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The ultimate cost isn’t to doctors’ careers. It’s to the diagnostic safety net that catches the atypical presentations - the ones that don’t fit the protocol, where pattern recognition from 1000s of cases matters. That’s what’s being quietly dismantled in an effort to save costs.

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What’s more disappointing is seeing senior clinical leaders backing this to the hilt - endorsing scope creep, signing off inadequate supervision models, staying silent on MAPs/ACPs - rather than taking a moral stand and demanding better for the profession.

Treasury constraint is probably a simpler explanation - cheaper roles are attractive regardless of ideology. But institutional inertia and genuine belief in “taskification” narratives among policymakers shouldn’t be underestimated.

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Hanlon’s razor aside, it’s not hard to wonder if the NHS specialty doctor recruitment fiasco and mass unemployment of doctors is failure by design. After all, policy direction suggests we don’t need doctors and instead just need “differently trained” advanced workforces.

Dr Matt Kneale @drmk.link · 21/11/2025

It appears Trump wants to end a war and label it peace through almost total capitulation. This short-term approach will strengthen Putin’s resolve and increase the risk of future aggression against NATO’s eastern flank. archive.today/2025.11.21-0...

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Reposted by Dr Matt Kneale

Athena Kugblenu @athenakugblenu.bsky.social · 21/11/2025

You're not asking trans people. You're asking all people. This affects us all. Anyone could be barred from services based on appearance. Since, surprisingly we all have a fecking appearance www.bbc.co.uk/news/article...

bbc.co.uk

Trans people could be barred from services based on appearance

The new code of practice on access to single-sex services cannot gain legal force until it gets sign-off from ministers.

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Reposted by Dr Matt Kneale

Trish Greenhalgh @trishgreenhalgh.bsky.social · 20/11/2025

What Martin said. Independent SAGE were not cranks, not extremists, not over-reacting. #covidinquiry

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Martin McKee @martinmckee.bsky.social · 20/11/2025

1/ How does the COVID Inquiry's Module 2 report align with what we said in @independentsage.bsky.social at the time? A 🧵on Transparency, Early & Decisive Action, Scientific Advice, Integration of Social & Economic Harms, Communication and Behavioural Science, Governance, Data and Preparedness

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Lizzi Collinge MP @lizzicollinge.bsky.social · 26/10/2025

Yesterday Reform UK were given the Rusty Razor award for the worst pseudoscience of the year. From denying climate change to platforming quacks, Reform propagate dangerous nonsense. www.skeptic.org.uk/2025/10/refo...

skeptic.org.uk

Reform UK win 2025 Rusty Razor award for worst psuedoscience of the year - The Skeptic

Nigel Farage's political party, Reform UK, has been named The Skeptic's 'Rusty Razor' award winner for worst pseudoscience of 2025

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Jeremy Corbyn @jeremycorbyn.bsky.social · 23/09/2025

I am disgusted by Reform UK's threats to people who have built a life in this country. They are coming for our neighbours. They are coming for our colleagues. They are coming for our friends. We are at a dangerous moment. This hatred cannot be appeased. It must be defeated.

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Bob Lawrence 🔵 @trumpluvsobama.bsky.social · 23/09/2025

A statement of fact for Tuesday, Sept 23, 2025. There is absolutely no link between Tylenol and Autism; however, there is an absolute link between Trump and Epstein. ✊💙

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That rhetoric and those protests are happening in the UK right now, which is why I am worried about the tide shifting.

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I agree not everyone with conservative views is far right. But there’s an important distinction: wanting controlled immigration or lower taxes is mainstream right wing. Calling refugees “invaders”, pushing “replacement” conspiracies and attacking hotels housing asylum seekers is far right…

Alex Andreou @sturdyalex.bsky.social · 20/09/2025

Reposted by Dr Matt Kneale

In case you thought I was exaggerating, here is the "debate" on Kimmel from Newsnight. David Frum explaining the horrific first-amendment-breaching executive overreach. British right wing hacks: bUt HiS jOkE wAs iNaCCuRaTe!

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Perhaps. But it feels that there tide is slowly creeping in that direction can that’s reflected in the rhetoric, protests and polls at the moment. Polls indicate may share the sentiment.

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There has to be hope – ways to counter the lies and rebuild something better. What keeps you fighting for this country and countering the hateful spite coming out of far-right protesters at the moment?

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Cllr Dr David Nicholl @drdavidnicholl.bsky.social · 06/09/2025

Is there anything left worth fighting for in Britain? After 14 years of mismanagement and the last 3 months of open xenophobia and racism, it feels bleak. I’m tied here through co-parenting, but I fear for my daughter’s generation.

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Reposted by Dr Matt Kneale

I was warning about the dangerous nonsense that Malhotra was spreading …over 3y ago. I even warned Nigel Farage in his GBNEWS show bromsgrovestandard.co.uk/news/video-a... Vote Reform get dangerous cranks

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Dr Rachel Clarke @drrachelclarke.com · 06/09/2025

This is exactly the kind of despicable scaremongering that Aseem Malhotra has made his modus operandi. Insinuations, hearsay, anti-vaxx, non-evidence-based, lurid, self-enriching, anti-scientific claptrap. Of course Reform UK lapped it up. 1/4

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Dr Matt Kneale @drmk.link · 06/09/2025

Just a reminder this man is still under GMC investigation as they agreed to reconsider their rule 12 refusal previously.

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13/ We didn’t just raise concerns - we submitted detailed, verifiable evidence which could have been followed up. DAUK’s submission was ignored in full. Not even cited. That tells me all I need to know about how seriously frontline doctors were taken in this review.

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12/ I want to share a tangible concern: what's to stop a PA in gastro from doing scopes? Nothing. Now add credentialled prescribing - and you have non-doctors sedating patients for invasive procedures...

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11/ Hundreds of doctors submitted safety concerns — including @TheBMA and @TheDA_UK. DAUK was verifiable, specific and addressed key gaps in the BMA's own dossier. Yet the Leng Review ignored it entirely. Not cited. Not analysed. Not even acknowledged

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10/ And what does the review propose as oversight? A new faculty for PAs under Royal Colleges — the same failed model that led to current confusion. This isn’t reform but reinventing a wheel.

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Furthermore what evidence said this was fair game? So far I’ve only seen evidence of unlawful prescribing of controlled drugs and ionising radiation.

9/ The prescribing and IRMER recommendations are especially reckless. You can’t shortcut pharmacology, radiology and pathophysiology into “credentialling modules”. These are advanced medical skills, not bolt-on tasks.

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.

7/ The review promotes “complementarity” rather than subordination. But these are assistants, not doctors-lite. Using language that implies clinical equivalence is not just confusing, it’s strategically misleading.

6/ “Credentialling” creates a separate track: from novice to “advanced” assistant, with escalating clinical rights — but no requirement for medical school, postgrad exams, or specialist training. It’s a parallel system.

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4/ The “no undifferentiated patients” recommendation? It contains a glaring exception: “minor ailments in adults”. Many life-threatening conditions start that way — breathlessness, cough, headache, rash. This loophole is dangerous.

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3/ The review endorses “Advanced PAs” with prescribing, IRMER powers, and higher pay bands — based on internal credentialling modules. No meaningful postgraduate or foundation-level clinical requirement.

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2/ Yes, it recommends a name change to physician assistant, uniform clarity, and a supposed ban on "undifferentiated" patients. But these are caveated, partial, and don't touch the deeper structural concerns.

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