Striking the right balance

1 April 2022

One of the biggest challenges I experience as Chair of our College is getting the right balance between describing how endlessly fascinating, stimulating and privileged it is to be a GP, and acknowledging how stressful and undoable a job it currently is for so many of us. I find myself constantly calibrating what I say to members, the media and politicians. I know I don’t get this balancing act right all the time.

There are some short term answers to the workload crisis that has been building over the last decade - practices are innovating, trainee recruitment is up, some pointless bureaucracy is being removed. But let’s not pretend that there are any easy, quick answers out there.

If the substantive solutions are long term in nature, how do we keep going during the tough time ahead? As I speak with College members around the country, I’m reminded of the Stockdale paradox. James Stockdale was a US Navy vice admiral who was a prisoner of war in Vietnam for over 7 years. When asked how he survived he described how he confronted the brutal facts of his situation in a clear headed-way, how he remained hopeful but how he never succumbed to blind optimism. The optimistic PoWs died quickly of a broken heart, he said, when they realised there was no quick way out.

I speak to GPs with broken hearts but I also speak to many GPs who still love their job – though too often they seem anxious about admitting it. The reality is that being a GP is fantastic – and if we don’t say that, no one will - and the brutal reality is it’s difficult. But we know what needs to be done to make it better.


Latest updates from your College

A wake up call to address GP pressures

The British Social Attitudes survey looking into public satisfaction with the NHS, published by the King’s Fund and Nuffield Trust on Wednesday, made for sobering reading. The College issued this response, and on Twitter, we have outlined our position in this thread.

Whilst depressing, the results are not altogether unsurprising. The NHS is reeling from more than two years of pandemic, and it has taken its toll. And whilst access to GP services was a key reason given for dissatisfaction with the NHS, reasons for patients being satisfied included quality of care, the range of services offered, and attitudes and behaviours of staff.

This reflects the tireless efforts of GPs and our teams to do their very best for our patients during the most trying of circumstances. It reinforces the real problem here: the NHS urgently needs to increase the GP workforce to give GPs and practice team members the resource and time needed to deliver safe, timely, personalised and appropriate care to our patients.

These results bring home the reality of the impact of pressures on the service and the impact these have on patients, which have been exacerbated by the pandemic. They must serve as a wake up call to politicians and decision makers to take their responsibility to boost the GP workforce seriously – which makes the decision of MPs to reject the workforce planning amendment to the Health and Care Bill (see below) all the more frustrating.

Disappointment in the Commons

Firstly, I want to thank those of you that emailed your MP through the College’s campaign on the workforce planning amendment to the Health and Care Bill. Nearly 2,000 emails were sent to MPs through this campaign to highlight the importance of strong workforce planning for the future of our NHS.

However, despite your efforts and the amendment having the support of 100+ health organisations, parliamentarians including chair of the Health Select Committee Jeremy Hunt MP and two former chief executives of the NHS - Lord Simon Stevens and Lord Nigel Crisp – MPs voted against the amendment on Wednesday.

This outcome is incredibly disappointing and yet again, a missed opportunity by politicians to make the necessary changes that the NHS desperately needs - my full response to the outcome can be found on the RCGP website.

The Bill now goes back to the House of Lords on 5 April, and will return to the Commons for a second time at some point after the Easter Recess. Take a look at a summary of the College’s work to influence the Bill so far.

But some good news

It wasn’t all disappointing news on Wednesday evening in the House of Commons. MPs supported the telemedicine amendment to the Health and Care Bill that will allow women requiring an early medical abortion to retain choice in how and where they receive this care.

Over the past few months, the College, RCOG, FSRH and others demonstrated joint support for this policy, introduced as an emergency measure during the pandemic, to be made permanent through a letter to the Prime Minister, a meeting with the Health Secretary and briefing MPs.

This is a really excellent example of cross-organisational working - we've heard from partners that the College's intervention had an important impact on the result of the vote - and a genuine move forward for women's healthcare.

Lobbying success on undergraduate tariff

We also heard some excellent news with a new Undergraduate Medical Education & Training Tariff for medical schools in England published this week. For the first time, from September this year, medical students will the same level of funding irrespective of training location.

This rectifies a longstanding disparity between funding for placements in secondary and primary care settings, which has limited the community-based teaching GP practices have been able to offer. It represents a 9.4% increase on current minimum tariff for primary care.

It’s an issue the College has been lobbying on for many years – you may remember signing the petition, which we hand delivered to the Department of Health back in 2018 – alongside colleagues at SAPC, and is a massive win for the future of our profession. Huge thanks to Joe Rosenthal and Alex Harding who has led on this work.

Ukraine: migrant health guidance

As the UK has started to receive Ukrainian refugees fleeing the Russian invasion of their country - and numbers are set to increase as issues with the immigration systems are ironed out - a number of you have been in touch asking for guidance on migrant health, should any refugees become your patients. The UKHSA have developed some helpful resources, which you can find on the GOV.UK website - and we’ll shortly be able to share with you an excellent resource being developed by our colleagues at the Royal College of Psychiatrists on mental health care for refugees.

One Day Essentials | Diabetes

Tuesday 26 April 2022, 09.30 – 16.50

Join us on Tuesday 26 April 2022 on our One Day Essentials Diabetes conference. It will cover a range of Type 2 Diabetes topics to support GPs in gaining knowledge and practical tips to practice evidence-based medicine. There is also always plenty of time for Q&A. The recording and slides are available free to those who registered for the live conference.

Register now


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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