A prolonged international crisis leaves a country bankrupt and exhausted

19 February 2021

A prolonged international crisis leaves a country bankrupt and exhausted.

It’s the late 1940s in post-war Britain. The solution? Courageous politicians with vision and tenacity driving through social reforms - including the establishment of the NHS - which the British public would probably not have accepted at any other time in this nation’s history.

I’m cautious about historical analogies but many commentators are asking whether this generation has the courage to create 'a 1948 moment' for post-COVID Britain.

If it’s going to happen GPs have a role to play because we see both the ills and the strengths of the communities that we serve. In an article written 15 years ago, Peter Davies, a GP in Yorkshire, said "this country needs a powerful and assertive medical profession to draw attention to the many problems within its society".

In ‘The Political Economy of Health Care: a Clinical Perspective’, Julian Tudor Hart poses typically challenging questions on whether doctors are sufficiently savvy to influence politicians.

I think we are.

So, for those who want to get political, what does your 1948 moment look like?


Latest updates from your College

Vaccination update

Last weekend, the NHS achieved a truly incredible milestone, delivering the first dose of the COVID-19 vaccination to more than 15 million people, and you and your teams are responsible for delivering three quarters of those.

A remarkable achievement, in such a short space of time. Well done, and thank you.

The challenge continues, as we begin vaccinating the next five priority groups and the College is continuing to call for clear, reliable and timely communications about vaccine deliveries, with as much notice as possible, so we can vaccinate as quickly and efficiently as possible.

There's been a lot of media attention this week on how patients in Group 6 will be prioritised for a vaccination. I spoke to The Times about this, making it clear that GPs will be following the JCVI priority list and, in line with guidance in the Green Book, applying a limited degree of discretion based on our clinical judgement and understanding of our patients. I also clarified that patients should wait to be invited before trying to make an appointment, even those who have been identified as clinically extremely vulnerable by the QCovid tool.

While the vast majority of patients understand the situation and are grateful for what general practice is doing at the moment, I know many of you are having challenging conversations with a small number of your patients eager to get vaccinated. I was appalled to read in Pulse that some GPs and practice staff are facing abuse from patients. This is completely unacceptable and I'm so sorry to hear it's happening.

NHS England - Everyone is Welcome in General Practice campaign

One hard to reach group of patients are our homeless populations. Many are unlikely to be registered with a GP practice, sometimes due to misconceptions about needing photographic ID or proof of an address to register, making it more difficult to invite them for vaccination.

This is also the case for many refugees, asylum seekers, and those from traveller communities.

This is why we're supporting NHS England's Everyone is Welcome in General Practice campaign, which you can read about in this blog by Dr Kiren Collison.

One initiative is downloadable 'Access Cards' to give to patients to cut through some of the myths about GP practice registration. Download these, and other materials, via the FutureNHS platform.

Loss of taste and smell

COVID-19 can present in many different ways other than a fever, cough and change in taste and smell - the official symptoms that patients have been told to look out for. The College has been in discussions with the CMO about the implication of what we believe to be an overly narrow definition. This is particularly a problem when the definition is used as a gateway to testing. As clinicians we know that Covid presents in many different ways, particularly so in community settings and with the new variants. I understand that the diagnostic criteria are currently being reviewed and we will stay engaged with these discussions.

As far as the third sign of the current triad is concerned, we know that loss of smell and taste have emerged globally as tell-tale signs of COVID-19 infection. Recently a College survey of members revealed that 54% of respondents had patients with ongoing loss of taste and smell after 12 weeks.

It’s essential that GPs are equipped with the tools and knowledge to manage consultations and have the necessary resources to care for patients both physically and emotionally when presenting with loss of smell and/or taste.

Clinical Champion for hearing loss Dr Devina Maru, Fifth Sense Chair Duncan Boak and ENT Professor Carl Philpott have written an article that provides a suggested systematic approach to the management of post infectious olfactory dysfunction in primary care and signposts support, information and a range of resources to help patients and families.

They are currently working with the James Lind Alliance, National Institute of Health Research, delivering a Priority Setting Partnership for smell and taste disorders. Please fill out this two-minute survey to help the research.

Pregnancy and COVID-19

GPs, along with midwives, are likely to be the first point of contact for pregnant women with queries about COVID-19 and vaccination, and how it might affect their baby.

The Royal College of Obstetricians and Gynaecologists (RCOG) has launched a dedicated webpage with useful information and resources designed for both healthcare professional and patients, to help address any concerns, and encourage them to understand the importance and benefit of getting vaccinated.

The Royal College of Midwives will be hosting a Twitter chat next Wednesday 24 February at 15:30 which will be aimed at patients, and might be of interest. RCOG are also conducting a survey of pregnant women, if you’d like to take it or promote it among your patients.

Drug Safety Survey on AZ vaccine

As part of a legal requirement for all newly approved medicines and vaccines, the Independent Drug Safety Research Unit (DSRU) is continuing to monitor the safety of the Oxford/ AstraZeneca vaccine by collecting 'real-life' information from patients who have received it. Given the large proportion of vaccinations taking place in general practice, the DSRU are keen for our patients to participate by filling out an observational questionnaire study, either before or after being vaccinated.

You can see more information on how to register interest, and encourage patient participation.

Situation in Myanmar

The College has been following the situation in Myanmar with great concern. Our thoughts are with our members in Myanmar as well as those members in the UK who have families and friends there. As a membership organisation for GPs and family doctors worldwide, we have worked for a number of years with our colleagues and friends in Myanmar to support the development of family medicine and improve Universal Health Coverage, including in rural and remote parts of the country. Patient safety and improved health outcomes have always been our paramount concern, and we remain hopeful that a peaceful solution will soon be found.


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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