Maslow’s hierarchy of needs

12 November 2021

We’re all familiar with Maslow’s hierarchy of needs which describes the factors which impact on our motivations and behaviours.

Put simply, the Russian American psychologist claimed that we won’t be motivated to change our lives unless we have adequate food, water, warmth, and rest. And once these basic needs are met, we need to feel safe and secure. And then we need good relationships and self-esteem. And only when all these needs are satisfied do we achieve our full potential.

Harry Burns, the inspiring surgeon, turned Scottish CMO, turned academic at the University of Strathclyde, thinks that Maslow got his hierarchy upside down. Harry is passionate about why poor people seem destined to stay poor and die young. He is convinced - and there’s biological evidence to support him - that the answer lies in the alienated and chronically stressful lives that they lead. Of course, we need our physiological needs to be met but if people aren’t fulfilled, their health suffers.

Harry says it’s about learned hopelessness and that’s why in my East London practice I spend as much time trying to raise the un-expressed social expectations of our deprived patients as I do questioning the inappropriate medical expectations of the wealthy ones.


Latest updates from your College

Letter to Health Secretary on GP access and A&E

Last week I mentioned that I had written to Sajid Javid to express the College's concern at comments attributed to him during a Health Select Committee, making a direct link between GP access and increased pressure on A&E departments.

I asked the Health Secretary for the evidence to support these claims and the letter has been picked up in today’s Guardian, the BBC and elsewhere. You can read the letter here.

These comments are undoubtedly playing into the concerning narrative that remote consultations are sub-standard. There will be many reasons for mounting pressures in A&E but we’re unaware of any hard evidence that significantly links them to GP access. Indeed, GPs and our teams make the vast majority of patient contacts in the NHS and in doing so, we alleviate pressures elsewhere in the health service, including Emergency Departments. The College will continue to defend hardworking GPs and practice teams against criticism.

I am also waiting for a response to the detailed letter I sent to NHS England Chief Executive Amanda Pritchard, following the announcement of the so-called winter ‘rescue’ package, and will keep you posted.

Mandatory COVID-19 vaccination

The COVID-19 vaccination has been a game-changer. It is the best protection we have against the virus and we would encourage all health and care professionals, indeed every eligible person, to have it if there is no medical reason why they shouldn’t. But as a College, we don’t agree with mandating it and I’ve been making this point in a number of media interviews this week, along with Honorary Treasurer Steve Mowle.

On Tuesday, the Government announced its decision to make COVID-19 vaccination a condition for employment in the NHS for anyone in patient facing roles, from April next year. While this was expected, it was nevertheless disappointing that the Government chose to ignore the concerns of the College, and other representative bodies across healthcare, including the Academy of Medical Royal Colleges.

As well as setting a concerning precedent about personal and informed choice about health interventions, the workforce implications are stark. We need all the people we can get working in general practice and given current trends, we are unlikely to be in a better position come April 2022.

The reality is that the vast majority of GPs and our teams are vaccinated because we understand how important it is. But mandating the vaccine for those who aren't could be counter-productive and lead to resentment and mistrust in the vaccination programme. A much better intervention would be enhanced education about the benefits of the vaccine. You can read the College's full response to the consultation on this issue and our media response to the Secretary of State's announcement.

Veteran Friendly Practice accreditation

Remembrance Day is always a time to reflect on those who have served, and those who are still serving, in the armed forces. Veterans often have unique health needs, and the College is working with NHS England and Improvement to encourage as many GP practices as possible to become 'veteran friendly' so that those who have served in the armed forces can be identified and receive the support they need.

The Canford Health Group Practice in Dorset became Veteran Friendly accredited in 2019. When they joined the scheme, they had no patients registered who were identified as veterans. Now they know that they have more than 100 veteran patients and are beginning to refer them for specialist support and treatment via services like Op Courage, Veterans' Mental Health Transition, Intervention and Liaison Service (TILS) and others.

The College’s Clinical Champion for veterans’ health, Veronica Grant, has spoken to GP Online about the College’s veteran friendly accreditation scheme for a podcast which should be published next week.

You can sign up your practice for Veteran Friendly accreditation here.

'Long Covid' updated clinical guidance

The College has worked with NICE and SIGN to update the Covid-19 rapid guideline ‘managing the long-term effects of Covid-19’ first published last year.

The revised guidance reflects the latest evidence and ongoing research into Post-Covid syndrome, ensuring that clinicians have the latest information to diagnose patients and deliver them the most appropriate care. It includes additions to the most commonly reported symptoms of 'long Covid' as well as reflecting the impact a diagnosis can have on a patient’s quality of life, such as the increased risk of reduced performance and/or increased absence at school or work. You can access it here.

The College is also running free monthly educational sessions to support and keep clinicians updated with any emerging evidence on long Covid.

Huge thanks to Gail Allsopp, our clinical lead for clinical policy, who has led the College's work on 'long Covid' from the start and has done a fantastic job navigating what has often been a minefield of new and conflicting information.

AGM and James Mackenzie Lecture

The Annual General Meeting of the College takes place next Friday 19 November at 14:00 at the College’s headquarters at 30 Euston Square. Notice and papers for the AGM will be available via the website.

The James Mackenzie Lecture will also take place on that day at 16:00. This year’s lecture 'Self-directed Healthcare: Numbers and Knowledge' will be delivered by Professor Maureen Baker, former Chair of the College and a driving force for patient safety. To register for one or both events, please email secretariat@rcgp.org.uk.

Both will be hybrid events that you can join in person or virtually.

Weight management survey

Help us shape future policy for weight management in primary care in England by sharing your thoughts and experience. We know how busy you are, but it should take less than five minutes.

The survey will be anonymous, and you can contact innovation@rcgp.org.uk for further information or to share additional thoughts.

Consultations with patients limited in English

We will be hosting a webinar on Tuesday 23 November, 19:00 - 20:30, to explore the impact of language and cultural diversity on the consultation, using video examples to illustrate. You will have the opportunity to put these skills into practice in a supportive environment with constructive feedback from colleagues. The evening will conclude with delegates sharing their experiences and learning for future practice. You can register now.

Baby Buddy app

The RCGP has endorsed Baby Buddy, a free, ad-free pregnancy and parenting app developed by the charity Best Beginnings, in collaboration with parents and healthcare experts across the UK. It's designed to support parents to give their child the best start in life.

The new app officially launches next month, but the team have released a beta version for our members to test and use with expectant parents. You can download it here.


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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