Tinkering and political posturing isn’t enough

22 October 2021

I gain solace in history. General practice is in crisis, but this isn’t the first time that our speciality has struggled and the care that we are able to offer to our patients has suffered.

Two major crises stand out. The first, which came to a head in the early 1960s, resulted in large numbers of GPs emigrating to work in Canada, New Zealand and Australia. The all-too-slow response from government was the 1966 GP Charter, a massive investment in teams and premises which boosted general practice for over two decades. The second crisis in the 1990s led, also too slowly, to the 2004 contract, less well received by some than the 1966 charter but still a very significant investment which expanded the multi-disciplinary team and systematised care for long term conditions.

And now general practice is in crisis again, to an extent which only a response from government of the scale and ambition that we saw in 1966 and 2004 will rectify. Last week’s ‘rescue package’ from NHS England and the Department of Health and Social Care in England lacked substance (I’m trying to master the understatement). It failed to address the fundamental problem that demand outstrips supply, it promised funding for locums which don’t exist, and it restated familiar bureaucracy-busting initiatives which for years have proved difficult to implement. And to add insult to injury, it attached strings which demanded yet more work from staff stretched beyond their limits. The irony of it all.

Tinkering and political posturing isn’t enough; nothing short of a substantive new initiative to rescue general practice will do.

Latest updates from your College

Annual Conference and GP 'rescue package'

Further to the above, the Secretary of State for England’s announcement dominated the start of our Annual Conference in Liverpool.

As we have said numerous times over the past week, £250k for general practice is a significant sum of money, but it’s the tip of the iceberg when it needs to be shared across over 7,000 GP practices in England. While this was billed as ‘new’ money, it’s only a little bit more in real terms than we would normally receive to get us through the winter and the way in which it will be allocated means that some of those practices most in need of support will be unable to get it.

The focus on GP access, and not workload and workforce, fuels the rhetoric that GPs are ‘refusing’ to see patients face to face which, as well as being inaccurate and unfair, undermines the relationship we have with our patients.

Added to this, the plans to increase more scrutiny and arbitrary services to rate the performance of GP practices will further demoralise our profession when we’re already on our knees and could lead to more hardworking doctors leaving before their time.

We need long-term, realistic, and tangible solutions to solve the crisis in general practice. What we got was a headline-grabbing, populist, short-term sticking plaster. I hope we have made our feelings very clear to Mr Javid and we will continue to fight for the rescue package that general practice really needs.

Notwithstanding the anti-climax of the announcement, the overall atmosphere in Liverpool was extremely uplifting and re-energising, not least because we were able to meet up with our peers and friends after such a long and exhausting time.

Annual Conference is always a College highlight, but this year’s event was even more special as it was touch and go whether an in-person event would happen due to the ongoing Covid situation. As it turned out, we attracted over 1000 delegates to the venue and over 350 people have accessed our sessions virtually. You can still see them here.

Despite the added pressures we have experienced as a result of the pandemic and the disgraceful recent criticism of GPs by certain sections of the media and some politicians, there was a real sense of optimism, energy, community and confidence. Culminating with the Inspire Awards on Friday evening, the Conference was a celebration of all that is good about general practice - and there’s a lot!

The Conference programme was packed with plenaries, CPD, policy sessions and networking events. I was delighted to have the opportunity to finally give my first in-person keynote address to members, after nearly two years as your Chair.

I also had the privilege of hosting ‘An audience with’ the Chief Medical Officer for England Chris Whitty, who received a standing ovation for his work during the pandemic. He is a very humble man and his praise for GPs and their contribution to the Covid effort was exactly what we needed to hear.

Other stand-out moments were Devi Sridhar, Chair in Global Public Health at the University of Edinburgh with her unique take on the pandemic, Michael Kidd, GP and Principal Medical Advisor to the Australian Government, who gave a thought-provoking John Hunt Lecture, and our own President Amanda Howe, who gave us some rousing words about self-belief and never doubting our value as GPs, whatever life throws at us.

Thanks to all of you who took part, in person or virtually. Thanks also to the College organising team and staff, led by Vice Chair for Professional Development Michael Mulholland, who unwittingly found himself in the media spotlight with his wry explanation for why the Secretary of State was unable to attend in person!

New Vice Chair and Honorary Secretary

With all the hustle and bustle of the Conference last week, some really important College news was almost overlooked.

Huge congratulations to Dr Margaret Ikpoh, who has been elected as our next Vice Chair for Professional Development, and to Dr Michael Mulholland who has been elected as our next Honorary Secretary, to lead on the development of College governance and all College consultations.

Margaret will be succeeding Michael, who has held the Vice Chair role for the last three years, and Michael will be succeeding Dr Jonathan Leach and Dr Victoria Tzortziou Brown who will be stepping down following their four-year term as joint Honorary Secretaries at the AGM in November.

Margaret, who is currently Chair of the Humber and Ridings Faculty and Associate Director of Primary Care Education at Hull York Medical School, beat off stiff competition from Dr Susi Caesar and Victoria and Dr Sonali Kinra who stood as a joint candidates.

Both roles are hugely important for the College, and I have great confidence that Margaret and Michael will be excellent. I thank Jonathan, Victoria and Michael for their amazing service. I’d also like to thank Susi, Victoria and Sonali for standing.

Both elections were conducted independently by Civica Election Services.

GP attack

I was appalled to hear about another abusive incident at a GP practice this week, this time in Watford. I’ve reached out to the practice to offer whatever support we can as a College, and my thoughts are with the GPs and staff at the surgery. It must have been a terrifying experience for those involved.

In no circumstances is it acceptable for GPs or our teams to be faced with abusive behaviour when we’re simply trying to do our jobs, looking after patients in incredibly challenging circumstances. In fact, it was the one thing in the Government’s announcement last week that held merit: there must be a zero-tolerance policy towards abuse of health and care staff, both in general practice and across the health service.

Tensions are running high at the moment. The debate around access to face-to-face services has become too polarised, and it is wearing away at the precious relationships we have with our patients. They are frustrated, and we are frustrated, but we must work together. GPs and our teams and our patients are on the same side - and we cannot afford to be turned against one another.

Mandatory vaccination

We've submitted our response to the Department of Health and Social Care's consultation on making vaccination a condition of deployment in the health and wider social care sector.

In our response, we have made clear that we strongly urge all health and care professionals to be vaccinated, unless there is a medical reason why they shouldn’t - and that the vast majority of healthcare professionals have been.

However, we don’t agree that vaccination should be mandatory as informed and educated choice about health interventions would be more beneficial long-term than enforcement, which risks leading to resentment and mistrust. We have also highlighted the potential workforce implications at a time when we need as many people as possible working in general practice and across the health and care sectors delivering essential patient care and services.

GP Frontline

I'm delighted to be able to let you know that our member magazine GP Frontline is back after a hiatus due to the pandemic.

It’s full of interesting articles about general practice, but the stand-out for me is our Big Interview with CMO for England, Prof Chris Whitty, who took some time out of his very busy schedule to speak to GP Frontline. It’s a genuine ‘exclusive’ as he hasn’t been giving media interviews, but he wanted to tell GPs just how appreciative he is of the work you and your teams have done during the pandemic - and his respect for our profession shines through.

We also address the terrible criticism general practice has been facing recently - and the work we’re doing to advocate on behalf of the profession amidst our current workforce crisis, depicted on this edition’s front cover.

Other articles include an introduction to incoming RCGP Wales Chair Rowena Christmas and current RCGP Scotland Chairs David Shackles and Chris Williams, and a look back at the life and work of Octavia Wilberforce to coincide with our ‘Women at the heart of general practice’ online exhibition. As part of our GP Lives series, there are profiles of a GP who has worked in Nepal for the last 30 years, a family physician who is also a social media star in the US, and a GP who worked in an East London health collective in the 1980s.

The College has also launched a new online member forum for members to easily find and connect with each other. This pilot focuses on conversations around equality, diversity and inclusion in general practice, health technology and a special area for all First5s. RCGP members can log in with their membership email address and password. Several College officers are using the forum daily including President Amanda Howe.

Join the conversation on forum.

Clinical Hot Topics - issues facing ethnic minority patients

The College is hosting two free online conferences covering a variety of clinical issues affecting ethnic minority patients in the UK.

The design and delivery of this conference is a collaborative effort of the RCGP Faculties of England, Northern Ireland, Scotland and Wales.

The first covers topics including the history of medicine, dermatology, haematology and rheumatology, obesity specifically related to cultural nutrition and mental health. There will also be a panel discussion on lifestyle medicine. You can register now.

The second covers topics including consultations and ethnic diversity, infectious disease and travel health, occupational medicine, lifestyle medicine and men's health. There will be panel discussions on end-of-life care and women's health. You can register now.

International mentorship

The RCGP is advertising for eight academic mentors to work with each of the eight faculty members of the Department of Family Medicine of CMC Vellore. The aim is to assist in transforming healthcare in India by building leaders and trainers in Family Medicine throughout the country and influencing the training and practice of Family Medicine. This will be a remote mentorship programme lasting two years and would include occasional virtual workshops run by mentors. You can view the advert for these posts on our website. Deadline is 29 October.

Any applications should be submitted to International’s mailbox.

CMC Vellore is a leading community-run medical school, hospital and research institute. The College is affiliated with the Tamil Nadu Medical University and RCGP has been working with CMC Vellore since 2017.

The COVID-19 pandemic has made it abundantly clear the importance of Family Medicine at the core of Universal Health Coverage. If this mentoring scheme with CMC Vellore proves to be positive, the possibility of expanding it will be considered. There is also enormous COVID damage across South Asia including Pakistan, Sri Lanka, West Bengal and Bangladesh. It may also be useful that if we get more volunteers than needed, we could explore how we could help these countries with something similar.

MyRCGP access

From 17:00 on Friday 29 to the end of Sunday 31 October we’re carrying out an upgrade to our database. This means that throughout the weekend you’ll be unable to access your MyRCGP account including member portal, member area and event bookings.

We’re sorry for any inconvenience - we’ll be back up and running as usual from Monday 1 November.

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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