We need to do more to support old fashioned - and highly effective - public health measures

5 February 2021

Politicians are telling the public that the jab will get us back to some semblance of normality and that we must continue to wash our hands, wear masks and keep our distance. All good public health messages. 
But are we hearing less about the other pandemic management imperative, self-isolation for those with or at risk of infection? Could this be a reflection of a hard reality - most people understand the importance of self-isolation but less than one-in-five people actually do so in line with national guidance?
Evidence tells us it’s not that people don’t want to self-isolate, it’s that they can’t afford to do so. Self-reported ability to quarantine is three times lower in those in lower socio-economic and lower income groups. As Cevik and colleagues point out in a recent BMJ editorial, lost wages are the primary reason for not following isolation guidelines. 
So, another example of COVID as the greater un-leveller. Solutions are being introduced but they don’t yet seem to be impacting on the one-in-five statistic. Until the vaccination programme kicks in we need to do more to support old fashioned - and highly effective - public health measures, especially in the socio-economically disadvantaged.

Latest updates from your College

Vaccine update

Over 10 million patients across the UK have now been vaccinated against COVID-19 - once again, a huge thank you to you and your teams for your hard work and dedication. This incredible milestone simply could not have been achieved without you, and it's a wonderful demonstration of the amazing capability, adaptability and willingness to get the job done that general practice is so good at.
There are still concerns about the transmissibility of new COVID-19 variants recently identified in the UK, and perhaps about the effectiveness of the COVID vaccines against them. This makes managing infection control in practices even more paramount. Thank you for everything you're doing to keep sites safe for patients and colleagues. 
We know that the approved COVID vaccines still provide a level of immunity against these new strains and an annual booster COVID jab - similar to the annual flu jab and probably to the same group of people - is increasingly likely to be part of our post-COVID future. This will obviously present further workload and workforce challenges. We are involved in early conversations about the role of general practice in the process and we’ll let you know when we hear more.
Our survey on the COVID vaccination programme closed last week, and we've been busy collating the data. Thank you to everyone who took part, especially at such a hectic time. 
Your responses overall were positive but over a third of GPs who responded said they needed an expanded workforce to deliver the vaccination programme and a massive 81% expressed concerns over managing essential workload in addition to the vaccine programme. 
76% of respondents said that the COVID-19 vaccination programme is going well, with 94% reporting high vaccine appointment uptake, although we remain very concerned about ‘vaccine hesitancy’ amongst people from some Black, Asian and Minority Ethnic groups and will continue to push for targeted measures to promote vaccine safety amongst BAME communities.
We also know that GPs in some areas are still facing hurdles with the roll-out, and your survey responses have highlighted a number of issues that need addressing. 
These include insufficient communications from health authorities on vaccine supply and last-minute changes to expected deliveries (37%), with 42% experiencing challenges with onboarding processes.  
We will use this information to inform our ongoing policy work and to continue representing your views to politicians and governments across our four nations as we try to resolve the issues affecting the smooth-running of the programme. 
Our efforts to get a larger workforce in place during COVID and beyond are central to everything we do.

You can read our latest top tips on securing additional workforce for vaccination in England (top entry on the page), and access the document (535 KB PDF) directly.

Care Quality Commission and BAME GPs

The College’s BAME Action Plan commits us to delivering positive change for all our Black Asian and Minority Ethnic members and Vice Chair for External Affairs Gary Howsam recently wrote to the Care Quality Commission with a number of questions and concerns raised by some of our members relating to CQC inspection activity, particularly the impact on GPs from BAME communities.  
The College has previously discussed with CQC the particular challenges faced by some Black Asian and Minority Ethnic GPs, especially those with other risk factors and in smaller practices, and the need to ensure they are well supported.  
We asked the CQC for information in four main areas: transparency of data held by the CQC on ethnicity of GPs and staff; how inspection results are monitored, and what information is already published; standardisation across inspections and the training provided to guard against conscious and unconscious bias; BAME representation in the CQC, both at regional level and within senior leadership, and learnings from COVID, the impact of which, as we know, has been particularly severe for Black Asian and Minority Ethnic clinicians and their patients. 
The senior leadership at CQC have responded to our concerns, outlining their approach to addressing the issues we have raised. Ethnicity data of GP providers is not currently collected but will form part of the new registration information collection process, along with type or location of the GP practice.  
While acknowledging that they are limited by the data currently available, they understand how important the issues that we have raised are. They say they are already taking steps to address inequalities in health and social care and are keen to work with the College in this area.
Gary Howsam and representatives from our BAME Action Group will be meeting with the Chief Inspector for Primary Medical Services in the next few weeks and we will continue to work constructively with the CQC towards an improved system that is supportive of GPs and keeps patients safe as we move away from the immediate crisis of the pandemic and into recovery.

Virtual Annual Conference

As you know, our usual face-to-face annual conference wasn't able to take place last autumn due to the pandemic, so we’ve brought it online. 'A Fresh Approach to General Practice' will be held next Thursday and Friday, 11 and 12 February. 
The event will be an excellent opportunity to collaborate with other GPs and primary care professionals and discuss what the future holds for general practice. There are over 30 sessions, including clinical updates, GP health and wellbeing, careers and medical education, as well as the chance to network with colleagues, debate key issues for the profession, and quiz healthcare experts.
We appreciate that current pressures will make it difficult for many of you to attend, so we’ll be recording the sessions for you to watch afterwards at your own pace.

More information and how to register.

WHO webinar

Over 600 College members and healthcare professionals from around the world joined us on Wednesday for the RCGP/World Health Organisation webinar on 'Global Lessons from COVID -19'.
The event offered insightful perspectives into the challenges, experiences and lessons learnt over the last year, which we hope will be vital in informing responses to future crises. The event was chaired by College Chief Operating Officer Valerie Vaughan-Dick and joining me on the panel were Dr James Campbell from WHO, Professor Yuanli Liu from China and Dr Lola Dare from Nigeria. It is expected to be the first of several high-level collaborations between RCGP International and WHO.
Global time differences for the speakers meant it had to take place during the working day so the videos and presentations will be uploaded shortly to our COVID-19 Resources Hub and YouTube channel.

Health inequalities and COVID

We want to do everything we can to increase vaccine uptake for patients disproportionately affected by COVID-19, and the RCGP Health Inequalities standing group is undertaking a project to increase vaccine uptake amongst our most vulnerable patients affected by health inequalities due to socioeconomic factors. 
The group is collecting examples of interventions by GPs, PCNs, health and social care teams, voluntary groups, and local communities, aimed at increasing vaccination uptake. If you'd like to contribute to the report by telling us about the excellent initiatives taking place in your practice and community, please fill out this form by 15 February.

Impact of COVID on BAME health professionals

Throughout the pandemic, the College has been at the forefront of conversations about the disproportionate effect of COVID-19 on our colleagues and patients from Black Asian and Minority Ethnic groups.
We still need further information on why this is happening so it can be addressed appropriately. If you can spare the time, please could you complete this UK-REACH survey on ethnicity and the risks of COVID-19 on health and social care professionals. It's being run by UK Research and Innovation and the National Institute for Health, and the results will be used to provide rapid recommendations to government, to help further protect health and social care workers during the pandemic.

I'm sorry we're asking you to complete so many surveys and questionnaires at the moment, especially when you have so much to do, but the input of GPs is so important in most of the major discussions currently taking place around COVID.

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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