Perhaps the responsibilities of general practice are moving full circle?

9 April 2021

In the dim and distant past, Medical Officers of Health, the predecessors of the current Directors of Public Health, often used to be local GPs. A colleague, whose father was a full-time single-handed GP in Caerleon and MOH for Caerleon Urban District Council, recently sent me a copy of his father’s annual report for 1935. 

The GP gave his Council colleagues a hard time for failing to complete promised public health projects and told the Council to take back control of public cleaning which was being carried out inadequately by private contractors. Plus ca change. The report ends positively:

"This year has been a year of marked improvement. The Council’s housing scheme has been officially completed, the scavenging of the district has been placed on modern lines, the children have been immunized against diphtheria, prontosil is being provided in the fight against puerperal sepsis, and the sewage system of the area is being made efficient. Taken together, the net result of all these should be a happier and healthier people."

I don’t hear of many GPs nowadays expressing passion for scavenging or sewage systems. But I am hearing from a growing number of practices that are taking action to improve the health of their communities, working hand-in-hand with local government and community groups.

Perhaps the responsibilities of general practice are moving full circle?

Latest updates from your College

AstraZeneca vaccine

I’m sure you’ve been following announcements around the Oxford-AstraZeneca (AZ) vaccine closely. Both the MHRA and EMA have said the overall benefits of the vaccine outweigh its risks - and that it is a safe and effective vaccine. However, given the narrower balance of risk and benefit for people aged 18-29, the JCVI is now recommending these patients are offered an alternative to the AZ vaccine.

The key thing - and I know you’ll be having these conversations with patients - is that the risk of blood clots following the AZ vaccine is incredibly low for all age groups. This change in guidance is a purely precautionary measure.

We quickly called for assurances that there would be enough supply of alternative vaccine for 18-29-year olds who choose not to have the AZ vaccine - and the Government have said this is the case.

We also called for guidance for vaccination sites on how to manage giving specific vaccines to some people, and others to others - and we’ve asked for guidance on how to manage conversations with patients aged 30 and over who express a preference for an alternative to AZ.

We have updated our own guidance in the form of Top Tips on dealing with the COVID-19 pandemic in general practice (Tip 6 covers changes in vaccination guidance).

Both the DHSC and NHSE have published a number of guidance documents over the last couple of days:

We need to take whatever opportunity we can to discuss the benefits of vaccination with patients, particularly any whose confidence has been knocked by the announcement this week. You’re all doing a fantastic job, and it’s important the high uptake we’ve been seeing is maintained as much as possible.

I spoke to BBC Radio 4’s Today Programme (2h 49mins in) this morning about the issue, highlighting the work you’ve been doing to reassure patients. My full statement has been published in full in the i, and has been featured in the Guardian.

Vaccine passports

We saw early plans about the potential introduction of COVID-status certificates this week - but with very little detail about how they would be facilitated, how they would work and what they would be used for.

We’re keeping up the pressure that any initiative put in place has zero impact on GP workload, so we can continue to focus on patient care.

We made this clear in the evidence we submitted to a Government review of a COVID status certification scheme last week, and our calls have continued to receive coverage in the BMJ, Pulse and GP Online.

Chronic primary pain guidance

Chronic primary pain is difficult to manage in general practice and the College has been calling for clinical guidance to support GPs to do this for some time.

NICE have published a new guideline that takes a holistic approach to treating patients suffering from chronic primary pain - and focusses on alternatives to pharmacological treatments (with the exception of antidepressants in some instances) such as physical and psychological therapies.

It is not suggesting that patients already taking pain medication should stop taking it - but the guidance is advising against starting new drug treatment.

We broadly welcomed this approach but have made it clear that patchy access to alternative physical and psychological therapies needs to be addressed, before this guidance will have genuine benefit for patients. You can read our response, with coverage in the Guardian and The Times.

The College will be working with the British Pain Society to hold a virtual One Day Essential conference on pain management on 23 April, which will discuss the guidelines further. You can register now.  


The next RCGP Live is taking place on Thursday 15 April at 19:00, and will focus on general practice post-pandemic, building on the College’s General Practice in a post-COVID World report, published last summer.

Join our panellists RCGP President Amanda Howe, former Vice Chair for Professional Development Kamila Hawthorne, Pauline Foreman, the College’s Medical Director for Primary Care Development, and RCGP Assistant Director of Policy and Campaigns Duleep Allirajah, to discuss managing business as usual alongside the additional COVID pressures, such as the vaccination programme, as well as how we can retain retired clinicians who’ve returned to the workforce during the pandemic.

The pandemic has demonstrated the expertise, commitment and willingness that our retired colleagues have to offer to our specialty and to patient care. They have been a tower of strength and we are very grateful to them.

The College has a thriving committee dedicated to our late career and retired members and it is going from strength to strength under the leadership of Chair Mona Aquilina. You can find out more about their work.

COVID vaccine in pregnancy

The Royal College of Obstetricians and Gynaecologists and Royal College of Midwives are hosting a webinar next week on COVID vaccines, pregnancy, fertility and breastfeeding.

It’s on Wednesday 14 April at 19:30 and you can find out more and register now.

The Faculty for Sexual and Reproductive Health has produced a clinical statement on the COVID-19 vaccine for pregnant women or those taking the combined oral contraceptive pill, which you might find useful.

Super-condensed Curriculum Guides 2021

We are very pleased to advise that we have now developed additional new 'Super-condensed RCGP Curriculum guides' for 2021. for 2021. They are intended as a resource for supporting educational conversations in training and as a means of identifying learning needs for professional development.

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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