Helen's annual conference speech

Publication date: 12 October 2017

Professor Helen Stokes-Lampard, Chair of the Royal College of General Practitioners, RCGP Annual Conference, Liverpool 2017

Good morning - welcome to Liverpool!

Welcome to the start of the 11th RCGP Annual Primary Care Conference

Welcome to the finest GP conference in the world –  a smorgasbord of inspiring speakers, the highest quality CPD, and of course, sparkling networking

I'm Helen Stokes-Lampard, and I have had the great privilege to be your Chair for almost a year now – it has been a remarkable time

I'm not just your Chair. I'm a GP, a partner in a surgery in Lichfield, Staffordshire and I know all too well the challenges we are all facing

It has never been tougher 

But we are also at a time of great opportunity – as long as general practice receives the investment it deserves, and GPs receive the support we need – there can be joy in the consultation

I had planned to deliver a normal, sort of 'Chair of the College type speech' but instead I want to tell you story, I want to tell you about Enid…  

All of you working in general practice sort of know Enid – you will all recognise her in your own surgeries; your own communities; your own lives

Enid is 84. She has hypertension, which is pretty well controlled

She has type 2 diabetes, which she is managing with diet and she has intermittent flares of osteoarthritis pain in both her hips

Enid has kind eyes, a warm smile and always 'dresses up' to come and see us at the surgery

Last year Enid lost Brian - her husband of 62 years

They always used to attend their appointments together, sitting in on each other's consultations – sometimes chiming in, sometimes holding hands anxiously if they anticipated bad news

And we have had our fair share of bad news to work through together as Brian's Prostate cancer gradually took over

Brian was her rock; her best friend and the butt of so many of her little jokes

But now he is gone, she is living alone and society is a bit uncomfortable about Enid – an ageing widow who's just a bit frail

She copes on her widow's pension

She has family - a daughter and some grand children living 180 miles away, and they all work full time

Enid is fiercely independent. She's getting a little bit forgetful - but she is certainly coping. She doesn't fit the diagnostic criteria for dementia and she doesn't want to be messed around with unnecessary testing or screening anyhow

She got a bit snappy with the reception staff a few months ago. She became a bit more demanding on practice time and resources than she had ever been before

I overheard a colleague talk about strategies to 'manage' her

The guidelines say - indeed the computer alerts flash at me - that I should be taking Enid to task about her weight, that I should nag her more about her exercise and be prescribing her more medication

But I am sure we can all see that Enid's main problem isn't medical

She's lonely…

After a life spent living with another person, she is now alone. When she wakes up, the house is silent - when she goes to bed, there is no-one to say good night to

So, I didn't follow the rules

I chatted to her, I listened. I did what all good GPs do – I saw the world through Enid's eyes for our precious few minutes together

I prioritised what Enid wanted over QOF, over NICE, and over the CCG guidelines – after all, they are only guidelines

Sometimes I offered advice about a new class, group, or a charity that I thought might suit her, might benefit her health and wellbeing

I gave her permission to miss Brian - permission to move on with her own life

Permission to carve out a new normal

And then in the final moments of our encounter, I do turn to the screen

I update her record as accurately as I can; tick the boxes that need ticking; and quickly consider everything else that the computer - in its well-intentioned but binary way - is telling me I should be doing

Because someone will be watching

Processing the data to see if I am a 'good' GP - to see if I am using the consultation 'wisely'

To see whether I am ‘minimising variation’ between my practice and nationally-determined best practice

Nowadays, someone is always looking over our shoulders.

In the end, Enid connected with a local primary school that is linking mature women with young mums who are a long way from their own families

Social isolation and loneliness are not the exclusive preserve of the elderly…

So, this project, recognising that the life experience of these older women - who have brought up children themselves and who now have the time and desire to help others - was exactly what Enid needed

A couple of hours, twice a week where she has purpose, is needed and appreciated. Where she can use a lifetime of experiences to help others

Enid isn't making GP appointments as regularly anymore – she is not taking up space in a hospital bed for a hip replacement she didn't really need. She's not taking anti-depressants and actually, she's not taking much medication at all

She did come in to see me a couple of weeks ago. Something routine

I noticed that Enid has started to wear make up again. She's had her hair done properly for the first time since Brian died

You get the picture

Social isolation and loneliness are akin to a chronic long-term condition in terms of the impact they have on our patients' health and wellbeing

They are not medical conditions. They are not something that can be treated with pharmaceuticals or that can be referred for further treatment in secondary care

But they must be addressed if we are to be patient-centred in our approach

Of course, I'm not the first person to be speaking about this

When the NHS was established society was different. Generations of families lived closer together – people knew who their neighbours were and felt part of their communities

Over 30 years ago, a study in the College's own academic journal - the excellent British Journal of General Practice - considered the impact of loneliness on older people's health and wellbeing

It mainly looked at people a bit like Enid - over 70, some widowed - and it found that the lonely did consult their GP more often, and in many cases their GP was the person they would come into contact with most frequently

Back then the focus was on physical limitations associated with loneliness - loss of hearing, decreased mobility - nowadays, as we strive for parity of esteem between physical and mental health, it's hard to ignore the impact on mental health as well

Another BJGP study from 1999 also found that lonely and social-isolated patients visited their GP more often – in some cases not because they were more poorly, but they wanted someone to talk to

They just wanted human contact

In 2010 research published in PLOS Medicine looked at 158 studies into the health effects of social isolation and loneliness involving over 300,000 people

The findings indicated that lonely people had a 50 per cent increased risk of early death compared to those with good social connections

More recently – just two years ago - a US meta-analysis of 70 studies, involving nearly three and a half million participants - published in Perspectives on Psychological Science - looked at how social isolation, loneliness and living alone affects premature mortality

It found that for those who reported being lonely, the likelihood of early death was increased by 26%, for social isolation it was 29% and for those living alone likelihood of early death increased by 32%.

It concluded that these three risk factors for mortality were comparable to those well-established risk factors of lack of physical activity or obesity, or mental health disorders

And it doesn't just impact on general practice – but secondary care too 

There are patients in hospitals up and down the country where patients just don’t want to go home – despite the indignities and lack of freedom, they have a community in hospital, they are not alone….

Loneliness inevitably takes its toll on the entire healthcare system

There will be robust debate as to whether addressing loneliness and social isolation is the role of the GP – or indeed the NHS at all - particularly at a time when we have so much to do anyway, and our responsibilities keep growing

And some might say that by GPs even considering the impact of loneliness then we are medicalising perfectly 'normal' life experiences

That's not what I'm saying

My view is that if something is adversely impacting on our patients' health and wellbeing, then we have a duty to recognise it and seek solutions

Enid didn't need more drugs to cheer her up or mask her pain – she needed a cure for her loneliness 

She needed human contact - and I was happy that I could signpost her to a scheme that would allow just that…

Enid's story is ongoing, but right now is going well

But it is not always possible right now to deliver this level of person-centred care. 

We need the time, the staffing and the resources to do it

In another practice - one that’s larger than my own - I might have been able to get Enid some time with a Care Navigator, or someone who can 'socially prescribe'.

Someone who can spend the time she needs with her - and find opportunities for an Enid-shaped space in society.

I'd really like that, I’m looking forward to that

And actually, there are a remarkable number of initiatives to help with social isolation - and minimise the impact it has on health - especially that associated with advancing age

If you have some time to read some of the amazing Bright Ideas submitted to our Clinical Innovation and Research Centre – CIRC 

You might come across Prime 75 

This initiative, shared by Di Whaller, the Manager at Arden Medical Centre in Stratford Upon Avon, identified that their ageing population was a cause for concern

They commissioned a service to identify over-75s at risk of being lonely, socially isolated or simply frail, and set up services for them to empower them to take more control of their health and wellbeing

Another was submitted by Claire Kaye, a GP at the Schopwick Surgery in Hertfordshire

They launched the Housebound Service – so that looking after their housebound patients didn't become a tick-box exercise

To ensure they received holistic care - simple and brilliant

I'm not sure how many of you caught a wonderful Channel 4 documentary this summer?

It followed a group of children whose nursery was moved into an old people's home in Bristol for six weeks

The experiment aimed to explore the impact of this mix of generations on the health of the residents, many of whom had no immediate family and reported feeling lonely

There was scepticism - not least from the residents, one predicting that it would be 'a total disaster'

But actually, there was marked improvements in both their physical and mental health and wellbeing over the course of the experiment. They walked faster, got more involved in life and were happier

These examples are what I mean when I talk about joy in the consultation - joy and reward in our professional live

They also showcase the fantastic potential of general practice - of healthcare in general - to innovate, when we have the time and resources to do so

Human beings are spiritual creatures

What makes us unique and special is more than our genetics and our environment – it's the things that make our hearts beat faster, and our minds buzz with anticipation

The things we love, the things we hate, what we dread and what we get excited about

It may be the love or touch of another person, soaring music, great wine or a magnificent view

But to deny our spirituality diminishes us

Earlier this year I visited the Bromley by Bow Centre in East London, with the Centre's founder and GP, Sir Sam Everington

As well as a thriving GP surgery, the Centre is also the home to several social enterprises, a park, beautiful gardens, a church and numerous other facilities

Several artists are based there, working alongside a large social prescribing team, who use a motivational interviewing approach to help members of the community

This has been found to help reduce dependence on GPs for issues that are more social than physical and psychological

As GPs we cannot fix all of society's problems – but we do get to see them and feel them – and we need to recognise their impact on health and have strategies to help our patients whilst protecting time to be doctors

If we attempt to fix everything we will burn out - in many cases at the moment we are burning out

The GP Health Service launched this year in England as part of the GP Forward View and run by our fabulous former Chair Clare Gerada, already has over 800 GPs subscribed… we understand the scale of the problem

That is why we need the £2.4bn a year extra for general practice - promised in the GP Forward View - delivered in England, in full

And we need equivalent settlements for Scotland, Wales and Northern Ireland. We need them fast

To boost our workforce

To give us the appropriate numbers of GPs, and members of the wider healthcare team, to ensure we can do our jobs safely, for the benefit of our patients and our own wellbeing

The NHS is there to provide high quality healthcare for all, free at the point of need

And as GPs, as expert medical generalists, as consultants in general practice we are there to ensure that care takes place at the front line, and to act as gatekeepers for the rest of the NHS

We are the bedrock of the NHS

So, let me take you back to Enid

I am not her friend, I am not her daughter, I am not her counsellor.

But I am her doctor

During our moments together in consultations, Enid is the focus of my professional world

She knows I will do everything I can to get the right outcomes for her.

That may not be longer life - that may not be the medication or treatment recommended by clinical guidelines, or my computer…

But it will be Enid-shaped care

This is what we should aspire to

This should be the future of general practice -  Enid shaped care…

In February, our RCGP Council – made up of nationally and locally elected frontline GPs from right across the UK - passed the College's updated position statement on quality. You can read the full report on our website

But in summary it says that we should act with ‘kindness, empathy, honesty and integrity' that we should ‘listen and share decisions in line with patient preferences'

And it talks about quality as 'Providing person-centred and co-ordinated care, understanding the interaction between physical, psychological and social issues and working closely with key partners, such as the extended Primary Care Team, and the voluntary, community and social care sectors.'

Mahatma Gandhi once said that the measure of civilisation or society is how they treat their weakest members

That is our most vulnerable - our elderly, our frail, our isolated

We live in a civilised, affluent society in the UK. However hard things get, however tough things are in our daily practice, we must remember that

Cum Scientia Caritas - that's the motto of the Royal College of General Practitioners - scientific knowledge … applied with compassion

It really has stood the test of time

So I call, right here right now upon the four governments of the UK for the time, the resources, and the freedom we need to do what is right for our patients

To innovate in their best interests

To act in their best interests

To allow us to deliver Enid-shaped care to Enid

And indeed to allow us to deliver personalised care to every one of our patients

To restore the joy in general practice

Deliver the GP Forward View in England in full; as the College has repeatedly said, we know there is progress but GPs are NOT yet feeling it on the front line

In Wales, Scotland and Northern Ireland - give us equivalent promises fast, and deliver them 

But resources and workforce aren't everything… Give us the freedom to deliver the care our patients need

Give us the time to care - don't make us spend it ticking boxes, preparing for inspections, or worrying that we haven't followed guidelines for fear of repercussions

Trust us to be doctors - let us treat our patients like human beings, and tailor their treatment to their needs

Let us have the resources so that we can spend longer with those patients who need it

I am not asking for generosity or excess: give us enough resource, enough time, enough people and enough professional support and encouragement

And I - we – we will give you great general practice

I want to give great care. Enid shaped care…

That's why I became a doctor

That's why I am a GP

That's why I will do everything in my power while I am your Chair to restore the good days to general practice

To make our profession a place where practising GPs are supported and given the respect we deserve

The medical profession of choice – where GPs can enjoy working throughout their entire careers

A profession to be proud of

Thank you…

Further Information

RCGP Press office: 020 3188 7633/7574/7575
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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