Writing exclusively in Pulse, Lord Bethell defends his comments on physician associates, and claims doctors are leading a campaign of bullying
When the pandemic left me punch-drunk with the sheer complexity of the challenge, I found inspiration in the phenomenal teamwork of frontline clinicians.
Their professionalism and spirit of comradeship lifted my spirits. When leadership was needed to unravel high-risk, highly complex challenges among hastily assembled teams of military, commercial, and medical staff, our senior doctors often stepped up. Because that’s what doctors do, they bring together teams of experts from different backgrounds to solve life-threatening problems.
Take my friend the heart surgeon who explained how his team had ditched their much-loved robots and retrained to work in the ICU unit, where they intubated struggling patients, one of the most challenging assignments. Or the people stood up to new testing, vaccine and emergency care facilities, often under difficult conditions, with doctors leading teams of squaddies, warehousemen, lab technicians, data scientists and all manner of critical players, from all manner of backgrounds.
We used to joke, ‘Thank goodness it wasn’t a computer virus,’ reflecting that people in tech didn’t have the same magic touch.
It was, therefore, with shock that I received a letter through a friend from a physician associate who described the sort of bullying and intimidation they received on a routine basis at work and on social media.
These ‘medical associates’ are critical workers in our healthcare system who individually deserve our respect and thanks for their difficult job. And they are much needed. Qualified doctors are leaving full-time employment in droves (partly because of the toxic workplace atmosphere). We are struggling to recruit and retain talent, domestically and internationally. The opportunities presented by new technologies require a different workforce mix. We have to do something to expand the healthcare workforce, and these highly committed roles are an essential opportunity to meet growing patient needs, alongside more significant roles for senior nurses, pharmacists, therapists and other respected professionals. I thank anyone joining such a profession for contributing to Britain’s healthcare mission.
But instead of respect, they tell me that medical associates are ritually humiliated on a routine basis to the point that mental health in their profession is an acute issue. They say that most have closed their social media accounts. They feel no one fights their corner. They feel treated as pariahs. This is because of a concerted campaign to extinguish their role: selling false narratives about patient safety and making ad hominem attacks on individuals.
Rotas and private personal details have been leaked to anonymous accounts. Individuals have been named, victimised, and defamed on social media for being a medical associate. Negative briefings turned into Twitter threads that make implausible claims about patient safety. Some were even publicly falsely accused of crimes. I am told this behaviour has escalated to such extremes that some PAs have received death threats. Doctors showing support are targeted with the same vigour.
When I raised this in parliament, I was smacked down by the same treatment, a highly orchestrated digital campaign. My professionalism was castigated. My family was insulted. My education was scorned—scurrilous comments on my medical history. My integrity was dragged through the gutter. The things said about medical associates were unverifiable, scandalous, intimidating, professionally inappropriate, and designed to denigrate a respectable cadre to the point that it might be extinguished.
I am a veteran of the social media pile-on. Anti-vaxxers. Jolyon Maughan. Angela Rayner. Michelle Mone. They’ve all had a go. But nothing prepared me for this insult and personal abuse, mostly from doctors (or anonymous emojis claiming to be doctors).
When I worked at the Ministry of Sound, we used to facedown local drug dealers, so I know what the intimidation playbook looks like. That’s what came my way. A deliberate attempt to frighten off a parliamentarian from supporting a worthwhile profession, from people who claim senior leadership positions in our health system, in clear breach of their code of practice commitments to integrity and respect for colleagues. That’s why I have passed a list of the most egregious offenders to the police. And why I have turned off comments on my Twitter posts.
It made me reflect on why doctors are held in such high regard within the healthcare system, by the public, and by parliamentarians like me. They have high status in the system because they have the unique skills necessary to perform a critically important leadership role in solving highly risky, highly complex problems. That is an almost sacred role.
But they cannot do this by bullying and intimidation. It is their responsibility to create a safe environment where the best decisions are made by a team of several clinical and non-clinical team members who trust each other. When the top doctor falters, it all goes wrong. The Ockendon Report on maternity services, the Francis Report after mid-Staffs, the Bewick report after UHB and the University of Exeter report on sexual harassment in surgery tell the story of when people abuse power and forget to respect colleagues.
I can shrug it all off and move on. But two things worry me.
What struck me about the nasty bullying of medical associates was that this smacked of old-fashioned professional jealousy and shopfloor protectionism dressed up in fancy clothing. Suppose this is the level of professional angst and bitterness over a relative-small workforce evolution like the regulation of medical associates. How will our doctors react when artificial intelligence shakes up the healthcare system, as in every other walk of life? The future of medicine is multidisciplinary teams, often supported by the latest technology. Significant changes are afoot. We are already behind the curve. How will Britain embrace the benefits of modern healthcare for our patients and taxpayers when there is a cadre of activists determined to snuff out any tweaks to the privileges of senior clinicians?
Secondly, where was the voice of the large majority of perfectly reasonable doctors? The briefings from the NHS are insipid. Leading doctors give dog whistle speeches that played into the shroud-waving safety narrative. The Royal Colleges are mainly silent.
Not only is this hands-in-pockets attitude unprofessional and spineless. It is also a recipe for disaster. If the bullies win this battle, they will switch their target. Who knows who’ll be next? Certainly, pharmacists and senior nurses who already fill the gaps between doctors should be worried. Pastor Martin Niemöller had a point. This is not a problem the politicians can fix. It is time the doctors faced into the problem of this toxic workplace culture and started holding colleagues accountable for their professionalism. There’s a vote at the Royal College of Physicians next on MAPs. This is a chance to stand up to the bullies.
Lord Bethell is a former minister of health
READERS' COMMENTS [30]
Please note, only GPs are permitted to add comments to articles
The difference between those others and PA’s are doctors won’t be forced to supervise the others. Medical unemployment and doctor replacement by PA is already a fact. Add to that a PA starts on 20k more than a junior doctor. When aircraft are flown by associate pilots , I’ll buy the notion of a PA. Until then I won’t supervise them and I will ensure my family don’t see them. The real reason for all of thus of course is free NHS care by non doctors and if you want doctor care, you will have to pay privately. I see no evidence of bullying of PA’d. The reverse ,doctors are being bullied into unwilling supervision.
We’re still waiting for the evidence from DOH and NHSE which demonstrates the clinical and economic evidence behind this role out of non-doctor led healthcare. If anyone has seen the studies, please let me know. This guy sounds like he’s eager to conflate doctors’ misgivings about this rollout with criminal activity. He should address the myriad questions about rolling out a new healthcare role before its scope has been properly defined and investigate why hospitals and practices are misusing this group of healthcare workers as replacements for doctors on rotas in roles for which they have neither the training nor the legally required qualifications. But no, let’s instead focus on non-specific claims of ‘nastiness’ and pretend that there are no questions at all as to the clincial or economic rationale of this government led overhaul of healthcare in the UK.
Oh dear. I understand that the concern with PAs is that they are not qualified doctors but are skilled and trained in their own area, When put into general practice they need supervising – as do junior doctors training within general practice. What hasn’t been sorted is who and how that supervision is covered when the doctors in a practice are already overstretched. Incredible practice nurses providing chronic disease monitoring and practice pharmacists having an overview of medications and monitoring their use and interactions have been a godsend to practices. PAs could be the same but not when they are pulled in in place of a doctor. Suggesting that GPs work is dealing with uncomplicated patients is far from the truth but believing that all patients have simple ailments requiring a lower level of expertise than the robot attached cardiac teams appears to perpetuate the myth that GPs are inferior beings who are failed hospital consultants. The bullying of GPs by government and media over the last few years is intolerable – especially when Jeremy Hunt is asking for better productivity from the NHS – GPs have already done this with more face to face appointments since the pandemic and added to it remote consultations that many patients often prefer rather than take time out of their day to take a trip to their GP. Practice teams are varied and hence multiskilled. Suggesting that all PAs are being bullied by stressed GPs who are expected to supervise them in a working day without a space to do so when the NHS is so badly supported by the government. The only thing keeping the service going is the commitment of those dedicated to their patients. Having spent my working life in the inner city give me a drug dealer any day rather than a politician using their media cronies to stamp on the people trying to do a good job in difficult circumstances. PAs will be useful members of a team but they need the supported role that their training expects and it is completely unfair to expect them to take the same role as a GP with ten years of training. There can be nothing more stressful for a profession than to be expected to take responsibility for a role they haven’t been trained for with the risks of the mistakes that could potentially follow.
A masterly class in sophistry by Lord Bethell designed to conciliate GPs (yet irritates further). Reminds me of what Arendt said about this sort of “argument”.
“The most striking difference between ancient and modern sophists is that the ancients were satisfied with a passing victory of the argument at the expense of truth, whereas the moderns want a more lasting victory at the expense of reality.”
Yet again. Can’t be part of the argument. So use the big Bully and Harrasmsnt to stop people from talking a out the facts. Seen it too many times. The course of the weak to stop real conversations happening. Sad..
Most of the bullying I have seen has been against General Practice itself by the incumbant government. Refusal to engage, starving of funds through the pandemic -and culminating in a miserly 2% budget uplift (again) to cover govt enforced 6-10% pay awards. Bringing in a tier of partly trained staff that we have to teach our job to (whilst denying opportunities to our fellow doctors and nurses) , but also supervise and take medicolegal responsibiltiy fo- ultimate coercive behaviour.
PAs do drive a wedge into the profession, but they also threaten existing already regulated and much more experienced individuals who are Nurse Practitioners or extended scope practitioners. Their title needs to return to Physician’s Assistant -the grammer is important.
Paragraph 7 appears to indicate that it is unfair for PAs to get this sort of behaviour from others, but it is quite OK for doctors to suffer it, because they can just leave and go overseas. This seems a little unbalanced to me.
The worst of all this is that the blokes who are responsible for the whole mess through failure to consult and consider effects on others, are getting away with riches and gongs for leaving a toxic mess behind them through their failures. They should face up and put it all right.
Maybe, just maybe, the reason for the emotion in this highly charged debate is because doctors (perhaps especially GPs) are fully aware that the training gained from the PA course will be entirely inadequate to the task of seeing undifferentiated patients in primary care, and it is therefore a life and death issue for our patients. Maybe we feel we have a responsibility to safeguard a health service (of sorts) and access to medical attention, as we have seen the outcomes from mismanagement due to inexperience or inadequate supervision? Maybe we are well aware there is a fatal train crash about to unfold on the population and are trying to warn anyone who cares to listen? Please don’t assume it relates to bad intent, or a toxic culture- I sincerely don’t believe this is a protectionist argument, but a safety matter first and foremost.
‘Doctors leaving in droves due to toxic workplace ’. Oh Lord so you get others there to replace them and groan about toxicity. What happens when patients groan in pain and suffering due to this. Why not act to remove toxic workplace and retain doctors. People kept it in past so crazy ideas like this were kept away whatever happened. I feel sorry for people and patients to suffer due to these follies daily..
Fantastic response Jo
Dear Lord Bethel
I have faced sexual predators so I know what gas lighting looks like
Read the Room
When he came before the house of Lords commissioner for standards, I am sure Bethel was represented by a barrister and not a legal assistant..
He opened himself to charges of “cronyism” published in The Guardian
In November 2021, it emerged that Lord Bethell had been part of a government meeting regarding a £600 million contract with Randox, the clinical diagnostics firm for which Owen Paterson was found to have breached[15] parliamentary standards in which, against protocol, no minutes were taken
In November 2021 he stated in a witness statement that three prior explanations he had given for why he could not access his messages – that he lost his phone, that his phone was defective and that he had given it to a relative – were incorrect and that he had deleted them because he incorrectly thought they were backed up
This is a man who admits to incorrect witness statements.
Hardly any a trustworthy source.
So last week this Lord says “GPs do not face huge amounts of complexity. Most interactions are incredibly straightforward.” – Lord Bethell.
This week, “doctors are held in such high regard within the healthcare system, by the public, and by parliamentarians like me”.
Which is it?
I believe this Lord Bethell misled the House, in a written answer to a parliamentary question – “NHS:
Protective Clothing Department of Health and Social Care written question – answered on 28th April
2020”;
https://www.theyworkforyou.com/wrans/?id=2020-03-17.HL2713.h&s=speaker%3A13194
“NHS Supply Chain and Public Health England have worked with manufacturers and/or independent testing
houses to formally test certain products, to see if it is possible to extend their life via accelerated age
testing. The products that pass these stringent tests are subject to relabelling with a new shelf-life (as
appropriate) and can continue to be used, all that are not up to standard will be destroyed.”
I FOIAed and wrote to Bethell directly.
No evidence of those “stringent tests” were ever provided to me.
Would you Lord Bethell be happy to see ir have your family see a PA? Would you actually, like the current PM, see a private GP. We’re creating a two tier system the rich will see private GPs the poor, some allied health professional.
Doctors are leaving because of “the toxic workplace “? Nothing to do with chronic underfunding by the Conservatives?
It must be frustrating, though, to recall all those abusive messages when you unfortunately lost your phone data, because you had lost your defective phone that you had given to a relative, before the enquiry into the Abingdon Health contract.
“Gaslighting” an overused term but this is the very definition. And he comes here to defend himself and present his entirely spurious arguments? Incredible, pathological lack of insight. But then he is a Tory – is there a Read Code for that yet?
The bully is complaining about bullying when he and his colleague’s bullying tactics arent working. Toxicity was created by parliamentarians like Lord Bethell.
Just when you thought this pathetic government of squatters and corrupt hangers-on couldn’t stoop any lower, this.. person.. pops up.
Honestly who could care any less about the opinions of some hereditary member of our triple-chinned cousin fiddling aristocracy?
“During the COVID-19 pandemic, he was Parliamentary Under-Secretary of State for Innovation at the Department of Health and Social Care and was involved in negotiating various controversial contracts.”
Oh! That’s who this is! Really covered himself in glory there, didn’t he!
Wow! Quite shocking
But mostly, depressing… sad and troubling.
The people of this country deserve so much better than the likes of Bethell.
Elevated thugs and bullies who are willing to drag discourse into the gutter with the clear intention of confecting division and conflict, presumably either to distract from their own serious political failings or to bring about certain advantageous outcomes for a select few regardless of the damage they cause for everyone else. Such people don’t really want to understand the reality of any issue.
Lord Bethell needs to look more fundamentally at general practice and address the fundamentals of poor funding and support for general practice
The figures indicate lower funding, higher list sizes ‘ lack or realistic deprivation funding
GP s are burning out and being misrepresented by Lord Bethell and the government
Invest properly in primary care and not put expensive sticking plasters on the problem in the hope it will staunch a major haemorrhage!
Sadly there are still those who believe that there is ‘good faith’ involved in this argument.
They believe that the intention is to improve the NHS, and improve care and to improve the health of the population.
The same people who managed to turn covid into a money-making exercise, are back.
They are using health care inequalities. They are using the need for medical care. They are using the good will and good faith of health care workers.
These self professed ‘bullies’ believe it is their right to exploit people for their own profit.
This profit is way beyond their needs, it is about identifying their ability to exploit their public roles to take as much as they can because they can.
This involves using their share holdings, and then deregulate the industry making the operating costs significantly less abusing the public role which they have on trust.
This is why the PA project is tied directly to under paying and under recognising all professionals.
This applies to the NHS, to education and to all public services.
‘Privatising’ the service removes it from the ability to siphon public money out into their personal accounts.
An analysis absolutely dripping in stereotyping, generalisation, projection and a stupendous over-estimation of understanding (aka ignorance). This guy has an axe to grind, an over inflated opinion of his own competence and it depresses me that people like this can do so much damage and feel so pleased with themself in the process. Thank god I am just a few years away from escaping from these idiots
The root cause of why politicians have led the NHS into the abyss aided by poor NHS leadership that they themselves often they endorse is encompassed in this rant in my opinion. The GMC additionally supports this regulatory ARR change but itself is an unregulated body in which many of us have absolutely no faith or trust whatsoever. It is sad other than I now see more clearly the underlying reasons for this continued politically led (poor NHS leadership assisted) decline in NHS healthcare.
comparing GPs to drug dealers……….. that’s a new insult to add to the collection . Completely offensive and unprofessional from a Lord
(hereditary) peer pressure
Or Lord of the F***Lies
An analysis steeped in privilege, partriarchy, conceit simply ignoring justifiable concerns from the profession. But the Lord knows best because, well he’s a Lord who has a Cardiothoracic surgeon mate …
Interesting that Bethell should reference Pastor Niemoller whose most famous quote was about the destabilising effect that the Nazis had on society through their cruel, vindictive and ultimately genocidal culture wars.
Perhaps he would like another quote attributed to a chap called Joseph Goebbels which goes along the lines of ‘accuse others of that which you are guilty of yourselves’ although I guess he may have heard of that one already.
Or that other one which was definitely his which was ‘make the lie big, make it simple, keep saying it and eventually they will believe it’.
Graced with an entire page in Pulse: an opportunity to argue the case in favour of PAs, and show us the evidence base demonstrating their safety and competence and how they would fit into the current system without further imposing on a an already depleted system.
Instead, free of facts, he plays the man not the ball. Doctors are all too aware of what gaslighting and bullying looks like Lord Bethell, we’ve been under Tory rule for 14 years.
Anyway I’m going to sign off now to make a donation to the Good Law Project.
(Hoping that the poor chap finds his phone)
‘When I worked at the Ministry of Sound, we used to facedown local drug dealers, so I know what the intimidation playbook looks like. That’s what came my way. A deliberate attempt to frighten off a parliamentarian from supporting a worthwhile profession’
This says it all. What an utter numpty. He’s like a character from the Fast Show.
Dear oh dear. This is the numpty that gave Matt Hancock’s girlfriend her Parliamentary pass.
He is not worth wasting your breath on. Head down. Ignore the hoo ha.
I am not supervising anyone full stop. It’s unsafe.
I will supervise medical students and junior doctors in their clearly demarcated, time delineated period of approval and it’s foxtrot oscar to the rest
Don’t get poorly, mate.
They were probably charging more than the market rate for their wares a bit like the Tories cronies and the crap PPE the were touting eh!