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It’s beginning to look a lot like Christmas 🎅🎄
Mariah’s defrosted. The streets are glowing. And winter flu is reminding us why PPE was once a personality trait.
This season’s “Flu-nami” is so nasty, COVID’s watching from the sidelines like: “damn.”
My Respiratory brethren. I salute you. You’re doing God’s work 🫡
👋 Happy Friday. Today’s Menu:
🩸 The Great Haem Debate: To Iron, or Not to Iron?
🎄 Deal or No Deal: An NHS Pay Deal Special
🧠 QuickBits: Other Top Stories of The Week
If you want to read any previous editions of The Handover, you can on our website.
RESEARCH UPDATE
🩸 The Great Haem Debate: To Iron, or Not to Iron?
To iron, or not to iron?
No, I’m not talking about your crumpled pile of wrinkled shirts that you pass over in favour of NHS scrub chic each morning (please iron them), I’m talking about the queen of haem, Fe.
Our red cells worship her. And for years, we worried nasty bacteria did too.
So the dogma stuck: don’t give IV iron in acute infection, lest we supercharge the bad bugs™. But the evidence behind that fear? Less than iron-clad.
And researchers from West Virginia (mountain mamaaa🎵) decided to try settle the debate once and for all …
Published in Blood(By The AHS) this week, researchers performed a retrospective analysis on a whopping >85,000 adults with iron deficiency anaemia hospitalised with an acute bacterial infection (2000-2024):
Most common infections were pneumonia (~27k), UTI (~23k) and MRSA (~15k)
Patients were divided into 2 cohorts: those who received at least one IV iron dose during the infection admission and those who did not.
The primary outcome? 14 and 19 day survival (secondary outcomes included changes in haemoglobin at 60-90 days, hospital length of stay, and RBC transfusion requirement).
So were the results team iron? Fe-nominally so!
IV iron was associated with a higher survival rate at 14 days across all major infection types (pneumonia 95.7% vs 91.5%, UTI 97.6% vs 95.7% and MRSA 97.6% vs 95.0%) - survival was maintained at 90-days too!
Haemoglobin outcomes also favoured the IV iron gang: they had larger increases in haemoglobin levels at 60-90 days compared with those who were not treated.
IV iron was also linked to reduced need for red-cell transfusions.
A small exception was bacterial meningitis (~143 patients), where IV iron did not show a significant survival benefit or haemoglobin improvement; likely due to very low numbers.
TLDR; IV iron🗣️🔛🔝🔥
Team Haem FTW
But hold on, pobody’s nerfect. Least of all this trial:
Observational, retrospective design => cannot establish causation
Selection bias => clinicians may have withheld IV iron in sicker or more unstable patients, influencing outcomes
Variable iron formulations, doses, and timing => heterogeneity makes it hard to isolate the true effect of IV iron
Inadequate adjustment for infection severity => key metrics (e.g., SOFA scores, inflammatory markers, antibiotic timing) were not standardised.
Underpowered subgroups => especially bacterial meningitis, limiting the reliability of conclusions for rarer infections.
Still, imperfections aside, the results are pretty team haem.
And after years of the iron debate going around and around like a ferrous wheel, it’s exciting stuff.
So in the great haematology debate of IDA, don’t pull a Hamlet, just give the damn iron.
POWERED BY MEDWISEAI
😥 Doctors and Med Student: I Have Bad News…
There’s a condition spreading quietly through our hospitals.
It affects thousands every year. Spreading faster than COVID-19
It’s called SCANG.
That’s right. Sudden Change Affecting National Guidelines 💔
We’ve spent hours, days, months committing national guidelines to memory.
Physical and emotional damage caused as a direct result of not knowing how many bricks an infant can stack at 15 months.
After smashing again(<1min) on Anki, it finally sticks.
Then. Poof.
They change the damn guidelines.
All that hard work. Gone.
Luckily, they’ve discovered a curative treatment - Medwise.ai
Think of it as ChatGPT, whipped into shape by NICE, royal colleges and society guidelines.
You get instant, accurate, evidence-based answers.
No more guideline trawling. No more second-guessing.
And they have users in 2000+ NHS organisations already. So your trust is likely covered already!
So try Medwise.ai today
And if you sign up with your NHS email, you’ll get access completely free.
Just click the button below 👇
NHS UPDATE
🎄 Deal or No Deal: A NHS Christmas Special
Not sure Noel Edmonds would wanna host this one…
Wes Streeting et al. have made a new offer to the “Moaning Minnies”, formerly known as The BMA. They hope the deal will put the “Juvenile Delinquents”, formerly known as resident doctors, at ease and stop next week's planned industrial action.
Is the deal any good? Let’s dissect…
On Wednesday, the 10th December, the offer was made. Wes led with this:
“Doctors asked me to deliver on jobs, especially unfair competition from overseas, and this comprehensive offer will deliver - providing resident doctors currently applying with more jobs, prioritising UK-trained graduates, and putting money back in the pockets of resident doctors. It builds on a 28.9% pay rise which has already been delivered.”
The deal supposedly includes a multitude of benefits, including:
Speciality training prioritisation for UKMG who’ve worked in the NHS for a significant period of time period
An additional 4,000 more training places, with 1000 being brought this year
Non-pecuniary(that’s a new word for you) benefits, such as reimbursement for exam fees.
For those working Less Than Full-time(LTFT), the allowance will bump from £1000 -> £1500
Tempting offer Mr Streeting…
Obviously quite pleased with themselves, they’ve added a cheeky contingency.
If we reject the plan, the offer is revoked, and we’ll be left with nish! Way to lay down the law, Wes 👍Really showing us who’s the boss round here.
But hang about…
Does something smell off to you🤔?
It’s the offer. And it smells just as bad as the side room of the patient with C.diff.
But let’s peel back the dressing on this oozing wound of a deal.
Fugazi Training Post:
So. About those 4000 “new” training posts being dangled in front of us. Turns out they’re not new at all. They appear to be just repurposed LED posts.
For those who don’t know, an LED stands for Locally Employed Doctor. These are your trust-grade doctors and clinical fellows. They’re real doctors, but they’re not in a formal training programme. No guaranteed supervision. No structured progression. Just vibes and rota gaps.
So what’s the plan?
Take these already-existing non-training jobs, repackage them with a shiny badge(speciality training posts), and pretend the workforce crisis is being solved. It’s a temporary patch on a chronic wound.
There’s no increase in the number of doctor jobs, just a reshuffle.
Worse yet, these posts will all vanish in a couple of years(temporary means temporary!). As it stands, they will not recur in the future. Potentially returning a fresh batch of doctors to the seas of unemployment. Sweet 🙃
UKMG Prioritisation: When Exactly?
Yeah… how?
The emergency legislation has failed to explain any details on how and when this prioritisation is set to work. It’s a bit wishy-washy at the moment. Fear being, accepting the deal will lead to another season of bureaucratic delays, postponing this action on this legislation into oblivion. In other words, we’re being asked to vote now and trust the details will appear later… a familiar NHS tradition.
Where Else Has it Fallen Short?
No detail on who gets these posts: We’re not told which specialities, which regions, or what training levels (core vs higher) will benefit.
No job security guarantees: There’s nothing for doctors already stuck in the bottleneck. No protections, no bridging roles, no assurances.
LTFT uplift is delayed and limited: The allowance rise to £1,500 doesn’t kick in until April 2026 and only applies to those on the 2016 contract.
No movement on conditions: No commitments on overtime pay, antisocial hours, nodal point reform, rota safety, or training quality.
Oh… and how could we forget. No mention of any advance on pay restorations!
The BMA have put the deal out to members via an online poll closing Monday :
Yes to the deal: No Strikes. BMA strike mandate is extended to allow implementation
No to the deal: Strikes continue. Deal off the table. Back to the picket line.
The offer, in actuality, isn’t all bad. But is it what you want?
Deal or no deal?
Still Striking?
QUICKBITS: OTHER NEWS YOU SHOULD KNOW
Any GPs/consultants reading The Handover? I know you're lurking out there…
I salute you. Completely ignoring the “For Gen Z Medics” line on the landing page and signing up anyway. It’s okay, we’re not ageist here. Everyone's welcome.
Here’s your reward: Money. Actual, real, shiny NHS-adjacent money🤑. For the first time since 2012, fees are increasing from £40 a document to £50 in Jan 2026. Then to £62.50 in April 2026.
It’s not exactly Bitcoin or Nvidia stock, but I’ll raise a glass anyway 🥂
Things have been a bit awkward for the last couple of years with Gonorrhoea. The STI with the most diabolical name of any medical condition just can’t stop mutating. Antibiotic resistance is a nightmare. Urethral discharge and dysuria that you can’t rid with an IM injection. Scary stuff…
Luckily, this RCT in The Lancet has found that a new antibiotic, Zoliflodacin, is non-inferior to ceftriaxone + azithromycin. With a cure rate of 91% vs dual therapies 96%, falling within the trial margin for non-inferiority. Of course, all this woe could be avoided if we’d all just use a johnny. No shade ofc.
Were you scared of needles growing up? Sorry, can’t help you with the trauma there. Psych referral perhaps? Talking therapy?
For the next gen, maybe they’ll need one less jab as this study in NEJM shows non-inferiority between one and two HPV vaccine doses in school girls (aged 12-16). The trial included 20,000 participants. Efficacy of two doses was 98.5% and one dose was 97.0% => no statistically significant difference.
Less stabbing. Same protection. Science wins.
Not exactly medical news, but a bit of Christmas cheer for NHS workers. Free Uber/Uber Eats voucher(according to this dudes TikTok Video).
Do with that info what you will. I’m just the messenger.
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