Why general practice is so fascinating, so rewarding and so challenging

19 March 2021

"I was confronted by the dispiriting realisation that my life, which from the inside has always struck me as fascinating, original and thrilling, makes for a decidedly boring series of data points."

That’s how the journalist James Marriot felt on filling out the census, which, he says, reminds us every 10 years that we’re nothing special.

My job as an expert medical generalist is to honour the uniqueness of each of my patients. But at the same time I make judgements about how the patient compares with others, where they sit on a normal distribution.

I guess that’s why general practice is so fascinating, so rewarding and so challenging - every day we balance the dryness of a series of data points in order to improve the health of our communities, with the wonderful uniqueness of the human condition.


Latest updates from your College

Vaccination programme update

I’m happy to be able to start with some good news that has just been announced from NHS England. The General Practice COVID Capacity Expansion Fund has been extended - to the tune of £120m - from 1 April until 30 September this year. This is something the College called for, along with the BMA, in our joint letter to the Chancellor ahead of the Budget earlier this month. You can read the full letter from NHSE.

This weekend we’re expected to hit the milestone of half of all UK adults being offered their first dose of the COVID-19 vaccine. When you think the first jab was only given in December, it’s a truly remarkable achievement - and you and your teams have delivered around three quarters of them.
   
With everything going so well, it was disappointing to hear of forthcoming disruption to supply of the Oxford-Astra Zeneca vaccine, requiring us to stop taking new bookings for April. Our ability to vaccinate depends on vaccine supply, so this will inevitably be frustrating for patients and GP teams, who just want to get on and protect patients.
   
We’ve been reassured that there are enough supplies to fulfil planned second doses, and that we’re on track to meet the vaccination targets set out by government. It remains key that we are communicated with as to when we will receive supplies.
   
I spoke on Radio 4’s The Today Programme about the disruption and what it may mean for patients yesterday morning, and my comments featured on the front page of The Guardian. I also spoke to Times Radio and BBC News Channel, and Vice Chair Michael Mulholland spoke to Sky News. You can read our full comment.
    
The other big vaccine news came in the form of welcome announcements by the MHRA and EMA yesterday that the AZ vaccine is safe and effective. This followed a number of European Governments taking the decision to suspend its use due to concerns about the risk of blood clots.
 
The MHRA has said available evidence does not suggest blood clots are caused by the AZ vaccine, and the WHO has made clear that its benefits outweigh its risks. The EMA has said the AZ vaccine is not associated with increased overall risk of blood clots, although it could not rule out a link between the rare occurrences of blood clots and the vaccine and will continue to investigate.
 
We hope these messages will rebuild any loss of patient confidence in the AZ vaccine that has resulted from this week’s controversy. It’s so important that as many patients as possible get vaccinated - and that depends on them believing that the vaccines are safe and effective. You can read our statement in full.

RCGP tracking survey

To help us influence government on important issues that have real impact on the profession, I’d encourage you to complete this survey by 5 April. 

I know you’re all busy, but your input will really help us to understand important aspects of current practice including workload, wellbeing, workforce and technology. It should take about 20 minutes to complete.

If you'd like to participate please fill out this survey if you're a member in England, or this survey if you're a member living in Scotland, Wales or Northern Ireland.

Women's safety

I think it’s fair to say that the case of Sarah Everard has affected us all and it has, once again, highlighted the issue of the personal safety of GPs and practice teams doing home visits.

We should all be able to carry out our work without fear for our own safety and security, but I’m sure we’re all aware of cases where GPs, predominantly women, have felt at risk when carrying out visits alone.

While the solution to this does not lie with the College, this is very troubling so I thought it might be worth sharing some of the guidance that’s currently available. Here are resources from NHS Employers, NHS Security Management Services and First Practice Management.

We’ll also raise the issue with the BMA and Local Medical Committees to see if more can be done following recent events.

However busy, we will always look out for our colleagues and ensure that our practices have measures in place to protect our teams. The events of the past week have shaken our newly and recently qualified women GPs in particular, so please do what you can to support your colleagues.

National Day of Reflection

Next Tuesday 23 March marks one year since the first official lockdown began. During the pandemic, we have seen more than 120,000 deaths to COVID-19,  16 of whom were practising GPs. Many more have suffered, either directly as a result of COVID-19 or indirectly due to restrictions that have been put in place as part of the pandemic response.
 
Marie Curie, our partners in developing resources to support GPs to deliver high quality palliative and end of life care, are holding a National Day of Reflection on Tuesday - an opportunity, as the name suggests, to remember those we have lost, how it has impacted on our lives, and how it may change them in the future.
  
You can find out more.

Climate change

College Vice Chair Gary Howsam wrote a powerful piece for this bulletin a couple of weeks ago on our 'other' health emergency - climate change. 

On Tuesday, I joined Terry Kemple, RCGP National Representative for Sustainability, Climate Change and Green Issues, for the webinar Net Zero carbon General practice; what will it look like, how will we get there?

It was hosted jointly by the College, the BMJ and the UK Health Alliance on Climate Change - ahead of the UN’s 26th climate change conference in Glasgow later this year - to consider how GPs and their practices can individually and collectively take action on climate change.

It was a thought-provoking event and the fact that over 200 delegates joined us during a global pandemic shows how critical this issue is for general practice and the wider health sector.

Issues and themes ranged from the practical ways in which GPs can protect planetary health to how GPs could influence pharmaceutical companies to achieve net zero.

Thank you to Terry for his unswerving commitment to sustainability within the College and general practice. Thanks also to Sheffield GP and new College Council member, Aarti Bansal, who spoke at the webinar about setting up the Greener Practice initiative.

Hundreds of GP practices are now using the Green Impact for Healthcare Toolkit which provides 100 practical actions to improve the environmental sustainability and quality of general practice, as well as saving money.

Gary Howsam leads our sustainability work at College Officer level which demonstrates, I hope, how seriously we take the issue. It’s a sobering thought that climate change will continue to have a devastating impact, long after COVID-19 is under control.

RCGP Mentoring

RCGP Mentoring is now open for mentees and mentors from across the profession to sign up. It aims to connect members with other members for informal peer support.
 
It also offers a range of resources to help you navigate the mentoring process, supporting you in your role as a mentee or mentor and ensure that your mentoring relationships are both helpful and enjoyable. I’ve already accepted requests from three early career GPs and look forward to meeting them shortly. I sometimes worry that our workload is putting pressure on the time-honoured ‘apprenticeship’ model of medicine and that it’s less easy to make time to provide support for our peers. RCGP Mentoring is an opportunity to address this challenge.

You can find out more and join today.


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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