As a clinician, I’m going to try my hardest to remember our patient-centred roots

14 August 2020

General practice prides itself on being patient-centred, rather than focusing narrowly on presenting problems or diseases. It’s challenging, often draining, but it’s why patients trust us and it’s what makes us effective. I guess that’s why, at the height of the COVID crisis, I felt both relieved and guilty that I had permission to narrow my focus.

For a few short months I was encouraged by national guidance to say no more often - no to open surgery front doors, no to self-limiting problems, no to taxing face-to-face consultations, no to making non-urgent outpatient referrals, no to unnecessary home visits. For some of us general practice was less patient-centred but for the first time in a decade, I felt I was able to manage my workload.

But this strange interlude wasn’t always good for how general practice is perceived. Some patients complained that general practice had shut up shop. Some care home staff complained that residents weren’t being visited or insensitive decisions about resuscitation were being made. Some policy makers and journalists complained that general practice was given an easy ride during the crisis.

The vast majority of these complaints were at best ill-informed and, let's face it, mostly grossly inaccurate. GPs have done a stunning job for their patients and have completely redesigned their services in the most difficult of circumstances. As your College, we have worked hard and consistently to get this message across. But we all know mud can stick.

The COVID crisis isn’t over, infection control is still required, hospital services are far from back to normal, and it looks like we’re heading for a very difficult winter. But as a clinician I’m going to try my hardest to remember our patient-centred roots.

COVID-19 update from your College

RCGP response to COVID

Our weekly update will be taking a couple of weeks off during the summer and will be back on 4 September. I wanted to take this chance to summarise what an extraordinary few months this has been for general practice and the College.

Firstly, thank you. For your dedication to delivering patient care, and for your professionalism and flexibility in the face of one of the greatest challenges to face the NHS.

COVID-19 has also posed challenges for the College as, like general practice, we’ve moved to an almost completely remote service for our members. Nevertheless, some of our achievements over the last few months have been remarkable.

We rapidly developed and introduced the Remote Consultation Assessment exam in lieu of the Clinical Skills Assessment allowing trainees to achieve CCT and get into the workforce. We’ve published our report, General Practice in a Post-COVID World, which is setting the conversation around what our profession will look like in the future. And we’ve rapidly increased our digital offering with a dedicated webpage and Resource Hub with news and CPD on COVID-19 that has had 3.15m views, an increase of 17.5% on usual activity.

We’ve had more than 12,000 media mentions since the start of the pandemic - more than 800 in national outlets, six appearances on BBC Radio 4’s agenda-setting Today programme and five front pages - ensuring a constant voice for general practice advocating on your behalf on issues that matter to you. Our series of #RCGPTogetherLIVE webinars, all available via our Youtube channel, as well as a number of online CPD events, have connected more than 4000 of you while we’ve all been working remotely and unable to attend networking and CPD events as we normally would.

It’s been a busy time and our work is far from over. We’ll continue to support you as we face an uncertain winter dealing with the aftermath of the pandemic, delivering an expanded flu programme and preparing for a potential second wave of COVID, on top of everything GPs normally do.

GP workforce developments

There have been a couple of important workforce-related developments that I’d like to share.

General practice education has long been chronically under-funded and last year RCGP trainee and student members wrote to the Health Secretary highlighting findings from the College’s Destination GP report. Among other things, this report flagged the barriers experienced by those wanting to join general practice, including that fact that underfunded practices struggle to provide opportunities to showcase general practice to aspiring medics.

Following discussions with the College, Health Education England and other relevant bodies, the Department of Health and Social Care has now announced a minimum tariff of £28,000 for GP placements from 2020/21. This will go some way to increasing the rate received for a student session which currently costs about £111 per session for each student. While there is further to go, this is a major boost for GP education and will help to foster a passion for general practice among the doctors of tomorrow.

Secondly, this week NHS England relaunched their two-year Fellowship programme for newly qualified GPs and GP nurses. It offers some impressive opportunities, including mentorship and support for GPs moving into salaried or partnership roles. Available to all new GPs in England, it builds on many positive examples of post-CCT fellowship programmes.

Complementing the scheme is a new programme which funds more experienced GPs to become mentors for those on the fellowship programme, allowing them to pass on their expertise to the next generation.

The College has helped to shape these schemes and will continue to support and refine the programmes going forwards.

Guidance on 'long COVID'

It is estimated that one in ten COVID-19 patients will continue to present with symptoms that last for more than three weeks. Many of these patients will be seeking our care and advice (many already will have) to facilitate their recovery and rehabilitation, but there is currently limited information and guidance to help us deliver this care.

This has been acknowledged in a BMJ paper on the management of post-acute COVID-19 in primary care, a collaborative resource produced by Trisha Greenhalgh and her team at the University of Oxford. It provides much needed clarity on the potential symptoms of what has become known as long Covid and offers ways we can support and aid patient recovery.

The College is currently producing eLearning for GPs on how to identify and manage long Covid, which we’ll hopefully be able to publish in coming weeks.

Bureaucracy review update

I attended the first meeting of the Expert Working Group for the NHSE&I Bureaucracy Review this week. The purpose of the review is to look across the sector at different bureaucratic processes that add little value and take GPs away from more important clinical work - something the College has been calling out for for some time.

I spoke about the need for a cultural change that would prevent the proliferation of bureaucracy in the long term and stop history repeating itself. Without underlying principles that put more trust in the profession, bureaucracy will always creep back in. As we say in our General Practice in a Post-COVID World report, we need to see a high trust, light touch approach to regulation which will allow GPs to do what they do best - look after patients.

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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