Dr Luke Craddock
@DrLukeCraddock
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F2 Doctor | BMBS | DV | RRDC | Fighting to better the working lives of doctors and protect patients | Views are my own š¦ š»
Nottingham
Joined August 2024
Whilst I would like to comment on the hopeful state of medicine within the UK this year, I cannot. Whilst the atmosphere is not hopeful, I am, and I am glad to be a part of teams trying to make it better for future generations. So here we go. Issues to highlight. 1/n.
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After working in A&E for just a little over a month, I thought I'd share my experiences as one of the front line doctors facing the current/ongoing crisis happening across our country. A quarter through my placement, I already feel burned out and morally fatigued. 1/20.
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Lack of community treatment. Many patients I see do not need to be in A&E, many are there as a result of a failing primary care service. "I couldn't get a GP appointment, so I have come to A&E" is something I have heard too often whilst working. 2/20.
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I cherish every positive comment I receive from patients about my care, I was taught to give gold standard, and that is what I aim to provide. The moral fatigue of not being able to do that in this failing system is harrowing, and we need to fight for change. 20/20.
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A reminder that today, I will be the second lowest paid staff member in the hospital as an F2 doctor. The lowest paid will be my F1 colleagues. We assess, diagnose, manage and treat patients for a bargain price of Ā£17-Ā£20 per hour every bank holiday.
Christmas Eve: 12:00-22:00.Christmas Day: 16:00-02:00.Boxing Day: 16:00-02:00.New Yearās Eve: 22:00-08:15.New Yearās Day: 22:00-08:15. I really struck out on luck for my emergency medicine rotation over the festive period š no family time for me I guess.
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If I introduced myself as a registrar at work and was found out I would be rightfully reprimanded. Here we have a PA listing themselves as a paediatric surgeon and rightfully being called out. That isnāt bullying.
Since @thetimes decided to go thereā¦. Is this level of deception acceptable?. Should parents who google this individual be lied to that heās a paediatric surgeon?
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Witnessing my first cardiac arrest was a truly harrowing experience. The sound of the patient's mother when we stopped CRP is one that will never leave me, and haunts me even now. A disrespectful statement, a cowboy hat and a hashtag. I really don't have words for it.
Itās time to take action. These are your beloved PAs. Deal with it @gmcuk. #lengreview .#paproject
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Many patients are presenting to A&E with conditions better treated in the community, however, as they lack access to services, they either cannot get treatment, or their condition deteriorates to a point that they need admission. Patients present like this daily. 3/20.
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Stroke as an example, the time window for urgent medical treatment is 4.5 hours. This means that by the time the patient gets to A&E, we have already passed this window. This leaves patients with now life long potentially preventable disability due to poor response times. 7/20.
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Honestly donāt know where to start with this one. Sarah could just see an actual GP, receive a diagnosis of rhinitis and a referral to an audiologist. Without being irradiated for no reason, and wasting the time of an ENT registrar.
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Lack of community care. What many patients need, is for some close supervision in the community. Someone to stay with them, who can keep them fed and hydrated and support their recovery. As this provision is lacking, often they are admitted as "social admissions". 4/20.
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These patients (many elderly) are then put through the ordeal of unnecessary hospital admission. Increasing the likelihood of them developing a new hospital acquired infection, or teams discovering non-symptomatic incidental findings that need treating/investigating. 5/20.
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This country really is a joke isnāt it. Fully qualified doctors with years of experience working as HCAs because there are no jobs. I really donāt get this distain Britain has against its doctors.
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Top GCSEs/A-levels, competitive degree application, difficult 5/6 years, 100k of debt on graduation, flung randomly around the UK, paid an insulting wage, replaced by lesser trained staff, no training numbers, no post CCT jobs. The fight continues, but I for one am tired.
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Ambulance times. I recently discovered that a few nights ago, waiting time for a category 2 ambulance was 4 hours, and up to 24 hours for a category 3. This is dangerous and harmful to patients. Some examples of conditions in each category can be seen below:. 6/20.
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PA or Junior doctor? @CHFTNHS . These roles are not interchangeable. Care to explain? . Wouldnāt be trying to put physician associates on doctor rota gaps would we? . Also for your information, the nomenclature has changed. Thereās nothing junior about your resident doctors.
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Medicine as a career in the UK is dead. Sadly I was naive at the age of 18 when I applied. I wanted a stable job, that paid well, and gave me opportunities to help people. The job now has unemployment looming, poor eroded pay, and caps my ability to help people.
Iāve taken a couple of months to make the decision but Iāve decided, for my mental health and overall wellbeing, Iām leaving the NHS in August.
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Once again this idea floats around. You canāt even guarantee jobs for doctors anymore, how are you planning to conscript them?
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This is the crux of it. āTheyāve been promised the impossible and sold a career that canāt exist: that of doing medicine without medical training.ā. There are no shortcuts to becoming a doctor. Medical school is not optional, it is essential.
"The idea that staff with only two yearsā formal training could safely see undifferentiated patients without direct supervision was always fundamentally flawed.". @HelenRSalisbury on the latest developments on physician associates.
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I did not consent to supervise these staff members. How is it acceptable I am put in a position where I have to supervise someone with less training than me (yet earns more than me) or my license be forfeit if any patient comes to harm. Short answer. It is not acceptable.
NO NO NO NO and NO. Resident doctors will no longer be your liability sponge . @BMA_James_Steen @TheBMA @DrPhilBanfield @BMAResidents
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āVery good nurse practitioners who are trained like doctorsā. Iām sure the ANPs at your local practice are amazing. However they are not trained like doctors.
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I really wish medicine as a career wasnāt this painful. I really do. Medicine as a subject is truly fascinating and a joy to practice. However, trying to map out a career in medicine, in the current climate, is a depressing and hellish experience.
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Constant pressure and awful rota patterns due to this staffing crisis very quickly lead to burnout. Again, I have only worked in A&E a month but I am exhausted. I covered every single day over Christmas and New Years because staff are spread so thin. I feel broken. 14/20.
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Well well well, look what we have here. If it looks like a duck, and quacks like a duck, then itās probably a duck. Sure looks like replacement to me.
Your statements were very reassuring @RCPEdin what went wrong? . Can you clarify your position on postgraduate training for physician associates? . @AndrewElder can you help us understand the plans the college has regarding this matter?
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All those conditions in category 2 require urgent assessment/treatment and will deteriorate as time goes on. As a knock on effect, this pushes category 3 calls to the back of the queue, leaving poor patients like Elizabeth sat at home in pain and suffering. 8/20.
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To conclude. I have great respect for permanent staff in A&E, every day feels like a venture through Dante's nine circles of Hell, with no Virgil as guide. Senior support in my department has been amazing and all the staff are commendable. 18/20.
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Christmas Eve: 12:00-22:00.Christmas Day: 16:00-02:00.Boxing Day: 16:00-02:00.New Yearās Eve: 22:00-08:15.New Yearās Day: 22:00-08:15. I really struck out on luck for my emergency medicine rotation over the festive period š no family time for me I guess.
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However, it should be better, far better. For patients and for staff. What we are witnessing as the 'new normal' is anything but and epitomises the state of the health service within the UK. Lack of staff, lack of capacity, lack of funding. 19/20.
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I joke, but it really is like a battlefield, patients in corridors, on trolleys, on chairs. Last week I found a patient's relative asleep on hard floor because we could not offer him a chair overnight. I am tired of apologising for issues I have no control over. 17/20.
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Seniors trying to relate to doctors this application cycle.
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Ambulance queues/waiting. At my hospital, we do not hold ambulances, this means that the department becomes increasingly overcrowded and unsafe. With the same number of staff covering more and more patients. Assessments, medication, interventions, etc are often delayed. 9/20.
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Staffing. There is a clear lack of staff in A&E, as the number of patients is ever increasing there is little provision to match that with appropriate staffing levels. Day on day I see staff working flat out, having to cover more patients than ever before. 12/20.
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What weāre walking into this August. Rampant doctor unemployment. Honestly hating my 18 year old self now. Should have chosen a different career.
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This means patients are waiting longer for assessment and treatment plans. This means patients are waiting longer for medication and interventions. This means patients are waiting longer for standard nursing care. Unacceptable yet accepted in modern Britain. 13/20.
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This is far from ideal, however, it is a view I share with the department that priority needs to be given to the patients in the community who have not received an initial assessment/treatment from a paramedic. This is a lose/lose situation for all involved. 10/20.
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I really donāt know what to say. Is it appropriate to have a PA teaching medical students or F1/F2 doctors? .
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Things like this really anger me. Institutions gave you a ladder they shouldnāt have and now youāre mad itās being taken away. Your post is honestly insulting to us doctors from working class backgrounds and areas of poverty. Being poor isnāt an excuse for cutting corners.
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Today is the turn of @UniofReading. The GMC got in hot water earlier this year when their mask slipped and they stated that physician associates study medicine, which they quickly backtracked on. If you donāt study medicine, then you donāt practice it. 1/2.
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Overcrowding is unsafe, there is more opportunity for things to be missed and patients to come to harm. As mentioned, it also provides an environment that breeds burnout amongst staff. To coin a phrase from my local MP, every day feels like "The Battle of the Somme". 16/20.
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Lack of capacity/overcrowding. Often 40-60% of our patients within A&E have been accepted by a specialty. However, as there are no available hospital beds, have to remain in the department. I often see patients waiting 16+ hours for a bed. 15/20.
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The IMT2 leaving the ward knowing theyāve spent all day working with less qualified staff who earn more than they do.
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A reminder that under the current system. New doctors are essentially randomly allocated to a region of the country for two years. Which they have to comply with to be fully registered. That includes if their partner is pregnant or has a stable job as examples.
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Other departments take a different view, many hospitals refuse to allow ambulances to handover patients if departments are 'at capacity'. As such our ambulances are held for hours at hospitals, decreasing the availability to patients and increasing wait times. 11/20.
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What in the fresh hell of misinformation is this?. āRequires two years intensive training on top of a masters qualification in a science subjectā. No it doesnāt.
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I will be supporting any policy pertaining to prioritisation for home graduate doctors for training numbers or job postings if I am at a BMA conference this year. We are failing our current medical students and future graduates, it is not acceptable.
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Today we learned the cutoff for IMT is 15 this year. This is an increase from last year AFTER they dropped total points from 40 to 30. Come this August, 100s if not 1000s of doctors unemployed. This is a national scandal.
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Kind of crazy to think how quickly a medical career has flatlined in the UK. Completely different landscape to just five years ago. Do we keep pushing adrenaline and continue CPR? Or just call it now?. All I know is I have regrets. The question on my mind. Was it worth it?.
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Interesting way to phrase it. āAll hands on deckā is not really a phrase I want associated with anaesthetics if Iām honest. If Iām having surgery, I want an experienced anaesthetist not an associate. 1/2.
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The colleges are realising their members will not stand for this corruption anymore. Everyday doctors are standing up for both the protection of patients and the standard of medical practice within the U.K. The GMC are next in line and should be very concerned about it.
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Triaged on a corridor, moved to an inappropriate ward. Treated by an under qualified staff member working out of scope amounting to gross negligence manslaughter. This is the modern NHS and it makes me furious. My condolences to Susanās family, this is unacceptable.
Thank you to Roy, Kate, and of course @LondonAnaesth for speaking further about this tragic case. The public are not safe when there is a dilution of standards and a refusal of the regulator to set univeral limits on what is appropriate for PAs/AAs to do.
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Simply unacceptable. āOpportunities to scrub in for theatre cases as first assistant and develop skills such as skin closure, minor ops and simple breast proceduresā. āPerform other tasks, not prohibited by law in which the PA has been trained and is proficient to performā
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Maybe what we need is a little less BeKind and a little more BeCompetent.
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Twice in one day. I donāt know what to say. I am not a surgeon, but our surgeons of tomorrow are being royally shafted.
I commend this PA for correcting the nursing student on their role. However, evidence is cropping up all over the place of PAs in theatre, either assisting or leading surgeries. This is not appropriate and far from the role that was sold to doctors.
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Following on from finishing my set of nights for New Years I am now confronted with this. 70 hours in 8 days, of which 51 hours (73%) are outside of normal working hours. I really donāt know how emergency medicine specialty doctors survive. This rota is inhumane.
Christmas Eve: 12:00-22:00.Christmas Day: 16:00-02:00.Boxing Day: 16:00-02:00.New Yearās Eve: 22:00-08:15.New Yearās Day: 22:00-08:15. I really struck out on luck for my emergency medicine rotation over the festive period š no family time for me I guess.
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New PA job hot off the press from @GreatOrmondSt. Theyāre looking for a Physician Associate in Specialist Neonatal and Paediatric Surgery. @RCPCHtweets is this acceptable scope?
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We need to prioritise home graduates. COI: I am a home graduate š¤£. In all seriousness, until we prioritise our home graduates it will cause further anger/negativity towards IMGs. The system is at fault not our IMG colleagues.
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A joke isnāt it, absolutely ridiculous. For anyone in this situation, schedule 10 of the contract (points 14-16) stipulate that employers must allow annual leave for life-changing events (as defined by the doctor), given the doctor provides a minimum six weeksā notice.
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āWe started completely on the wardsā . āNegotiating to see patients in clinic and to assist in theatreā. A mockery of anyone doing IMT/CST or a higher pathway from those stems. Clear opportunities for learning taken away. Doctors are crying out for opportunities like this.
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Why is your 4 year PA programme listed under undergraduate medicine? @edgehill . There are only two degrees I see which are undergraduate medicine (well one really considering once you complete the foundation year you transfer to the typical A100 course). #PACourseCon
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What we witnessed yesterday with IMT will only get worse unless there is drastic action. Most F1 doctors can't amass a portfolio to compete with these self assessment scores. We are training doctors only for them them to end up unemployed.
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Iām sure cardiology is challenging, however, saying it is more challenging than general practice shows a clear lack of insight and is disrespectful towards our GP colleagues.
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Make of this what you may. Histopathology interviews came out today. This person is an F2 doctor who didnāt make interview. Look at their application portfolio. Change is needed.
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I commend this PA for correcting the nursing student on their role. However, evidence is cropping up all over the place of PAs in theatre, either assisting or leading surgeries. This is not appropriate and far from the role that was sold to doctors.
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Iām paying 52% marginal tax on locums. That Ā£60 soon becomes Ā£28.80. Not a chance in hell Iām working any shift I donāt have to in the current crisis for that. My time is worth more to me. As Eilidh states, those shifts are awful.
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Sadly the public donāt see this. Newly qualified doctors given a randomly generated rank and asked to preference, when in reality, if their rank is low, theyāre going where no one wants to go. Not acceptable and a disgusting way to treat some of our best and brightest.
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This is my loan amount. The interest is currently 4.3%. This year that means my loan will grow by around Ā£4450. I would have to earn about Ā£75,000 this year just to cover just the interest on my loan, without decreasing any of the capital. For years this value will increase.
Once again this idea floats around. You canāt even guarantee jobs for doctors anymore, how are you planning to conscript them?
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Todayās episode of #PACourseCon highlights @BSMSMedSchool. First thing to note is the blatant lies. Your website states āwe have a 100% pass rate on the PA national examā. However the FOI tells a different story. You charge Ā£10,500 a year. Stop lying. 1/8.
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The amount of pressure it has taken to move this issueā¦. The issue in question, annual leave refused with 6 months notice. Absolutely disgraceful. Imagine if we start to actually treat doctors like the professionals we are.
Update - after a lot of back and forth and some very helpful BMA input, my shifts have been moved by the trust and annual leave has been approved. Many thanks @fletchjack @ERunswickBMA @BMA_James_Steen for the advice.
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Itās pretty simple really. Student nurses used to receive a bursary, in addition to the option to complete a diploma to practice instead of a degree. The reward of poor pay, awful working conditions, and a graduate tax for all their working lives is simply not good enough.
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āIf youāre attracted to a career in medicine, you may be interested in becoming a physician associateā. @BoltonUni the GMC has stated that PAs do not study medicine, so how can they have a career in it? . #PACourseCon
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Imagine, some doctors are so worried about unemployment this year they have applied to GP with no desire to actually be a GP. They just need a secure job while they work on their portfolio for the specialty of their interest. What a sad state of affairs.
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PA canāt request a CT head to rule out haemorrhagic stroke. PA canāt prescribe Alteplase if needed for thrombolysis. PA canāt prescribe secondary prevention anticoagulation, antihypertensives, or statins. Stroke sure sounds like a great place for a PA.
āThese posts will support the expansion of Resident Doctor numbersā. āIt is desirable but not essential that the Physician Associate has prior experience in one or more of the following areas: Stroke Medicine, Care of the Elderly, Neurology or Neuro-rehab.ā.@LeedsHospitals why?
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Meanwhile for us on Plan 2 š¤£
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Certain member of the MDT waiting for a computer to come free so they can unintentionally illegally prescribe or request a scan.
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A brilliant statement and a good start. I will look forward to seeing the updates on how this future policy is put into action. Home graduate doctors must be prioritised for training posts.
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Came across this on Reddit. The responses were eye opening. Clearly PAs have been sold a lie by institutions. 8 hours following the post and not a single reply advocating for this person to do the course. #PACourseCon. 1/6.
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Currently on my 56th hour of work this week in A&E. Not in the best of moods working night after night but happy to be a nuisance providing resistance to the constant pushes of doctor replacement with lesser trained staff.
Is this how you speak about the doctors working around the clock in a broken system to keep patients safe this winter?. Here's to being a nuisance š§.
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I see regular requests for locum cover on my current ED group chat. I would love to pick up shifts. However at Ā£22 per hour post taxes/SL, when I already work 45 hours a week. It isnāt going to happen. Iād imagine most have the same opinion.
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Honestly, unemployment sits on mind and drops my mental health quite substantially. I have a feeling it is going to be a massacre this year. There are very few safeguards for those failing to get a NTN, too few locums, LED/JCF contracts.
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Given the drivel written by the Daily Mail I never thought there would be a day Iād purchase a paper. However, I had to get a copy of this article. Nice to see patient safety concerns highlighted instead of uproar that doctors dare to ask their pay awards match inflation.
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Weāre finally going to get the data just prior to regulation. Would you look at that for timing. @doctor_oxford it seems youāre going to breech over 100 days of requesting these results. The GMC state they have ālistened and reflectedā, I personally prefer the term gaslit.
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A picture tells a 1000 words, so what does a video show?. In these videos, it shows a clear timeline of regulation being sought after for a view of future PA prescribing, and to the same effect, rights to request ionising radiation. 1/12.
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Itās the Wild West at @royalmarsdenNHS. Admission clerking for cancer patients, bone marrow biopsies, lumbar puncture, ascitic drain insertion, consent by proxy, authorisation of chemotherapy.
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Seriously. How blind can an institution be. Whoās paying the 30 pieces of silver? This canāt be unintentional, clearly there are some dirty handshakes under the table. Guess ongoing patient harm is fair play in exchange for a knighthood. For shame.
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This is a joke right? . So I have had my work devalued and my pay lost against inflation, in a harsher working environment that those practicing before me. Now you're only going to give that back if I promise to work harder?. Medicine is a dead career in this country I swear.
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Waiting for UMAPs to put out a statement threatening legal action against the RCPCH for their announcement today.
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Well, we found the thirty pieces of silver. The @RCPhysicians used PAs as an attempt to bail them out of financial hardship. Sacking their morals and exploiting PAs in the process. Brilliant. This choice has left the college with irreparable damage to its reputation.
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Many messages from medical students wanting to help saying āIām just a medical student how can I help?. You arenāt ājustā anything, and donāt let anyone else tell you otherwise. As medical students you have the most to lose from the training issues. Make your voices heard.
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What would actually help doctors is a band 4 role which does basic procedural skills, takes notes on ward round and preps discharge summaries. However, thatās not what we have and is not what is being pushed by institutions. Gaslighting is rife, both to doctors and MAPs.
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The crux of it really. Everybody wants to be a doctor, but nobody wants to lift no heavy-ass books. There are many routes into medicine; undergraduate, postgraduate, a foundation year (like I did). Either do it properly or donāt do it at all. Donāt half-arse patient safety.
āMy goal was to practice medicine, but didnāt think I needed to become a doctor to do itā. If your goal is to practice medicine, you need to study medicine first. There are no shortcuts to patients safety. Pause the role immediately, then review whether they should continue.
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Many universities still listing that physician associates have future job prospects in GP. With the college stating that they oppose the role of PAs within general practice. In addition to the scope document that makes them economically unviable. Isnāt this a tad misleading?.
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Stumbled on this. Discrimination has specific meaning in the UK. Just because you say itās discrimination doesnāt make it true. Anyone from UMAPs care to explain which protected characteristics the BMA/RCGP guidance is either directly or indirectly discriminating against?
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This always makes me chuckle. Various other members of the MDT (including students), have easy access to software in which they could request a scan or prescribe something. Whatās funny is, they donāt. If a crime is committed the perpetrator is at fault, not the system.
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