GPs are at the forefront of tackling health inequalities

19 June 2020

I’ve never been a great advocate of universal triage in general practice. Too often it has felt to me like a barrier put up by doctors, one that’s easily circumvented by the most able and sometimes insurmountable for the most vulnerable.

But the Covid-19 crisis is encouraging me to re-think. As a result of the pandemic all practices are getting used to using different models of clinician-led or digital triage to guide patients to the most appropriate service.

And to my surprise many patients that I speak to like what they are experiencing.

Much of the time, their decision to self-care or seek professional help isn’t straightforward. Most patients aren’t sure when to seek help from their local pharmacy or how to make contact with direct-access services in their communities.

Most patients aren’t sure which clinician in the primary care team best meets their needs or whether they should ask for an email, telephone, video or face-to-face consultation. And most patients aren’t sure when it’s appropriate to go to the Emergency Department.

We assume patients understand the NHS and how it works but they don’t. This lack of knowledge is wasteful, frustrating and sometimes unsafe.

All forms of triage help practices to manage demand for their services. Patient-led digital triage helps patients to be self-reliant and to prepare for clinical consultations when they are required.

Triage will evolve, become more sophisticated and the concepts of triage and consultation will gradually merge.

Universal triage may have been introduced in a hurry as a result of a crisis but it seems to me it’s here to stay.

COVID-19 update from your College

College commitment to addressing health inequalities

COVID-19 has highlighted health inequalities in society, though sadly these inequalities existed before the pandemic and they will exist after.

As GPs we are at the forefront of tackling them, and as a College, this is a responsibility we are taking seriously.

On Wednesday evening, as part of our #RCGPTogether Live webinar series, we held a discussion on health inequalities in patients, chaired by ‘deep end’ GP and RCGP Scotland Chair Carey Lunan with representatives from the Health Foundation and the College’s Health Inequalities Group.

It was well-attended and wide-ranging, with some passionate contributions. You can watch it back if you were unable to attend.

We’ve also committed to hosting an event looking at the challenges faced by our black, Asian and minority ethnic (BAME) colleagues in general practice and what the College is doing and could do to help address them. More details on this shortly.

This week Public Health England published the second part of their report looking into the impact of COVID-19 on BAME communities.

The key criticism of the initial report was the lack of recommendations: this time it includes seven recommendations, including developing public health campaigns that specifically target BAME communities, provision of appropriate PPE for BAME healthcare professionals, and support for people to report incidents of racism.

Broadly we are supportive of the recommendations. Now we need action, which will require government investment and commitment.

Learning from the pandemic

I wrote last week about how one lesson we should learn from the COVID-19 pandemic is that GPs can be trusted to do what’s right for their patients – and one of the things we don’t want to see is a return to the level of bureaucracy GPs had before the lockdown.

There is a place for regulation, of course, and in some circumstances, it can highlight when a practice is struggling and needs support.

However, a reduction in regulatory burden and a more ‘high-trust low-check’ ethos will ensure we continue to have more dedicated time to delivering high-quality and safe patient care.

I have made these thoughts clear to the CQC and issued this public statement, which has been covered by Pulse and GP Online, along with similar concerns from our colleagues at the General Practitioners Committee of the BMA and the Practitioner Health Programme.

Call for clarity – and no more blindsides

We’ve written to Secretary of State for Work and Pensions, Therese Coffey, this week calling for clarity and guidance for GPs around the working rights of patients who are shielding.

This is something many members are reporting that their patients are asking them about.

Thank you to joint Hon Sec Jonathan Leach for making these concerns clear in a BBC interview this morning. The letter has also been covered by GP Online and Pulse.

Linked to this, we heard via the HSJ about plans to start winding down the shielding programme at the end of July – although Government is clear that no decisions have been made, especially around timing. Read my response.

What’s essential is that GPs are given an opportunity to influence decisions and plenty of notice ahead of the decision being made public, so that we can prepare to advise our patients accordingly.

Too many times the profession has been blindsided by Government announcements recently – first with changes to shielding guidance a few weeks ago and last weekend around advice for patients to wear face coverings in practices – and this mustn’t happen again, as I’ve made clear.

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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