General practice is both retaining what’s good and transforming itself

8 October 2021

I’m not sure I’m qualified to tell a neurosurgeon how to improve what they do. It would be nice to see the same level of humility exercised by some policy makers and NHS leaders commenting on general practice. It feels like many people are convinced that they are experts in our speciality. And this commentariat are saying that the British model of general practice is old-fashioned, and that GPs aren’t doing anything to improve it.

I encourage them to open their eyes. What they’ll see is a sector which, despite the extreme stresses it’s operating under, is evolving, thoughtfully and rapidly, to meet the needs of patients, communities and the wider health and care systems. General practice is both retaining what’s good and transforming itself.

It’s keeping a local and personal front end and at the same time realising the benefits of operating at a larger scale. It’s building around the key role of the expert medical generalist and at the same time working as a multidisciplinary team. It’s preserving the one-to-one face-to-face relationship with patients and at the same time embracing new consultation technologies. It’s focusing on providing care for individuals and at the same time leading local efforts to improve the health of communities and populations.

Old-fashioned? Resistant to change? I don’t think so.

Latest updates from your College

Conservative Party Conference

As excitement builds for the College’s Annual Conference (and online) next week, a brief update from me about our activity at the Conservative Party Conference in Manchester earlier this week. The College hosted a fringe event alongside the BMA. Our event aimed to raise further awareness about the workload and workforce challenges in general practice and explore what must be done to address them. Chris Smyth from The Times chaired an in-depth discussion with panellists including myself, BMA Chair Chaand Nagpaul, Anita Charlesworth of the Health Foundation and Sandesh Gulhane, a GP and MSP, who was recently Shadow Cabinet Secretary for Health and Social Care for the Scottish Conservative Party.

I stressed the need for the government to urgently tackle workload challenges in general practice, through addressing current administration obligations for GPs, extending prescription rights, and widening the healthcare workforce that are able to sign off fitness notes. These are all key areas of reform that the College has been continuing to urge the government to implement and were widely supported by my fellow panellists. There was also widespread acknowledgement by panellists and members of the audience of the contribution of GPs and our teams throughout the pandemic, particularly in delivering the COVID-19 Vaccination Programme while continuing to provide care for patients.

I also met with MPs including Health Select Committee member Dr Luke Evans MP and Parliamentary Private Secretary to Ministers in the English Department for Health Dr James Davies MP - both GPs - to reiterate the challenges in general practice, and potential solutions. It was positive to hear MPs understanding the pressures we’re working under and that we are now seeing more patients than prior to the pandemic. That said and as expected, a large proportion of MPs still don’t, as they are continuing to hear considerable numbers of complaints about GP access from constituents. The College will continue to engage with parliamentarians to inform them about the pressures in general practice and you can help us by sharing our GP Action Plan with your MP.

Fighting back in the media

It was disappointing to read reports in the media this week on a BMJ study that found six in ten patients presenting with red flag signs of cancer were not referred to a specialist. This was attributed to new ways of working during the pandemic, namely remote consulting. In fact, this BMJ study is based on data collected in 2014/2015, six years before the pandemic began. Since then, new guidance has been published and GP referrals under the urgent pathways have increased by 44%, despite intense workload and workforce pressures. Furthermore, the percentage of cancer diagnoses made through this urgent pathway has increased from 48.4% in 2014-15 to 54% in 2019-20. There wasn’t much mention of that in the reporting - you can read our response.

Patients need to have confidence in their GPs and our clinical judgement on appropriate referrals to specialist services. Media reports, and the continuing narrative that remote consultations are substandard, is damaging this.

I have written to the Daily Mail to set the record straight and expect this letter to be published shortly.

World Mental Health Day

World Mental Health Day is on Sunday 10 October. This is a chance to recognise our current challenges as GPs - meeting the increased psychological needs that many patients have as a consequence of the anxieties and losses of the COVID-19 pandemic, looking after patients with new and ongoing mental illness, and also trying to address the wellbeing needs of our teams and ourselves.

It is also a chance to recognise the global challenges - and this often makes us appreciate the NHS and the role of GPs and their teams even more. The RCGP is a member of the World Organization of Family Doctors, through which we advocate for the development of general practice globally, and part of the reason is to add psychological skills to primary care services. There is also a very active Working Party on Mental Health through which many RCGP members contribute to helping GPs in other countries to develop their skills and thinking on mental health.

Addressing mental health issues of course takes time and skill, so the College advocates for the need to build more GPs into the workforce, lengthen consultations, and manage workload. We have also added many CPD resources on wellbeing and are working with the Royal College of Psychiatrists on shared issues. Noting the day can help us value what we do as GPs, and why we do it - and keep ourselves psychologically fit as well.

International mentorship

The RCGP has just signed an agreement with the Christian Medical College (CMC) in Vellore, India, about developing a mentoring programme for Family Medicine faculty members working at CMC Vellore. CMC Vellore is a leading community-run medical school, hospital and research institute. The institute includes a network of primary, secondary and tertiary care hospitals around Vellore. The College is affiliated with the Tamil Nadu Medical University and RCGP has been working with CMC Vellore since 2017.

The RCGP has advertised for eight academic mentors to work with each of the eight faculty members of the Department of Family Medicine of CMC Vellore. The aim is to assist in transforming healthcare in India by building leaders and trainers in Family Medicine throughout the country and influencing the training and practice of Family Medicine. The mentors will be unremunerated volunteers. This will be a remote mentorship programme lasting two years and would include occasional virtual workshops run by mentors. You can view the advert for these posts on our website.

Any applications should be submitted to International’s mailbox.

The COVID-19 pandemic has made it abundantly clear the importance of Family Medicine at the core of Universal Health Coverage. If this mentoring scheme with CMC Vellore proves to be positive, the possibility of expanding it will be considered. There is also enormous COVID damage across South Asia including Pakistan, Sri Lanka, West Bengal and Bangladesh. It may also be useful that if we get more volunteers than needed, we could explore how we could help these countries with something similar.

Improving continuity of care

Developed by general practice, for general practice, the RCGP and Health Foundation are pleased to launch a practical, in-depth toolkit on continuity of care.

The toolkit looks at the evidence behind continuity and why it is beneficial for patients and clinicians.

It combines real-life examples, ready-to-use resources, and improvement methodologies developed by Morecambe Bay Primary Care Collaborative and One Care GP federations, as part of the Health Foundation’s improving Continuity in General Practice programme.

The Kieran Sweeney Prize 2021

Re-invigorating relationship-based care is a priority of mine as Chair, so I was delighted to hear this would be the topic of the Tamar Faculty’s Kieran Sweeney Prize this year. This is a national UK prize for medical writing by GPs, in honour of the memory of Dr Kieran Sweeney, with a prize of £1,000 for the best original piece submitted by a practicing GP in answer to the question 'What does the future hold for the relationship between a patient and their GP in the UK?'.

The competition opens on 1 November 2021; deadline for entries is 13 December 2021.

Please email to receive the entry form and rule and entry criteria.

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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