We should endeavour to listen to the lived experiences of our colleagues which have helped to remove the cloak of invisibility that has shrouded so many for years

21 May 2021

As we approach the anniversary of the death of George Floyd, our nation's conscience is reawakened in dealing with our own challenges around structural racism. There has been a reignition of much needed local and national debate, reflection, and action on racism in the United Kingdom. Deaths of Black men in police custody are not a rare event here and Mr Floyd's death, an event that unfolded at an intersection in Minneapolis, witnessed through the lens of a world in lockdown, was a catalyst for the Black Lives Matter movement. The harrowing images of Mr Floyd's death brought racism into sharp focus... again.

So where do we go from here? The COVID-19 pandemic, which needed all of society to work together for the benefit of all, continues to expose deep seated injustices and inequalities in society that pre-existed the pandemic. As GPs we are all too familiar with difficult conversations with our patients. If we truly want to address the racism that exists for our colleagues and patients, we need to normalise previously difficult conversations with each other and deal with the uncertainty that change brings. Silence is not an option, as Lee Lawrence, author of The Louder I Sing states: "can we look in the mirror and live with the consequences of doing nothing?" However, there are many of our affected (and unaffected) colleagues who still choose to remain silent.

In his Mackenzie Lecture to the College, Professor Donald Crombie placed emphasis on our College motto, Cum Scientia Caritas, translated as Science with Compassion. He defined compassion as "feeling with another human being". As allies and upstanders we should endeavour to listen to the lived experiences of our colleagues which have helped to remove the cloak of invisibility that has shrouded so many for years. Moving beyond the science, and data, can we extend this "feeling" for others beyond the confines of our consulting rooms to foster more inclusion and representation from the 35% of our membership who identify as Black, Asian or Ethnically diverse?

This is the right time for action, our collective "kairos" where courage is needed to strive for a root and branch change to systems. The ask is simple, although I acknowledge the action less so: that is the need for us to work together in breaking down the barriers that maintain inequalities and indifference to racism. It takes resilience to weather this storm, harder still amidst the denials, challenges and even boos that we encounter daily. But whether it is on a football pitch, in a board room or GP surgery, we must stay bold and courageous, using our authentic voices to ensure we pass on the torches of change to our next generation. So, as I reflect on the words of the late Supreme Court Justice Ruth Bader Ginsburg, I ponder on this, when we consider racism in our organisations and society: "We ask no favours for our skin colour; all we ask of our brethren is that they take their knee off our necks".

Post written by

Dr Margaret Ipkoh

Margaret is the Faculty Chair for Humber and the Ridings. In August 2020 she was nationally elected to Council and stands for diversity and inclusion.

She is also an Associate Director of Primary Care for Hull and York Medical School and sits on their EDI board. She currently represents Primary Care on the North East and Yorkshire Regional People Board.

She has developed a keen interest in research delivery in Primary Care and is currently the research cluster lead for her practice Holderness Health, involved with facilitating several COVID-19 trials.

Twitter: @docmagsy

Latest updates from College Chair Martin Marshall

Equality, Diversity and Inclusion at the RCGP

I try to keep my weekly message short and sharp, but this week I wish to cover two big issues in detail.

The death of George Floyd a year ago this Tuesday and subsequent activism by Black Lives Matter brought into acute focus the failure to address systemic racism and focused the world’s attention on the specific needs of ethnic minorities. It made us all take a look at ourselves, our behaviours and our own conscious and unconscious bias. Microaggressions, however unintentional, are a form of racism, as is staying silent.

At the College, our Equality, Diversity and Inclusion (EDI) work was already underway, but last year's events were the catalyst to ramp up and accelerate this work by actively looking at our practises as an organisation and in general practice as a whole. It opened up the table for difficult conversations within RCGP and with some of our stakeholders, identifying the 'blockers' in place and starting to remove them.

College Council has always been a platform for intellectual and forthright debate, but I don’t think I have ever seen it more galvanised than during the last year for the discussions around two Motions related to race.

The first was brought by my own North East London Faculty and led to a College-wide statement of solidarity and support for all our members and patients from UK ethnic minority communities. 

We saw positive change when six women from UK ethnic minorities were elected to all vacant Council seats last August. Two of our new Council members, Sonali Kinra and Margaret Ikpoh, who writes today's Just Saying, brought and seconded a Motion to February Council this year, calling on the Care Quality Commission (CQC) to look at the impact of its work on ethnic minority GPs. You can read the full statement.

We will be holding a roundtable with the CQC’s Chief Inspector for Primary Care, Rosie Benneyworth, next week. Thank you to those members who answered our call for your lived experiences which will be used to inform the meeting.

The disproportionate impact of COVID-19 on ethnic minority health professionals and patients became very evident to the College very quickly, prompting a wave of new policy and media work throughout the year.

We called on Equalities Minister Kemi Badenoch for an update on the implementation of recommendations in the Fenton report and sought assurances for the safety of our colleagues.

We wrote to the Government asking for a rationale as to why patients from ethnic communities were not identified on the 'priority list' for COVID vaccination and highlighted low vaccine uptake, calling for a public awareness campaign after our own College analysis revealed that over 90% of people vaccinated had been white. We also questioned the findings of the Government’s Commission on Race and Ethnic Disparities report

Our aim is to improve the working lives of ethnic minority GPs from training onwards, and we are in the process of reviewing the training curriculum for any evidence of inadvertent discrimination, as well as reviewing policies for undergraduate and postgraduate placements. We are monitoring our new Recorded Consultation Assessment exam - established at speed last year to replace the Clinical Skills Assessment during the pandemic - for differential attainment. We will continue to work with Statutory Education Bodies in all four nations to challenge and support the need for better diversity and inclusion in all parts of undergraduate, postgraduate and specialty GP training and will be bringing in enhanced support for International Medical Graduates, based on their own lived experiences. 

It’s important that our CPD resources reflect evidence of the unique needs of ethnic minority communities in presentation, medication effectiveness, language, and health literacy. We have started reviewing our COVID-19 resources, looking specifically at the guidance on areas we know are clinically high risk for people who are from a UK ethnic minority. As we move out of the pandemic and CPD resources come up for review, we will ensure that race and ethnicity are part of this. For those who did not see our December issue of the BJGP Open, it is well worth a read.

We are also looking at improving our own College processes, and an EDI message is now part of every formal College agenda. We are also introducing EDI statements to ensure that each of our committees and boards begin with diversity and inclusion at the top of the agenda.

We have encouraged all our members to review and update their personal EDI data and now have race and ethnicity data for 84% of our membership. We have started collecting data on all protected characteristics and this will be made available online from the autumn. These metrics will allow for greater transparency and identify progress and impact on an annual basis.

Our Faculties are also proactively recognising and embracing diversity by actively encouraging more ethnic minority members to get involved. We are developing role description and will be working with local teams to recruiting Faculty EDI champions. If you are interesting in getting involved please get in touch. 

We are also asking all College committees, boards, and groups to actively look at their make-up and question whether they are reflective of their communities, and have commissioned a review of College Fellowship to improve representation.

This rundown is not exhaustive and a report on our latest EDI progress will be shared with RCGP Council in September. As usual, we will be making all the papers available in the members' section of the website.

None of this work is a 'quick fix'. Most are long-term initiatives and some could take several years before we see the full impact, but I hope it is a demonstration of our commitment to making a meaningful and tangible difference to current and future GPs.

I’ve served deprived multi-ethnic communities as a GP for over two decades but I’m still on a personal journey, learning more about equality, diversity and inclusion every day. I guess we all are, and certainly the College is.

We still have a huge amount to do, but thank you for your challenges over the past year and for your suggestions on how we can improve representation within your College and the working lives of our ethnic minority members.

Update on NHS England's letter

As GPs, we want to do what's best for our patients. We all want to get back to a more normal way of living and working, building on what we’ve learnt from the pandemic. But only once it is safe to do so. We are still in a pandemic, and we need to take a cautious approach to this, acting on data about vaccination rates and the B.1.617.2 variant.

The anger, upset and frustration I have seen this week from members following NHS England’s letter to the profession last Thursday evening has been the worst I’ve seen in recent memory. 

This is unsurprising, given that we’re 15 months into being at the forefront of tackling a pandemic, GPs and our staff are exhausted, we’re facing criticism in the media, and it’s not over yet. 

The tone of the letter, not recognising this and the intense pressure GPs are working under, was misjudged - and the timing, telling practices to make significant and, for some, impractical changes in just three days, was unacceptable.

Many of you thought that we, as a College, were not forthright enough in our criticism of the letter. I hope we expressed our views clearly in our updated statement.

We gave NHS England the opportunity to reflect on the concerns of the profession in its updated Standard Operating Procedure (SOP), which was published yesterday. Unfortunately, it didn’t address the issues of timing, safety and practicality we hoped it would. We were also concerned to see additional developments in the SOP which have not been discussed with ourselves or the BMA, including the suggestion that online consultation services should be available at all times and practices should consult their CCG before switching off services out of hours.

Our role as a College is to represent what we are hearing from our members and to work with the centre to find solutions to this crisis. Actions like the NHSE letter makes the latter difficult, but on behalf of you all we will continue to make your case to policy makers and politicians and we are working day and night to do so.

Queen's Speech

Earlier this week MPs debated the health aspects of the Queen’s Speech, which sets out the legislative priorities of the Government. As a College, we briefed MPs about the workload and workforce crisis facing general practice ahead of the debate. 

We emphasised that current workforce targets are not being met and the Government must urgently invest in the expansion of the GP workforce. You can see a summary of our briefing on Twitter.

We will continue to hold the Secretary of State for Health and Social Care to account for the targets set out in the Conservative Party manifesto, where they pledged to increase the number of GPs by 6,000 by 2024. Just 414 full-time equivalent GPs have entered the profession since the pledge was made.

Early Career Research Award winner

The RCGP Scientific Foundation Board (SFB) and the Society for Academic Primary Care (SAPC) are pleased to announce the winners of the 2021 Awards for Outstanding Early Career Researchers: Dr Samuel Seidu (Academic GP) and Dr Shoba Dawson (Primary Care Scientist).

The awards are judged by a panel of primary care academics working with the RCGP and SAPC. It recognises the contribution of early career researchers to advancing primary care theory and practice.

Find out more about Dr Seidu and Dr Dawson by reading their interviews in this Clinical News article.

Find out about other College and NIHR awards.

World Family Doctors Day

Wednesday was World Family Doctors Day. This is a day of celebration of the fantastic work GPs and family doctors do across the world every year - but during a pandemic, it seems particularly apt.

Through your membership of the College, you are also a member of WONCA, the World Organisation of Family Doctors.

They have just launched their call for applications for the 2021 WONCA Foundation Award, which aims at furthering WONCA's mission of "fostering and maintaining high standards of care in general practice/family medicine" by enabling physicians to travel to appropriate countries to instruct in general practice/family medicine, and physicians from developing countries to spend time in areas where they may develop specials skills and knowledge in general practice/family medicine.

Find out more (110 KB PDF).

Post COVID-19 syndrome - where are we now?

Join us for this free webinar on 8 June on development in understanding and managing the long-term effects of COVID-19. We will be joined by the Office of National Statistics, who will share new figures from June 2021 on those who are affected by the ongoing symptoms of COVID-19. There will be an opportunity to ask questions and hear about the launch of new RCGP resources to help you learn more and keep up to date with the evidence as it changes. You can register now.

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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