COVID-19 has presented us with a lens through which to view health inequalities

2 October 2020

During the last six months there has been a focus on all forms of inequity in the UK. The Black Lives Matter movement has required us all to stop, think and take action. We are now in Black History Month and the impact felt within the RCGP is palpable, necessary and welcome.

The COVID pandemic has presented us with a lens through which to view health inequalities. As a GP partner in a practice with surgeries at both ends of the deprivation spectrum, in York and Hull, I feel obliged to comment on what I have noticed.

In the first three months after the initial lockdown we saw more than three times as many deaths in the under 60 age group in Hull compared to York. The individual stories were sobering - suicides, drug-related deaths, childhood deaths, bodies lying undiscovered for days as people were socially isolated with no one to check on them. All with backgrounds that experts like Michael Marmot have pointed out to us repeatedly.

Looking after our population in Hull is challenging. We are under-doctored compared to York and the national average. There is some hope as GP training places are fully recruited. We are so grateful to have International Medical Graduates making up approximately 70% of our new ST1 cohort in Hull. We must do everything we can to support them to settle into and thrive in our community. In York IMGs only make up 20% of this year’s ST1 cohort. I think we should reflect on the reasons for that difference.

Things are made more challenging by the funding situation. Various factors including lower life expectancy mean that the weighted capitation in Hull is less than York - so less money per patient. For similar reasons our disease prevalence is lower meaning less money per QOF point. This effectively means we receive inadequate funding for our Hull surgeries, where there is low life expectancy and high deprivation, and higher funding for our York surgeries where the opposite is the case. Presumably other practices in deprived areas feel similarly.

Post written by

Professor Mike Holmes, RCGP Vice Chair (Membership and International)

Mike is a GP in Yorkshire and Vice Chair of the Royal College of GPs with responsibility for Membership and the International work of the College.

He has been a Partner with Haxby Group since 2002 caring for 50,000 patients in the cities of York and Hull and part of At Scale Collaborative. Mike is a Director of Nimbus Care Ltd caring for 130,000 patients in York and is working with all the practices to develop a Primary Care Home model of care.

Mike is also a GPSI in vasectomy although half his practice time is in a leadership role developing a multi-professional workforce.

He is a board member of the North LETB and leads development of Advanced Clinical Practitioners and Physicians Associates for the Local Workforce Action Board. He is also RCGP Clinical Lead for their General Practice 'At Scale' Programme.

Latest updates from College Chair Martin Marshall

Creating a more inclusive culture

The recent Black Lives Matter movement and events earlier in the year exposed the depth of the racism and bias that still exist in our society, but also served as a potential watershed moment for racial equality.

Over the past months the College has been in listening mode - we’ve heard accounts of the shocking prejudice still faced by Black Asian and Minority Ethnic GPs, but also of the courage and determination shown by BAME GPs in times of adversity, and the integrity of others who have stood up for them in solidarity and support.

It’s clear that there are opportunities to grow, learn and improve, both within the College and general practice itself.

RCGP Council has already committed to a BAME Action Plan, informed by the experiences and expertise of Black Asian Minority Ethnic GPs, as part of our wider work on Equality Diversity and Inclusion.

Under the leadership of our President Professor Amanda Howe, we are now working hard to transform the Action Plan into tangible measures that will improve the working lives of our Black Asian Minority Ethnic members and improve health outcomes for BAME patients.

One element of this is the College’s Equality, Diversity and Inclusion video project, which we will be launching next week to coincide with Black History Month.

We want all our members to play a part in shaping the future culture of general practice and the video project aims to provide a space for shared support, consolation and advice.

We want GPs to use it as an opportunity to share your lived experience, but also your expectations for the future and your views on how we can all work together to create inclusive general practice.

Watch out for more details on our social media channels next week.

To mark the 33rd anniversary of Black History Month, the College will also be celebrating the achievements and contributions that GPs from African and Caribbean descent make to general practice.

Throughout October we will be showing our commitment to supporting BAME members and promoting inclusion and diversity across general practice.

We have a long way to go but we all have a responsibility to create a fairer future.

Flu vaccines

I have written to Health and Social Care Secretary for England Matt Hancock for assurance on flu vaccine supplies after hearing of shortages as a result of extra cohorts being added late to the programme due to COVID and what looks like a higher uptake of the vaccine in the at-risk groups.

We’ve heard anecdotally that some practices are having to wait for over a month for replenished supplies. This is obviously deeply concerning, especially when we plan so meticulously for the flu season every year.

We want the maximum number of people possible to be vaccinated and we know that many practices are already running evening and weekend flu clinics, whilst adhering to social distancing measures. Many practices are also collaborating with neighbouring practices delivering flu vaccines in non-typical settings such as large community centres, 'drive through' clinics, or car parks.

These practices must be reassured that they will have sufficient flu stocks as we approach winter and that any distribution problems will be communicated to GPs as a matter of urgency.  I’ve been giving media interviews all week on flu vaccine supplies and prioritisation for at risk groups, including Radio 4 Today Programme this morning.

This is not about GPs 'rationing' supplies but about ensuring that our most vulnerable patients are given priority.

Our press statement has received coverage in over a 100 national and regional outlets including: BBC News, iNews, Daily Mail, Daily Mirror, Daily Express, The Daily Telegraph, The Evening Standard, The Times and ITV.

Health and Social Care Committee

Earlier this summer I gave oral evidence to the Health and Social Care Committee inquiry into workforce resilience and burnout in the NHS. The Committee has now published their full report 'Delivering core NHS and care services during the pandemic and beyond' and I am quoted talking about the shift to remote consultations, reinforcing our message that general practice was open for business during the pandemic.

COVID resources and research

The College will be working with the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) to develop a rapid guideline on the longer term impact on patients of COVID-19. It will ensure that people requiring on-going support and treatment because of symptoms relating to 'long COVID' are identified quickly and are supported by the NHS.

It will be published by NHS England and Improvement and we anticipate it will be out before the end of the year. This is excellent news and I am very grateful to Gail Allsopp, the College’s Clinical Lead for Clinical Policy, for all her work in getting us to this stage.

We have also have launched some useful 'top tips' on COVID and children.

The importance of primary care research in the fight against COVID cannot be underestimated and this was the subject of our latest #RCGPTogetherLIVE.

Hosted by College Vice Chair for External Affairs, Gary Howsam, speakers included Phil Evans from the NIHR on when the vaccine might be ready and Chris Butler from the PRINCIPLE trial spoke about lessons learned from the H1N1 virus. Polly Duncan, Chair of the Primary Care Academic Collaborative, explained how trainees could get involved in research and Simon de Lusignan, director of the RCGP/Oxford Research and Surveillance Centre (RSC), reminded us all that 'coding is caring'. Joint Honorary Secretary, Victoria Tzortziou Brown, gave us her perspective on health inequalities through a research lens. You can catch up on the session now.

The PRINCIPLE trial marked its 1000th recruit this week and is the biggest acute care community COVID trial in the world. The work going on at the RSC is phenomenal and we owe Simon de Lusignan, Richard Hobbs, Nick Thomas and the entire team huge thanks for what they are achieving.

Regional launches of the Personalised Care Institute

Last month the College hosted the national launch of the Personalised Care Institute - a virtual organisation promoting evidence-based, personalised care training to all health and care professionals. Throughout October we will be hosting regional launch events in The Midlands, South East, North East and Yorkshire, London, North West, South West and East England. Find out more.

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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