Action by individuals can change society but institutions have a responsibility to set a tone and to lead

1 April 2021

There’s nothing like an existential crisis to encourage us to step back and rethink what matters. I’ve had more conversations with people during the pandemic about what kind of society we want to live in than I’ve had in the previous decade.

I don’t like the slang term 'woke'. A word used by some as a compliment and others as an insult seems to me to be unhelpful. But I guess the concept - an awakening, to be socially aware - is what’s driving these conversations.

Do we want to live in a society in which our opportunities are determined by our ethnicity, or sex, or sexuality? In which we tolerate inequalities and ignore deeply embedded social causes of ill-health? In which we live in what David Wallace-Wells, author of The Uninhabitable Earth, described as 'a state of half-ignorance and half-indifference' to the health of our planet?

Rhetorical questions, of course but important ones for all institutions in our country, including our College. Action by individuals can change society but institutions have a responsibility to set a tone and to lead. And even though changing society is not the College’s primary mission, we are more than playing our part.

Latest updates from your College

COVID certificate consultation

The College has responded to the Government’s review into a potential COVID-status certification scheme. We have made clear that the introduction of any such initiative must have 'zero impact' on general practice workload. The last thing we need whilst we’re so busy is to be lumbered with cumbersome red tape, diverting our time away from patient care.
We’ve also raised concerns about the possible widening of inequalities from the introduction of COVID vaccination certificates for domestic use - and said that steps must be taken to ensure patient data is kept as safe and confidential as possible, especially if any certificate is based on a digital platform.

Our submission featured in The Times this morning and I spoke to Times Radio. You can read our corresponding press release and full submission

GP workload

Given our pre-emptive strike against the potential introduction of vaccine certificates impacting on GP workload, it was apt to read reports this week in both GP Online and Pulse highlighting just how hard GPs have been working, and just how much pressure our services are currently under.
Thank you to everyone who participated in the Pulse survey, which we supported. This has given a useful snapshot that has gained the attention of the national media. I spoke to Sky News and you can read my comments in the Express, Mirror, Metro and more than 200 local outlets via Press Association.

Vaccination associated thrombembolic events

While the risk/benefit analysis of both COVID vaccines is clear-cut on a population scale, the MHRA continues to investigate possible links between the Oxford/AstraZeneca jab and thromboembolic events in individual patients.

As the vaccination programme shifts to younger age groups we will need to be on the alert for patients with persistent headaches lasting beyond two or three days after having the vaccine. NICE has issued new guidance on the management and testing for venous thromboembolism diseases.

It also includes useful links to MHRA advice on the management of patients on warfarin and other coagulants during the pandemic.

Race report

Issues surrounding race have been prominent in the media this week with the trial of Derek Chauvin, the former policeman accused of killing George Floyd in the US, and the publication of the report from the Commission on Race and Ethnic Disparities here in the UK. The report has proved controversial in that it concluded that while overt racism exists in the UK, the country is not institutionally racist. 
This isn’t the experience of many members who have reached out to us over the last few months - we know that across the NHS, staff from Black, Asian and Minority Ethnic communities have worse experiences than their white colleagues in many ways. And we know where health inequalities exist in society, they disproportionately affect patients from BAME communities.
We all have a responsibility to identify and challenge discrimination within our own structures. It is vital where incidences of racism happen, that they are identified, taken seriously and addressed.
At the College, we’ve been doing a lot of work around equality, diversity and inclusion, particularly over the last year. Our most recent activity has been in raising awareness of low vaccination uptake among BAME communities and calling for targeted communication campaigns to address this, which the government took on board. We’re now hearing that uptake among many Asian communities has improved greatly, but uptake among Black communities remains low. Joint Hon Sec Victoria Tzortziou-Brown spoke to LBC about this earlier this week (2h 38m in).
Over the next couple of months we will be running short life working groups to develop action plans to address all nine protected characteristics.

Remote care

Thank you to those who got in touch following my comments in the Guardian earlier this week about remote consultations. I’m in no doubt that remote consulting is here to stay in general practice in some form - I know some of you like it, I know some patients do too and there are many positives to this way of working. Ultimately, it’s allowed us to continue working, delivering our services to patients in a safe way throughout the pandemic. 

But from speaking to colleagues across the country - and it’s a recurring observation at College Council - I get the sense many GPs miss the level of face to face contact with patients that they’re used to. And I think we know many patients prefer face to face appointments with their GP.
This was echoed by GP trainees responding to the King’s Fund’s annual trainee survey - with the vast majority saying they’d only want a maximum of two days working from home a week, and analysis of their free text answers concluded that this was because delivering care remotely is not the job they chose when they chose general practice.
There is a balance to be struck. We’re currently offering more than 50% of consultations in general practice face to face - not including the COVID vaccination programme - and it feels about right to me. But we don’t want to get bogged down in arbitrary ratios. It needs to be up to individual practices to decide how they deliver care, based on their knowledge of their patient population. You can also read my comments in GP Online.

We’ll be publishing a position paper on remote care in coming weeks.

Spring General Meeting

The Spring General Meeting will take place on Friday 14 May 2021.

To register for the meeting, which will be via Zoom, please email and include your name and either your GMC number or RCGP Membership number.

You can find out more.

Post written by

Professor Martin Marshall, Chair of RCGP Council

Professor Martin Marshall is Chair of the Royal College of General Practitioners and a GP in Newham, East London. He is also Professor of Healthcare Improvement at UCL in the Department of Primary Care and Population Health. Previously he was Programme Director for Population Health and Primary Care at UCLPartners (2014-2019), Director of Research & Development at the Health Foundation (2007-2012), Deputy Chief Medical Officer for England and Director General in the Department of Health (2006-2007), Professor of General Practice at the University of Manchester (2000-2006) and a Harkness Fellow in Healthcare Policy. 

He is a Fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012. He has advised governments in Singapore, Egypt, Canada and New Zealand, has over 230 publications in the field of quality improvement and health service redesign and his primary academic interest is in maximising the impact of research on practice. In 2005 he was awarded a CBE in the Queen’s Birthday Honours for Services to Health Care. 

A co-founder and driving force of the Rethinking Medicine movement, Martin has a passionate commitment to the values of the NHS, patient care and ensuring the GP voice is central in a time of great change. When he’s not working, he likes being outside, preferably on a mountain or a coastal path with his wife Sue and their puppy. 

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