John Alcolado
@Jcalcolado
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Medical Education, Endocrinologist, Acute Medicine, NED
Joined August 2012
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The invidious position of junior doctors is that we spent years teaching them how to be good doctors,failing them in exams for any shortcomings, then they are thrown into an NHS that is so poorly funded & staffed that they can’t deliver the standards we told them were essential
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If you are a retired doctor, before you express your views about current junior (and senior) doctors pay, just reflect on the fact that your final salary scheme pension is INDEX LINKED to inflation and perhaps support a similar standard to those actually working
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I was on Acute Medical Unit for 21 hours over the weekend. My observation is that the trainees/“juniors” worked incredibly hard and the acuity and complexity of the patients are a world away from when I was a houseman in the 1980s
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Comparisons not always helpful but for those interested I got paid £13,000 pa for first house job in 1986 (1:3 rota), equates to around £49k now. No student debt and bought my first house for £35,500 with 100% mortgage & got £100 back for furniture! Free hospital accom & parking
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Well, some medical school must be proud of how they taught communication skills to their medical students !
"If you asked the average person on the street if they would be happy to pay a doctor £19-an-hour I think you get a resounding yes"
@RobLaurensonD4P
told Sophy that Steve Barclay was "pinching pennies" in the dispute over the 35% pay rise demand
#Ridge
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During my time as a Director of Medical Education I fought this tooth and nail…cancelling (contractually required) teaching for the most junior doctors is unacceptable. Trusts get 100% of FY1 salaries yet can’t give them the minimum training to ensure they are safe…shocking
🚨 Extreme pressure at
@WalsallHcareNHS
has seen all teaching for doctors cancelled next week - the trust has also told staff it is seeing its worst ever pressures in A&E:
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I was at a Board meeting of a certain Trust that voted to re-instate parking charges for patients, relatives and all staff and then later sent an email out to Board members asking them to register their cars so they could be exempted!
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Cardiologists with private practices seem to have form on telling junior doctors they should not strike
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In recent years,perhaps a function of getting older,I have sometimes wondered if our recent medical graduates were as well-prepared as we were
#boomer
. Too many tick-box OSCEs? From what I have now witnessed, the reality is that they are dedicated & brilliant
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Chester Medical School will take its first grad entry med students in Sept 22.However,due to lack of government funds & cap on places for UK students,we can only take international students.Meanwhile NHS desperately short of doctors & UK students can’t get place to study medicine
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Anyone with me for nominating
@RobLaurensonD4P
and Dr Vivek Trivedi for
@HSJnews
Awards 2023 Clinical Leader of the Year category? Would love to see how they report and cover that one!
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Dr Sarah Clark has been re-elected as President of
@RCPhysicians
1998 votes to 1749. Although I did not win, I am glad I stood and contributed to the debate and came closer than I initially expected.
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When I was a Foundation School Director back in early 2010s, the number of FY doctors not going straight into specialty training was low enough for me to offer them 1:1 advice and support. Now a more common question is “what are you doing for your ‘F3/F4” year
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Just preparing to work this Christmas weekend, 37 years since my first…anyone remember when we actually closed wards over Christmas because of spare bed capacity and had sherry and chocolates in the sister’s office ?
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THERE ARE NOT ENOUGH STAFF BECAUSE YOU DO NOT PAY THEM A FAIR WAGE…..what don’t you understand?
Being stuck on hold to your GP when you need to see a doctor is deeply frustrating.
We will end the 8am rush for appointments by making sure patients are either given an appointment immediately when they call or directed to a more appropriate service.
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My understanding of “Martha’s Rule” announcement is there is some money for 100 hospitals to print posters & leaflets. No new money for more critical outreach, staff or resources…Good to empower worried patients/relatives but real risk is lack of resource in overstretched system
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Taking medical histories, examining people and starting them on treatment whilst they are sat in a waiting area or lying on a trolley in a public corridor were not on the curriculum or in medical school/Royal College exams.
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Support to all my colleagues taking part in action industrial action today in support of fair wage and conditions whilst highlighting the perilous state of the NHS. I know you have not taken this step again lightly. You are our future
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Doctors should only have to explain once to Dept of Health, Treasury, PM, employers, media, and across Government why there is a retention and staffing crisis in the NHS
'Patients should only have to tell their story once across social, primary and secondary care' - senior NHS boss tells
#Hsjprovider
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Can’t move for doctors and nurses in NHS hospitals…there are so many that they are literally sitting around waiting for patients to turn up and wishing the waiting lists were longer…Can I have a job in the Government based on my misleading statements please?
#sarcasm
📈The latest stats show record numbers of NHS staff, with over 5,100 more doctors and over 11,800 more nurses working in the NHS compared to January 2022.
The NHS will soon publish a long term workforce plan focused on recruiting and retaining more staff.
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In life, timing is everything…18 months ago I was the only one brave/foolhardy enough to stand against incumbent President of RCPLondon…I lost…but I think I was on right side of history so no regrets…next time there will be a wider choice.
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SJTs for Foundation School selection
What's the worst test in medicine and why is it mycoplasma serology?
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Personal view, and not necessarily that of any organisation with which I may be associated: I continue to unequivocally support my younger colleagues (“junior” doctors) following their announcement of industrial action on March 13-15.
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The hours I have spent trying to explain this! If a med school takes 100 new students each yr, in steady state, it will graduate 100 doctors each year, whatever the length of course..shortening to 4yrs only increases output for a single, one-off year, at price of less trained drs
Can someone teach our NHS & medical leaders basic maths. Shortening training doesn’t lead to more doctors, just doctors working independently for around 5% longer over their lifecycle. This is a solution for what?
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I sometimes still wish I had got another couple of hundred votes in the Presidential election back in April, or that Members were allowed to vote. Just transfer the fee ! Who has the greatest financial reserves here? Trainees or the College ?
I appreciate it hasn't been easy for
@MRCPUK
, but to cancel an exam and insist you pay another £657 upfront for the next PACES diet and get the refund for the cancelled sitting later really isn't optimal with the cost of things at present
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Quite simply the best hospital I have ever worked in over my 35 years in the NHS
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@trentconsultant
@dr_lungs
@mreschen
@OutbreakJake
On top of their basic salary, doctors are able to supplement their income by buying lotto tickets, potentially boosting their take home to over £1m each year, (pitched to DHSC as next comms piece)
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For those concerned about media reports of doctor apprentices working straight as school leavers, defo worth reading HEE documentation. Lots of lazy media reporting today…but defo major concerns regarding funding and support for clinical placements for this route 1/2
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This April Fools article was clearly published a day early by mistake in the Times. “Take over” = elected mandate (98%) Junior doctors strike: How a Reddit rebellion took over the British Medical Association
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After I was unsuccessful at standing for President RCPLondon last year, I suggested changes to allow Members and well as Fellows to vote…what has happened since? The College has increased the number of fellows required to nominate a contender from 5 to 20…
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I feel the Royal Colleges should commit to capping any exam and membership fee rise to no more than the average doctor pay increase. They generally have far higher financial reserves than those sitting the exams
As a Head of School I’m deeply uncomfortable with the
@RCRadiologists
raising their exam fees by 22% this year.
I know inflation is high, costs have gone up, and college exams don’t make a profit but 22%, really?!?
Doctors are genuinely struggling to afford their exams!
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I am also standing so please go onto website, read election statements and watch videos and then make your choice
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Over 42 years since starting medical school and after nearly 38 years working as a doctor, a long day on acute medical unit yesterday reminded me afresh that medicine is hard…intellectually, practically and emotionally but also personally (if not financially) rewarding
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We are going to need lots of physios and pulmonary rehab specialists over the next few years. The acute phase, ICU pressures and peak admissions will last weeks/months..but the sequelae will last years. Let’s start planning longer term workforce and service needs now
Polio, Spanish Flu, WW1, COVID19.... physio has responded and risen to the challenge before, it will do so again!
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As an update on my standing for
@RCPhysicians
President earlier on year, and losing narrowly to incumbent, I am pleased to report that the College will convene a group to consider the issues I raised, including voting rights for Members and review of canvassing rules
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£17bn in 2021-22 to healthcare companies….cost of junior doctors pay restoration <£1bn a year…everything costs money but where to spend is a political decision (assertion that triple lock pensions not inflationary but pay restoration will be, is another example)
150 healthcare companies earned over £17bn from the public sector in FY21/22.
Find out who they are & who they're working with in our latest report:
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2/2 I have previously tweeted and written about this, including my view that it is the wrong solution to the wrong problem but being driven by apprenticeship ideologues and is more about churning out cheaper doctors than a real desire to sort workforce issues
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@drmattuk
I have investigated this and the original email appears to have come from an NHS employee and not from Aston medical school. We will ensure our partner NHS trusts are aware of our examiner requirements
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But you didn’t share the survey data with Council, despite Council literally meeting a few hours before the EGM…so how can trust be regained by this statement?
We are undertaking a major governance refresh that is being led by Council members and we are committed to modernising the college and its working practices as quickly as possible.
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Medical Royal Colleges that have spent years sucking up to the Torys and trying to exercise “soft power” are now busy trying to lay the foundations by sucking up to the Labour Party in anticipation of next election…perhaps just represent your members, fellows and professions
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I don’t often post family stuff but it’s great to welcome Lucy Taylor to the family having married my son Nathaniel. Its taken a wedding but now a third Alcolado on GMC register. Every blessing to both of them
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I predict an increasing number of Foundation posts coming out of the UKFPO recruitment system and being ring-fenced for graduates of the local medical schools….this year’s system will just accelerate a return to what used to happen in the 1980s
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A couple of days with local GPs
@drliza_revivepx
training at local field hospital has taught me that if it were not for the, relatively invisible, work they are doing in the community, our hospitals would have been overrun as in Lombardy and Madrid. World class primary care in UK
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Undoubtedly there will be a contested election for PRCP London later this year by next Palm Sunday at the latest. If you decide to stand, be prepared at attempts to dissuade you..but I have confidence the RCP complaints procedure works..anonymised for confidentiality
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“Won’t austerity cause real harm to people?” Government: “yes,but short-term price is worth paying for long-term benefit to country”Doctors “we are striking to help preserve long term future,staffing levels & safety of NHS” Government: “You are callously causing short-term harm”
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Royal Colleges will still need funding to run these (but at cost, not profit), so best solution is probs for employers and/or NHS (education) to fund Colleges direct, or make cost 100% reimbursable. Motions all well & good, but need realistic plan to operationalise
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Want to see future of general practice in UK? Take a look at what has happened in dentistry when professionals are driven-out by imposed contracts & market forces have free rein. Part of proposed solution is for dental hygienists to work “to top of their scope”…sounds familiar?
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Our younger and newer NHS doctors and colleagues deserve our full support as they battle to ensure their working conditions will allow them to provide the standard of care they are desperate to provide,and which we trained them for.
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“There isn’t clinical placement capacity for more medical students” I’m told.…me on MAU this weekend no medical students, but 60+ inpatients with range of symptoms, signs and diagnoses,from eosinophilic vasculitis to myeloproliferative disease,to diabetes, and team keen to teach
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I am expecting update from
@RCPhysicians
@DrSarahClarke
via one of her usual emails in the next few days explaining her position & future of College. I think it’s least Members & Fellows deserve, even if it is to confirm she is staying. Not right to deal with this with silence
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It’s hard to keep up…the
@RCPhysicians
website and official channels are silent and no official emails…Fellows and Members learning of resignation of Deputy Registrar and u-turn regarding data publication on Twitter from council members
Happy to announce that
@RCPhysicians
will publish data from the pre-EGM members’ survey across platforms before 9 am TOMORROW 18/3/24.
It should have been out earlier.
I am pleased data can be reviewed by fellows before voting for the
#RCPEGM
motions closes.
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Voting for the
@RCPhysicians
Presidential election has now closed. Whatever the outcome, thank you to the 3800+ Fellows that participated. The result will be announced shortly after 630pm today.
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RCP London College Day has come around…annual election of President (by statute)…I predict some interesting developments, one way or another, before the day is out and I will be posting later
#RCPEGM
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@parthaskar
@AstonMedicine
@RCPhysicians
@RobJimFleming
@OrthopodReg
@trishgreenhalgh
@morefluids
@Rezaidi
@doctor_oxford
@doctorhelgi
@DrSelvarajah
@drphiliplee1
@eveosh
Partha.. I have investigated. I did not come from Aston medical school but from NHS employee. Working urgently to ensure all NHS partners are aware of our examiner requirements.
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Excellent from
@parthaskar
“The public knows that the failings in the NHS aren’t the fault of this generation of doctors who face burnout, understaffing, stagnant pay, unsustainable debt, and a lack of career progression or opportunities to specialise…”
Via
@bmj_latest
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In 6 days time the RCP London will have a President with a new elected mandate. I am standing. Please take a look at election materials on website and make your views known. It is a binary choice. Ask Fellows you know whether they have voted. Around 75% won’t have voted yet.
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Well if there was no IA, there defo would be no talks…JDs tried for almost 2 years and Government refused. So to now say stop IA and we will talk is classical gaslighting.
Really unbalanced interviewing on R4 today calling on
@TheBMA
to call off strikes & enter talks in junior doctors’ dispute.
Doctors are willing to negotiate.
@RishiSunak
&
@SteveBarclay
are the ones refusing to talk.
Why not come to ACAS, Steve?
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@TCleare
Correct, they were long hours but we were often in bed by midnight when on call and the registrars and senior registrars used to go home to bed, especially if we were on ward cover rather than intake. The number of beds covered was also much smaller. Different times!
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Thank you for putting out your own statement rather than just going with the insipid
@AoMRC
statement that was sneaked out at end of last week
RCEM statement on upcoming industrial action by junior doctors
@RCEMpresident
Read full statement here:
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This tweet either deliberately attempts to mislead regarding the nature of pay increments and need to maintain their relative value or exposes an inexcusable fundamental ignorance of basic economics…from a Government department. Don’t take people for fools
⬆️ Junior doctors will get a pay rise of between 8.1% and 10.3% depending on where they are in their training.
This is a fair and reasonable increase as recommended by the independent pay review bodies.
Full details below 👇
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Congratulations to my youngest son, Simeon, on his A level results today and confirmed offer to study Computer Science
@cardiffuni
@CompScienceCU
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As you start returning to work after the industrial action tomorrow, it would be a good time to discuss with your consultants what they have learnt during cover and if they have any new insights into what could be done to make your jobs easier 1/2
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The list of RCP London Council members. Only a minority are directly elected by Fellows…I pointed this out when I wrote to College last year after my defeat in the presidential election…suggesting an urgent governance review should address this
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We can discuss and reach different conclusions but to try and close down a debate by asserting that an “idea” is ill-judged and damaging sounds like an attempt at censorship. It’s failing to listen to criticism that has got training pathways to where they are today.
'The idea that an apprenticeship scheme cannot work within the medical profession is both ill-judged and damaging. Especially considering similar schemes have played a vital pathway to train many of the NHS’s nurses,' says Nichola Hay MBE
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My time line is full of examples of appalling ways doctors, especially early-career ones, and academics are being treated. It’s as though all those organisational development, leadership programmes and culture statements/graphics are all for show
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I would also like to see all future candidates standing for President of RCP London to state in their election materials whether or not they would accept an Honour from His Majesty the King on leaving the role…it is possible to decline these or make clear they will be accepted.
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A traditional definition of “professional” involves an element of those that belong having a degree of self-regulation, setting their own standards, and gate-keeping entry, defining what is “other”….none of that is intrinsically wrong or elitist..it’s just being professional
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Earlier this year I challenged the incumbent President of Royal College of Physicians London & she won by a narrow margin.I suggested some governance changes including allowing members to vote & was pleased to learn my suggestions were being explored..however don’t hold breath
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At last contested election for President of
@RCPhysicians
the turnout was only 25.9% (only Fellows can vote) & margin was 53.2% to 46.8%, difference of only around 250. When next election announced please VOTE or don’t complain later…it matters big time
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If you are a clinician, please, please find time to get involved in early years medical student teaching. The students really appreciate it, and it will ensure the basic sciences are taught in a relevant way. Don’t just get involved in clinical placement teaching.
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Voting in
@RCPhysicians
elections including for President now open. I am standing. No canvassing allowed but Fellows & Members will get email from CES with access to election site.Only Fellows may vote.Vital to get good turnout so please vote & encourage Fellows to do so
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I also had benefit of the 1995 NHS pension scheme with normal retirement age of 60 (despite it being eroded in recent years by tax charges) I don’t believe current generation of doctors are worth any less or that UK economy or GDP in 2023 is in worse position than in the 1980s.
Comparisons not always helpful but for those interested I got paid £13,000 pa for first house job in 1986 (1:3 rota), equates to around £49k now. No student debt and bought my first house for £35,500 with 100% mortgage & got £100 back for furniture! Free hospital accom & parking
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Reality is no time is a good time now, given state of clinical academic training pathways & funding. We have seen collapse in research MD/PhD amongst clinicians. I don’t advocate back to old days when everyone felt they had to do MD/PhD but defo need to review current pathways
What is the best time to do a PhD as a clinician?
Typically
FY2 = PGY2 (intern years)
CT = PGY3-4 (junior resident)
ST3 = PGY5 ('mid' resident)
@aneelbhangu
@rupert_pearse
@NatalieBlencowe
@DrJamesGlasbey
@_tomabbott
@drjackoids
@JohtChandan
@KKCheng4
@adbeggs
@ewenharrison
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I have been humiliated & had my basic human rights denied because the private Coutts Bank has refused to open an account for me despite my agreeing to pay in my NHS consultant salary. It must be enough because
@MailOnline
say doctors are rolling in money
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Anything but a personal apology or acceptance new leadership is required to move forwards
Our president Dr Sarah Clarke said: ‘The RCP’s strength comes from our community, and I acknowledge that our engagement with you needs to improve. I want us to work together to restore trust and be the professional association that you deserve.’
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Remember there is also an election for members of Council and Academic VP ongoing…closes Monday. Please read the statements and vote…we have seen how voting can make a difference…
#RCPEGM
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The reluctance of providing source data/info is usually inversely proportional to the likelihood that the withheld data supports any biased or flawed apriori hypothesis, or, for those who find Likert scales too difficult…people hide bad stuff not good
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Nominations for
@RCPhysicians
council soon open. Last year I stood against incumbent President & narrowly lost. I have decided not to stand again this year, to see if proposed changes discussed at AGM materialise. In meantime, I may stand for another role to try & effect change
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Almost 2 years after joining
@uochester
@UoCMedSchool
an exciting milestone today as we interview prospective applicants to start on our graduate entry medicine programme for Sept 2022. Enormous thanks to all that have helped get us this far
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All the medical Royal Colleges do need to ensure they listen to the “grass roots” and properly represent their members and fellows. Otherwise they risk becoming anachronistic old folks clubs
With regret I’ve decided to vote against the proposed
@RCRadiologists
governance changes for 3 reasons:
- concerns about diluted radiologist influence
- lack of risk assessment of proposals
- no specific examples of what could be done better under proposals
Sorry
@halliday_kath
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What is certain is that next election will be decided by physicians over age of 40, many retired & most not on social media. Until members get a vote, best that can be done is for them to ensure the Fellows they know are aware of their views & vote with eye to the next generation
At last contested election for President of
@RCPhysicians
the turnout was only 25.9% (only Fellows can vote) & margin was 53.2% to 46.8%, difference of only around 250. When next election announced please VOTE or don’t complain later…it matters big time
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Well I stood against President 18/12 ago,narrowly lost.Decided not to stand again this (following) year, patiently expecting change.Ive been disappointed.I suspect others wont be prepared to wait & will stand, even if I don’t. It’s about how things are done,not just what is done.
I really hope that those critical of the way specialist societies / Royal colleges are run & the decisions they make actually stand for elections in the future.
That is the only way to try to implement change.
Whatever you think of those elected (such as myself), we put
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@parthaskar
@RCPhysicians
@NHSEmployers
@ShivaniM_KC
@mmamas1973
@trishgreenhalgh
@DrLKVaughan
@UKGastroDr
@doctor_oxford
@RowanHarwood
@OrthopodReg
@RoshanaMN
@AntonEmmanuel2
…and whatever change in leadership is required to restore confidence in the College
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What I don’t understand is why the pensions “triple lock” was not considered inflationary but committing to raise public sector salaries at least in line with inflation is considered unaffordable and destabilising to the economy. Is it perhaps due to who generally votes how?
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We are still here
@DerbyHospitals
despite the adverse weather. Many thanks to rest of team, especially on MAU and ED and Estates for keeping access roads open
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I knew about Occam’s razor, in medicine…a single unifying diagnosis is generally better than suggesting multiple ones to explain a clinical presentation, but I have now been reminded of Hanlon’s razor….
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Proud and delighted to welcome our largest ever cohort of Graduate Entry Medical students on their first day with us
@MedicineUoN
@UonAnd
@UoNSU
@UHDBTrust
@UniofNottingham
@ShearerWest
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I long for a time when the medical Royal Colleges move towards being more vocal in supporting and lobbying for their members and fellows rather than falling into the trap of focusing on being close to government in closed rooms..influencers not lap-dogs
Everyone knows but no one does anything.
>The Royal Colleges and professional associations… have no influence.
>NHSE have no power to publish their own plans.
>The DH is up to its armpits in dissembling and distraction.
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After an evening watching our
@HouseofCommons
debate it was so refreshing to switch over and watch
#thebighospitalexperiment
I wonder which of the two work places and public servants people think are most worthy of our admiration?
@UHDBTrust
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15 minute break between virtual meetings with cup of tea and roses in garden. Some things about remote working I will miss...
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Unpopular opinion…I don’t begrudge MPs a single penny of their salary… brass necks must be very expensive to buy and maintain
MPs’ pay review body says that “MPs play a vital role… & this should be reflected in their pay”.
The starting salary for an MP (no experience necessary) is £86,584.
A doctor (5-7 year at university & typical student debt of £100k) starts on £29,384.
Who would you pay more to?
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Like many debates where agreement is unlikely, it’s because the two sides are coming at it from fundamentally different positions…do we aim to get away with absolute minimum competencies/standards or do we strive for most qualified we can…I know which I would prefer & is safest
76% of Drs do tasks for which they are overqualified -
@drcolinm
justifies for extending scope of practice of other groups
How do you define overqualified though?
Like if I never do another inter hospital transfer so what, I’ve done tons, but I’m not overqualified for it..
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