We absolutely have to give ourselves and our staff a break over the summer

11 June 2021

I feel like the Grim Reaper when I point out, yet again, that general practice is in the middle of a workload crisis. And I feel like the Grim Reaper’s evil uncle when I suggest that we probably face an even tougher time in the winter. I say 'probably' because there’s so much uncertainty about how infectious diseases will play out over coming months and how they will impact on NHS activity.

COVID first: the third wave has started and it’s almost entirely caused by the Delta ('Indian') variant. It’s 65% more infectious than the Alpha ('Kent') variant so the wave will probably be big. But we don’t know how pathogenic it is, so we aren’t sure what impact it will have on consultations in general practice, hospital admissions or deaths. And its impact will be determined by the continuing success of the truly remarkable vaccination programme and by government policy on lifting lockdown restrictions. More people vaccinated (probably) means a smaller third wave. More restrictions (probably) means less spread. And more public concern (probably) means better continued adherence to restrictions. And then there will (probably) be a fourth wave in the autumn or early winter. So, lots of probablies.

And then there’s the 'usual' respiratory infections, impacting primarily on children, older people and the vulnerable. RSV rates are increasing right now in children. Parainfluenza the same. Influenza will (probably) be a problem this winter despite general practice’s fantastic ability to vaccinate their communities - because we’re less sure than usual what strains to vaccinate against in the absence of the usual southern hemisphere pre-alert. And as a consequence of COVID, all of these common viruses are hitting unprotected people - unprotected immunologically most obviously, but also socially and emotionally with people unused to common infections and more anxious about them. So epidemics of common respiratory infections will (probably) hit general practice at the same time as another wave of COVID and at the same time as booster COVID and influenza vaccines need to be given. Even more probablies.

So much uncertainty. What do we do? Hard as it is, we absolutely have to give ourselves and our staff a break over the summer. We can’t continue at the pace we’ve been working without a rest. Then work with colleagues in primary and secondary care to plan for the worst possible scenario. And hope that it doesn’t materialise.

Latest updates from your College

College lobbying 'win' on data sharing

Our calls for a pause to the rollout of NHS Digital’s GPDPR programme have been heard and the Government announced on Tuesday that the scheme would be delayed until 1 September. The deadline for patients to opt out will be similarly extended from 23 June to late August (exact date TBC).

This is really good news, and also a good example of how the College works hard to bring about genuine change at the highest levels in the best interests of our members and our patients.

It’s essential that NHS Digital now embarks on a comprehensive public communications campaign so that patients and clinicians are fully aware and fully understand the GPDPR programme. We need it to pull out all the stops to ensure as many people as possible understand the benefits and risks of data sharing in order to make an informed decision about whether they are happy for their data to be shared - and if not, how to opt out.

We have been very clear that it is entirely inappropriate for GPs to be left with the responsibility of informing patients about GPDPR, particularly given our extreme workload pressures and the fact that we are legally required to comply with the collection.

We will continue to engage with NHSD, via our Joint GP IT Committee with the BMA, and will hold the organisation to account on delivering robust public engagement during the pause.

You might be interested in my article published by the BMJ today.

Long term effects of COVID-19 and Post COVID-19 syndrome

This week we launched a new eLearning course to support GP teams in treating patients who report symptoms persisting more than four weeks after initially falling ill with symptoms of COVID-19.

This 60-minute module introduces key recommendations from the NICE/SIGN/RCGP guidance. We also use case studies to look at the impact of post COVID-19 syndrome on patients and how to manage their symptoms and experiences in general practice.

The course is free to access for all members of the primary care team.

Continuity of Care in general practice

Join us on 30 June 2021 at 13:00 for a webinar about the benefits of Continuity of Care and how you can overcome the challenges of implementing continuity in your practices. We will recap the evidence for continuity and discuss barriers, enablers, and practical tools that can help. You can register now and see more information. A recording will be accessible on our website following the event.

Medical examiners update

On Tuesday, NHS England published a letter announcing the extension of medical examiner scrutiny on deaths not referred to the coroner in non-acute settings.

These experienced clinicians come from a wide range of medical backgrounds and their role enables them to put the bereaved at the centre of the process, giving them the opportunity to ask questions or raise concerns, and supporting oversight and transparency. Currently, medical examiners review deaths that have occurred in NHS Trusts, and now this national system is ready to extend scrutiny to deaths that occur in the community.

The RCGP is supportive of the medical examiner system being put on a statutory footing across all parts of the health service. It provides an opportunity for valuable learning and good bereavement care for friends and family of the deceased and can be used to support local learning and quality improvement activity.  

However, we need to see more detail on the governance structures outlining how concerns raised about deaths in general practice will be investigated and how this will support learning in primary care. It is vital that the system is resourced to comprehensively evaluate deaths within the service they occurred and that any workload implications are carefully considered. We are aware that the BMA has some concerns about the proposals and we will continue to work with them and to engage with other stakeholders on this important issue.

EU Settlement Scheme - 30 June deadline

The deadline for applications to be made to the EU Settlement Scheme (EUSS) is rapidly approaching.

If you are a doctor who arrived in the UK before 31 December 2020, you must apply by 30 June 2021. It is free of charge and in applying and being granted pre-settled or settled status, you will have secured your rights to continue living and working in the UK.

In addition, an application must be made for every eligible child within your family. If you and your family members have lived in the UK for many years or have a permanent residence document or EEA Biometric Residence Card (BRC), you still need to apply to the EUSS (or apply for British citizenship) to secure your existing rights in the UK.

You can apply to the EUSS and check your immigration status on GOV.UK.

William Pickles Lecture 2021

The William Pickles Lecture will be held on 25 June 2021, from 18:30 to 19:30 via Zoom.

Professor Sheona Macleod will deliver this year’s lecture on the theme of 'The Future Doctor - Touching Hearts and Minds'. Professor Macleod is Deputy Medical Director, Education Reform for Health Education England and Honorary Professor, University of Nottingham and University of Leicester.

The Pickles Lecture is usually part of our Spring General Meeting, but we have decided to run it separately to enable more College members to join online. It promises to be a stimulating thought piece, as well as honouring William Pickles, who was a GP for over 50 years and our first-ever College President in 1953.

To register for the lecture, please email secretariat@rcgp.org.uk.

National Volunteers' Week 2021

We’ve been celebrating the efforts of our Member volunteers this past week and our website has more details of the blogs, activities and messages we’ve shared.

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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