Perceptions of self-worth underpin clinician well-being and effective professional practice

15 January 2021 

What is the most common reason for a GP seeking professional help when they’re struggling with their mental health, as so many are doing during this terrible crisis?

This is the question I asked of the amazing team running the Practitioner Health Programme, led by our very own Dame Clare Gerada, a national confidential service for doctors and dentists with mental illness and addiction problems who want to remain in clinical practice.

I thought I could guess the answer - most likely workload, perhaps triggered by a personal crisis. But I was wrong.

The commonest reason for not being able to cope is not feeling valued - by patients, by the media, by colleagues in the NHS and by our political masters. The barrage of criticism experienced last year by many GPs as a consequence of redesigning our services during the first wave of pandemic has taken its toll. Recognition of the heroic efforts of general practices to deliver the COVID vaccination programme have helped but the workforce is feeling stressed.

Perceptions of self-worth underpin clinician well-being and effective professional practice. It’s remarkable how selfless people will be when they feel that what they’re doing, however tough, is valued by others. And it’s not surprising that when they don’t feel valued, they break down. Now more than ever we need to care for the many clinicians who are struggling valiantly to care for their patients and communities.

Latest updates from your College

Vaccine update

So far, more than 2.6 million people across the UK have received the first dose of their COVID vaccine. A significant proportion of those will have been delivered by general practice. It has taken a tremendous effort to get here, and there is still a long way to go but I think it’s important that we also take a moment to celebrate our successes and reflect on the fantastic work of yourselves and your teams to make this a reality.

We’re still seeing some localised supply issues - reflected in the regional breakdowns from PHE we saw yesterday - but we have been told by NHS England that all vaccine sites will receive supplies this week and next.

If you are experiencing any issues, whether about supply or something else, do let us know via our member forum - this way we can identify trends, and raise them at the highest levels of government across our four nations.

One example of this is the unnecessary red tape facing retired GPs wanting to return to the profession to support the COVID vaccination programme - something we’ve been lobbying hard to cut over the last few weeks. As a result, this process has now been made significantly easier, including new regulations which have been put in place allowing any GMC-registered retired doctor to be exempt from needing to be on the Performers List if returning to support the Enhanced Services Specification COVID vaccination programme.

I hope this more streamlined process will be more appealing to our fantastic retired GPs who are so enthusiastic about returning to help with the vaccination effort - because, frankly, we won’t be able to do it without them.

We also heard the very welcome news that the CQC have suspended routine practice inspections, and they will only be inspecting practices where they have significant concerns about patient safety.

Whatever can be done to reduce workload to free up our time for the COVID vaccination programme, the expanded flu programme and our frontline patient-facing work should be done, and cutting our bureaucratic workload is a good starting point.

We’ve also now published, with the BMA, updated workload prioritisation guidance (567 KB PDF) to reflect the additional pressures GPs and our teams are facing.

The COVID vaccination programme is understandably getting a lot of media interest, and we’re working hard to raise workload issues, workforce issues, and issues GPs are experiencing around delivery of the vaccine. Since the beginning of the year, we’ve been featured 1,016 times in the media, 105 times in national outlets, and just this week I’ve appeared on both BBC’s Panorama and ITV’s Tonight programmes. I hope you think we’re getting the message through about just how hard GPs and our teams are working, in the most difficult of circumstances.

WHO webinar

In a major coup for the College, we will be hosting a free webinar in collaboration with the World Health Organisation on 'Global Lessons Learnt from the COVID-19 Pandemic' on Wednesday 3 February.

It will explore challenges experienced at the start of the crisis, ways in which health services adapted at speed to manage increasing demands and the epidemiological and global public health lessons learnt during the pandemic.

Joining me on the speaker panel will be: Dr Jim Campbell, Director of Health Workforce at WHO; Professor Yuanli Liu, Founding Dean, School of Health Policy and Management at Peking Union Medical College, and Dr Lola Dare, President of the Centre for Health Sciences Training, Research and Development in Nigeria. It will be chaired by RCGP Chief Operating Officer, Dr Valerie Vaughan-Dick.

It’s a Zoom event but we’re expecting it to be very popular so please register.

Due to different time zones, it will be held from 12:00 - 13:15 GMT when I realise a lot of you will be in practice, so it will be recorded for the College’s YouTube channel and the video and presentations will be uploaded to our COVID-19 Resources Hub.

More details and registration.

RCGP Together LIVE - Brexit

The next RCGP Together LIVE is on Tuesday 19 January at 19:00, looking at Brexit and its impact on the health service. We’ll be covering issues, such as the NHS workforce, social care, and the Northern Irish border.

Vice Chair Gary Howsam will be hosting a panel including NHS Confederation’s Danny Mortimer, and our former Vice Chair for Professional Development Kamila Hawthorne.

Submit your questions on social media using #RCGPLIVE and watch live on Tuesday. Register now.

COVID Oximetry

The College, in collaboration with Academic Health Science Network, hosted a webinar on Tuesday, exploring the association between COVID-19 and oxygen saturation.

Emergency preparedness expert and former RCGP Chair Maureen Baker hosted a panel that discussed the COVID Oximetry@home model, silent hypoxia, and how to monitor and manage vulnerable patient groups including care home residents and people with learning disabilities.

So far, 2,500 have watched the webinar. You can watch the webinar, get further clinical information and patient resources via the AHSN Network website.

GP care in secure environments

Jake Hard, our excellent Chair of the College’s Secure Environments Group, has asked me to highlight to GP practices the importance of accepting and registering patients from the secure estate - prisons, young offender institutions, secure training centres and immigration removal centres - prior to their release.

Pre-registration from within the secure estate will help patients to access the necessary healthcare support and ensures continuity of care following their release - particularly important with the current COVID pressures and to ensure the smooth rollout of the vaccination programme. It means that individuals who leave the secure estate between the first and second doses of the vaccine who have been registered with a GP will have their GP record updated to show their COVID-19 vaccination status.

Later this year patients within the secure and detained estate will be offered the opportunity to GMS register with healthcare at their place of detention. This will allow a GP2GP transfer to take place, electronically transferring the patient’s community GP record into the clinical system across the secure estate.

When a patient who has GMS registered at their secure site then registers back in the community, either directly with the practice or via pre-registration, a GP2GP transfer will then be triggered to transfer the patient’s record back to the community GP, ensuring the safe and effective handover of that patient’s care whilst in the secure setting and with that, GPs will be better informed about long-term conditions, ongoing health concerns and specialist care.

This is a contractual agreement and there’s more information on how to do this on the NHS England website.

Thank you to Jake and to all our colleagues working in this difficult area of healthcare. It’s a really tough job but critical to addressing health inequalities and improving public health.

VdGM Edinburgh Online

The Vasco da Gama Movement Edinburgh forum has had to be postponed until January 2022, but we have a special online event planned for 6 February 2021.

After a challenging year, this will be a celebration of everything that makes the spirit of the VdGM for newly qualified and future GPs so special. You’ll learn about traditional Scottish culture, a day in the life of a Scottish GP, take part in a quiz and try out a ceilidh (traditional Scottish dancing)! We look forward to seeing as many of you as possible online. 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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