Dr Matt Kneale

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.

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...

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

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.

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.

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.

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.

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.

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.

I’ve had time to read the Leng Review in full. While some celebrate minor cosmetic wins, I see the formal entrenchment of a parallel, underqualified medical workforce — built without medical training.

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🗣️| @drmk.link: “There's unease at the direction of travel towards a fragmented, task-based model which implies ‘anyone can do it’.
"Medicine can't be reduced to checklists and delegated tasks. It's a complex, deeply responsible profession that demands a medical degree and years of further training."

🗣️ | @drmk.link spoke on #physicianassociates at the @fflm.bsky.social Conference
He will be speaking on the topic at our conference this Saturday.
Conference details, including how to join us in person and online ➡️ dauk.org/jenny-vaugha... #DAUKConf25

After lunch, we’re diving into two streams— @drmk.link will be leading our Legal Medicine stream with an insightful session on the move from discovery to accountability around the role of the Physician Associate #FFLMConf25

Great to be at the FFLM Conference today. I’ll be speaking later on the move from discovery to accountability around the role of physician associates—looking forward to the discussion.

#FFLMConf25 @fflm.bsky.social @thedauk.bsky.social

DAUK's @drdavidnicholl.bsky.social and @drmk.link discuss why Brexit is making it harder to get life-saving treatments in @theipaper.com

The FFLM has endorsed the National Network of Designated Health Professionals' position statement on the commissioning of child sexual abuse medical assessments. You can read the full statement here: fflm.ac.uk/press-and-po...

Carney: The system of global trade anchored on the United States.. is over. Our old relationship of steadily deepening integration with the United States is over. The 80 year period when the United States embraced the mantle of economic leadership… is over.

I always knew ChatGPT would show its value someday.

5/ Trump’s “America First” weakens deterrence, but Xi knows invasion risks uniting Congress, collapsing global semiconductors, and exposing PLA vulnerabilities. The next two years are critical—but not guaranteed for China.

4/ Likely moves instead:

→ Blockades (90% of Taiwan’s energy is imported).
→ Cyberattacks on TSMC (54% global chip market share).
→ Seizure of Kinmen/Matsu islands to test U.S. resolve.

www.understandingwar.org/backgrounder...

Taiwan plans major defense purchases for 2024 including Harpoon missiles and F-16 upgrades Taiwan plans significant defense acquisitions for 2024, including Harpoon missiles and upgrades to its F-16 fleet.

3/ But invasion isn’t inevitable:

✔️ Taiwan’s asymmetric upgrades (Harpoon missiles, F-16s) raise costs for Beijing.

✔️ Xi faces internal issues: slowing growth (5.2%), unemployment, and unrest.

✔️ PLA amphibious gaps remain (only 6 Type 075 carriers operational)

armyrecognition.com/news/navy-ne...

Lai pledges to raise Taiwan's defense spending to over 3% of GDP - Focus Taiwan President Lai Ching-te (賴清德) said Friday that his government would aim to increase defense spending to 3 percent of Taiwan's gross domestic product (GDP) this year, hours after U.S. President Donald T...

2/ Why now?

Trump ties U.S. defence aid to economic demands (e.g., Taiwan must raise military spending to 3% of GDP or face reduced support).

His Ukraine peace plan forces Kyiv to cede territory, and signals that U.S. allies are expendable.

focustaiwan.tw/politics/202...

1/ If Trump is kompromat and China is allied with Russia, the PLA may see 2025–26 as the best window to invade Taiwan. Trump’s Congress backs him, and he seems unwilling to spend American dollars defending former allies like Ukraine.

NHS England has no idea about GPs Reform will only happen when the organisation confronts how lamentably wrong-headed it has been.

‘There is simply no conception (within NHS England) of how pivotal GPs are to the cost-effective performance of the health service - let alone to holistic patient care’
So says the ever-insightful
@pwhitakerwriter.medsky.social
www.newstatesman.com/politics/hea...