Student protests

Students have expressed fear of being penalised for engaging in activism, with one participant explaining: “I always felt that, as a medical student, partaking in activism was going against the standards that we are expected to adhere to.” Some students have voiced concerns that their involvement in political activism may be seen as ‘unprofessional’, and there is growing anxiety over professional consequences. One student said: “My medical school would consider it unprofessional. They have said doctors should be apolitical.” Another student expressed fear about potential retaliation from the General Medical Council (GMC), citing the suspension of doctors involved in climate action groups such as Just Stop Oil. The overarching sentiment among students is that their right to protest is not adequately protected.

Right to protest

As one student noted: “The university has not gone out of its way to ensure our rights to protest are protected.” As activism in the UK increasingly faces criminalisation, medical students feel their voices are being silenced. One student shared their anxiety about the potential impact on their future career: “Protest is being increasingly criminalised in the UK and we are a highly regulated profession (GMC).” Another reflected on the fear of prejudice from university staff, stating: “The stigma and prejudice staff of the medical school will hold against me and may use to influence results when sitting exams.” A particularly concerning comment came from a student who said that ‘on pro-Palestine marches, people were being threatened with expulsion’.

Solidarity

The Doctors’ Association UK (DAUK) stands in solidarity with medical students, advocating for the protection of their right to protest and express their political beliefs without fear of professional retribution. The ability to stand for justice, human rights, and humanitarian causes is integral to the ethos of medicine, and it is imperative the medical profession supports its students in doing so. Medical schools must provide clear guidance on how students can appropriately express their political and social views without risking professional repercussions. With increasing instances of humanitarian events and global unrest, medical schools should take a proactive stance on educating their students on how to advocate for causes important to them, while ensuring their professional standards on protest are relevant and fit for the modern day. Please support our work by contributing to our crowd funder or by becoming a member.

Picture credit: Markus Spiske on Unsplash

Hottest year on record

It’s official. 2024 was officially the hottest year on record, breaching for the first time the 1.5C threshold set by the Paris Climate Agreement. Stable weather patterns we have taken for granted for millennia are breaking down before our eyes and we are seeing the effects of this in the UK and globally. Last year gave us widespread flooding in north and south Wales, Manchester, Shrewsbury, Worcester, Loughborough, West Sussex, the Isle of Wight, Dorset, Newcastle, Surrey, Oxfordshire. Just about every region in the UK experienced severe flooding and storms.

Climate change

The increased severity of weather is human-caused climate change through the burning of fossil fuels. And this is just the beginning. We will experience stronger storms and worse flooding in the years to come. The Californian wildfires demonstrate the strength of the natural forces around us and the futility of our actions when faced with the impacts of climate change. During 2024, wildfires in Greece, Portugal, Turkey, Brazil, New Zealand, and other countries caused immense damage. For many people, they brought the climate crisis even closer to home. What we have previously viewed as ‘normal weather’ is rapidly disappearing.

Rising temperatures

And as we continue to emit more carbon from fossil fuels than we absorb, global temperatures will continue to rise. Catastrophic weather events will increase in frequency and intensity. They will affect our food production, our public services and our health. 2025 can be the year the UK shifts the dial on climate change action. In addition to the Government’s Net Zero commitments, we must go further and faster to secure a liveable future. Legislatively, we must pass the Climate and Nature Bill, to lock into law a commitment to restore nature by 2030. Nature is our greatest ally in reducing carbon emissions. We must help it to help us all. The second reading of the bill is on 24 January and we urge everyone to contact their MPs to ask them to attend.

Public health

Furthermore, we need a public health awareness campaign on the climate crisis. The UK public needs to know why we have to take stronger and more urgent climate action, in the same spirit as highlighting the importance of wearing masks in the pandemic. We urge the Government to work with healthcare professionals to make this happen. Our Health, Our Planet is already having an impact in raising this awareness. We welcome discussions with national and devolved governments on the use and amplification of the resource to raise awareness to everyone what climate change means for our health, and what we must do to secure a safe and liveable future for all. Please support our work by becoming a member or donating to our Go Fund Me.

Today marks one of the most pivotal moments in modern public health; the closure of the last coal-fired power station in the UK.

Coal was instrumental in giving the UK an economic headstart with the industrial revolution and for over 140 years has contributed to powering our homes and public services.

It has contributed to the living standards we expect today, but this has come with a heavy price of climate catastrophe through the release of greenhouse gas emissions.

The heatwaves, floods, crop failures and spread of disease from climate change have come about because of the warming effect caused by the greenhouse gases released from coal, oil and gas.

The effects on health have been seen across the globe, though the UK continues to be somewhat sheltered from catastrophes on the scale of the floods in mainland Europe or the wildfires in Canada.

Nevertheless, we are becoming more exposed to the wrath of the environment. While this year has made itself known for being one of the wettest on record, it is a record that will inevitably become the norm.

People often say ‘China, Russia and the US are all much higher carbon emitters, anything the UK does is negligible’.

However, carbon emissions are cumulative. Some of the gases we released 140 years ago will still be in our atmosphere today.

For the first 50 years of the industrial revolution, the UK was responsible for approximately 100 per cent of global greenhouse gas emissions, predominantly because of coal.

Morally, the UK has a duty to lead the way to a decarbonised future running on cleaner energy. The current Government has announced plans to phase out gas from our energy grid by 2030.

This must be an absolute deadline and we encourage the Government to increase their ambition and meet the target comfortably before the next election – all our lives depend on it.

We all have the power to bring this change sooner. Moving your money away from banks that invest in fossil fuels and switching your energy supplier to a renewable one will accelerate change.

If you are a GP partner, make this change on a much bigger scale and move your whole practice away from fossil fuels. Crucially, tell your current supplier and bank the reasons why you are leaving.

And what better day to do so, than the day that coal is phased out of our power grid and confined to the history books, exactly where a fossil fuel should remain.

Visit ourhealthourplanet.co.uk to find out more about decarbonising your home and workplace and about how climate change is affecting our health in the UK.

NHS Practitioner health is a free, confidential primary care mental health and addiction service with expertise in treating health and care professionals in England and Scotland. It is a self-referral service to which doctors and senior health service staff can turn in times of distress, depression, anxiety, suicidal impulse and addiction. The service is currently treating more than 6,000 doctors and other health professionals. 60 per cent of these are hospital staff. No new referrals can be accepted by the service for hospital (secondary care) staff from Monday – because there will be no funding to treat them.

Without warning, this bombshell has been dropped on the service which must close its doors immediately to staff in distress and difficulty. No other service exists which can offer safe, effective, confidential and compassionate care for those who have dedicated their lives to caring for others.

More than 32,000 doctors and others have been treated by the service since it was founded by Dr Clare Gerada in 2008. Ironically, the decision to cease funding care for hospital staff flies in the face of Dr Gerada’s founding instinct – which was a response to the tragic death of a mother and baby. The mother was a junior hospital doctor who was so scared of the stigma of mental health that she could not seek help from the very profession she was seeking to join – psychiatry. If another doctor like her were to seek help on Monday, she would find the gates of NHS Practitioner Health closed to her.

I have worked for NHS Practitioner Health for five years. I qualified as a GP in 1984. I have first-hand experience of involvement in the compassionate care that doctors and other health service staff have come to trust. I know that it is a safe, effective, reliable service that provides a unique lifeline to doctors on the edge. We keep doctors in work, helping them through their troubles, discharging them only when they have recovered. Our service serves all the patients that our own patients treat. The benefits of Practitioner Health spread out from the doctors we treat, across the whole of the NHS.

Our service is the first port of call now for those concerned about the wellbeing of doctors. The GMC and the other professional regulatory bodies routinely recommend that their members turn to us for help. Responsible officers and occupational health practitioners, training programme directors and educational supervisors, general practitioners and psychiatrists, coaches and counsellors all signpost troubled NHS staff, knowing that self-referral to NHS Practitioner Health will help.

The new commissioners should think again, urgently, today – and reverse their decision. By all means, have a review, a cost-effectiveness analysis, test the market to see if a cheaper, more effective service could be commissioned. But to cease funding without evidence and in the face of the mounting pressures in the health service, burnout, issues with retention, understaffing and underfunding is perverse, wrong and irrational.

It is also profoundly disrespectful to the practitioners working for NHS Practitioner Health who strive to support their colleagues when they are at their lowest point.
Think again!

Dr Peter Bailey

It’s fine. I have a legitimate job offer. I’m a key worker. I’ve studied and trained in the UK I’ve been in the UK for close to a decade. I’m just here to visit and fix up my living arrangements before applying for my visa. I’m sure they’ll understand. That’s what I had thought. Until I found myself in detention at the UK border. Several months before, as I booked my flights in advance to get back to the UK to start a new medical job, I kept reassuring myself with similar thoughts. I tried to ignore the fact that the health board was taking forever to get my certificate of sponsorship issued; despite my regular reminders, and with few replies on their end. As the number of days to my flight and my new job decreased, the certificate of sponsorship was still nowhere in sight. The niggling worry at the back of my mind slowly grew. Flying without a work visa, I thought: I’ll just come in with a visitor’s visa first to sort out my living arrangements. I’m sure they’ll understand. I need to settle in so that I can start work the minute the visa is issued. The NHS as a civil service/public institution would not let me work without one, the border control would understand that. Instead they said I was at risk of starting work without a visa. I was detained at the border, with my mobile phone taken away from me for several hours. I was informed that I would be put on the next available plane back to my last port of call, which was a city in Europe and nowhere near my home country. I remember how completely surreal it felt, like a living nightmare. Thanks to friends who rallied support from MPs, DAUK, and my union the BMA, I was able to have the deportation order rescinded with extraordinary difficulty. Unfortunately not everyone is so lucky to be that well supported. As it is, being a NHS doctor is hard enough with the pressures currently on the system, let alone adding on the worry about your right to legally remain in a country. And the sad part is that I know I’m not the only one. I have other non-UK colleagues who speak of the pressure of waiting for visa extension decisions long after their current visa has expired. Of being unable to leave the country to visit their loved ones for fear of not being able to get back after. I’m sure many readers who are also overseas workers have their own experiences to share. The government repeatedly declares that they’re supporting and fixing the NHS. Do they forget, for instance, that approximately 25% of doctors working in NHS England are non-british nationals? Having the threat of detention and deportation over one’s head does little to help with making the UK an appealing country to come to work. I personally know of several excellent colleagues who previously had planned on working in the UK but feel it is no longer worth it and have returned home. If the UK government truly believes they are doing the right thing to address the workforce shortage in the NHS by attracting qualified healthcare professionals from overseas, then they need to sort out fundamental issues such as the visa application backlog, and making it easier to get indefinite leave to remain.

Our thoughts on the BMJ report as we reflect on the end of #raceequalityweek2023.

Abridged excerpt from Slay in Your Lane:

“Living in a white, patriarchal society means [black women are] often reduced to patronizing stereotypes, rather than being treated as intelligent equals worthy of society’s time and respect.”

This is entirely relevant to the NHS and we just need to look at those at executive level, the salary and contract security gap and the punitive culture that gets used by people in Britain.

Many are sick of it, have left medicine or the country because of it and are calling for the GMC to be disbanded and replaced by another organisation. (Please see petition link for interest). This has probably come from seeing executives who have overseen huge miscarriages of justice in their decade long tenure, simply staying in their positions believing empty apologies have gone unnoticed. Charlie Massey’s statement of the imperative need to now act is absolutely the truth for the survival of his job and perhaps even the GMC.

Ethnic minority doctors working in the NHS are twice as likely as white doctors to be referred by their employer to the General Medical Council and it is shameful we need reports and reviews to get people enforcing these behaviours to change. When we hear of those committing suicide such as Dr Suresh whilst waiting a decision, that life matters and that life was ruined by an unjust culture. We need to be aware those that are able to refer need to be trained and that includes in unconscious bias with significant help to those that come from homogeneous backgrounds and have chosen to not become literate in anti-racism.

It would seem that those enabled to weaponise the punitive culture see black and brown people as their racial inferiors and perhaps not even human but just like cattle – animals that need to learn obedience. As we become more and more global this culture is going to anger the already angered international community and is not good for public relations during a time where Britain is showing signs of being increasingly economically vulnerable. We are currently reliant on as much as 25% of our healthcare workforce being international. What they seem to get is not gratitude or good vibes but toxicity driven by structural racism that organisations are clearly still negotiating.

Please find recommended books below (all reflect on British racism to avoid dissociating to America etc)

DAUK would also like to invite you to our conference where we have an anti-racist panel as well as discussing the dehumanising culture we can find ourselves navigating, often feeling alone or unable to help others. If you opt for face to face it is a good way to meet like minded people and network with some of the most amazing medical advocates. There is also an online option too. Please see below for further details and think about supporting our Overseas NHS workers day 2023. Follow the updates on our Overseas NHS workers day 2023, when we celebrate the contribution of our migrant NHS staff.

DAUK conference & Exhibition

Sign the Petition: Create a new regulator of doctors to replace the General Medical Council (GMC)

The General Medical Council (GMC) needs to be replaced by a new, fully accountable body, with transparent, constructive and competent practices and policies. It’s time to establish a different organisation, that can truly, yet efficiently, represent the needs of patients and doctors.

“I’m so very sorry for the long wait…”. These apologies are now the first words I express to my patients in the Emergency Department and I am always anxious to hear their response. If they voice understandable frustration, then I must dedicate precious minutes to further apologies and explanations, as I empathise with their warranted (albeit difficult-to-digest) negative feedback. In true British spirit however, I am invariably met with something along the lines of “oh that’s ok Doc, I know how busy you all are and I’ve really been ok here”. While these verbal exchanges offer some relief to both parties, they should not be the opening dialogue of a medical consultation and the situation certainly is not ok! Especially not in an Emergency Department where it is often a matter of life or limb to be seen and treated quickly.

Years of underfunding, understaffing and surging demand have now reached a breaking point and the sword of Damocles hangs over NHS staff and patients with an increasingly sarcopenic grip. Waiting times and suboptimal care are at an all-time-high, while staff morale and patient satisfaction are at all-time-low. Both patients and staff suffer every day and despite the alarming accounts and crisis calls from the frontline, the situation continues to deteriorate.

In the Emergency Department, corridor medicine has become the new normal, waiting times in the double-digit hours now represent the new standard of care and chaos reigns. These chaotic corridors are a morbid motorway of sirens, screams, sickness and sadness. As I survey the madness, I see my depleted colleagues; healthcare assistants undertaking vital observations and investigations on overwhelming hordes of patients, all the while coordinating a food and drink service for those who haven’t had anything in hours; nurses administering life-saving medications and infusions while desperately playing “bed jenga” in an attempt to create space and dignity for the dying; paramedics waiting hours to transfer patients into a hospital bed, while helplessly turning down their radios from dispatchers desperate for anyone free to attend the next cardiac arrest, seizure or major haemorrhage; and my senior medical colleagues valiantly extinguishing fire after fire from an empty tank, while their hands are tied behind their backs. It used to be patients that would burst into tears in hospital, now it’s usually the staff.

Sadly these stories are not unique to one department or hospital, they occur each day throughout the country. It is so very wrong and you don’t need a medical degree to diagnose it but year-after-year we are discredited and gaslighted with statistical spin and political puppetry. The situation is unsafe, unfair, unsustainable and frankly, unforgivable – people’s lives are literally on the line and we all deserve better! In a last ditch effort to engender real change, nurses, paramedics and junior doctors are now exploring industrial action. It’s not just about our wages; it’s about securing the necessary funding and commitment for a safe, effective and sustainable NHS, while raising awareness about the terrible conditions inside a once world-leading healthcare service.

I would urge all those on the other side of the table and in positions of influence over the NHS to step down from their ivory towers and spend just 24-hours in the trenches of A&E. Here they would be faced with the fallout from years of neglectful placebo pushing, while withholding the real medicine; more beds, more staff and more funding.

Many of my colleagues and I, see the government’s response to this as a proxy for their wider commitment to the NHS. If they continue to disengage, discredit and deny, then I fear that for swathes of staff this will not be a temporary walkout but a permanent one and the soul of the nation will suffer an untimely death.

Global carbon emissions must peak by 2025 at the latest and be falling rapidly by 2030 in order to prevent the worst impacts of climate change, according to a report released this week by the International Panel on Climate Change. However, current policies do not come close to being adequate. (1)

The climate crisis is a healthcare crisis. Globally we are already seeing the effects of a warming atmosphere by more than 1°C: raging wildfires in Siberia, Australia, and across the Americas, fatal heatwaves in Canada and Europe, and increases in the number of storms we experience here in the UK.  

Aside from the immediate threats to health these extremes pose, as UK healthcare professionals we already see consequences of the climate crisis more than we might realise: the asthma attacks triggered by air pollution, the psychosocial hardships of having homes flooded or destroyed by storms deepening inequality, the anxiety in children who are terrified of what their world might look like with the effects of climate change.(2) It is even hypothesised that COVID-19 may have emerged in part due to climate change. (3)

First, do no harm. One of the fundamental principles of medical ethics, something that we must adhere to on a much wider scale, for the patient in front of us and for our children alongside us. The reusable coffee cup, the car-share, switching off the computer at the end of the day, individually seem insignificant actions, but together, as one of the largest employers in the world, the NHS can be a powerful instrument in the battle against climate change. But we must start now. This is the decade to prevent catastrophic damage to our home, and we are already two years in…


1. Intergovernmental Panel on Climate Change. Climate Change 2022: Mitigation of Climate Change. United Nations; 2022.
2. Hickman C, Marks E, Pihkala P, Clayton S, Lewandowski R, Mayall E et al. Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. The Lancet Planetary Health. 2021;5(12):e863-e873. doi: 10.1016/s2542-5196(21)00278-3
3. Dash S, Dipankar P, Burange P, Rouse B, Sarangi P. Climate change: how it impacts the emergence, transmission, resistance and consequences of viral infections in animals and plants. Critical Reviews in Microbiology. 2021;47(3):307-322. doi: 10.1080/1040841x.2021.1879006

Starting medical school in 2008 felt like a dream. I can’t say that it was a lifelong dream though. You see, I didn’t grow up wanting to be a doctor. Trudging through the pits of depression, anxiety, and agoraphobia through law school led me to medicine. Back then, my interests faced inwards. However, confronting myself emotionally made me realise that service is important. Medicine is how I chose to live out that value.

While the first and second year of medical school was a blast in every way, the third year whiplashed me into a stormy path to learn some hard lessons. I had a car accident. Worse yet, I sustained a spinal cord injury and quadriplegia.

Despite all this, I still love life. I’m grateful for everything that I have. This includes some of the intricacies that such an injury bestows on life. 

I was in New York during a December. Coming from Australia’s hot summer, this was a chilly change. Thanks to the condition that changes the body’s response to thermoregulation, I wandered around shivering in New York looking like a well-wrapped ninja stopping occasionally for hot water. These are things that few people realise about a spinal cord injury. Not even I understood what was to come when I woke up on an intensive care bed in 2010. Apart from the very dramatic changes physiologically, life suddenly changed socially as well. We lost money, friends, and family. My own family, which was once a warm fortress of safety, fell apart. What was left was mum and me. I often felt physically and figuratively naked.

Being a patient was tough. I watched medical students do ward rounds on me, addressing me clinically. I rarely felt like a person. There were harsh doctors. There were encouraging doctors. There was a loss of autonomy and empowerment. For months, I didn’t even choose when I showered or ate.

In that hospital was a nurse who was oddly particular about cleaning the male patients’ privates. While one was chilling out in the ward waiting for the day’s therapies, you would often hear this nurse’s booming voice rolling down the corridor. If you were unlucky enough to remain in their path, the inevitable question came. “Have you cleaned your little man today?”, they would say. Regardless of the answer, you would be dragged off to the bed to have the little man cleaned.

With an unusually clean little man, five years went by. I slowly put life back together and plotted the never-ending dream of coming back to medicine. Some said that I shouldn’t do it. Some of my best friends talked about the challenges that would lie ahead and encouraged me to pursue another path. They wanted me to avoid the pain.

This was a time that I remembered the very thing I understood during that time in law school. When we come to the end of our life, no one else will be accountable for the choices we made. If I didn’t give medicine a try, I would regret it forever.

My mum and I, with the support of a forward thinking medical school, came back in 2015. I started life again in Gold Coast, Australia with nothing. We had a couple of bags, a broken wheelchair and some borrowed furniture. I spent weeks in the medical school’s clinical skills lab with a supportive general practitioner, school staff, and a simulated patient learning how to do a physical examination again. This time, I had to think laterally about achieving the same clinical outcome through different physical means.

I figured out how to do most things. I put my head down in a way that I never have before. The injury has forced me to focus my head more. I passed exams and started proving that this can be done. Perceptions however, were still adversarial.

I became privy to a disturbing email circulated on 14 October 2015. In the email, an academic stated that they had developed national inherent requirements for medical students. The academic, who knew me, wrote, “we should refer to them if we are making any difficult decisions about candidates’ suitability to enter or remain in the MD.  They do not bind us to exclude anybody but it is hoped that they will provide some legal protection where we do have to make the difficult decision that a candidate’s disability cannot reasonably be accommodated to enable them to study medicine.” Reading these words was nauseating. By this point, I’d gone through many clinical rotations successfully. Why was there suddenly policy that allowed schools to prevent people like me from study medicine?

I read through these inherent requirements. They prescribed physical qualities that would surely exclude me from going through medical school. Fortunately, I wasn’t affected by and graduated in 2016.

Then, another challenge came. In our state, domestic graduates are guaranteed internships. I also had a contract with the Health Authority that bound me to work for them for five years after graduating. Nonetheless, my application was removed from the pool to be “considered separately in a bespoke process”. As the opaque process dragged on, I asked more questions. At one point, I was told that I wouldn’t be starting work with my colleagues and was offered free psychological support instead of a job. After going through the rigours of a spinal cord injury and depression previously, psychological support was not what I wanted. I wanted to work.

I had a lot of supporters in the community, doctors, media and politicians. Emergency physicians in our department even offered to give up some of their salary to fund my position. Thanks to everyone, I was offered a job at the twelfth hour and I started work in 2017.

I have loved every minute of this job. It’s everything that I imagined it to be. And more. The challenges medicine places on a person allows one to experience parts of humanity that would otherwise be inaccessible. I have not only grown as a person, but have come to appreciate people even more.

They have been more than one tired nightshift in the emergency department where I have shared journeys with patients going through life changing events. Medicine happens. We all have the technical skills. My most memorable moments on the job have been the difference just a cup of tea and a chat has made.

The challenges didn’t stop with the internship though. I once started a conversation with a radiologist about pursuing a career in the specialty. Their first reaction was, “I have so many concerns about this. Can you even type?” Later, in response to my questions about the roadblocks roadblocks they kept putting my way, I got a call one day. They said, “You cannot work in our department with a spinal cord injury. If anyone asks, you can’t tell them that I said this. You have to tell them that it is the position of our whole department that you are not wanted.”

Lucky for me, there were many more radiologists that were willing to fight for what’s right. Right now, I work in Australia’s busiest emergency department surrounded by a supportive team that I call family. I even met my beautiful fiancé there.

I am heartened that we are now changing policies about medical students with disabilities in Australia. We are developing professional standards to include a variety of people in this profession.

 I like to think that having a wide variety of perspectives benefits our patients. After all, shouldn’t our lived experiences go towards caring for our patients better? The arguments for including a diverse group of people in the practice of medicine are many and obvious.

Most importantly, what we do as doctors has an effect on the rest of the community. We have always had the privilege of being thought leaders. The work that has been done on doctors with disabilities have had widespread repercussions for employment and education broadly. For our profession, leading the way is a must.

Dr. Dinesh Palipana OAM, LLB, MD

Doctors with Disabilities Australia

Griffith University