Wow. I mean… just wow. I’m lost for words. I just love the way you tapped on the email. None of the other readers tap like you do. So you’ve earned this. You deserve it. A gift. I got you some med news 😊 

👋 Happy Friday. Here’s what we got:

• 👩‍⚖️ NHS Judgement Day: The Leng Review

• 😵‍💫 Brainrot and Teen Mental Health - A Prospective Cohort Study

• #TheMoreYouKnow: Other Top Stories of The Week

If you want to read any previous editions of The Handover, you can on our website.

NHS NEWS

NHS Judgement Day: The Leng Review

Judgement Day is upon us. Medical Ragnarok has arrived. The Leng Review has been released.

Yes. The one you’ve all been waiting for. After months of frothing controversy, leaked emails and unhinged r/doctorsUK threads (admit it, we’re dramatic), Professor Gillian Leng has dropped her independent review into PA’s and AA’s. 134 pages of deep dives into the roles, the evidence, and what it all means for the NHS.

And I’ve got to say… after all that build-up, the conclusions are really… lukewarm? 

Yeah, the review is pretty on-the-fence. The overall conclusion is PAs and AAs should neither be abolished outright nor left to continue unchanged. It validates doctors' feelings, whilst at the same praising the PA's value to the MDT. How delightfully diplomatic 🙄

But still, it drops 18 recommendations based on the available evidence

Here’s your high-level summary of the biggest takeaways

How safe are PA’s?

Leng’s team looked at everything they could get their hands on: a rapid review by KCL, national datasets, incident reports, and stakeholder surveys. And what did they find? That the evidence is... not good. Most studies were tiny, outdated, observational, and riddled with flaws or bias..  

In short, the data provided no definitive proof of harm, but also no real assurance of safety. A real shoulder shrugger.

Recommendation: In light of this Prof Leng has thus decreed PAs “should not see undifferentiated patients” except within clearly defined national clinical protocols

Translation: follow-ups and protocol-driven cases only. No more first-line diagnostic roulette. This aligns pretty closely with what most doctors have been shouting into the void for months: PAs are not substitutes for doctors.

Who Supervises Associates?

Some trusts have proper oversight. Others? Just vibes. Doctors are legally responsible for anything a PA does under their name, but haven’t been trained to supervise. No time in job plans, no formal prep, no clarity on who’s in charge. Just “can you keep an eye on them while you manage eight patients and a crash call?”

Not ideal.

Recommendation: Every PA and AA should have a named supervisor. Not a rota buddy, not a random consultant. An actual doctor with protected time, line management responsibilities, and ideally, some leadership training.

So. More training, more responsibility, same pay? Classic NHS–wouldn’t have it any other way 🙂

So Are You The Doctor?

So you look like a doctor? Walk like a doctor? Stethoscope like a doctor? But you’re…not one?

Reality is, Billy down the road doesn’t know what a physician associate means. Same way they don't know what a registrar, clinical fellow or FY3 is. As all the same to Billy. Billy's in ignorant bliss. 

The review cites public feedback demanding to know “who is treating me and what expertise they have.” There “cannot be full trust from patients... while issues about lack of clarity remain.”

The nuance is “associate” suggests a more independent or parallel professional. An equal. “Assistant”conveys a supportive, subordinate role.

Recommendation:

• PAs are now Physician Assistants

• AAs become Physician Assistant in Anaesthesia (PAAs)

• New uniforms, ID lanyards, and badges to visibly differentiate roles

• Separate regulatory standards from doctors

• Distinct job descriptions for primary vs secondary care

Hopeful, that clears things up Billy 👍

Some other big findings include:

• No GP speedruns allowed: New PAs can’t jump straight into primary care or psychiatry. Two years of hospital XP required first. Think of it as a tutorial level before they get sandbox privileges.

• Level up or log out: Career progression for PAs and PAAs is now a thing. With more training, they can unlock new skills. But only with supervision. It’s like Pokémon evolutions, but with prescribing rights.

• Anaesthesia expansion on hard mode: No mass rollout of AAs unless the Royal College says so. Consultants are still gatekeeping like they’re Nespresso pods.

• Multidisciplinary teams, but make it make sense: NHS must build proper team models that don’t casually erase doctor training. No more associates taking clinical time away from resident doctors.

There’s loads more in the full document. So if you’re feeling brave, you can read the full Leng Review here.

Or… If you enjoyed this, we could do a full deep dive. More context, more detail, more novel insights.

Let me know in the pole below 👇️ :

RESEARCH UPDATE

Brainrot and Teen Mental Health - A Prospective Cohort Study

There is a new paediatric frontier ahead. 

Doctor–We have a problem. It’s the iPad Kids…they’re growing up.

The children who swiped before they crawled are now entering secondary school as teens! And with that, social media arrives. What’s first? TikTok. King of 5 minute microtrends and neologisms

Skibidi Toilet. Mogging. Dwerking. Gyat. Rizz. Pookie

Yes. These are real words of the youth. What do these terms mean? I have no idea. My mid-20’s have never felt so old.

But some make sense, Doomscrolling and Brainrot. The perfect encapsulation of the negative impact social media has on mental health. By now, the link between poor mental health and heavy social media use is well established. That’s no secret. But the research to-date has been missing something. A bit of nuance.

A new prospective cohort study published in JAMA wanted to be different to previous studies in two main ways:

1. They looked at addictive use, not just screen time totals. Instead of treating all screen use the same, they focused on compulsive patterns – like checking constantly or feeling anxious without your phone. And not just social media. Phone use and Video games were included too.

2. They tracked kids over time: Most studies were snapshots; this one followed 4,285 children from age ~10 to 14 across the US to see how habits changed and what actually happened to their mental health.

The aim was to identify long-term patterns(called “trajectories”) of addictive social media, phone, and video game use in early adolescence… and determine if these patterns were linked to suicidal behaviour, suicidal ideation, or broader mental health symptoms.

To do that, researchers grouped kids by shared patterns of addictive use:

• Low trajectory: Consistently low use over time.

• Increasing trajectory: Started low or moderate, then steadily escalated.

• High trajectory: High from the beginning and stayed that way.

How did they measure this? With a quiz of course. A self-reported 6-point questionnaire was given to these kids across years 2-4 of the follow up regarding their social media/phone/video game usage. Then at year 4 both child and parent reported whether their child had suicidal behaviour, ideation or -ve mental health symptom.

This is what they found:

1. Screentime = poor predictor: Just tracking hours spent online? Useless. When addictive use trajectories were accounted for, raw screen time had no significant association with suicidality or mental health symptoms.

2. Increasing addictive use trajectories were common: No surprise. 31% of children saw rising addictive social media use. 25% in mobile phones. 

3. Suicidal implication: Kids within the high or increasing groups were more than twice as likely(Risk ratio 2.1-2.4) to report suicidal thought or behaviours than those in low groups.

Now, this is just an observational study. This means we cannot draw causation conclusions, only the association. Also, a lot of the study was pretty subjective. Self reported questionnaires, parental reporting and lack of objective screen data (like app usage logs) impact the studies quality. Future studies should look into this.

But so far the TLDR is: If you’re trying to spot risk? Don’t ask how many hours. Ask how hard it is for them to stop. That’s where the real red flags are.

QUICK BITS: OTHER NEWS YOU SHOULD KNOW

• New Breast Cancer Treatment: Not gunna lie, we are not holding back any punches on breast cancer this year. NICE have approved a new combination therapy to stop cancer recurrence in the early stages of the disease. Good riddance!

• UK First: Babies Born With 3 Peoples DNA: And who said polygamy doesn’t work? Jokes aside, this breakthrough was done to prevent a fatal mitchondrial disease. The technique involves enucleation, full details described in this study

• Epipen ❌ Nasal Spray 👍️ - New Spray For Anaphylaxis: Honestly, we have been killing it this week. A nasal spray for anaphylaxis has been approved for use in the UK. No need to remember blue to the sky, orange to the thigh! Brush up on inhaler technique tho!

• Cool New Strategy To Tackle Alzheimers: Please. You’re spoiling my nerdy arse. So we know that Tau bodies characterise Alzheimers disease. Problem is, there’s not much we can do about them. We can’t just pick them out. The brain is delicate. They made a short peptide that wraps itself around the Tau fibrils and breaks them apart. Smoothly and safely. Neat

• Wes VS BMA - The Final Showdown: Streeting and BMA leaders are set to have a final meeting regarding strikes. Mr Streeting will be hoping to make the BMA an offer they can’t refuse. But he’s insisted wages will not change. So I’m not sure what he’s gunna do. Hopefully, not deliver a horse head(if you don’t get the reference, watch The Godfather!)

Handover Over 🫡 

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