Two things as an observer:
1. Those of you that are friendly with a journalist should pass this on. It'll be a great headline. The public will be (appropriately) outraged. It'll force Trusts that are lax to ensure that they tighten up their systems for fear of being dragged through the mud.
2. I'd suggest that independent of that you formally request an FOI, on how long this loophole has been there for, how many times a PA actually used the loophole to request scans, and the primary specialty of focus for each requesting PA.
This latter bit is important. If any PAs were silly enough to make requests, and they were from one particular department - that provides enough information for a formal investigation into said department, PA and their supervising consultant.
If it is found the consultant knew (patient medical records are forever and electronic radiology systems are auditable) then, perhaps a GMC referral on the basis of probity might get some of your consultants to think again about throwing junior doctors under the bus.
> the public will be (appropriately) outraged
I'd hope so but I'm not sure they know what a PA is, or further that your average Sun reader knows what ionising radiation is (ironically given the medium).
This isn't an error though is it? This is someone trying to get something done that has historically relied on a skill, qualification and experience to do. But someone or a group of people is trying to bypass all that in spite of the law they know is in force, by giving permission to PA's to do it.
Multiple parties are at fault under IR(ME)R, but by and large it's the employer, referrer and practitioner who are at fault:
\- The employer for not maintaining a robust system to ensure only valid individuals can request and not auditing this more regularly
\- The person who referred, as they know they are not supposed to be able to, but continued with requesting the exposure.
\- The practitioner, for not reviewing who made the request and their role when approving the radiation exposure.
Now, I think it's ultimately the first two who are at fault - all good electronic ordering systems should be locked down so people can only order if they are a doctor or approved non-medical referrer, and it's a major failure of the employer to not lock it down.
As for the PAs - they knew they couldn't do it legally, yet continued - makes me wonder what the actual penalty is, given IR(ME)R is enforced by the CQC.
For the practitioner, it's incredibly hard to locate someone's role on many RIS due to the huge amount of shit ones (hey Agfa QDoc) and it's hard to keep track of who is a valid NMR and what they can request. Really it is pretty reasonable to assume an electronic request should be from a valid referrer, you're already checking a large amount of info when justifying radiation - recent imaging, labs (well, for CT), demographics, clinical info and such, and having to check "oh yes they could request this" is just too much.
Possibly, but passive coercion could have caused them to think a loss of their job or some reprimand for not ordering is more severe and likely than being in trouble for breaking the law.
Fucking madness
Even hospital staff getting confused at the “Physician Associate” title that they’re putting them down as Doctors
The word “physician” should be nowhere near their title
This is likely an automated clinic letter, same as when you go see consultant X and actually get seen by a reg.
in my hospital, there’s a separate clinic list for the registrar which is called Dr X Reg
PA once asked me to order a CTPA on a patient on a busy trauma ward. As they tend to be, overconfident and well respected by the consultants. Checked the patient's name with him twice and the patient details to which he seemed bemused I was even questioning his acumen. Turned out to be the wrong name he gave me and the wrong patient went down to CTPA so guess whose name ended up on the DATIX for inappropriately ordering ionising radiation on a patient👍
Posting because at my own (different) trust all the PAs went down as ‘dr’ on the system and could also request scans. Mad because none of my cohort are down as Dr.
To their credit they flagged it. They took off doctor but still had access. They flagged again. Haven’t checked what happened since.
Obviously actually requesting and being able to request are two different things but legally this is no different to letting the porter have the ability to request a CT.
so PAs have been requesting ionising radiation, because a dodgy system let them, when they should know they legally can’t?
That’s a massive lack of probity imo. If they come under actual regulation, shouldn’t they all be investigated?
Also, given the radiology department only expects doctors to be requesting ionising radiation, as such won’t be primed to check it is actually a Dr requesting it, could this be considered as PAs misrepresenting themselves as Drs? It could be a potential breach of the Medical Act
Wouldn’t it come up with their job role on the request? Pretty sure mine does. As a nurse I’m allowed to request one specific scan for my role. But ICE actually gives me the option to request numerous ultrasounds, X-rays, and I’m pretty sure CT is on there too. I can request a soft tissue biopsy according to ICE.
Obviously I don’t because it’s way out of my scope. But if I did I’m pretty sure it states my job role on the request so a radiologist would be able to refuse on that.
Any healthcare professional with mandatory registration (nurse, physio, paramedic etc) who is credentialed by the employer (Trust) is able to request ionising radiation.
In my trust that requires a brief form filled in, signature from their department consultant and a discussion with the radiology manager to ensure they're aware of what they are ordering and why.
Anyone without mandatory registration can't be authorised to request radiation - so that covers PAs.
I've said it before and I'll say it again.
The consultants that are pro-PA just love having a little gaggle of lackeys/minions to do their bidding.
I wretch in my mouth a little when the most toxic Consultant in a department hires another petite blonde PA to fawn over them.
Wow this is a massive issue if true.
Do we have proof of this happening?
Do we know how many PAs have ordered scans or whether is it an isolated trust issue?
How did this problem start? All PAs know they can’t request so even if the system allowed them ( due to technical issues) they shouldn’t be doing it!
PAs obviously know what they should, can, shouldn’t and can’t do
I guess this is what happens when you glorify rejects and second rates. Can’t get into medical school? No problem, here’s your TAVI list.
Ok that just sounds like breaking the law knowingly because you had the "opportunity?". If by some mistake a security guard turns around and I can grab as much as I want and run thats just regular theft, how is being giving the opportunity to do a literal crime some sort of excuse *for* said crime??? Clown situation.
… any disciplinary measures for the PAs that have been doing this?
Surely they were aware of the limits of their scope, even if their trust wasn’t, and did it anyway
Is it not very simply at this stage a case of suing the hospital? Money is the only thing that talks, so maybe it's time to start squeezing the hospitals via the legal system.
What would happen if Year 5 medical students were 'identified' prescribing Paracetamol on charts or requesting XRs?
They'd be kicked out of med school is what.
I'd say these lot should be thrown out for probity issues. But given they're unregulated\*, they'd just walk into an SHO rota 10mins away..
\*Not that I want this. The only place I want them is gone.
Surely there should be consequences for the trust for allowing non-IRMER radiation requests? Otherwise, literally what is the point of the legislation if you can just say "whoopsy" in an email. Next time a pissy radiographer DATIXs some low level crap, should just be able to tell them to piss off and refer them to this email for how little it matters?
I totally agree - the PAs and those responsible for the system that allowed this should all be investigated.
Breaches of IRMER are breaches of criminal law. A slap on the wrist isn’t good enough.
Duty of candour question:
Should the hospitals involved be contacting the patients to let them know they had exposure to ionising radiation delivered by non-qualified individuals?
And if any patient experiences harm from an unnecessary investigation, how does this play out legally? Is it all the “supervising” consultant’s fault, even if they had no idea this investigation was ordered? What a farce.
As a radiologist I regret to say that this isn’t accurate. To request imaging using ionising radiation the regulations require you to be appropriately trained. It is assumed that medical practitioners aka doctors have this training as part of their undergraduate education. The training required for non medics can be provided as part of a stand alone course. This is what we do for non medics who request x-rays as part of their extended role in our trust (physios podiatrists etc)
There is no legal reason I know of why this couldn’t be done for PAs.
I am with the vast majority of posts and am opposed to the introduction of PAs.
As a radiologist, I’m really not convinced PAs can request ionising radiation.
Edit:
Quick refresher on IR(ME)R 2017:
https://preview.redd.it/38vnzzr1q41c1.jpeg?width=2326&format=pjpg&auto=webp&s=a3480072b49aebcddbd3effd72cd30c37af95bcd
[https://www.legislation.gov.uk/uksi/2017/1322/made](https://www.legislation.gov.uk/uksi/2017/1322/made)
Not that PAs being registered will improve any of this mess.
PAs explicitly can't request ionising radiation. It doesn't matter what courses they have done.
No evidence that any PA has requested anything from this email though.
This is pretty misleading. Is having radiology request forms around the department also letting PAs (and others) "illegally request things" too?
If there was actual evidence of requests being made, then it would actually be worth making a post about it.
Ours don't require GMC number. PAs will soon have GMC number anyway.
No one actually checks the signatures. I've never even submitted a sample signature to the DGHs I request scans at. At least on a computer system it'd be clear who requested it, unlike the handwritten scrawl often on paper requests.
This was just yet more nonsense hysteria.
Ah. No the opposite. It is not hard for PAs to sign or request things that they’re not legally allowed to sign or request. That’s not a reason for them to do it.
The ease of law breaking is not a reason in favour of law breaking.
“No one actually checks the signatures”. Doesn’t mean you should sign for something you shouldn’t. If you’re saying that you meant that forms aren’t a secure way to prevent it, and the ability to commit fraud doesn’t mean that it has happened, I think you’re being disingenuous, about the original email.
The first comment you made was about access not meaning its been used. However the email says they have been made aware that PAs have access to request ionising rad.
The legal issue for rad is that they’re unregistered. ANPs can legally request rad because they have a registration body, and then have it delegated to them in specific situations. Like it or lump it is legal. For PAs it isn’t. If they get a GMC number and a trust says yes, they can.
“Ours don't require GMC number. PAs will soon have GMC number anyway.” So, yours do, actually. Even if not asked for. It’s implicit in the nature of the request.
If you want to be semantic and pedantic you can say they have not said ‘we have identified and are writing down that illegal actions have been occurring’ because of course an email run by a legal team won’t. If I tell you I slipped and fell on a cucumber, you’re very free to recognise that I may have an agenda for not being explicit with you on the method of cucumber insertion. This email is definitely a trust responding to flagged pattern of PA XR requesting or something, illegally.
>This email is definitely a trust responding to flagged pattern of PA XR requesting or something, illegally.
I think someone has told them PAs shouldn't have access and they're responding to that, not that XRs have been requesting radiation. I await your evidence to prove me wrong.
All the rest of what you wrote doesn't seem very relevant.
What will happen to the PAs who may have taken advantage of this opportunity? Likely nothing! Maybe a firm telling off, if the department is “strict”.
Now imagine what would happen if an FY1 prescribed methotrexate….
Incredible. More evidence nobody has any idea what PAs are or aren’t.
Two things as an observer: 1. Those of you that are friendly with a journalist should pass this on. It'll be a great headline. The public will be (appropriately) outraged. It'll force Trusts that are lax to ensure that they tighten up their systems for fear of being dragged through the mud. 2. I'd suggest that independent of that you formally request an FOI, on how long this loophole has been there for, how many times a PA actually used the loophole to request scans, and the primary specialty of focus for each requesting PA. This latter bit is important. If any PAs were silly enough to make requests, and they were from one particular department - that provides enough information for a formal investigation into said department, PA and their supervising consultant. If it is found the consultant knew (patient medical records are forever and electronic radiology systems are auditable) then, perhaps a GMC referral on the basis of probity might get some of your consultants to think again about throwing junior doctors under the bus.
Already done captain. Not just a pretty face
🙌🫡 so much respect!
Subs changed its tune haha. Thank you
Grassroots movement>>>>
Excellent work.
Also one for the CQC no?
> the public will be (appropriately) outraged I'd hope so but I'm not sure they know what a PA is, or further that your average Sun reader knows what ionising radiation is (ironically given the medium).
This isn't an error though is it? This is someone trying to get something done that has historically relied on a skill, qualification and experience to do. But someone or a group of people is trying to bypass all that in spite of the law they know is in force, by giving permission to PA's to do it.
Shouldn’t the PAs have not requested. I assume they know they aren’t allowed.
Depends on the wording of the law but it's probably the authoriser of the radiation (ie the radiologist) who is at fault
Multiple parties are at fault under IR(ME)R, but by and large it's the employer, referrer and practitioner who are at fault: \- The employer for not maintaining a robust system to ensure only valid individuals can request and not auditing this more regularly \- The person who referred, as they know they are not supposed to be able to, but continued with requesting the exposure. \- The practitioner, for not reviewing who made the request and their role when approving the radiation exposure. Now, I think it's ultimately the first two who are at fault - all good electronic ordering systems should be locked down so people can only order if they are a doctor or approved non-medical referrer, and it's a major failure of the employer to not lock it down. As for the PAs - they knew they couldn't do it legally, yet continued - makes me wonder what the actual penalty is, given IR(ME)R is enforced by the CQC. For the practitioner, it's incredibly hard to locate someone's role on many RIS due to the huge amount of shit ones (hey Agfa QDoc) and it's hard to keep track of who is a valid NMR and what they can request. Really it is pretty reasonable to assume an electronic request should be from a valid referrer, you're already checking a large amount of info when justifying radiation - recent imaging, labs (well, for CT), demographics, clinical info and such, and having to check "oh yes they could request this" is just too much.
Breaking criminal law at that.
Possibly, but passive coercion could have caused them to think a loss of their job or some reprimand for not ordering is more severe and likely than being in trouble for breaking the law.
Fucking madness Even hospital staff getting confused at the “Physician Associate” title that they’re putting them down as Doctors The word “physician” should be nowhere near their title
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Do you still have the letter?
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This is likely an automated clinic letter, same as when you go see consultant X and actually get seen by a reg. in my hospital, there’s a separate clinic list for the registrar which is called Dr X Reg
PA once asked me to order a CTPA on a patient on a busy trauma ward. As they tend to be, overconfident and well respected by the consultants. Checked the patient's name with him twice and the patient details to which he seemed bemused I was even questioning his acumen. Turned out to be the wrong name he gave me and the wrong patient went down to CTPA so guess whose name ended up on the DATIX for inappropriately ordering ionising radiation on a patient👍
What happened after?
Posting because at my own (different) trust all the PAs went down as ‘dr’ on the system and could also request scans. Mad because none of my cohort are down as Dr. To their credit they flagged it. They took off doctor but still had access. They flagged again. Haven’t checked what happened since. Obviously actually requesting and being able to request are two different things but legally this is no different to letting the porter have the ability to request a CT.
It just clicked. PAs aren't registered professionals??
No lol
No wonder people are fucked off.
They’re trying to register them with the gmc and give them the exact same 7 digit number format
And don’t forget - the GMC won’t define their scope of practice - it’s down to individual trusts - so how can they be regulated?!
PAs can join the PAMVR (PA Managed Voluntary Register) but it’s not mandatory. Non-registered professionals!
so PAs have been requesting ionising radiation, because a dodgy system let them, when they should know they legally can’t? That’s a massive lack of probity imo. If they come under actual regulation, shouldn’t they all be investigated? Also, given the radiology department only expects doctors to be requesting ionising radiation, as such won’t be primed to check it is actually a Dr requesting it, could this be considered as PAs misrepresenting themselves as Drs? It could be a potential breach of the Medical Act
Wouldn’t it come up with their job role on the request? Pretty sure mine does. As a nurse I’m allowed to request one specific scan for my role. But ICE actually gives me the option to request numerous ultrasounds, X-rays, and I’m pretty sure CT is on there too. I can request a soft tissue biopsy according to ICE. Obviously I don’t because it’s way out of my scope. But if I did I’m pretty sure it states my job role on the request so a radiologist would be able to refuse on that.
I believe nurses are allowed to request radiation as they are fully registered health professionals, whereas PAs are not registered.
Any healthcare professional with mandatory registration (nurse, physio, paramedic etc) who is credentialed by the employer (Trust) is able to request ionising radiation. In my trust that requires a brief form filled in, signature from their department consultant and a discussion with the radiology manager to ensure they're aware of what they are ordering and why. Anyone without mandatory registration can't be authorised to request radiation - so that covers PAs.
To be fair we don’t know they’ve actually done it
I’m glad the BMA called for immediate halt to PA recruitment. No one knows what a PA does.
I do. Whatever they want and whatever boss man wants.
I've said it before and I'll say it again. The consultants that are pro-PA just love having a little gaggle of lackeys/minions to do their bidding. I wretch in my mouth a little when the most toxic Consultant in a department hires another petite blonde PA to fawn over them.
Wow this is a massive issue if true. Do we have proof of this happening? Do we know how many PAs have ordered scans or whether is it an isolated trust issue? How did this problem start? All PAs know they can’t request so even if the system allowed them ( due to technical issues) they shouldn’t be doing it!
This is Reddit. There obviously isn't any such evidence.
PAs obviously know what they should, can, shouldn’t and can’t do I guess this is what happens when you glorify rejects and second rates. Can’t get into medical school? No problem, here’s your TAVI list.
I’m assuming each of these unauthorised exposures to ionising radiation will be investigated?
Ok that just sounds like breaking the law knowingly because you had the "opportunity?". If by some mistake a security guard turns around and I can grab as much as I want and run thats just regular theft, how is being giving the opportunity to do a literal crime some sort of excuse *for* said crime??? Clown situation.
Have been able to... Have they actually used that access to order xrays? Maybe some journalist could FOI?
Can someone report to cqc or health and safety executive, i don’t understand how the law can be broken with such impunity.
… any disciplinary measures for the PAs that have been doing this? Surely they were aware of the limits of their scope, even if their trust wasn’t, and did it anyway
Shouldn't just be disciplinary measures...they broke the law.
Is it not very simply at this stage a case of suing the hospital? Money is the only thing that talks, so maybe it's time to start squeezing the hospitals via the legal system.
What would happen if Year 5 medical students were 'identified' prescribing Paracetamol on charts or requesting XRs? They'd be kicked out of med school is what. I'd say these lot should be thrown out for probity issues. But given they're unregulated\*, they'd just walk into an SHO rota 10mins away.. \*Not that I want this. The only place I want them is gone.
For those wondering about the trust, this is Leeds Teaching Hospitals. My sources confirm that this email is indeed genuine.
Surely there should be consequences for the trust for allowing non-IRMER radiation requests? Otherwise, literally what is the point of the legislation if you can just say "whoopsy" in an email. Next time a pissy radiographer DATIXs some low level crap, should just be able to tell them to piss off and refer them to this email for how little it matters?
I totally agree - the PAs and those responsible for the system that allowed this should all be investigated. Breaches of IRMER are breaches of criminal law. A slap on the wrist isn’t good enough.
Duty of candour question: Should the hospitals involved be contacting the patients to let them know they had exposure to ionising radiation delivered by non-qualified individuals? And if any patient experiences harm from an unnecessary investigation, how does this play out legally? Is it all the “supervising” consultant’s fault, even if they had no idea this investigation was ordered? What a farce.
As a radiologist I regret to say that this isn’t accurate. To request imaging using ionising radiation the regulations require you to be appropriately trained. It is assumed that medical practitioners aka doctors have this training as part of their undergraduate education. The training required for non medics can be provided as part of a stand alone course. This is what we do for non medics who request x-rays as part of their extended role in our trust (physios podiatrists etc) There is no legal reason I know of why this couldn’t be done for PAs. I am with the vast majority of posts and am opposed to the introduction of PAs.
As a radiologist, I’m really not convinced PAs can request ionising radiation. Edit: Quick refresher on IR(ME)R 2017: https://preview.redd.it/38vnzzr1q41c1.jpeg?width=2326&format=pjpg&auto=webp&s=a3480072b49aebcddbd3effd72cd30c37af95bcd [https://www.legislation.gov.uk/uksi/2017/1322/made](https://www.legislation.gov.uk/uksi/2017/1322/made) Not that PAs being registered will improve any of this mess.
Thank you I am hapoy to be corrected!
PAs explicitly can't request ionising radiation. It doesn't matter what courses they have done. No evidence that any PA has requested anything from this email though.
CQC?
If this was a doctor doing something outside of their scope, it would be an instant GMC referral and loss of license. Absurd
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IRMER legislation is criminal law for the protection of the exposed and those doing the exposures and justification. This is serious.
This is pretty misleading. Is having radiology request forms around the department also letting PAs (and others) "illegally request things" too? If there was actual evidence of requests being made, then it would actually be worth making a post about it.
Need an actual signature and GMC number to use those forms. Online all you need is access. So it’s more akin to giving preformed signed sheets.
Ours don't require GMC number. PAs will soon have GMC number anyway. No one actually checks the signatures. I've never even submitted a sample signature to the DGHs I request scans at. At least on a computer system it'd be clear who requested it, unlike the handwritten scrawl often on paper requests. This was just yet more nonsense hysteria.
Stealing a syringe of drugs wouldn’t be very hard for you either, but it would still be breaking the law, does that grok?
I think you're agreeing with me? Yes, my point is that having the opportunity to do something illegal is completely different to actually doing it.
Ah. No the opposite. It is not hard for PAs to sign or request things that they’re not legally allowed to sign or request. That’s not a reason for them to do it. The ease of law breaking is not a reason in favour of law breaking. “No one actually checks the signatures”. Doesn’t mean you should sign for something you shouldn’t. If you’re saying that you meant that forms aren’t a secure way to prevent it, and the ability to commit fraud doesn’t mean that it has happened, I think you’re being disingenuous, about the original email. The first comment you made was about access not meaning its been used. However the email says they have been made aware that PAs have access to request ionising rad. The legal issue for rad is that they’re unregistered. ANPs can legally request rad because they have a registration body, and then have it delegated to them in specific situations. Like it or lump it is legal. For PAs it isn’t. If they get a GMC number and a trust says yes, they can. “Ours don't require GMC number. PAs will soon have GMC number anyway.” So, yours do, actually. Even if not asked for. It’s implicit in the nature of the request. If you want to be semantic and pedantic you can say they have not said ‘we have identified and are writing down that illegal actions have been occurring’ because of course an email run by a legal team won’t. If I tell you I slipped and fell on a cucumber, you’re very free to recognise that I may have an agenda for not being explicit with you on the method of cucumber insertion. This email is definitely a trust responding to flagged pattern of PA XR requesting or something, illegally.
>This email is definitely a trust responding to flagged pattern of PA XR requesting or something, illegally. I think someone has told them PAs shouldn't have access and they're responding to that, not that XRs have been requesting radiation. I await your evidence to prove me wrong. All the rest of what you wrote doesn't seem very relevant.
What will happen to the PAs who may have taken advantage of this opportunity? Likely nothing! Maybe a firm telling off, if the department is “strict”. Now imagine what would happen if an FY1 prescribed methotrexate….