A collective 'thank you' for everything you are doing

16 October 2020

The last thing you expect when you’re working flat out during a global pandemic is to be criticised for not doing enough.

Yet in the space of a few months, there seems to have been a shift from GPs being clapped by the public on Thursday evenings to growing criticism by certain sections of the media, politicians and other parts of the NHS who don’t seem to understand the pressures we are under and the reasons why we’ve had to change the way we work.  

So today, as Officers of the RCGP across all four nations of the UK, we want to say how grateful we are to you for the way in which you have responded to this pandemic.

As practising GPs ourselves, we know first-hand what you are doing on behalf of your patients and the rest of the NHS right across the UK. You and your teams are truly outstanding.

Throughout this whole period you have followed the advice of the four governments and four NHS bodies and transformed general practice in a remarkable way, practically overnight, to meet the challenges of COVID-19 and the needs of your patients.

You have cared for those most vulnerable to the virus - our shielding patients, those in care homes, our Black Asian and Minority Ethnic communities, those at the end of life and those in deprived areas,  and you have done so with remarkable professionalism and compassion.

You have also cared, with restricted access to diagnostics, for non-COVID patients whose hospital appointments and operations were cancelled. We see examples every day of how you are working with colleagues across all specialities and sectors within your local systems to support your local populations. This truly is a time for collaborative working and we are proud to see the role general practice is playing.

Despite these unrelenting pressures, you keep on going.

Following a brief drop in consultation numbers at the start of the pandemic, when people said they were anxious about using the NHS or didn’t want to overburden it, demand in general practice has risen consistently and is now exceeding that of previous years due to the significant medical complexity GPs face.

Numbers of patients with anxiety and mental health problems are rising, perhaps reflecting the health and economic consequences of the pandemic. GPs are now also grappling with the effects of Long COVID in the community and taking the lead in the largest-ever flu vaccination programme.

We therefore find it extraordinary when the contribution and efforts of our profession are not recognised.

The change to a different way of working was necessary in the face of the most serious health emergency for a century. It would have been totally irresponsible - and catastrophic - to continue seeing nearly one million patients face to face in general practice every day when the infection rate of COVID was high. Moving to remote consulting also meant that some GPs were able to stay working when they had possible COVID symptoms themselves and these arrangements have kept colleagues and patients safe.

But despite active lobbying for many months for realistic public messaging to this effect, very little has materialised as it’s a difficult political message to sell.

We will soon be launching our own four-nation public information campaign highlighting that general practice is, and always has been, open for business during COVID-19, and that GPs are continuing to see patients face-to-face wherever there is clinical need - but because of the continuing infection control measures we have to have in place, including PPE and social distancing, remote consultations are likely to be with us for some time.

We want to see a national conversation which recognises that NHS resources are finite, never more so than now, and we need to be able to prioritise the care we offer to those with the greatest need. We want to work with our patients, encouraging and supporting them to play their part in ensuring NHS resources are used sustainably, promoting self-care where appropriate.

This latest criticism seems to have started with NHS England’s recent letter that appeared to question the contribution of GPs to the pandemic effort. Today’s Care Quality Commission report (see more below) shows that 94% of practices in England continue to be rated good or outstanding - yet the media are telling a different story.

As well as being damaging and demoralising, the impact of this negativity is far-reaching. It causes some patients to question the trust and the confidence they have in us, and may even delay their presenting to us with potentially serious symptoms. It deters medical graduates from choosing general practice, it disheartens both our trainees and experienced GPs, causing too many to leave the profession early.

What we must never lose sight of is that the majority of our patients think we do a great job and understand exactly why we’re doing what we’re doing - even if it doesn’t make headlines.

We are proud to be part of this College and to be representing 54,000 hardworking and dedicated GPs across the four nations of the UK. We will continue to do everything we can to defend the whole of our profession and our reputation against these undeserved attacks.

We’ll continue to tell MPs, MSPs, MSs and MLAs what the situation is really like ‘on the ground’ and why we are working in the ways we are. We’ll continue to challenge the negative sections of the media and call out criticism from other parts of the health service to get the message across that without GPs, the NHS would collapse.

The voice of frontline GPs is powerful and we ask for your help to advocate for general practice and the fantastic work GPs do so that we can change the narrative of this pandemic.

But for today, our message is a collective Thank You for everything you are doing. There is still a long way to go before we see the end of COVID-19, but you have our support throughout the challenges ahead.

Post written by

  • Martin Marshall, Chair of RCGP Council
  • Amanda Howe, President
  • Mike Holmes, Vice Chair Membership and International
  • Gary Howsam, Vice Chair External Affairs
  • Michael Mulholland, Vice Chair Professional Development
  • Jonathan Leach, Joint Hon Sec
  • Victoria Tzortziou-Brown, Joint Hon Sec
  • Steve Mowle, Hon Treasurer
  • Carey Lunan, Chair of RCGP Scotland
  • Mair Hopkin, Joint Chair of RCGP Wales
  • Peter Saul, Joint Chair of RCGP Wales
  • Laurence Dorman, Chair of RCGPNI

Latest updates from your College

CQC State of Care report 2019/20

The Care Quality Commission’s State of Care report 2019/20 shows that 94% of GP practices in England were rated 'good' or 'outstanding' up to March this year. Given the immense pressures you’re all under, that’s incredible and I’m sure it will be reassuring for patients. The report also highlights numerous examples of good GP care both before and during the pandemic.

Unfortunately, the headlines surrounding the report focussed on comments made at its press launch around GP access. I understand how demoralising it will have been to see those headlines as you were beginning your day’s work and, as outlined above, we are pushing back against unfair claims that general practice hasn’t been open during the pandemic.

Read my response.

Relationship-based care and improving the health of our communities roundtables

On Wednesday we hosted two virtual policy roundtable events - one on improving the health of our communities, and another on relationship-based care.

The events were attended by a range of experts from our GP communities, academics, think tanks, other professional bodies and policy makers. Both were incredibly positive and engaging sessions, helping to move our thinking along in these two important areas to shape our influencing work.

The discussions will feed into the paper I’ll be taking to UK Council in November on relationship-based care - my enduring priority during my tenure as Chair - and our ongoing work around improving the health of our communities through the ministerial working group in England, and various influencing activity across the UK.

Flu vaccination programme update

I gave my 10th interview this year to BBC’s influential Today Programme on Thursday (about 48 minutes in), and also spoke to Radio 4’s You and Yours earlier today, about continued frustrations I’m hearing from members about the expanded flu vaccination programme, which I know you’re currently all hard at work delivering.

While it’s encouraging that so many people are coming forward for the flu jab as it means messages about its importance are getting through, what I’m hearing is that the 'stop/start' nature of deliveries is causing logistic issues for practices, with some having to postpone flu clinics. There’s also a health inequality angle as if we have to turn away a hard-to-reach patient because of shortages, getting them back in when we have sufficient vaccines will be doubly hard.

Following my letter to Health and Social Care Secretary Matt Hancock a couple of weeks ago, the Department of Health and Social Care have published new guidance, offering clarity on prioritisation and how to order more stocks when you run out. I hope you find it helpful. In the meantime, we will continue to press for assurance that all patients in the expanded 50-64 year old group will be able to have a flu vaccination, if they want one.

Guidance for extremely clinically vulnerable people

As new lockdown measures continue to be implemented across the UK, something particularly pertinent to general practice is what guidance is being given to those most extremely clinically vulnerable to COVID-19.

Following several unsubstantiated rumours over the weekend, Deputy CMO Jenny Harries announced on Tuesday that although official shielding was not being re-introduced, guidance has been produced for those considered most vulnerable about how to best keep safe according to the new three-tier system that has been introduced.

The College would only want to see widespread shielding introduced as a last resort given the unintended consequences on patients' physical and mental health we witnessed during lockdown. Now that we know more about COVID-19 we would like to see any re-introduction of shielding tailored to patients using robust risk assessment tools - several of which we know are in development. In the meantime, it is vital that if any form of shielding is re-introduced that general practice is consulted, so that we know how to best answer any queries or concerns our patients will have.

Queen's Birthday Honours

Many congratulations to the eight GPs who were recognised in the Queen’s Birthday Honours last weekend, many of whom are members of the College. These include: former Chair Clare Gerada, who becomes a Dame, our Immunisation Lead George Kassianos, awarded a CBE, RCGP Scotland Chair Carey Lunan, Trustee Board Chair Nigel Mathers and Council Member Carter Singh, all awarded MBEs, as were Northern Ireland GP, Joseph Palmer and Caingorms GP, Julie McIlwaine. Hareen de Silva, former SYNT Faculty Chair, was awarded a British Empire Medal.

These awards should be seen not only as a celebration of individual personal achievements but also a reflection of how hard general practice has been working during the pandemic to tackle COVID-19 in the community, and continue to care for patients, with both COVID and non-COVID conditions, in the most challenging of circumstances.

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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