Time for a conversation on GP contracts?

22 April 2022

I’m going to do something dangerous this week and talk about GP contracts. And before anyone gets bothered, I do understand the time-honoured distinction between the College, with our focus on the quality of patient care and standards, and our friends in the General Practitioners Committee of the BMA, with their focus on professional terms and conditions. I really do.

It’s not the mechanics of the GP contract that concern me, it’s the purpose. An insightful commentator once described a professional contract not as a description of what needs to be done, but as a starting point for a conversation.

So what kind of conversation do we want to have about the job of a GP? I want to talk about the many different ways in which we contribute to addressing the needs of our patients and to improving the health of the communities we serve. We provide direct clinical care of course, that’s our raison d’etre. But just as essential to our patients’ health and care we also carry out administrative tasks to support and maintain the standards of that care, we lead and manage our teams, we spend time redesigning and improving what we do, we teach and supervise, support and undertake research, contribute to NHS planning and wider professional activities.

Most hospital consultants have a contract that reflects the importance of all of these professional activities to patient care and, as much as is possible, allocates protected time to them. GPs don’t. The provision of clinical care – the most important, rewarding and demanding of professional activities – occupies the vast majority of most GPs’ time. Other activities are squeezed in, or funded through separate contracts.

I’m not asking for a consultant contract but I am asking for a contract which values what GPs do. Time for a conversation?

Latest updates from your College

Email your MP to back the workforce amendment

Next Monday is likely to be the final time that MPs will vote on amendments to the Health and Care Bill before it becomes legislation in England. This is your last chance to join 2,000 other GPs in backing the RCGP campaign to ask the Government to put together a proper workforce plan for the NHS. We have made it easy for you to email your MP to ask them to change the law to require that the Secretary of State publishes a detailed NHS workforce plan.

Sadly, the amendment was rejected twice by MPs so far, but the good news is that members of the House of Lords have insisted they think again. You have one last chance to remind your MP why it is so important to back the campaign, and I urge you to get involved now.

Infection control: remain cautious

Official guidance from the UKHSA on infection and prevention control in healthcare settings is changing as we continue to slowly move out of the Covid-19 pandemic. In general practice settings, this includes the relaxing of social distancing measures in waiting areas.

We accept that this change has to happen at some time, but Covid rates are still high and there is still need for caution. NHS England have been clear that patients and staff should continue to practise good hand and respiratory hygiene including use of face masks.

Infection prevention and control measures were not new in the pandemic. Practices have always adopted proportionate IPC measures to keep patients and staff safe. We are confident you will continue to do so.

RCGP position on inclisiran

The RCGP, alongside the BMA, have continued our discussions with NHSE and the Accelerated Access Collaborative around the newly recommended drug for the treatment of high cholesterol, inclisiran, amid concerns about its roll out directly through primary care. Unfortunately, our concerns have not been acted on and therefore our cautious position on use of the drug, as described in previous blogs, remains unchanged. We would therefore encourage practices to continue to treat patients with high cholesterol following standard lipid guidelines, focussing on all available options starting with lifestyle changes and statins, escalating patients to high intensity statins and ezetimibe where appropriate and if considering injectable therapies consider all options, being aware that if you initiate inclisiran in primary care, as the decision maker, you take full responsibility for the prescribing.

Since inclisiran is a black triangle drug, if you do decide to prescribe it before the long-term outcome and safety data is published, please ensure you:

  • Undertake shared decision making with your patients, ensuring a full and detailed informed consent is taken, documenting the lack of long-term evidence and unknown long term safety profile of this new and novel medication
  • Encourage your patients to report all side effects to you, however minor, ensuring you fill in a MHRA yellow card when they are reported to you
  • Report any potential drug interactions or concerns of your own at the earliest opportunity

This approach will enable any as yet unknown issues to be identified early and help inform how the medication can be used in the future, alongside the trial data that are expected to publish in 2026. The full statement for members explaining some of our key concerns can be found here.

Important guidance on sodium valproate

You may have seen an investigation in the Sunday Times that found some pregnant women were being prescribed sodium valproate in packets without warnings in or on them. You can read the College’s response here.

Please be aware of the cross-college guidance on the use of sodium valproate, which aims to help prescribers navigate some of the more challenging prescribing decisions they may have to make in this area.

Sodium valproate should not be prescribed to women of child-bearing age unless they are on a pregnancy prevention plan, or there are exceptional circumstances. Whilst most prescriptions for sodium valproate will likely be made in secondary care, some will be made in general practice.

Wonca conference: bursaries for Ukrainian doctors.

I would like to express our gratitude to the Eric Gambrill Foundation who are providing bursaries for two Ukrainian doctors to attend the WONCA Europe 2022 Conference, in June. This is an important show of solidarity for colleagues there. The Foundation is named after a former President of RCGP and is run by his family through the RCGP's international department.

The family are also supporting the participation of doctors from Africa and South Asia, as well as providing grants for several RCGP doctors to take part in a workshop in the autumn on mentoring, along with our partner Christian Medical College Vellore in India. Thank you members of the Gambrill family.

RCGP in the media

It has been a good week for getting our key concerns into the national media agenda. I had an opinion piece published in the New Statesman, highlighting the Government’s failure to deliver on its 2019 manifesto pledge of an additional 6,000 GPs by 2024.

This comes off the back of my article published in the Daily Express  in response to the GP work-life survey published by the University of Manchester last week.

It was also great to see Vice Chair for Professional Development Margaret Ikpoh interviewed in The Sun about NHS screening programmes, explaining when and why patients should attend when invited. A great engagement opportunity. Margaret has started writing a regular column for Pulse and you can read the first one here.

I was also quoted in The Guardian about a Sunday Times investigation into sodium valproate (see above) being taken by pregnant women. The full College response is here.

PTSD in the police: how primary care can help

Tuesday 3 May Online via Zoom 19:00-20:30

There are currently approximately 260,000 police personnel in the UK and many more who have worked for the police. They may have health needs due to their police roles, not least trauma-related mental ill health. This webinar will cover key messages addressing the roles, challenges, and associated health issues within modern policing and how GP can approach such needs.

One Day Essentials | Ear, Nose and Throat

Thursday 23 June Online via Zoom 09:00-17:30

This conference has been specifically devised with the busy GP in mind. We aim to address the most common and essential learning needs that primary care practitioners have. The topics are handpicked to cover the core and important areas where knowledge of the subject is vital. We aim to fill the day with key points that you can directly translate into your daily practice.

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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