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cover of episode The data on physician associates in the UK, and speaking up in the NHS

The data on physician associates in the UK, and speaking up in the NHS

2025/3/12
logo of podcast Medicine and Science from The BMJ

Medicine and Science from The BMJ
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People
C
Cameron Abassi
H
Habib Naqvi
H
Henrietta Hughes
J
Jugdeep Dhesi
K
Katie Bramall-Stainer
K
Kevin Fong
T
Thea Stein
T
Trish Greenhalgh
Topics
Trish Greenhalgh: 我最近完成了一项关于英国医师助理和麻醉师助理有效性和安全性的快速系统综述。研究发现，关于这个主题的英国研究证据非常有限，而且大多数研究都集中在非临床方面，例如医师助理对自身角色的看法，而不是他们实际工作表现的评估。此外，几乎没有研究关注患者安全事件，包括与医师助理相关的死亡或严重伤害事件。在初级保健环境中，医师助理需要大量的监督，他们的工作效率可能不如全科医生。在医院环境中，医师助理的知识优势在于他们对特定病房运作方式的熟悉程度，而不是高级临床知识。总的来说，目前的证据基础与英国NHS的现状不符，这令人担忧。 Habib Naqvi: 我是NHS种族与健康观察站的首席执行官。我们的工作是揭示种族和族裔在健康和医疗保健方面的差距，并提供解决方案。近年来，人们对种族主义在健康和医疗保健中的作用有了更多的认识，但这并不意味着问题已经解决。有证据表明，结构性种族主义直接和间接影响人们获得医疗保健的机会、经历和结果。解决种族主义不仅能改善少数族裔的健康和福祉，也能改善整个社会人口的健康和福祉。Reform UK提议解散NHS种族与健康观察站，这被视为一种荣誉，因为这意味着他们的工作正在产生影响。 Katie Bramall-Stainer: NHS员工普遍感到在工作中表达担忧并不安全，并且缺乏提供患者所需护理的资源。许多医生都经历了道德损伤，这与他们无法提供他们认为应该提供的护理有关。在初级保健中，全科医生面临双重风险，因为他们不仅要面对来自英国皇家医师学会的监管，还要面对当地的绩效评估。 Jugdeep Dhesi: NHS员工害怕表达意见并遭受报复，并且即使他们表达了意见，也可能不会导致改变，这导致了无力感。道德损伤是由于资源有限和表达担忧无效而导致的倦怠。 Henrietta Hughes: 员工无法表达担忧会影响患者安全，因为这会阻止潜在问题的及早发现和解决。领导力在创造安全的心理环境方面至关重要，而缺乏这种环境是导致员工无法表达担忧的主要原因。 Thea Stein: NHS中的人际行为既是问题的一部分，也是解决方案的一部分。心理安全感对于创造良好的工作文化至关重要，而这需要从一线管理开始。NHS中一种过时的领导模式，强调控制和目标达成，而不是倾听和合作，阻碍了员工表达担忧。领导者需要能够承认自己不知道答案，并与团队一起寻找解决方案，而不是试图独自解决所有问题。

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Shownotes Transcript

We've just published a new rapid review on the safety and efficacy of physician and anaesthetic associates in the UK, which was commissioned to support the ongoing Leng review of these new roles in the NHS. Trish Greenhalgh, professor of primary care at the University of Oxford, joins us to discuss the data she found.

Habib Naqvi is director of the NHS Race and Health Observatory, and is holding up a mirror to the NHS on it's support for ethnic minority patients and doctors - he joins us to talk about the work they've done, and why Reform UK's manifesto pledge to disband the Observatory is a matter of pride. 

Finally, our annual trip to the Nuffield Summit is not complete without a roundtable, this year we asked the question "What is stopping staff from speaking up?". Our panellists raised the usual issues of hierarchy and psychological safety, but also how the lack of positive change from senior leadership has habituated people into thinking "why bother".

Our panel;

Katie Bramall-Stainer, chair of the General Practice Committee of the BMA Jugdeep Dhesi, consultant in geriatric medicine at Guys and St Thomas Hopsital Henrietta Hughes, the UK's patient safety commissioner Thea Stein, chief executive of the Nuffield Trust 

 

Reading list

Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research)

Together we can challenge the racism that persists in healthcare)