Managing expectations

18 February 2022

Our practice in East London serves a highly diverse population. Half our patients are ‘established’ East Enders – poor, ethnically and culturally diverse. The other half are ‘new’ East Enders – young professional couples working in the City or Canary Warf. The voice of the first group is too often stifled, the voice of the latter loud and clear.

I wish it weren’t the case but one of our jobs as GPs is to manage the expectations of the patients we see. The NHS is finding it increasingly difficult to provide what patients need, never mind what they want. The consequences for patients of the pandemic backlog are distressing. NHS England has made a commitment to eliminate waits for treatment of over 18 months by April 2023 and waits of over 65 weeks by March 2024. Many people think even these inadequate targets are unattainable with the current workforce.

We have to explain this reality to our patients and I’m not finding it easy. I say that for half my patients I spend my time suppressing their expectations and for the other half trying to elevate them. The former feels demoralising, the latter feels professionally satisfying but so tough when public services don’t have the capacity to respond.


Latest updates from your College

Council discusses Relationship-Based Care

As you’re receiving this, our governing Council meeting is coming to an end. We’ll give you a full update next week, but topics on the agenda include an update on our work on invigorating relationship-based care, and a paper initiated by RCGPNI Chair Laurence Dorman on the importance of having a common language for remote consultations. Search #RCGPCouncil for a sense of the discussions.

Accelerating citizen access to GP data

At the end of last year, I let you know that we had successfully called for a delay to plans from NHSX/EI to give patients automatic access to new entries on their GP record. This was put back to April 2022. I know that as this date approaches, you will be hearing more about the programme and that many of you still have concerns about the implications for your most vulnerable patients. We are in the process of updating our patient online toolkit to provide guidance on the ways some of these risks can be mitigated. 

This work is due to be completed at the end of March. At the same time, we are continuing to raise concerns with NHSX/EI and ask a clear explanation of how safety is being ensured, particularly with respect to safeguarding. We are also making it clear that sufficient time must be given for general practice to digest guidance and prepare before any changes to patient record access go ahead.

Covid-19 vaccinations: 5-11 year olds 

You’ll have seen that 5-11 year olds in England, Scotland and Wales are now eligible for a low dose of the Covid-19 vaccine, following guidance from the JCVI. The College supports this decision on the basis it will be parents’ choice as to whether to vaccinate their children. Recognising the huge pressures you and your teams are working under, we agree with the expectation that most vaccinations are delivered via mass vaccination centres and pharmacies, though PCN sites that have capacity will contribute. We understand that NHS England will be writing to PCN vaccine sites in England imminently.

RCGP in the media

Our newest Vice Chair, Margaret Ikpoh, took part in a comprehensive feature in The Sun advising the paper’s readers about when they should and shouldn’t seek GP care.

We all want our patients to get appropriate care, and we want them to know we’re here to help, but sometimes it isn’t the GP they need to see – sometimes self-care is the best option – and Margaret gets that often tricky message across brilliantly.

I also commented in a feature in The Telegraph about mental health referrals from general practice. We made clear that many areas are running self-referral systems, but that ensuring patients receive the most appropriate mental health care is a priority for GPs and our teams.

2022 Annual Conference, in conjunction with WONCA Europe

There’s not long left to secure your discounted earlybird ticket for our 2022 Annual Conference, in conjunction with WONCA Europe. The deadline for discounts, of up to £75, is 28th February so don’t miss out.

The Conference will be a great opportunity to connect and share ideas and experiences with a global network of practitioners. I look forward to meeting you there!

Register now

Next Gen GP meets LCARM conference

In the College's 70th year, come and explore the opportunities, challenges, and rewards possible at every stage of a career in general practice. Join us in London for a special full day conference on the theme of transitions, designed for those in their later career or retirement, and those looking to begin a career in general practice.

Hear from leaders of the profession on navigating different career pathways. Network with fellow GPs and future GPs, sharing knowledge and expertise between communities.

The event will be hybrid with limited in-person attendance and sessions streamed to watch online.

Register today

School attendance and health

Our President Clare Gerada is representing the College on Education Secretary Nadhim Zahawi’s Attendance Action Alliance. This is a group of national sector leaders from education, social care, health and beyond who have pledged to work together to tackle the underlying causes of school absence.

Dame Clare has taken on this role is to spread the word about the importance of school to children’s mental and social health - and the crucial role GPs play in providing reassurance to children and their families post-Covid. She is being supported by Rowena Christmas, Chair of RCGP Wales and Safeguarding lead for Wales.

The most up-to-date evidence suggests that children and young people – including those children previously considered clinically extremely vulnerable - face a very low risk of serious illness from COVID-19.

Through her work with the Education Department, Clare says she is seeing a lot of appreciation for the work we do as GPs. We’re also pleased that the Department is supporting work to reduce GP workload and has issued guidance to schools that they should not ask parents to seek doctor’s notes to authorise illness.

You can read more on our website.

Air Quality Summit

A big thank you to Liliana Risi and Tamsin Ellis from my own Faculty of North East London who represented the College at the Mayor of London's Summit on Air Quality yesterday.

The presence of the College was acknowledged and welcomed throughout the event, including by Sadiq Khan himself and by Professor Sir Stephen Holgate, Special Adviser on Air Quality at the Royal College of Physicians, who hosted the event.

North East London Faculty is actively supporting the Greener Practice London, a network of healthcare professionals whose aim is to enable primary care to take actions for the health of patients and the planet. Initiatives so far include Faculty climate equity scholarships to help develop leaders and work for fairer environments for the populations we serve. Next steps include linking up with the College’s other Faculties for collaborative work.

As GPs, we’re well aware of the serious impacts of climate change and poor air quality on the health of our patients, and I'm really proud that our College is showing leadership in this important area, locally and nationally.

Antibiotic Resistant Strains of Gonorrhoea detected in England

We've been asked to share the following message with members by the UK Health Security Agency.

Four cases of ceftriaxone-resistant gonorrhoea were detected in England in December 2021 and January 2022. Ceftriaxone is the last line empirical therapy to treat gonorrhoea, so the circulation of ceftriaxone-resistant strains in the UK compromises the effectiveness of this antibiotic to treat gonococcal infection. Ceftriaxone-resistant strains are very rarely detected in the UK and, prior to December 2021, all cases were associated with overseas travel (for example, see the Eurosurveillance webpage).

General practitioners play a key role in providing sexual health care but, due to the complexities of managing patients with gonorrhoea (see Chapter 11), they are recommended to refer suspected or confirmed cases of gonorrhoea to their local sexual health service for treatment (ceftriaxone 1g IM), to obtain specimens for culture, for test-of-cure, and partner notification.

In instances where such cases are assessed as being likely to be lost to follow-up, they should be treated in line with the UK national guideline for the management of Neisseria gonorrhoeae.

Lastly, where appropriate, your patients can be tested for gonorrhoea and other STIs at sexual health services and by using online STI self-sampling services such as freetest.me and SH:24.


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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