The expert medical generalist is a remarkably effective and cost-effective clinician

24 July 2020

Should general practice be a doctor-heavy medical specialty?

This might sound like a stupid question when there clearly aren’t enough GPs to go around, and it might appear insulting to the growing number of allied health professionals joining the primary care team.

And this growing workforce - pharmacists, nurses, physician associates, physiotherapists, mental health practitioners, health coaches and link workers/social prescribers - are worth their weight in gold.

Effective multidisciplinary teams are providing a wider range of services, specialist skills and are freeing up doctors to do what they do best in ways that Dr Finlay could only dream about.

But the nagging question remains, is the expanding primary care team a strategic choice or a pragmatic response to poor medical workforce planning?

I’m guessing that 30 years ago 90 percent of appointments in general practice were provided by doctors. Now, according to NHS Digital data, it’s closer to 50 percent. Is this a trend which should continue?

Research evidence shows that the expert medical generalist is a remarkably effective and cost-effective clinician.

In the longer term is there a case for general practice remaining a doctor-heavy specialty? 

COVID-19 update from your College

Vaccination expansion and College guidance

We’ve heard today that the flu vaccination programme will be expanded to include people aged 50-64 and children in Year 11 at school, as well as all those thought to be extremely clinically vulnerable to COVID-19 and people living in their households.

This is a sensible move ahead of what will likely be a busy winter, particularly with the ongoing threat of a second wave of COVID. The more people who protect themselves from influenza, the better.

However, we do need to be sure that we have enough vaccines for the millions more people who will be eligible - and GPs need more details about the practicalities of how this expanded flu vaccination campaign will work.

I made these concerns clear in our response, which appeared on the front page of The Times and across BBC bulletins.

I was also interviewed for Good Morning Britain and BBC News Channel, and Vice Chair for Professional Development Michael Mullholland spoke to Sky News and LBC on the issue.

Mass vaccination programmes are always a challenge, and one GPs and our teams prepare for meticulously every year - but it will be particularly challenging this year with COVID.

Practices will need to ensure measures are in place to keep staff and patients safe and help reduce spread of the virus. As such the College has developed guidance for delivering mass vaccination programmes (601 KB PDF) while COVID remains a threat.

The guidance outlines challenges posed by COVID, approaches to delivering large-scale vaccination programmes in this context and addresses practical considerations, such as social distancing in GP surgeries and vaccine equipment layouts.

Thank you to joint Hon Sec Jonathan Leach, Simon Stockley and Kate King for leading this work, and everyone else involved.

Tier 2 visa breakthrough

We heard some good news this week for final year GP trainees from overseas who are due to achieve CCT.

Several of you have been in touch with the College to let us know about the difficulties you’re having securing a Tier 2 visa - therefore affecting your ability to stay in the UK and working in the NHS - when your training comes to an end this summer.

This issue is that recruitment uncertainties associated with COVID have led to delays in trainees being able to secure the appropriate employment necessary to apply for the Tier 2 visa before their current visas, sponsored by Health Education England or equivalent bodies in the devolved nations, expire.

However, we expect the delays in recruitment to be temporary, and we’re going to need every GP possible as we move into the next stage of the pandemic and the focus shifts from secondary care to the community.

It makes absolutely no sense for these trainees, who have been on the frontline during the pandemic and want to continue delivering NHS patient care, to face deportation because of what amounts to bad timing.

It’s something we’ve been raising with HEE, National Education Scotland and Health Education and Improvement Wales, as well as pushing for this to be sorted with the Home Office.

We heard on Tuesday that Home Office Ministers have agreed with representations from the College, HEE, and HEIW to grant a three-month extension.

This will allow newly qualified GPs from overseas to secure employment and get the necessary documentation to stay in the country.

We continue to work with NES and the Scottish Government to seek a resolution for Scottish trainees - and it hasn’t been flagged to us as an issue in NI, but if you are in NI and find yourself in this predicament, do let us know.

MRCGP update

The first sitting of the College’s new exam, the Recorded Consultation Assessment (RCA), saw 1117 trainees submitting 14,521 video consultations.

It’s encouraging that based on this first diet, the results are on a par with those of the Clinical Skills Assessment during 2018-19. Trainees are already submitting consultations for the next exam diet, which will be marked in August.

Getting the RCA from concept to completion in such a short space of time, and in incredibly difficult circumstances, has been a remarkable achievement.

Our Applied Knowledge Test has also been able to start again, with an initially limited capacity, and 221 candidates sat the exam last week. The next exam will be in August with capacity for up to 1500 trainees.

This vital work means that GP trainees are achieving CCT and entering the workforce, where they’re desperately needed. In fact, the College’s GP Specialist Application team has made more than 1200 recommendations for CCT since the beginning of June, and another 500 applications are expected in the next few days.

Congratulations to everyone completing their training this summer, as well as our trainers, educators and examiners for all your support in getting them there.

Congratulations to Clinical Adviser of the Year winners!

The RCGP Clinical Advisers Network provides an opportunity for GPs to use their knowledge and experience to influence the development of clinical policy guidelines and quality standards.

Over the past few years, 96% of the clinical policy consultations in which the network has been involved have resulted in direct and important change to UK national policy and guidance, in the best interests of general practice and our patients.

The RCGP Clinical Advisers of the Year awards recognise the most impactful and insightful contributions made to this clinical policy programme by established clinical advisers and by those clinical advisors who are within their first year of joining the programme.

This year we are pleased to announce Dr Marian Davis as the winner of the RCGP Clinical Adviser of the Year 2020 award and Dr Sam Finnikin as the winner of the RCGP New Clinical Adviser of the Year 2020.

Congratulations to you both on this excellent achievement and thank you for your significant contributions to the network.

The RCGP Clinical Advisers Network is open to all practising GPs across the UK. Visit the website for more information on how you can join the network.

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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