct 11
Doctors make mistakes. Doctors miss things. None of us are perfect. A child who has been seen by a senior doctor who sends them to the ED for further assessment should not be discharged by someone who is not a doctor. Where are the senior EM and paeds doctors condemning this?
Luke Mordecai@Shr_NottinghamOct 11
Doctor substitution is being championed at the highest levels yet anyone with a grain of common sense or integrity knows it’s nonsense I wonder what platitudes @theRCN or @RCEMpresident would offer these parents given their involvement in enabling this scenario?
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Genuinely shocking that you can go to A&E - in this case sent there by a GP - but be discharged without ever seeing a doctor telegraph.co.uk/news/2026/10…

‘Our son died of sepsis after nurse ignored GP referral’

Dylan Cope, nine, was discharged from hospital after being wrongly diagnosed with flu

telegraph.co.uk
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Dr Done@Dr_Done_Oct 12
The thing that never happens happened again
Janet Eastham
@JanetEasthamOct 10
Dylan Cope died after an A&E nurse practitioner mistook his abdominal pain for flu, having ignored his GP’s referral for suspected appendicitis. His family thought she was a doctor. A coroner found he would have survived had a senior doctor examined him. telegraph.co.uk/news/2026/10…
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Seems obvious but we know its not happening and patients are in danger. Agreed !!
Neena Jha@DrNeenaJhaOct 11
Replying to @DrNeenaJha
We need a nationwide policy that states: ANY patient who has been referred in to hospital by a GP should be assessed by a doctor ONLY. NO person without a medical degree should be independently diagnosing, managing or discharging undifferentiated patients in A&E. End.
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Dylan Cope died after an A&E nurse practitioner mistook his abdominal pain for flu, having ignored his GP’s referral for suspected appendicitis. His family thought she was a doctor. A coroner found he would have survived had a senior doctor examined him. telegraph.co.uk/news/2026/10…
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Replying to @JanetEastham
If a GP (a highly qualified doctor) says a child has appendicitis, then it is for someone who actively manages appendicitis regularly, to say they do not, and no-one else. Simple. A correct diagnosis countermanded by someone less qualified is inexcusable.
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Formal email sent to @DHSCgovuk and @NHSEngland Regards PA protocols @lengreview 1. No role for PA to see undifferentiated patients. The supervisory time asked for is not available - and thus will lead to lesser supervision than planned and thus safety issues 2. Absolute no regards Resident Doctors holding responsibility. If anyone as a senior wants to be a liability sponge? Do it yourself- not lean on RDs 3. Given present suggested protocol- review of pay bands as not cost effective - in environment of other staff being de-banded. That will be position with respect to @RCPhysicians and @gmcuk too You may not agree with it- but in a democracy- I am allowed to have an opinion And that’s mine as a senior clinical leader with years of work as a trainer- and leading on safety issues. You give yours and let’s see what comes out as the final one. @djnicholl @thomasdolphin @mmamas1973 @DrNeenaJha @BMAResidents
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Loud and clear!
Neena Jha@DrNeenaJhaOct 6
I have a very simple solution to this…. **HIRE ACTUAL GPs!!** Who are qualified to see EVERYTHING- from babies to adults, head to toe, minor to serious Who do not require supervision & are medico-legally responsible for their own work Enough with putting patients at risk!!
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The British Medical Association has unveiled hundreds of accounts of missed diagnoses, delayed care and other patient safety incidents involving advanced practitioners (nurses, pharmacists, physiotherapists and paramedics) who are increasingly being used to substitute doctors in the country’s hospitals and GP clinics ausdoc.com.au/news/she-had-e…

‘She had every red flag for lung cancer, but the nurse practitioner blamed statins’: UK alarm over...

The British Medical Association has published alarming accounts by doctors of alleged patient harm involving nurses and pharmacists.

ausdoc.com.au
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Two children died after serious failures involving APs. How can expanding AP roles be defended when such failures are already documented? Yet we're being asked to accept even more substitution. Worse may yet come if we keep moving in this direction. Patients deserve better.
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You are absolutely right! these people taking drs jobs think they are equivalent… dangerous delusion ( not for them but for patients) this is a clear example of dun-kruger :little knowledge big confidence—> harm to patients. People should refuse non doctors for their own safety
Dr Peter💚🤍💜 🏴󠁧󠁢󠁳󠁣󠁴󠁿 🇳🇿
@WingsEcosseSep 24
Replying to @MedRegoncall1 @AKAsusangreen
I have PhD in Physiology so better qualified than these. Except I have enough knowledge to understand a lot of medical education which I lack. Diagnostic training, deep knowledge of pharmaceuticals and of course that supervised residency period. The prospect of doing these roles horrifies me at a deep level. These people are an example of a little bit of knowledge being a dangerous thing. I have taught medical students, that doesn’t make me a medic.
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The Med Reg
@MedRegoncall1Sep 24
xitter.cf/Doctors_net_uk/status/…
Doctors.net.uk@Doctors_net_ukSep 23
The British Medical Association is calling for a ban on advanced practitioners being used on doctors’ rotas, as it publishes a dossier of accounts of when patient safety has been put at risk. buff.ly/gyn0vGq

‘One of the medics’: Dossier reveals examples of APs being used as doctor substitutes

The British Medical Association is calling for a ban on advanced practitioners being used on doctors’ rotas.

doctors.net.uk
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#WorldCancerCongress 🇬🇧 DOCTOR SUBSTITUTION Advanced Practicioners Nurses Radiographers Physician Associates @IARCWHO @uicc @CPME_EUROPA @UEMSEurope @uemo_europe @myESMO @ESTRO_RT @ASCO @CR_UK @macmillancancer @ProstateUK @BreastCancerNow @Roy_Castle_Lung @bowelcanceruk
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“The fundamental question is whether it's essential to go through medical school and the subsequent years of training to deliver care at doctor level. If the answer is yes, filling rota gaps with advanced practitioners is fundamentally wrong and offers the public lesser care. If the answer is no, medical training needs to reflect this by removing distinctions of specialty training posts between doctors and non-doctors and revising medical school places.” The above basic issue being ducked by Medical Education & Training Review? Is what is symbolic of present NHS and its persistent “reviews” A disconnect with reality. Via @bmj_latest bmj.com/content/393/bmj-2026…

Partha Kar: NHS workforce planning is missing clarity and direction

The healthcare workforce has been in constant flux in recent years. Besides conversations about the next version of the workforce plan due this year, some other recent developments are interlinked...

bmj.com
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