Phil Smith retweeted
🎼 It takes an orchestra to manage refractory disorders of gut-brain interaction
In Frontline Gastroenterology, the team at a London neurogastroenterology centre explain how they built a multidisciplinary service:
🩺 Gastroenterologist
👩⚕️ Nurse specialist
🥗 Dietitian
🧠 rist
Each brings something different. Together, they improve symptoms, quality of life and costs compared with gastroenterologist-only care.
Read the full review
doi.org/10.1136/flgast…
#FrontlineGastroenterology #DGBI #IBS #Neurogastroenterology #MultidisciplinaryCare
In Frontline Gastroenterology, the team at a London neurogastroenterology centre explain how they built a multidisciplinary service:
🩺 Gastroenterologist
👩⚕️ Nurse specialist
🥗 Dietitian
🧠 rist
Each brings something different. Together, they improve symptoms, quality of life and costs compared with gastroenterologist-only care.
Read the full review
doi.org/10.1136/flgast…
#FrontlineGastroenterology #DGBI #IBS #Neurogastroenterology #MultidisciplinaryCare
0
11
33
4,359
Sadly you will not be surprised @drsanjoykumar. This happened in Notts but it is happening across the country & many senior leaders actively sanction/endorse this behaviour. All that matters to them is saving face & reputational damage control. A truly appalling state of affairs
“the individual who deleted the files could not be identified by any investigation”
-This has got to be the biggest scandal heard from the same Trust that breached medical notes of our children from Nottingham attacks.
- We found data breaches and now systematic and planned data deletion. This is totally scandalous.
I have long said the Sec of State for Health needs a total management replacement at this hospital immediately……..
Sec of State you are sleeping on the job…..get on with it.
This Trust has got to be the most scandal ridden in the country.
“Get Nottingham right, get the country right”
@YvetteCooperMP @DHSCgovuk @KemiBadenoch @DamianHinds
bbc.co.uk/news/articles/…
3
8
37
1,063
Phil Smith retweeted
“the individual who deleted the files could not be identified by any investigation”
-This has got to be the biggest scandal heard from the same Trust that breached medical notes of our children from Nottingham attacks.
- We found data breaches and now systematic and planned data deletion. This is totally scandalous.
I have long said the Sec of State for Health needs a total management replacement at this hospital immediately……..
Sec of State you are sleeping on the job…..get on with it.
This Trust has got to be the most scandal ridden in the country.
“Get Nottingham right, get the country right”
@YvetteCooperMP @DHSCgovuk @KemiBadenoch @DamianHinds
bbc.co.uk/news/articles/…
-This has got to be the biggest scandal heard from the same Trust that breached medical notes of our children from Nottingham attacks.
- We found data breaches and now systematic and planned data deletion. This is totally scandalous.
I have long said the Sec of State for Health needs a total management replacement at this hospital immediately……..
Sec of State you are sleeping on the job…..get on with it.
This Trust has got to be the most scandal ridden in the country.
“Get Nottingham right, get the country right”
@YvetteCooperMP @DHSCgovuk @KemiBadenoch @DamianHinds
bbc.co.uk/news/articles/…
72
472
1,492
21,071
Phil Smith retweeted
I’m a believer in systems thinking & just culture in healthcare - but when it comes to the pattern of deliberate concealment of the trust after healthcare harm - I think we need to start seeing serious custodial sentences for the perpetrators & senior leaders who enable it.
4/4
4/4
12
40
307
5,599
Phil Smith retweeted
Horrified but sadly not surprised at confirmation from Nottingham that maternity records were ‘intentionally’ deleted. This is a playbook I’m familiar with.
1/…
1/…
14
90
593
30,895
Phil Smith retweeted
On Thursday I wrote about the 2014 injunction Russell Brand obtained against a woman who accused him of assault.
I've now obtained the final order. It's breathtaking.
She had no lawyer. No trial. Yet she was silenced for life - even barred from speaking to the police.
🧵:
I've now obtained the final order. It's breathtaking.
She had no lawyer. No trial. Yet she was silenced for life - even barred from speaking to the police.
🧵:
479
4,034
9,649
993,860
He'll be upset this isn't about him, but it isn't*. It's about anonymity as that's across the news at the moment re injunctions etc. Why is it okay to pay to remain anon or be anon on an expert panel for instance but not when speaking out? Is anonymity for the privileged few?
Why be concerned about someone reporting you if you are confident that you are behaving properly and professionally (as I believe you are)? I disagree with what you campaign for but you have every right to do so.
1
0
2
348
Phil Smith retweeted
Hepatitis A outbreaks continue among men who have sex with men (MSM) despite an effective vaccine.
@FrontlineGastro review of 38 studies: offer vaccination to all susceptible MSM, especially those on PrEP, living with HIV or with an STI 💉
Read the full paper here:
fg.bmj.com/content/17/5/3…
@BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
@FrontlineGastro review of 38 studies: offer vaccination to all susceptible MSM, especially those on PrEP, living with HIV or with an STI 💉
Read the full paper here:
fg.bmj.com/content/17/5/3…
@BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
2
2
6
627
Phil Smith retweeted
⏪ Throwback Fridays ⏪ . 📰 Disorders of gut-brain interaction: What is the cost of treatment 💰 ?
Upadhyaya et al surveyed 660 people with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder (hEDS/HSD) about their healthcare use and costs over 6 months.
🔑 Rome IV criteria for a disorder of gut-brain interaction (DGBI)
💷 Mean healthcare costs were £3389 per patient over 6 months, mostly from outpatient consultations (36%) and admissions (23%)
📈 Costs roughly doubled with functional dyspepsia (FD): about £4000–4300 vs about £1700–2000 without FD
💊 The median number of medications was 6, with a high anticholinergic and opioid burden
💡 The authors call for cost-effective multidisciplinary services for this group.
🔗 doi.org/10.1136/flgast…
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @WorldGastroOrg @ulstergastro @AmCollegeGastro @Aegastro @WAGE_media
#GITwitter #Neurogastro #gastroenterology #Hypermobility #EhlersDanlos
Upadhyaya et al surveyed 660 people with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder (hEDS/HSD) about their healthcare use and costs over 6 months.
🔑 Rome IV criteria for a disorder of gut-brain interaction (DGBI)
💷 Mean healthcare costs were £3389 per patient over 6 months, mostly from outpatient consultations (36%) and admissions (23%)
📈 Costs roughly doubled with functional dyspepsia (FD): about £4000–4300 vs about £1700–2000 without FD
💊 The median number of medications was 6, with a high anticholinergic and opioid burden
💡 The authors call for cost-effective multidisciplinary services for this group.
🔗 doi.org/10.1136/flgast…
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @WorldGastroOrg @ulstergastro @AmCollegeGastro @Aegastro @WAGE_media
#GITwitter #Neurogastro #gastroenterology #Hypermobility #EhlersDanlos
0
2
5
560
Great thread by @DrLKVaughan on speaking out and its real cost. But always remember:
"First they ignore you, then they laugh at you, then they fight you, then you win"
"First they ignore you, then they laugh at you, then they fight you, then you win"
I am fully supportive of the anonymity of anon accounts.
Not only have I been reported to the GMC, I have been asked for 'chats without coffee'. There was one memorable morning when I had to 'chat' with the Deputy CEO, the MD and the CEO of a group hospital over something
/
1
9
26
1,858
Phil Smith retweeted
I am fully supportive of the anonymity of anon accounts.
Not only have I been reported to the GMC, I have been asked for 'chats without coffee'. There was one memorable morning when I had to 'chat' with the Deputy CEO, the MD and the CEO of a group hospital over something
/
Not only have I been reported to the GMC, I have been asked for 'chats without coffee'. There was one memorable morning when I had to 'chat' with the Deputy CEO, the MD and the CEO of a group hospital over something
/
Why be concerned about someone reporting you if you are confident that you are behaving properly and professionally (as I believe you are)? I disagree with what you campaign for but you have every right to do so.
11
44
199
22,087
Phil Smith retweeted
What do you do with your patients with refractory bile acid diarrhoea who have either not responded to or are intolerant of bile acid sequestrants 🤔 💭
🔥 Read this new paper from @DrCJBlack @alex_ford12399 and team who show liraglutide (GLP-1) could be the answer 🔥.
1️⃣ red in 61% of patients, with a further partial response in 23%
2️⃣ In responders, mean daily stool frequency fell from 10 to 3 (p<0.001)
3️⃣ Only 1 patient discontinued due to AEs
fg.bmj.com/content/early/…
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @AmCollegeGastro @Aegastro @WAGE_media
#GITwitter #gastroenterology #diarrhoea #MedEd
🔥 Read this new paper from @DrCJBlack @alex_ford12399 and team who show liraglutide (GLP-1) could be the answer 🔥.
1️⃣ red in 61% of patients, with a further partial response in 23%
2️⃣ In responders, mean daily stool frequency fell from 10 to 3 (p<0.001)
3️⃣ Only 1 patient discontinued due to AEs
fg.bmj.com/content/early/…
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @AmCollegeGastro @Aegastro @WAGE_media
#GITwitter #gastroenterology #diarrhoea #MedEd
1
7
18
1,042
Phil Smith retweeted
Eating disorder admissions to an acute NHS hospital rose steadily from 2014 to 2022, peaking during COVID-19.
🚨 New study calls for every patient to be reviewed by the nutrition support team.
Read the full paper here:
fg.bmj.com/content/17/5/4…
@BritSocGastro @my_UEG eting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
🚨 New study calls for every patient to be reviewed by the nutrition support team.
Read the full paper here:
fg.bmj.com/content/17/5/4…
@BritSocGastro @my_UEG eting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
0
3
3
442
Phil Smith retweeted
Whatever be the abuse taken, whatever be the personal impact, however much attempts made to ignore (Been fascinating to see behaviour of local Deanery under @NHSE_WTE recently)?
Once a stand was taken in 2023?
That consistency does not shift.
Patient safety sits paramount.
roup -which has sent this now to @RCPhysicians
The RCP must:
1. Reject the draft national clinical protocol for physician assistants outright.
2. Take leadership by developing its Interim guidance for physician associates working in the medical specialities into formal national guidance.
It is a matter for physicians what elements of clinical practice we consider can be safely delegated.
Up to @Mumtaz_Patel_1 @OGMustafa @HilaryWMedic @RunningMadProf and Council next.
You all were part of the senior leadership who lost an EGM once.
It's not a bad thing to heed history.
@djnicholl @mmamas1973 @PhilSmithIsBack
Once a stand was taken in 2023?
That consistency does not shift.
Patient safety sits paramount.
roup -which has sent this now to @RCPhysicians
The RCP must:
1. Reject the draft national clinical protocol for physician assistants outright.
2. Take leadership by developing its Interim guidance for physician associates working in the medical specialities into formal national guidance.
It is a matter for physicians what elements of clinical practice we consider can be safely delegated.
Up to @Mumtaz_Patel_1 @OGMustafa @HilaryWMedic @RunningMadProf and Council next.
You all were part of the senior leadership who lost an EGM once.
It's not a bad thing to heed history.
@djnicholl @mmamas1973 @PhilSmithIsBack
Dear @bmj_latest & @pulsetoday so far
57 signatures in our open letter to @RCPhysicians
40 current FRCPs, 12 current members and five recently resigned – four fellows & one MRCP.
This will be submitted to RCP on Monday
#physicianassistant
dauk.org/rcp-letter/
1
49
84
3,701
Phil Smith retweeted
TOpClass groups perianal Crohn's patients by symptoms, disease burden and anatomy, and ties each class to a treatment goal.
@FrontlineGastro commentary: patients move between classes over time, so reclassify at every visit 🔄
Read the full paper here:
fg.bmj.com/content/17/5/3…
@BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman
@FrontlineGastro commentary: patients move between classes over time, so reclassify at every visit 🔄
Read the full paper here:
fg.bmj.com/content/17/5/3…
@BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman
0
2
4
684
Phil Smith retweeted
⭐ Check out this new prospective study comparing the role of a novel sedative agent, Remimazolam, versus midazolam in ERCP 🤩 .
Key findings 🔑:
1. Remimazolam was associated with shorter length of stay (1.7 vs 3 days, p=0.04) 🏥
2. Fentanyl dose was lower with remimazolam p<0.001)
3. Increases in productivity led to estimated savings of £71381 per year 💰
Is it time to move on from midazolam 🤔 ⁉️
fg.bmj.com/content/early/…
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @pancreatitis_nl @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @UHSEndoscopy @WAGE_media
#GITwitter #livertwitter #gastroenterology #Endoscopy #ERCP #MedEd #Sedation
Key findings 🔑:
1. Remimazolam was associated with shorter length of stay (1.7 vs 3 days, p=0.04) 🏥
2. Fentanyl dose was lower with remimazolam p<0.001)
3. Increases in productivity led to estimated savings of £71381 per year 💰
Is it time to move on from midazolam 🤔 ⁉️
fg.bmj.com/content/early/…
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @pancreatitis_nl @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @UHSEndoscopy @WAGE_media
#GITwitter #livertwitter #gastroenterology #Endoscopy #ERCP #MedEd #Sedation
1
2
7
611
Phil Smith retweeted
📰 Frontline Gastroenterology: a visual guide to immunotherapy in hepatocellular carcinoma
How does HCC evade the immune system, and where do checkpoint inhibitors act? This figure maps the immunosuppressive tumour microenvironment and the main drug targets.
🔑 Key points:
🧬 D-L1, downregulate MHC-I and secrete IL-10, TGF-β and VEGF
🛑 Tregs use CTLA-4 to block T cell co-stimulation via B7
😴 Exhausted CD8+ T cells co-express PD-1, TIM-3 and LAG-3
💊 Drug classes: anti-PD-1 (nivolumab, pembrolizumab), anti-PD-L1 (atezolizumab, durvalumab), anti-CTLA-4 (ipilimumab, tremelimumab) and anti-VEGF(R) (bevacizumab, cabozantinib)
Read the full article here👇
🔗 fg.bmj.com/content/early/…
@BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
How does HCC evade the immune system, and where do checkpoint inhibitors act? This figure maps the immunosuppressive tumour microenvironment and the main drug targets.
🔑 Key points:
🧬 D-L1, downregulate MHC-I and secrete IL-10, TGF-β and VEGF
🛑 Tregs use CTLA-4 to block T cell co-stimulation via B7
😴 Exhausted CD8+ T cells co-express PD-1, TIM-3 and LAG-3
💊 Drug classes: anti-PD-1 (nivolumab, pembrolizumab), anti-PD-L1 (atezolizumab, durvalumab), anti-CTLA-4 (ipilimumab, tremelimumab) and anti-VEGF(R) (bevacizumab, cabozantinib)
Read the full article here👇
🔗 fg.bmj.com/content/early/…
@BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
2
12
34
2,037
Phil Smith retweeted
Just to showcase how far down the rabbit hole some of the Royal Colleges (in this case @RCoANews), along with @NHSE_WTE @NHSEngland @gmcuk et al have all gone- on the hubris of idealogy.
Myth 1:
There isn't enough doctors to do the job.
Fact:
In the context of anaethesia?
The competition ratio for Anaesthetics CT1 in the NHS is 10.54:1 for the 2026 Round 1 recruitment cycle (5,766 applications for 547 posts)
AFTER removing those pesky foreigners aka IMGs (as far as I am aware)
Myth 2:
There isn't enough money to hire doctors
Fact:
Look at recent job advert for a Physicians Assistant (Anaesthesia)
Salary & Pay Scale: NHS Agenda for Change Band 7 (£55,524 - £62,652 per annum)
Above doesn't factor in cost of supervision via a Senior Consultant
Riddle me this.
What is the feasible reason to have these roles when you have trained doctors (NOT foreigners)- done at cost to tax payer to do the role?
It makes no clinical, financial or policy sense.
Yet?
Here we are.
Pontificating why NHS is non-productive or has safety issues - wherever you look.
I repeat to all.
Do NOT do to others you wouldn't want to do to your loved ones.
@RoyLilley @JanetEastham @lengreview @KamranAbbasi @DrNatBroughton @YvetteCooperMP
Myth 1:
There isn't enough doctors to do the job.
Fact:
In the context of anaethesia?
The competition ratio for Anaesthetics CT1 in the NHS is 10.54:1 for the 2026 Round 1 recruitment cycle (5,766 applications for 547 posts)
AFTER removing those pesky foreigners aka IMGs (as far as I am aware)
Myth 2:
There isn't enough money to hire doctors
Fact:
Look at recent job advert for a Physicians Assistant (Anaesthesia)
Salary & Pay Scale: NHS Agenda for Change Band 7 (£55,524 - £62,652 per annum)
Above doesn't factor in cost of supervision via a Senior Consultant
Riddle me this.
What is the feasible reason to have these roles when you have trained doctors (NOT foreigners)- done at cost to tax payer to do the role?
It makes no clinical, financial or policy sense.
Yet?
Here we are.
Pontificating why NHS is non-productive or has safety issues - wherever you look.
I repeat to all.
Do NOT do to others you wouldn't want to do to your loved ones.
@RoyLilley @JanetEastham @lengreview @KamranAbbasi @DrNatBroughton @YvetteCooperMP
THIS is the question.
Let me take it one step further.
Your most loved one is due to have surgery.
You have a choice as to who 'puts them to sleep for the procedure'- and then 'wakes them up'.
1. It's either a trained Anaesthetist aka a Doctor
2. Or a Physician Assistant in Anaesthesia aka Not a Doctor
The answer to me is obvious.
Not in bazillion years should it be number 2.
If you @NHSEngland @NHSE_WTE actually believe in 'Informed Choice'?
Inform them properly- not dupe them with made up titles.
What a two tier system we have descended to.
I repeat- do NOT do to others what you won't do to your loved ones.
10
105
257
17,640