Shaping the future and standing up for the profession

10 July 2020

"The GP’s job is to entertain the patient whilst nature takes it course." Is this age-old maxim funny? Or is it cynical? Or insulting?

I wear my entertainment role with pride. Like all GPs, I was trained to use time as a diagnostic and therapeutic tool.

Sometimes I get it wrong, thankfully not often and rarely with adverse consequences. But most of the time both patients and overloaded hospital services benefit from my ability to manage uncertainty and absorb risk.

So how should GPs respond to growing complaints that we 'failed' to diagnose cancer on the patient's first visit to see us, or that we 'missed' the 'barn-door' pneumonia that followed a prolonged viral upper respiratory tract infection?

Even some experienced GPs are losing their nerve in the face of these criticisms.

One argued in a recent issue of the British Journal of General Practice that making an early and accurate diagnosis in general practice was an 'unarguable aim'.

They described watchful waiting as 'about as sensible as standing on a railway platform without a timetable, hoping that a train will come along soon'.

But if GPs stop watching and stop waiting it is likely that many more patients will suffer than will benefit. And the NHS will collapse in the face of unnecessary action. 

COVID-19 update from your College

Shaping the future

The College published ‘General Practice in a Post-COVID World’ this week, identifying some of the key lessons we need to learn from the pandemic to shape general practice for the future. It followed three themes:

  • new ways of working enabled by digital technology
  • reducing workload by eliminating unnecessary contractual and regulatory compliance activities
  • developing the public/community health function of general practice.

The report appeared on the front page of The Times, which focussed on the 'compelling' case put forward in the report to maintain some form of 'total triage' system post-pandemic. Honorary Secretary Jonathan Leach also spoke to Times Radio. The idea has gone down favourably with many people, and not so well with others - clinicians and patients alike.

But it shows that the College is leading the debate as to what our profession looks like in the near and further off future, and that we’re open to constructive criticism and new ideas as we move forward to do what’s best for patients.

The second focus of the report was on our calls for a 'greater trust, less bureaucracy' approach to regulation compliance in general practice.

We've shown over the course of the pandemic that many of the box ticking exercises we spend our time doing are unnecessary in order to deliver safe care, and this needs to be reflected in future practice.

I've set out my argument in more detail in GP Online, and it’s also been covered by the BMJ and Pulse.

Linked to this, the College has been pushing hard for a reduction in bureaucracy for GPs in our lobbying work, as well as making practical suggestions for how to ensure GPs are trusted to do what they do best - organise and deliver care for their patients.

I am, therefore, cautiously pleased to see some of the announcements from NHS England and CQC over the last week.

QOF will continue to be paused across many indicators (291 KB PDF), with GPs given the freedom to use their professional judgement in managing their patients with long term conditions.

The CQC have also confirmed that they will not return to the routine inspection programme that we saw pre-COVID-19.  

There is still much work to be done in this area, and we will continue our advocacy.

Please take a moment to sign up to our supporter action and tell your MP what needs to happen to make general practice sustainable as we move into the next stages of the pandemic.

Learning from the past and present

The report of the Independent Review into Medicines and Medical Devices Safety by Baroness Cumberlege was published on Wednesday, with important implications for the whole of the NHS, including general practice. It was looking at three specific areas:

  • Hormone Pregnancy Tests, particularly Primodos
  • Sodium valproate during pregnancy
  • Pelvic mesh.

The report doesn't make for comfortable reading. It's clear that mistakes have been made, both historically and more recently, that have led to devastating consequences for patients.

While the report was damning at a systemic level, there are lessons to be learnt for all of us. We’re analysing the report in detail and will be making a formal response.

The report made a number of recommendations - one of which was for a mandatory declaration of interests register for all doctors to improve the transparency of payments made to clinicians, and that this should be centralised by the GMC.

This has been RCGP policy for a couple of years now, following a paper brought to College Council by Margaret McCartney, and this report will give us impetus to push for it to become a reality.

You can read joint Hon Sec Victoria Tzortziou-Brown's letter about this in The Times this morning.

Standing up for the profession

Throughout the pandemic, you and your teams have been working tirelessly to deliver care to patients with COVID and non-COVID conditions, so it was highly frustrating to see a number of critical articles in the press earlier this week about our profession’s response to COVID-19.

In each case, the College has been quick to defend your hard work - firstly with a letter to the Daily Telegraph, which was published in full, responding to an article unfairly accusing GPs of dismissing the concerns of patients with prolonged symptoms of COVID.

Unfortunately, on the same day my letter was published, an opinion piece by columnist Allison Pearson, made similarly disparaging comments about GPs in a tirade against the whole NHS and how it has responded to the pandemic.

The paper wouldn’t publish a letter from me two days in a row, but you can read my response.

I know how demoralising these articles can be at the end of a 12-hour day seeing patients when you’re exhausted.

There isn’t anything we can do to stop them being written, but the College will always defend the profession when and where it can.

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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