Maureen Baker's speech to the Special LMC conference 2016

Publication date: 30 January 2016

Dr Maureen Baker, Chair of the Royal College of GPs has addressed the Special LMC Conference 2016. Here is the full text of her speech.

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Thank you conference.

It’s a pleasure to be addressing so many friends and colleagues here today.

We’re all here because we share the same passion for, and belief in, the fantastic care that general practice provides to more than a million people every day.

We know that general practice is more important to the NHS than ever before.

In the College we have a saying that the NHS works because of general practice, and general practice works because of GPs.

Any threat to general practice is actually a threat to the sustainability of the whole NHS.

From my own practice, and from the conversations I have with GPs around the country every single day, I know how tough it is for all of you simply to keep your heads above water.

We know that patients value us – and I think we should be hugely proud of the fact that according to the latest GP Patient Survey 91% say they continue to have trust and confidence in their GP.

But we also share the same profound concerns about the future of general practice, because the service we care about so much is now facing pressures greater than at any time in its history.

At the start of 2016, it really feels like general practice is at a major crossroads.

As I see it, there are two possible roads general practice could take from here.

The first is the one we are all worried about.

That way lies a deepening crisis for general practice, unsustainable workloads, exhausted GPs and local practices closing down by the dozen because there is no one left to run them.

My recent paper pointing to the patient safety implications of excessive workload and fatigue in general practice received an overwhelming response from GPs for whom very high levels of stress and tiredness are a fact of daily life.

In this scenario, promises from politicians to sort out general practice and primary care come to nothing, and the service we know and love goes into long term decline, with disastrous implications for patients and the NHS as a whole.

Since I took office I’ve been saying that general practice is on the brink, and I’ve been accused of scaremongering.

But we all know that this isn’t scaremongering.

We saw only last week figures showing that in 2015, 72 practices were forced to close their doors, forcing more than 200,000 patients to register elsewhere – a huge leap from the previous year.

GPs and our teams are making in excess of 370m patient consultations a year to keep up with the demand of our growing and ageing population.

That’s 60m more consultations than five years ago, yet funding for general practice has declined dramatically in real terms over the last ten years, and our workforce has remained stagnant.

That just isn’t sustainable – we just can’t work any harder than we already are.

We know that GPs are already leaving in droves – and if we continue down this road that will quickly escalate even further.

In the Midlands alone a study recently commissioned by the RCGP’s Midland Faculty found that 82% of GPs said they intend to leave general practice, take a career break and/or reduce their clinical hours of work within the next five years.

This first road leads to disaster for general practice and the NHS.

But, there is a second, alternative route for general practice to take – if we’re given the support to do so.

This path is by no means easy either, but it leads towards a situation where general practice once again becomes properly valued and recognised for what it is – a stimulating, exciting career at the cutting edge of a 21st century healthcare.

Where GPs have time to give patients the care they need and deserve.

Where we have the freedom to shape and improve services for our patients, working with colleagues across the NHS.

Where a renewed sense of vocation and professional pride make being an NHS GP once again the best job in medicine.

This is what we need to strive for, and we need to make 2016 a real turning point for general practice

We’ve been at this crossroads for too long, and we need to decisively set off down this second road - the high road - towards a more positive future for general practice with no further delay.

But how can we get there, when so many GPs are now regularly seeing 50-60 patients per day, and are doing everything they can just to stop existing services from toppling over?

Ultimately, general practice needs to be properly resourced in the long term to do the job it needs to do for the NHS.

The funding crisis in the acute sector cannot be allowed to derail that necessary investment.

There’s a real risk that despite good intentions, money continues to be sucked up by the acute sector; we cannot allow this to happen.

The scandalous decline in general practice funding as a proportion of the NHS budget – which College analysis has shown is down from nearly 11% ten years ago to just 8.3% today – must be reversed.

And we need to ramp up the campaign to recruit, retain and return as many GPs as possible in the coming years, building on the work already underway through the 10 point plan agreed between RCGP, GPC, NHS England and Health Education England.

But gradual change isn’t enough given the scale of the pressures practices across the country are facing now.

I was particularly struck by something NHS England Chief Executive Simon Stevens said earlier this month when giving evidence to the House of Commons Public Accounts Committee.

He told MPs on the Committee that GPs don’t want promises for the future.

He said that GPs “want to see the cavalry arriving now”.

This is exactly what RCGP is calling for – an emergency package of measures, backed with funding, to save general practice from the brink.

We need to see that cavalry coming over the hill, and we need to see it soon.

RCGP has been developing some costed proposals that we would like to see as part of such an emergency package.

Resilience teams that can be parachuted into practices from whom practices can request help to plug staff gaps that might otherwise tip them over the edge.
A new return to nursing scheme to support those who’ve left the workforce to enter general practice, giving us a new cadre of at least 500 new practice nurses over the next year.

Real action on medical indemnity, which is now completely out of control.

Grants to help practices upgrade their IT infrastructure.

Mental health workers based in practices for real time referrals and support.

More investment in our underfunded and undervalued GP out of hours service.

These are just some of the tangible steps we want to see taken as a matter of urgency.

We believe measures such as these – backed by significant resources – are the absolute minimum requirement to give us our first steps down the right road.

It would also send out a clear signal that things are going to change.

That general practice has a future that will attract young medical graduates looking for a rewarding career in medicine.

That GPs will have the power to shape our own destiny, working in collaboration with colleagues around us in primary and secondary care to improve care for our patients, and not be dictated to from above.

But before we can go any further we need two big changes of policy.

First, the constant stream of newspaper headlines and announcements making unrealistic promises to patients that they will be able to access their GP 7 days a week 365 day a year, have got to stop.

Where GPs decide that this is deliverable in their local areas, and there is clear evidence that patients want it, then they should be supported.

We know from the evaluation of the Challenge Fund that in many areas there isn’t a strong appetite for access to routine services on Sundays, and it would be irrational, nonsensical and downright bizarre for the government to force this on GPs regardless of actual need.

We all need to use the NHS pound in the best possible way to benefit all of our patients.

In the vast majority of communities up and the down the country, what is needed urgently is investment in in-hours GP provision and also better funding and support for our excellent out of hours GP services, which are already available round the clock.

Second, we all know the current inspection regime for general practice is not fit for purpose and has to change.

Last year the College asked GPs to share their experiences of dealing with the CQC, and the response was damning.

We heard about GPs immense frustration with a regime that demotivate and de-professionalises clinicians and staff, taking them away from front line patient care.

Of course some form of regulation is necessary, but the system should be working to support practices – not beating them with a stick because a GP has not attended a refresher training course on how to resuscitate.

The CQC has now launched a large-scale review of its approach, and this is an important opportunity to drastically change the inspection regime and ensure it upholds standards of care whilst letting good GP practices get on with the job they are there to do.

The result must be a new proportionate and meaningful regulation regime and an end to the heavy handed, bureaucratic and frankly soul destroying system we have in place now.

And I call again now for the immediate suspension of CQC inspections, because the service just can’t cope with it.

This is a make or break moment for the future of general practice.

I know that in many respects things look pretty bleak at the moment.

I’m a big fan of the Lords of the Rings films, and for me, where general practice is at the moment is like that scene where Sam and Frodo have to take the long road through the Land of Mordor to get to Mount Doom (!).

Yes, that may sound a bit dramatic things really can feel that bad sometimes – like you’re carrying a heavy burden through an unforgiving landscape, with all hope for the future rapidly draining away.

But we know it doesn’t need to be like this.

Fundamentally, the NHS needs a strong thriving general practice in order to survive.

We can, and we will, work together to fight for our profession and for patients.

I think we can definitely take some inspiration from the way our junior doctor colleagues have campaigned so passionately for their cause, using principled, evidence-based arguments.

We can, and we must, hold those in power to account and ensure they keep their promises to protect general practice as the jewel in the crown of the NHS.

In my final year in office I am going to do everything I can to fearlessly drive forward our campaign to ensure we move on from this crossroads and get general practice back on the right road.

Thank you.


Further Information

RCGP Press office: 020 3188 7574/7575
Out of hours: 0203 188 7659

Notes to editor

The Royal College of General Practitioners is a network of more than 52,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.

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