Doctorsaurus Rex & The Rise of the Noctor
Part 2: Fifty Shades of Covid Tyranny: The Present
“During the last generations the medical monopoly over health care has expanded without checks and has encroached on our liberty with regard to our own bodies. Society has transferred to physicians the exclusive right to determine what constitutes sickness, who is or might become sick, and what shall be done to such people. Deviance is now “legitimate” only when it merits and ultimately justifies medical interpretation and intervention. The social commitment to provide all citizens with almost unlimited outputs from the medical system threatens to destroy the environmental and cultural conditions needed by people to live a life of constant autonomous healing.
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Limits to medicine must be something other than professional self-limitation.
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Professional power is the result of a political delegation of autonomous authority to the health occupations which was enacted during our century by other sectors of the university-trained bourgeoisie: it cannot now be revoked by those who conceded it; it can only be delegitimized by popular agreement about the malignancy of this power.”
From author’s Foreword (1995 edition), Limits to Medicine, 1976, by Ivan Illich
Illich was right, and his wish is granted. Medicine has been removed, with the accelerant of State covid policy from ancient, professional normative values. Illich would, nonetheless, be more unhappy: medicine and the definition of health is now under the centralised, global control and delimitation of a State-corporate-military complex.
Previously, I had written on the strange death of medicine. It is, I realise, strange because it is a transformative event. Some colleagues say it is the ‘American privatisation’ model nearly fully-implanted. It is more than that. It is the reformation of a church. The new, State-nominated priest is the Noctor. I am surrounded by so many, I no longer remember what all their acronyms mean. Nurse ACP & ANP, non-nurse PA & HCA, Paramedic FCP & AP, etc. They seem to know not that much medicine, they have less or no experience of my role, but they do most of what I do, and they are paid less than a GP (usually, but not necessarily). Often, their pay exceeds a junior hospital doctor’s. I believe it is a recipe for poorer individual healthcare provision and iller health.
Even after the independence of physician and surgeon education was adulterated by a Rockefeller petrochemical industry, at least the discipline of meaningful, strict medical diagnoses survived. Post-covid that, too, is gone. Today, it is normal for a worried, well patient to book an appointment simply to tell you they have been diagnosed with covid by a piece of cheap, profitable plastic. The question is begged, What am I still doing here? Catalysed by covid policy, extinction has crept upon UK family physicians like a silent assassin. They were too busy, and self-assured to notice. Other leading and managing colleagues sold the rest out in favour of self-interest, and cheap labour for short term fixes.
The Prehistoric Doctor
At the inception of the NHS, up until the early 1950s, GPs were performing complex emergency abdominal surgeries, and providing the general anaesthesia. GP colleagues working in off-shore Scotland were performing appendicectomies in the 1980s. In the 1990s ‘Clinical governance’, ‘restructuring’ and Calman’s 1995 ‘Calmanisation’ restricted medics’ professional flexibility and self-determination in favour of standardised, accelerated senior career paths to consultant posts. As a junior doctor I had the liberty of doing any job in any specialty at anytime I chose, thus becoming a well-rounded doctor moulded in my own image with the blessing of my seniors. One entered a didactic medical hierarchy … a ‘firm,’ where one lived and died by the professional standards and prejudices of one’s boss, he who ultimately carried a major clinical responsibility for your actions on his patient. It was simple and effective, but not infallible. It did serve to prioritise clinical care over box-ticking.
By 2000, Harold Shipman became the standard by which the UK profession was judged and mistrusted. Naturally, aspiring school students became a self-selected cadre of uncaring, murderous sociopaths; unfiltered and promulgated by medical school selection processes and education. We do-gooding killers had to be stopped by GMC over-regulation and over-reach. Yearly revalidation introduced to placate the public’s fear did nothing to prevent a future Shipman. It simply created a culture of obedience and silence where neither is a professional asset. In that process, the GMC itself underwent a communist reformation to its constitution. Professional values were admixed with lay-person values both in its structure and in the panel of its disciplinary process. No longer would fundamental human rights and the professional ethical judgement of a reasonable body of one’s senior peers be enough. Confected political correctness became king. By 2006 ‘Modernising Medical Careers’ policy had constrained junior doctors to an early choice of specialisation. This was not a good thing: the earlier one is professionally compartmentalised and elevated, the less clinical experience, and the more easily one is controllable.
By 2020 the State of Covid destroyed professional standards of medical safety and ethics in favour of pushing unnecessary, lethal, improperly-vetted injections for profit. It advised normally-competent, caring doctors to suspend standard, simple treatments and referrals for standard symptoms and signs. Most complied, awaiting the miracle gene juice, silently implementing orders, and inappropriately denying care. The irony of Shipman should not be lost. State and doctor, fused, were hurting, maiming and killing.
Now, the premature elevation to professional medical competency occurs before the cradle: non-medical staff are delivering the bulk of general practice patient care. Increasingly, they are not even qualified nurses. This increases the power the State has upon the profession and upon population healthcare. The interests of service providers increasingly trump individual patient choice and the wisdom of professional medical experience and seniority when it comes to each patient. One of the most remarkable inverse trends this millennium has been how wise senior professional colleagues are seen as old nags to be worked to the bone on basic service provision, until the final journey to the glue factory. Old, wise doctors are expected to work and be treated like young, inexperienced ones. It is humiliating, inappropriate, and injurious to the profession and to patient care. Both are now in decline and crisis.
Over my career, dedicated consultants’ offices, their secretariats and car parking spaces diminished, while managers installed and expanded theirs. It always struck me as contrary: surely a hospital without doctors at the vanguard of patient care is a non-starter? A de facto Manager-Patient relationship was born. This was sold as beneficial to the profession, but it was more beneficial to hospital administrators and politicians. After a life in the profession our seniors’ experience and confidence is subversive to management, and so that natural authority is now managed into the ground. In the NHS, Field Marshall Montgomerys are being sent to muck out the barracks’ latrines, day in day out.
The changes of the last four decades have dumbed down the profession, reduced our autonomy, and handed the mantle of our ethics from the ancient Greeks to Pharma and politicians.
A Country Practice
A senior GP colleague, living in his community, and being doctor to most of it for over 30 years, including to said patient. His neurologically-compromised neighbour falls, and lacerates a shin outside the front-door. It is wintery. An ambulance is called. An off-duty hospital nurse arrives, then a ‘fast-responder’ in a fast-looking car, and then, a blue-light ambulance. The off-duty nurse says the haematoma requires hospital. The fast responder says there is no way ‘Health & Safety’ would permit him to lift the man off the stone-cold pavement. He calls for a precious paramedic crew and their blue-lit ambulance to whisk him an hour to the nearest hospital. The fallen man does not wish to go, but goes by tick-box exhorts above common-sense. Amidst a sea of centrally-controlled, State algorithm health implementers, there has been standing an older man in a dressing gown, drinking his Sunday morning mug of tea, He is the off-duty GP, and neighbour. He says it did not require hospital, or an emergency. Someone in authority simply had to agree to take him back inside to the warmth of his house. No one listens to the man once-heard. He is, these days, a State-neutralised, decentralised, autonomously-thinking threat. No longer relevant, no longer audible. Another extremely respected GP colleague and mentor has fled after 35 years service to become a fast responder. A first aider with a car and oxygen. Imagine her patients’ faces. She will be compelled to train for the noctor privilege with a six month starter course. Individual agency in the West is at a nadir. We have reached a point of collective cultural insanity and conjoined infantilism.
The current state of the State NHS: a paradigm shift in doctoring
Covid policy has hastened a paradigm shift in healthcare. But for the majority who are rendered reliant upon State medical services being fearful, elderly, impoverished or cognitively impaired, the State could not get away with it all so easily. Medical colleagues do not help. Many continue to be blinded by, base themselves within, and celebrate being part of a politicised medical system counterproductive to health but conducive to status and profit. An unrealistic system of healthcare and healthcare regulation which regularly abuses and humiliates both those delivering and those receiving healthcare. It is a system which has recently been extremely damaging to society.
It is not only the medical paradigm. Everything has become the worst version of politics. Science is conducted politically, as is teaching, policing, justice, and journalism. No one in any position of professional authority within these professions which are based upon ethics, honesty, logic, openness, critical thinking, and due process is employing those techniques properly. Rhetoric, sophistry, and emotional manipulation are all they need to keep rising to the top. Any doctor or nurse who points this out is whacked by the system and by colleagues. The noble and courageous Dr David Cartland is an exemplar of many cases in point. It would not make sense in a normal world to silence, threaten and destroy a canary in a coal mine. It is a subversion of a natural order happening in all disciplines everywhere in the West. A symptom of a crashing financial system, led by the greedy with no idea except of tyranny. They cannot hear that they are wrong, and should be gone.
Whether one believes covid or not, amidst dysfunctional, crashing NHS computer systems which operate slower than the stressed NHS employee can think; and serial junior doctor strikes for non-living wages, it remains true that healthcare has been industrialised, centralised and moved away from the realm of qualified doctors, beyond the pale of ethics, rights and morality. A political-corporate tail wags the medical dog.
At inception there was no NHS pushing of anything, only a pushing of patients away. Even patients apologised for attending and using a precious, new social resource. Now everything is pushed to ensnare patients for third party benefit. There has been an expansion in group SMS contact with patients for agendas not driven by the patient: come measure your cholesterol, come have your jab, come have psychological reprogramming for jab hesitancy, be part of our research study, or please don’t bother us today for we are too stressed. There is reducing State interest and incentive for patient-initiated contact. Instead, why not visit the self help app, or endure the auto-consultation followed by, if one is lucky enough to get through, a telephone-whipping from an automaton.
Take, for example, an invitation to our practice NHS ‘well-person nurse examination’. Behind it is only one outcome for the doctor. The invitation consists of only one strategic blood test: a cholesterol screen. Then, an inevitable, potentially anxiety and statin-inducing, QRISK calculation by the healthcare auxiliary, followed by a mandatory appointment to the doctor. The doctor has a difficult conversation with a patient if she dares be honest about the facts. She is under pressure to prescribe. Everything NHS is tending toward State-corporate agenda-driven medical contact.
Seniority: a distinguished NHS doctor politically extinguished
One of my more learned NHS colleagues, now former NHS colleague, was snuffed out a year ago. He is a surgeon, hard-working, dedicated and caring. He kept a department alive for two years whilst colleagues ran away because of their ethnic covid risk, their blood pressure, or their ACE inhibitor prescription being catastrophically linked to a said spike protein affinity for ACE2 receptors. We might forget how bad the madness was. Some of these colleagues continued to feel safe earning in private practice.
During this covid saga, my colleague noted a dangerous clinical-prescribing error, also conflicting with departmental guidelines, by a consultant colleague 15 years his professional junior. My colleague sent a generic, non-confrontational email asking colleagues to take note of the guidelines. No inquest or meal was made of the specific error, no particular colleague made to feel humiliated. One year later he was hounded out of the NHS, and is now close to retiring outright 15 years before his time. He has no interest in private practice for profit, only in helping those most in need.
The junior colleague (a newly appointed consultant) who had made the error, complained that the senior colleague had used the term ‘Junior Consultant’. Another (senior) consultant colleague conducted a year long inquisition, and asked the other consultants to provide other evidence throughout my colleague’s 15 year tenure of other such documented examples of subjectively-offensive, correct use of English. There weren’t any. The reasoning applied in my senior colleague’s case decided, ‘We are all consultants, there are no seniors or juniors’. Are we not all also doctors? Triggered junior (sorry) doctors may have found another reason to strike.
My colleague was compelled to apologise to the junior consultant for his correct, inoffensive use of the English language in an English NHS hospital. He did, and then immediately resigned. This exemplifies a now commonplace, self-policed tyranny. On this occasion it was the linguistic communist strain of it operating in the modern workplace. Even more incomprehensibly, his shocked clinical colleagues and clinical manager asked him to reconsider this reasonable, objective resignation response to an unreasonably held, subjective offence. The result is another un-doctored, senior doctor. Society is eating itself, and the State aids and abets it.
A Medical Extinction event
I have noted a degree of online disquiet in GP social messaging fora. Non-doctors are increasingly practising as if, and in place of GPs. Someone on a group refers to them as ´Noctors´. Non-doctor doctors. GPs are now performing only 40% of the GP consultations in UK practice. Pre-covid, back in November 2019 it was 50-52%. This is not all. Factor in a greater proportion of this 40% being, now, conducted remotely by GPs. GPs who may be contracted through remote, third party organisations. Sometimes, they are working from abroad, and have no prior working knowledge of the community, culture or individuals, and still work to ten minutes-a-patient. This is far from the ideal of the UK GP doctor-patient model. In this, a highly trained and experienced GP would know each and every patient, many from birth. The GP would see patients in vivo - the least risky, most efficient and most rewarding way for all concerned. The brief contact was compensated by more available, frequent contact. This reduced anxiety, and increased accuracy of diagnosis and safety of treatment. The results of this change to doctoring, witnessed first-hand, are distressing, dangerous and shocking.
An isolated old man languishing on a worn-out couch, not seen for months, telephoned only by a remote, third party colleague unknown to any of us. A casual treatment of undiagnosed, severe leg pains by morphine; doubled the next week by the same telephonic negligence. The immobilised, elderly patient hallucinates and calls distressed. It is clear the patient is at risk of several underlying pathologies which may have required an emergency ambulance weeks ago, and for which morphine is entirely inappropriate and hazardous. All this would have been obvious with a casual, caring glance at the complex notes or by a familiar GP, or if the doctor were present. But this GP is remote, cold and on autopilot, churning rapidly through the numbers to appease the system at the expense of a patient.
It does get worse. Imagine now only replacing the doctor with a noctor:
An elderly patient, unseen for a year, except by a series of noctors who take bloods and procrastinate, ‘repeat urea & electrolytes in two months’. The noctors are reassured, ‘U&Es stable; repeat in two more months’. This carries on for a year. The problem is the patient’s renal function suddenly plummeted one year ago from normal to 90% less, and to the brink of dialysis. No one understands somebody needs to do something else. I speak to the elderly wife of the patient, chance-referred to me by a concerned community worker. She says, ‘Doctor he hasn’t been seen by a doctor. Nurses just keep taking bloods.’ I do not blame my colleagues. We are in increasing crisis, I haven’t had a lunch break for four years, and often struggle to find time to visit the toilet. Like a workhorse with a nosebag, I can eat and drink as I work, but I draw a dignified line at catheter and leg bag.
Most of my patients do not even notice the noctors are not doctors, nor do they seem to care. Some noctors are more bogus, and introduce themselves as ‘part of the medical team’ or ‘Generalist Practitioners,’ even if neither doctor nor nurse. Everyone seems to be in the process of being permitted some kind of prescribing liberty and professional loosening-of-association. I know too much, and I know what I do not know. I would think thrice about prescribing on the phone without physically seeing patients. A picture paints a thousand words. Noctors with little knowledge or experience seem incredibly comfortable with prescribing like this.
This should be unsurprising, since covid. I witnessed in one UK NHS general practice the extraordinary spectacle of our janitor and social worker being pressured by management into injecting the immuno-compromising, genetic elixir of spike protein into my patients. The social worker was un-jabbed, and the janitor broke into a sweat and demonstrated a greater sense of medical ethic than my collective profession. He said, ‘No way. That’s not right’. Correct.
I say to my colleagues and the Royal College of General Practitioners, it is our just dessert. Our complicity in political lies, assistance in the destruction of our medical ethics and the sacred relationship of trust and confidence with our patients is unforgivable. Most of us have become de facto Noctors. Deserving of the title for behaving in a most un-doctorly way during covid. Transforming into unethical, weaponised, uncritical and obedient State instruments, precisely when one should not have, qualifies one. Many basked in the glory of being a frontline hero in a faux crisis. If an entire profession and its leaders say nothing, and behaves as if corporate technicians, it deserves nothing. The system has found a more desperate, cheaper, less-regulated and equally unethical technician to replace you. Soon, AI will replace all that. We will all go the way of shorthand writers.
Who are the Noctors? What is ARRS?
In my locality, not only are we losing auxiliary and clerical staff to the local weapons industry which is busy ramping up munitions production for WW3, but paramedics now do the bulk of routine, non-urgent GP home visits for chronic disease. They have replaced the dwindling availability of GPs. At a time when the job is so stressful and unsatisfying, many are leaving or working less to protect their health. Once upon a time, paramedics were the experts in pre-hospital emergence care, and we were told in the severest tones they should never be bothered or have their time wasted by chronic disease (‘see your GP, you time-waster’). They were said to be too busy rushing in-between emergencies and Emergency Departments.
Nurses now perform much of the general practitioner work, particularly the routine chronic disease management of diabetic and respiratory disease in clinics. We no longer have enough nurses to deliver this care, and GPs complain it is not what they do, anymore, as they have become deskilled. This is true. But it can easily, and may have to change. In addition to paramedic and nurse noctors we also have the launch of NHS Pharmacy First advanced service, which inverts the classical ‘history-examination-diagnosis-treatment’ model of medicine on its head: this year the frustrated patient and embattled GP receptionist will have to decide on the correct diagnosis for it to correctly arrive at the threshold of the inexpert pharmacist. GPs have already raised concerns about this scheme.
GMC regulated Physician Associates
A more controversial phenomenon is the rise of the non-medical, non-nurse and briefly medically-educated Physician Associate to add to the NHS armamentarium. Already, there have been PA disasters, and there is increasing confusion and concern. PAs are being promoted by the government funding policy, ‘The Additional Roles Reimbursement Scheme’ (ARRS). This has made available to GP surgeries £1,412 million in 2023/24 to employ people in 17 new roles. GP surgeries were excluded from using this money to pay for practice nurses and GPs. Some practices that are short of funds are relying on ARRS funded roles. GPs are panicking, petitioning and crying ‘employment crisis’ too late. But, deep down, one should know from covid that resistance is futile. The blurring of professional boundaries is becoming extraordinary. PAs soon may become GMC regulated. In reaction, doctors’ bodies threaten the government with legal action. I suspect GMC-regulation is a way of giving PA’s prescribing rights, since all PAs need to find a way to prescribe is a HCPC regulator. It is also another self-fulfilling prophecy for GMC self-preservation.
The dangerous defunding and un-doctoring of general practice is recognised as serious by the BMA, which released this strong message about the upcoming unacceptable ‘new GP deal’ being tendered by the government. The matter is going to a GP referendum on the 1st March 2024, in an election year. GPs seem serious about a remedial response if the government will not heed their sincere safety warnings.
One might see where this is going. Soon, GPs may be doing less than 25% of GP consultations. The General Practitioner role is becoming extremely generally practised by all-comers. In one English general practice, 11 GPs were ‘offered voluntary redundancy’ in favour of ARRS staff roles created through ‘new (unsustainable and unsafe) ways of working’, three GPs walked. Since covid policy it has become a free-for-all. How soon is it before the pharmacist, paramedic and nurse are also refusing to see patients to the face, or complaining they are deskilled in their traditional purpose? How soon before all these, and the physiotherapist all decide leaving their professions and re-qualifying as a PA is the way forward?
It is not an efficient nor resilient model. A paramedic attending a complex, chronic disease or palliative care case, traditionally the remit of a non-urgent home visit by a GP is not appropriate. Paramedics in a case like this can often only safely do nothing but report findings. They, via messages passed to over-worked GP receptionists, who in turn suggest an over-worked GP, given none or a maximum 10 minutes’ grace, should remotely respond or prescribe based on a vicarious, inexpert examination and opinion. It is as if a phantom visited leaving a phantom diagnosis and a phantom treatment. The only safe alternative is a morale-sapping reduplication of all the work by an increasingly side-lined, demoralised GP. A car mechanic or vet would deem it unsafe to work like this on your car or your dog. Why should humans deserve less?
The noctors or their unsuspecting patients often and eventually have to defer to a doctor. Often that point is when the patient is feeling far worse. Fortunately, there remain a few older GPs with sufficient experience to shore up the chaos and conceal it from manifestation. But they are dinosaurs entering an ice-age in a medical extinction event. They are fleeing, retiring and reducing their hours just as they are being replaced with technicians paid to follow algorithms. I, a Hippocratean anachronism, have chosen to work increasingly, and voluntarily in the more wise and respectful ‘less-developed world’. The doctor-patient relationship, and application of basic knowledge and critical thinking stills applies there, but it is so yesteryear, here in the UK.
There has been a planned intent to de-doctor the NHS for many years. Consider ‘A Roadmap to Practice’ for the plan of Paramedic First Contact Practitioners (FCP) and Advanced Practitioners (AP) in Primary Care, or the NHS Pharmacy First advanced service. View these within the government proposals to regulate all healthcare professions under one monolithic regulatory body and one code, and you will realise the Hippocratic doctor is nearly as dead as a dodo.
Where is our profession’s future, when there is no future? I suspect if newer-trained doctors are as dumbed down and ethically unconscious as the society they are reared in, so, the gap between them and noctors may not be as great as with old schoolers. Junior doctors may still believe in their doctorly omnipotence. They strike for their rights, and clamour for rewards for compliance with a medical tyranny they do not even know has occurred. Many seem to leave the country, the profession or avoid general practice entirely. They do not seem to realise recent history and present trends. Their entire didactic tradition of medicine is being demolished and replaced with low-paid technicians, who are even more likely to obey, and perhaps less able and less likely to criticise government medical policy.
Noctorism
Noctorism is destructive to professional boundaries, ethics, efficiency and expertise. It furthers the destruction of the culture of a professional hierarchy of learning and quality control. Imagine an army with an inverted, a muddled chain of command, faulty systems and no funding. I hear regularly of a variety of noctors, undermining doctors’ decisions based on flowcharts, or miseducation rather than clinical nuance. They return patients for another unnecessary consultation. It can only end in a continued NHS chaos that hungry corporations will inevitably be commissioned to replace and parasitise upon. It is not merely a NHS tending to the private American model. It is more profound. It is the marginalisation and eventual death of the physician. Surgeons will survive, for a little longer. The next step will be the permanent end to the physician-patient medical model. Enter a pure corporate, Big Pharma-patient model: a non-Hippocratean, non-medical technocratic medicine delivered by AI automatons.
This is a brave new world where ambulance crew are GPs, State GPs are killing you softly, men identify as female babies, teachers and the Tavistock transmute little boys into women whilst your geo-tagged courier flings your parcels onto the ground and flees. Nothing does what it says on the tin anymore. A world where the democratically elected politician determines the Truth, and decides what you can and cannot think. It is a topsy-turvy world where there is no right to voice a professional opinion subjectively offensive to the state.
After three decades, I regularly feel unqualified and incompetent to be part of the medical profession. A veritable medical imposter. It is the price of circumspection learned from being an expert in managing medical uncertainty and life-death decisions at their riskiest, in the community. My observations tell me so should feel many more of our inexperienced noctors, although many appear to not. The new noctors appear less stressed than me and seem to deal with serious clinical conditions with less concern and effort. It may be understandable, they do not carry the can, nor will they know what they don’t know they are missing in their management. Or are they simply better than me? Meanwhile, we are expected to supervise, and take responsibility for their mistakes, while they are the seed sown for our demise.
The responsibility and stress of general practice is overwhelming, particularly in a collapsing system. Unfortunately, the rise of the noctor inevitably makes the general expectation of standards within and upon the GP profession lower. Less of one’s colleagues notice or care about one doing the wrong thing. To put it another way, would one be happy for a GP to be repurposed into a non-scientist senior scientist, a non-paramedic paramedic at a pre-hospital multiple trauma, the non-dentist dentist drilling your teeth, or to be the non-nurse nurse nursing you?
Many GPs and hospital consultants seem happy to be siloed behind phones, attempting to ‘see’ patients ‘telephonically’. None of this was conscionable pre-covid. If the profession continues to support this unprofessional attitude, it will find it is deservedly losing its professional territory, and those patients to private and enterprising hassle-free paramedics, GMC-regulated PAs and nurses. It is a shame-worthy situation for the GP profession. We should be unsurprised if we are sent to drive ambulances to emergencies, replace striking juniors in emergency departments, and performing nursing and phlebotomy services. GPs have been time-stressed so much over recent years they have been gladly ceding work to a Trojan horse, but soon we may have none left. Old GPs may be soon all be working from and seeing their ex-patients in A&E departments, deputising for migrated and striking juniors, and perhaps mopping up after a deserted, noctor-led general practice system in private, doctor-led general practice.
State-engineered System Chaos
If one is not allowed to deliver individualised, nuanced and intelligent medicine the result is as we have already witnessed in covid: a centralised and widespread algorithm of State policy-worsened health. The noctor-technician policy will only worsen the problem of a reduced long term patient knowledge of and continuity of holistic care for a patient which used to be the hallmarks of the old family doctor-patient centred model. This will lead to more unnecessary investigations, less working knowledge of each patient and consequently poorer, less focused care with more consultations. It will cause more error and more over-prescribing. There is already a distinct feeling patients are increasingly being looked at as beans to be counted, then stewed, as inappropriate, in an official formulary of chemicals.
Those who think that noctors are not being pitched against GP or hospital doctors, be made aware their provision is in this way also undermining the training of junior hospital doctors. Often noctors are too busy being doctors to perform their core clinical activity. For instance, one consultant colleague reported hospital opticians are too busy being and supervising junior ophthalmic doctors to provide refractions for her.
Even teachers have become noctors, and their schools health modification facilities during covid. They undermine parental and child informed consent, and doctor-patient-parent relationships in favour of State-pharmaceutical agendas. Complementing allied professionals is one matter but up-ending our profession and our training structure with noctors is an existential attack.
It does seem doctors have become too over-qualified for their own profession; but why have a qualified, responsible and accountable named-physician when one can instead have multiple incoherent, over-investigating, under-qualified individuals working without direct accountability within in a State-created crisis?
Unintelligent, State-confected over-investigation is causing chaos, rather like the recent covid PCR False Positive Pseudo-Epidemic as explained here by Dr Mike Yeadon. Ultimately, any such attempts at decentralising and decerebrating a clinical diagnosis only benefits those corporations and State actors that politically and financially prosper from the pharmaceutical and pandemic business.
The problem is global. The WHO and Public Health are also anti-doctor and pro-noctor. WHO director-general, Tedros is a noctor, as are many who have quietly displaced doctors in leading community public health posts in the UK and worldwide. Any lukewarm, non-medical, compliant body in a medical position seems to suffice for the hygiene socialists. Thus, ailments are less and less being seen as personal healer-patient issues with optional, ethical individual solutions. They are, on the contrary, being seen as public health issues with technocratic, veterinary group solutions.
Farewell, Doctors
This new, noctor revolution is reminiscent of the back-protecting NHS Direct (and its successor, NHS 111) which, in 1998, instead of reducing GP and A&E attendances increased them, societal medical neuroses and individual dependency upon the State. ‘Lay referral system’ is no-longer a thing because of it; and because the family and community units have been State-shafted. Less State intervention was far more more effective than NHS Direct. The same will be said of the supplanting of Hippocratean doctors, by lesser, State-obeisant colleagues, and now, with noctors. I fear it will make an already noxious State healthcare provision dumber, less-efficient and more dangerous.
There are excellent noctors, but they are the exception, not the rule. They should not be presented as a replacement. In a sense they should have been doctors, and some do re-train. It is not a wisdom that brickies or road-layers should be given a fast pass to civil engineer. Why is it wise for medicine? I do not believe good safe medicine can occur like this. I know senior nurse colleagues who agree. I suspect it is desperate and wilful State crack-papering and can-kicking. Surely, not even noctors would wish their system of healthcare upon their families?
I do not advocate for doctors and allopathic medicine at all costs. There are far better alternative approaches for many conditions. Whatever one thinks of the GP model, it is efficient in doing most of the NHS’s work for a tiny proportion of the NHS budget. Change that and one is left with a dumbed down, problem-creating machine. Consider where a GP is purported to deal with a complex case in 10 minutes with all the administrative and preparative work included. Here, a lawyer would justifiably charge three hours work for those three phases of work to do it carefully and properly; and, if a patient tries to lever five problems into that rare appointment, a lawyer would relax and charge five times more, and prepare for a rich season of regular, escalating work.
I know some PAs are being offered £80k per annum for a 40 hour week on the locum market. This is a GP salary, without the skill, responsibility or stress, and no need for a loan for nursing or medical school. Such incentives are destroying the core of the traditional and well-tested medical model and replacing it with an unsustainable, unsafe bureaucrat’s pipe-dream. It is so nonsensical, one must ask, is this move to counter-productivity deliberate?
The hallmark of a doctor should be an intelligent, caring, critically-thinking, autonomous, ethical, safe decision maker. One of the most effective medical and social acts of a general practitioner imbued with the status of professional medical learning, experience and ethics is impactful patient advocacy. This is no longer allowed to be the case. One needs only consider the wicked government covid jab non-exemption exemption scheme. Where was the profession for those intelligent patients who knew something was not right with the jabs? If the vocation is a medical free-for-all with no firm ethical code, no one respects or trusts anyone.
The profession and our regulator deserve to now be recast into something better. Putting one’s professional house in order requires introspection. When one points the finger, few retain the insight to realise three fingers point to oneself. Medicine’s decline is medicine’s fault.
I cannot care about a medical profession and regulator which does not care about its own core ethics. Our noctor nemesis has not even a cultural memory of ethics. The profession must decide, and do or die. The monopoly is already broken and was never, in itself, important. What is important is medical ethics, at the root of which rests an essential humanity and intuitive morality. This is our profession’s ancient, decentralised ethical cryptocurrency which the State is desperate to destroy.
Beware, other professions, you are not immune and the medical revolution does not stop: Dinosaurs! Make way for the ‘Medical Apprentice’!
“General Practitioners dominate primary care by right of an inherited tradition, because they are there. This situation won’t last; if doctors are to retain a leading role in the future, they’ll have to earn it, and if some other kind of health worker can do better in terms of measured health outcomes, good luck to them.”
From Foreword, ‘A New Kind of Doctor’, 1988 by Dr. Julian Tudor Hart, FRCGP, FRCP
28th February 2024
Life mirrors parody. Any (equally fake) registered doctor and noctor who supported, complied with, remained silent about and advised lockdowns, masks, treatment coercion, denial of choice, standard treatments and fake experimental, unnecessary covid pseudo-vaccines without adequate testing, and proper informed consent need not attend. MHRA, EudraVigilance and VAERS figures, Astra-Zeneca vaccine’s procrastinated UK market withdrawal and UK excess mortality figures cannot all lie, no matter how hard the ONS tries to reimagine the data.
Concern continues to be expressed as to how junior doctors will learn, subsist or co-exist with the noctor
The GMC and Noctors are both State weapons against doctors and population health. PAs may not yet realise the GMC may also become also their worst best friend. They will have to pay (hopefully the same as doctors) for the privilege of the instant karma.
Some doctors are grumpy but remain largely politically naïve.
Non-doctor doctors. GPs are now performing only 40% of the GP consultations in UK practice. Pre-covid, back in November 2019 it was 50-52%.
All links are archived and if broken may, in the majority, be found by searching the link on archive.is or, in the small minority, on web.archive.org.
Terms and conditions apply. The Covid Physician is no longer legally able to self-represent or self-identify as (still) an unheroic (NHS) medical doctor, as prescribed by law. Hence, please consider all current, past and future essays as parody, political commentary or as works of literary art by a non-medical non-doctor. This article is an artistic expression and personal view of life, should not be taken on trust, and certainly does not purport to necessarily represent the views of the medical profession or the NHS. Any patient details have been anonymised.
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I find myself struggling with your dilemma. On the one hand, I sympathise with your predicament and observations because you're 'old school'. On the other hand . . . I have lost all respect for the medical trade in general due to their appalling behaviour over the past 4 years - with the exception of a very few such as Dave Cartland, Ahmad Malik, you & maybe a handful more. The vast majority, however, have disgraced themselves & I hold them in contempt.
Some nurses are capable and savvy. I had a THR a few weeks ago. The excellent nurse who checked me in noticed that I had said, among other things, 'no blood transfusions' on the consent form. She queried whether I was a JW. I'm not, but explained that I didn't want any blood because it is doubtless tainted with spike proteins, LNPs & God knows what else. I was happy for them to shove in some saline if needed, but otherwise I'd take my chances. Likewise, I didn't want any experimental gene therapy jabs or anything else not directly essential for the procedure.
She stopped what she was doing, looked around, put her mouth close to my ear & said; "I've seen enough over the past few years to know something is seriously wrong. If I was being admitted to hospital today, I would do exactly the same as you". She showed better critical thinking than any of the doctors I saw - and over the next couple of days delivered outstanding and attentive nursing care. She'd probably be the best kind of 'noctor'.
Brings back memories of my GP who, seeing a growth on the back of my neck, told me to hop up on the table. A bit of alcohol on his hands and my neck, the site was numbed and out came the scalpel, followed by "Oops - I've nicked a vein" as I felt the blood roll down my neck. 25 years later and I am still here. Or the GP who was my family GP from my birth who roped me into helping take disabled people on holiday to France. Before we got to Dover he handed out sea-sickness tablets to everyone else. To me he held up a small vial in which, he said, were bits of a poisonous South American spider. In small doses it was claimed that it prevented sickness. Was I up for him and myself trying it? Why not - I had trusted this guy since my earliest memory. I found myself spending the crossing heaving up in the gents. My only satisfaction was that my GP was in the next cubicle. They don't make doctors like that anymore, I am sad to say. Both men were marvellous doctors.