College Chair says huge thank you to ‘remarkable and inspiring’ GPs as he marks first year in office

Publication date: 20 November 2020

RCGP Chair Martin Marshall has said a ‘huge thank you’ to GPs for their ‘remarkable and inspiring’ response to the pandemic in a speech to mark his first year in office.

Professor Marshall told the audience at the RCGP’s virtual Annual General Meeting that he ‘couldn’t be prouder’ of the way in which general practice and the College have reacted to the COVID-19 crisis.

“The media and politicians’ attention may have been on Intensive Care Units but, quietly and compassionately as always, GPs were getting on with the new ‘day job’ - embracing technology and transforming our ways of working so that we could continue to deliver care and services to our patients, albeit in a different way in order to control the virus and keep our patients and our teams safe,” he said.

“To all our members, from the Foundation doctors and trainee GPs who were thrown in at the deep end to the retired colleagues who came back in their thousands to help the NHS effort, a huge thank you on behalf of the College.”

Professor Marshall, a GP in East London, admitted that his first year as College Chair had not been what he had anticipated:

“This time last year, I outlined my priorities for my three-year term of office -  the importance of reducing GP workload and boosting the primary care workforce; of reinvigorating whole person, relationship-based care; of providing practical help to support new ways of working within teams and across networks; and how we had to introduce new ways of engaging a larger proportion of members in the work of the College.

“I had it all mapped out - but life is what happens while you’re making plans, and we all know what happened next”

He highlighted the many ways in which GPs had contributed to the pandemic effort.

“The way in which general practice has transformed, almost overnight, to meet the challenges of COVID-19 and the needs of patients has been remarkable and inspiring.

“You have cared for those most vulnerable to the virus – those who are shielding, those in care homes, our Black, Asian and Minority Ethnic communities, those at the end of life and those in deprived areas. You have worked in hot COVID hubs and the Nightingale hospitals and helped NHS 111 and its equivalents in Scotland, Wales and Northern Ireland. And you have done so with remarkable compassion, professionalism and fortitude.

“Now you are supporting patients with long-term symptoms of the virus and the psychological effects of the pandemic; managing the backlog of patients who chose not to seek care during lockdown - and gearing up to roll-out the first COVID vaccine at the same time as deliv­ering the biggest-ever and most complicated mass flu vaccination programme. All of this in addition to delivering care to more than a million patients every day who present to us with conditions unrelat­ed to COVID-19.”

Professor Marshall also reflected on the College’s work on behalf of its members over the past year - including the development of the new Recorded Consultation exam in just 10 weeks. 

“This was an extraordinary achievement for the College, our examiners and our trainees who had to deal with the worry and uncertainty of having their MRCGP cancelled. As a result, more than 1500 new GPs who would otherwise have remained in training are delivering care for patients,” he said.

He described how the College had brought together a panel of GP experts experienced in previous pandemics to develop resources at pace to support GPs - and gave examples of how the College had influenced the governments of the four nations on behalf of the profession.

“We have listened to our members’ concerns and used our influence to campaign on tech-enabled consulting, PPE, testing and tracing, shielding, care homes, workload prioritisation, end-of-life care, anticipatory care planning, ethical issues and supporting returners,” he said.

Turning to the ‘devastating impact’ of the pandemic experienced by Black Asian and Minority Ethnic communities, he said the defining events of the summer following the death of George Floyd and subsequent activism by the Black Lives Matter movement had demonstrated the need for the College ‘to accelerate’ its work to address racism and discrimination.

“As a College, and as a profession, we all have a responsibility to identify and call out discrimination and to lead more by our example. We have a lot of work to do but I hope we are already making progress and at Council, we will be welcoming five newly-elected members and one member who has been re-elected – all of whom are women from Black, Asian or minority ethnic backgrounds. We’ve always been a diverse College and we are committed to greater diversity in our leadership,”

Concluding his summary of the past 12 months, Professor Marshall said:

“Our College and our specialty have changed significantly in my first year as Chair. But what doesn’t change is the trusting relationship between GP and patient, the foundation stone on which general practice was built and continues to grow stronger.

“The COVID experience has only reinforced my decision to retain the priorities I set out in November last year and we will continue to promote the importance of relationship-based care.

“We know there is further adversity to come but we will do everything we can to support you, your practice teams and your patients right across the UK.”

Further Information

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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.

RCGP Chair Martin Marshall speech to AGM

20 November 2020

What a difference a year makes.

I remember this time last year so vividly as I became Chair of Council. I remember how proud I felt to be representing my specialty and my College, how excited and how humbled I felt, as I outlined my priorities for my three-year term of office.

I highlighted the importance of reducing GP workload and boosting the primary care workforce; of reinvigorating whole person, relationship-based care; of providing practical help to support new ways of working within teams and across networks; and how we had to introduce new ways of engaging a larger proportion of members in the work of the College.

I had it all mapped out - but life is what happens while you’re making plans, and we all know what happened next.

Within three months of me taking up post we were facing the biggest global health emergency for a century, arguably the most difficult period in the entire history of our NHS, and a monumental challenge for our College. The sheer force of Covid-19 has dominated our work for the last year and will continue to do so for some time to come.

Whilst it’s meant that I haven’t had the first year of office I anticipated, I couldn’t be prouder of the way in which general practice and the College have responded. We have truly seized the opportunities that come with crisis.

The way in which general practice has transformed, almost overnight, to meet the challenges of COVID-19 and the needs of patients has been remarkable and inspiring.

The media’s – and politicians’ - attention may have been on Intensive Care Units, but quietly and compassionately as always, GPs were getting on with the new ‘day job’ - embracing technology and transforming our ways of working so that we could continue to deliver care and services to our patients, albeit in a different way in order to control the virus and keep our patients and our teams safe.

Triage and remote consultations have been necessary to ensure effective infection control and the benefits that technology has offered to patients and clinicians ensure that many of the changes we’ve implemented are here to stay. But we won’t forget the importance of face-to-face consultations in building rapport with patients and for picking up both hard and soft signs. Our challenge is now to get an appropriate balance between remote and face-to-face consultations.

GPs have cared for those most vulnerable to the virus – those who are shielding, those in care homes, our Black, Asian and Minority Ethnic communities, those at the end of life and those in deprived areas. You have worked in hot COVID hubs and the Nightingale hospitals and helped NHS 111 and its equivalents in Scotland, Wales and Northern Ireland.

And you have done so with remarkable compassion, professionalism and fortitude.

As well as being at the forefront of tack­ling the second wave of COVID-19, GPs and our teams are now leading the rehabilitation of our communities after the first.

You are supporting patients with long-term symptoms of the virus and the psychological effects of the pandemic; managing the backlog of patients who chose not to seek care during lockdown - and gearing up to roll-out the first COVID vaccine at the same time as deliv­ering the biggest-ever and most complicated mass flu vaccination programme. All of this in addition to delivering care to the more than a million patients every day who present to us with conditions unrelat­ed to COVID-19.

To all our members, from the Foundation doctors and trainee GPs who were thrown in at the deep end to the retired colleagues who came back in their thousands to help the NHS effort, a huge thank you on behalf of the College.

Just as general practice has adapted, so has the College, and I’d like to thank the Officer Team – Amanda Howe, our brilliant President who also found herself in a job that was different from what she expected; Vice Chairs Mike Holmes, Michael Mulholland and Gary Howsam; Joint Honorary Secretaries Jonathan Leach and Victoria Tzortziou Brown, and Honorary Treasurer Steve Mowle -  for their amazing work, for their support and their challenge over the past year, for their collective wisdom and their expertise. Mutual support within the Officer team has enabled us to keep going through some pretty challenging times.

The power that comes from being a four-nation College has never been more evident than during the last year. My thanks to the Chairs of the College in Scotland, Wales and Northern Ireland - Carey Lunan, Mair Hopkin and Peter Saul, and Laurence Dorman - for their remarkable work, support and counsel. The five of us have been meeting at least once a fortnight and their hard work and determination to do the best for their members in their respective countries, as well as supporting each other, is awesome.

We are very sorry to say goodbye to Carey Lunan, whose three-year term comes to an end shortly. Carey, you have been a formidable force for GPs and patients in Scotland. Your management of Scottish government, the media and other stakeholders has been a masterclass in skill and tenacity and despite all the conflicting pressures, you have stuck to your priorities of tackling health inequalities and promoting GP wellbeing. You are one of the most value-driven leaders I’ve had the honour to work with. We will miss you a lot and promise to build on your work.

I’m conscious that some of you will have been at our virtual Building the Future of General Practice event last month where I spoke at length about what the College had done to support our members during the pandemic. You may have heard some of this before but please bear with me as I focus on a few selected headlines, beginning with the MRCGP exam.

The cancellation of the Clinical Skills Assessment and sittings of the Applied Knowledge Test in mid-March following Government guidance meant that the thousands of trainees due to CCT during the summer had their lives put on hold, with their job offers, mortgages and other life commitments hanging in the balance.

The process of developing the new Recorded Consultation Assessment from conception to delivery was 10 weeks! This included tendering for a provider, design of the assessment, GMC approval and a pilot.  As a result, more than 1500 new GPs who would otherwise have remained in training are delivering care for patients.

This was an extraordinary achievement for the College and for our trainees who had to deal with the worry and uncertainty of having their MRCGP cancelled.

My thanks to Vice Chair of Professional Development Michael Mulholland and Chief Examiner Mei Ling Denney for their incredible leadership, to our fantastic examiners and GP trainers, and to our staff teams, all of whom worked non-stop. And a particular mention to our brilliant AiT Chair, Anthony James, for his invaluable contribution while he was preparing to sit the RCA himself!

From the onset of the pandemic in the UK, we realised that our members would be looking to the College for practical support to help them with the day job – not least in translating the huge volume of new guidance that GPs were being bombarded with into something meaningful and useful.

Crucially, our efforts to reduce the more bureaucratic aspects of general practice led to the temporary suspension of appraisal and CQC inspections of practices in England during the first wave of COVID. We will continue to work with the Academy of Royal Medical Colleges and other stakeholders in order to do everything possible to make the process less arduous. My thanks to our Medical Director for Revalidation Susi Caesar, who also chairs the Academy’s Professional Development Committee, for ensuring that the views of GPs are central to this ongoing work.

We established an expert panel of Officers, Clinical Leads and GPs with experience of other pandemics, including former Chair Maureen Baker and Simon Stockley. I’d particularly like to thank Joint Honorary Secretary Jonathan Leach who has become a highly respected national expert in all things Covid.

We set up a dedicated Covid hub of resources on our website, as well as providing members with a dedicated email for their questions. The resource hub and the College’s e-learning hub now house a wide range of materials, robustly quality assured, to support GPs and their teams. The website has been viewed nearly 700,000 times and the College’s eLearning platform saw a 170 % increase in users.

Enormous thanks to all of the passionate members who gave their time and expertise to develop this work, particularly Dirk Pilat for leading the online learning resources and Gail Allsopp for her work on post-Covid syndrome.

The ethical dilemmas of developing and implementing new guidance at pace have been enormous but Joint Honorary Secretary, Victoria Tzortziou Brown and Simon Gregory, Chair of our Ethics Committee, have skilfully navigated the College and GPs through the maze. Additional thanks to Victoria for her excellent work on the changes to death verification rules and for her leadership of the College’s consultation on assisted dying earlier this year – the largest consultation on an issue of public policy that the College has ever conducted.

Under the leadership of our President Amanda Howe and Marcus Baw, Chair of our Informatics Group, we established a Members Forum to ensure that we responded quickly to member queries and concerns. Over 3000 members have registered, and it has set a blueprint for our future engagement with members.

We’ve also produced an extensive range of webinars, blogs, vlogs, videos and other digital materials, and held virtual events, many led by our Faculties who have quickly adapted to remote Board meetings and some of whom are reporting an increase in attendees as a result. I’ve already mentioned our hugely successful virtual Building the Future conference last month, which attracted 1555 delegates.

We’re even managing to hold Council meetings by Zoom - something that I would never have imagined could happen a year ago – and without losing the quality and richness of discourse.

Thank you to all members of Council for your support during my first year in office. It has been a privilege to chair such powerful and intellectually-stimulating debates involving such committed professional leaders.

I also want to express my gratitude to Nigel Mathers, Chair of Trustees, to the Trustee Board, and to our Honorary Treasurer Steve Mowle for their expertise in navigating us through some pretty difficult challenges over the past year.

Credit is also due to all our committee chairs, committee members, clinical leads, and representatives who have continued to devote their valuable time to furthering the College’s aims and objectives.

My thanks again to Vice Chair for External Affairs Gary Howsam for seizing our ‘green agenda’ on behalf of the Officer team and making sure we continue to make progress in this vitally important area whilst everything else is going on around us.

We have continued to engage extensively with policymakers and politicians from all parties right across the UK, working closely with system leaders, national patient groups and our fellow Royal Medical Colleges.

The launch of our report ‘General practice in the post-Covid world’ in July resulted in nearly 1000 emails being sent to MPs from our supporters, highlighting the need for greater support for GPs in the management of Covid in the community.

We have listened to our members’ concerns and used our influence to campaign on tech-enabled consulting, PPE, testing and tracing, shielding, care homes, workload prioritisation, end-of-life care, anticipatory care planning, ethical issues and supporting returners.

Our letter to Universities Minister Michelle Donelan demonstrating the impact of the A-Level results fiasco on prospective medical students helped bring about a Government U-turn on university places.

When we raised our concerns over flu vaccine supplies to manage this year’s programme, English Health Secretary Matt Hancock intervened personally and rapidly.

We have held workshops with our members and patient and carer group to gain further insights for our policy development, including shaping our views on the delivery of remote and face-to-face care. The #RCGPTogetherLIVE webinar series has attracted more than 4000 members.

Our GP is open campaign, launched earlier this month to coincide with the second lockdown in England, was developed in partnership with Owen Richards and the Patient Carer Partnership Group. Owen is such a powerful advocate for patient care - but he understands the pressures our profession is under and wants to work in partnership with us, and for that we are very grateful.

The wellbeing of GPs and practice teams is paramount for the College and my thanks to Vice-Chair for Membership Mike Holmes for the excellent initiatives he has led to ensure that GPs have looked after their own health, as well as that of their patients.

I’m also immensely proud of the College’s work in supporting Covid-related research and surveillance though the RCGP/Oxford Research Surveillance Centre, including the PRINCIPLE trial and the provision of high quality workload data. This is an extraordinary collaboration, involving 1000 GP practices and led by Simon de Lusignan and Richard Hobbs in Oxford and our research lead Nick Thomas, a collaboration which could have a significant impact on reducing the duration and severity of the pandemic.

We have maintained an exceptionally high level of media coverage across the UK with more than 15,000 mentions in broadcast, print and online outlets since the start of the pandemic – including 11 appearances on BBC Radio 4’s flagship Today Programme since March. This has meant a constant and consistent ‘voice’ for general practice on issues that matter to GPs and patients. We have used the media to promote and, where necessary, defend the reputation of the profession and hold the Government to account. The College’s voice has also been prominent internationally, for example through CNN, the Wall Street Journal and the New York Times.

I have spoken previously about the devastating impact of the COVID-19 pandemic experienced by Black Asian and Minority Ethnic communities and the tragic loss of our GP colleagues, but the death of George Floyd and the subsequent activism by the Black Lives Matter movement in the summer brought health inequalities, social injustice, and structural racism into even sharper focus.

The RCGP has a long-established Equality, Diversity and Inclusion Steering group that I co-chair with Chief Operating Officer Dr Valerie Vaughan-Dick.

We had also been working with a group of Black Asian and Minority Ethnic GPs to inform our BAME Action Plan and have been actively implementing measures including diversity and inclusion training for all College Officers, Council members, examiners and staff.

But the events of the summer – including a very powerful and impassioned motion to June Council from my own Faculty, North East London - demonstrated the very real need to accelerate this work.

As a College, and as a profession, we all have a responsibility to identify and call out discrimination and to lead more by our example.

An Action Plan was approved by Council in September and my thanks to all who have contributed.  We have a lot of work to do but I hope we are already making progress and tomorrow at Council, we will be welcoming five newly-elected members and one member who has been re-elected – all of whom are women from Black, Asian or minority ethnic backgrounds. We’ve always been a diverse College and we are committed to greater diversity in our leadership.

We have more positive news in that our total membership is increasing – now about 54k, active resignations are down by 7% and we’ve seen an 8% increase in reinstated members.

But in common with many other organisations, the College has taken a serious financial hit as a consequence of COVID-19.

Chief Operating Officer Valerie Vaughan Dick and the Executive Management Team have kept the College running and operated ‘as near to business as usual’ for members despite the challenges - including the logistics of dispatching the entire College staff to work from home at very short notice when the first lockdown was announced.

My thanks to Valerie and the Executive Directors – Ben Clacy, Fiona Erasmus, Harriet Jones and Mark Thomas - for their leadership of the organisation and the support they provide to all the Officers. They are excellent managers and we are privileged to have them as members of the leadership team.

And of course my thanks to all of the College staff across the UK for their commitment and hard work. My involvement and interactions with them have been largely confined to Zoom for most of my tenure so far but I see how diligent they are and the energy and enthusiasm they invest in trying to improve the support and services we deliver to our members.

Our College and our specialty have changed significantly in my first year as Chair. But what doesn’t change is the trusting relationship between GP and patient, the foundation stone on which general practice was built and continues to grow stronger.

The Covid experience has only reinforced my decision to retain the priorities I set out in November last year, now formalised in our Strategic Plan 2020-23, Putting members at the heart of everything we do, approved by Council in February. The delivery of most of the priorities has been catalysed by pandemic. The delivery of relationship based care, my personal passion, has been more of a challenge as we’ve focused on ensuring effective infection control, and that’s why we will be giving it special attention over the next year.

We know there is further adversity to come – and we know we won’t get everything right all the time – but we will do everything we can to support you, your practice teams and your patients right across the UK.

Thank you again to everyone who has contributed to the College’s work this year, I’m sorry we don’t have time to mention you all in person, but your efforts have helped us through these most turbulent of times and will enable the College and general practice to emerge even stronger.

President, Members, Fellows, I am pleased to present to you the RCGP annual report for 2019-20.

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