What should general practice stop doing?

25 February 2022

What should general practice stop doing? That’s the question that’s increasingly being asked by clinicians struggling to do the undoable, and by others whose job it is to make our job doable.

There’s no shortage of suggestions: fitness for work or firearm certificates; prescribing; unnecessary bureaucracy; health promotion programmes; vaccinations; urgent care; out-of-hours care; caring for people with complex long-term conditions; children; older people. The list goes on.

The fundamental question for me is whether we want a contract that draws tight boundaries around what we do, passing everything else over to other primary care providers, or whether we want a permissive contract that ensures whatever we do is properly resourced.

I’m a generalist, not a partialist or a fragmentist. I don’t believe that what I do is a series of disconnected transactions which can be picked off and moved elsewhere at whim. I want to work as part of a multi-disciplinary team, focusing on where I as a highly trained GP add value, but I want our whole team to provide an integrated comprehensive service for our community.

At this time of crisis, I fully understand why GPs might feel they have to hand over responsibility for some certification and prescribing. I could even be persuaded that evidence-based health promotion activities are better delivered on high streets and in gyms or libraries rather than in general practice. But any suggestion that we should give up our commitment to whole-person comprehensive care feels like a pathway to oblivion. 


Latest updates from your College

Situation in Ukraine

We’re all still coming to terms with the news that Russia has invaded Ukraine. Even though there has been speculation about this for some time, it has still come as a shock. As ever, in conflict situations, there will be bloodshed, hurt and casualties, and brave medics will be there, putting themselves in danger, tending to the sick and the injured. We stand in solidarity with them, as well as with our members and staff who have family and friends in both countries. If you want to help you can do so by donating via the Red Cross.

Council offers insight, expertise and lively discussion

Last Friday our governing Council – your elected representatives - met for a fantastic discussion on a number of timely and comprehensive papers that will shape the policy direction of the College. It made for insightful and rich debate, with Council members representing your interests by bringing their extensive frontline experience to the discussions.

Topics on the agenda included an update on our work on invigorating relationship-based care; a paper initiated by RCGPNI Chair Laurence Dorman on the importance of having a common language around remote consultations, and steps that can be taken to improve College member retention. Council also addressed the ongoing issue of Covid-19 focussing on what we’ve learned from the pandemic, notably from the perspective of health inequalities.

Thank you to all who took part – you can get a sense of the discussion by searching #RCGPCouncil on Twitter, and all members can access Council papers on the member section of the website.

National and Council Elections

If you’re interested in becoming involved with Council, we’re seeking nominations from College members to join UK Council as a Nationally Elected Member. There are six positions available. This is an ideal opportunity for GPs who want to directly influence what the College does to get involved.

We are also seeking nominations from Council members to succeed me when I come to the end of my three-year term as Chair of Council, and Gary Howsam, who will come to the end of his term as Vice Chair for External Affairs, in November.

Online nominations may be made between 21 February and 22 April via the dedicated nominations microsite. Please visit the microsite to read further information about the positions. Ballots will take place this Summer and the successful candidates will begin their terms of office in November 2022.

Applied Knowledge Test bookings

The booking window for the next Applied Knowledge Test opens next week and we wish to alert trainees to a change in our processes so that we can manage your queries most effectively.

All trainees should have received a message from Chief Examiner Rich Withnall earlier today. From Wednesday 2 March to Friday 4 March, trainees with any queries about their AKT booking are advised to contact the Exams team by email at exams@rcgp.org.uk, with a brief description of their query, including a phone number and GMC number.

During this time, telephone callers to the Exams Team will receive an automated message and we will be unable to respond to phone calls while we prioritise emails. We’ll also be unable to respond to individual queries on social media.

We appreciate that this is a very stressful time for trainees and this way, we can assess the nature of the query and ensure that trainees get the solution they need as quickly as possible. It also means that trainees are not spending valuable time trying to get through on busy phone lines.

A wide range of FAQs are available on our website (PDF file, 392 KB). You may also wish to look at our bookings page.

Future of Covid vaccine programme

As of yesterday, legal Covid restrictions in England were lifted. Whilst many will take this to mean the pandemic is over, on the frontline we know it isn’t, and what is yet to come is unknown – and I know many practices will continue to maintain infection control measures, in the best interests of protecting their staff and patients.

We also heard that the Government has accepted the recommendation of the JCVI to implement a further booster campaign for over-75s and extremely clinically vulnerable people in the Spring. As the National Audit Office report said this week – see below - the success of the Covid vaccination programme has in large part been down to GPs and our teams, but with so many other pressures on us, it would be unrealistic for general practice to lead all booster programmes moving forward. You will have received a letter from NHS England earlier this week outlining that PCN vaccination sites are not expected to play a leading role in the forthcoming booster programme, but they may be called on to get involved where appropriate and where they have capacity.

Extension on tele-medical abortion care

The College joined the Royal College of Obstetricians and Gynaecologists, Faculty for Sexual and Reproductive Health and others in writing to the Prime Minister this week to put pressure on the government to enable tele-medical abortion care to be offered as a permanent option for women seeking these services.

The government has since announced a six-month extension to the policy, which was introduced in March 2020, when the former Secretary of State for Health and Social Care gave permission for the first medication in an Early Medical Abortion (mifepristone) to be taken at home to ensure women were able to continue to access abortion care throughout the pandemic.

Telemedicine has created a more equitable service which has enabled thousands of women to access the care they need more quickly, and just as safely, while also being a more efficient use of NHS resources. Whilst the six-month extension is positive, the College will continue to support the calls of leading healthcare organisations including the Academy of Medical Royal Colleges to ensure that women are offered choice about their healthcare that is in line with best clinical practice, and for telemedical abortion care to be offered indefinitely.

Allyship and anti-racism eLearning

In support of the College’s commitment to equality, diversity and inclusion, we are launching a new, free eLearning course on allyship and anti-racism. This action-oriented module focuses on allyship and bystander intervention in racism and racial discrimination. It aims to help you:

  • understand how language can perpetuate exclusion
  • recognise microaggressions
  • reflect on the lived experiences of people experiencing racism
  • use strategies and phrases to safely support colleagues and patients
  • create an inclusive environment in your practice.

Learn more about the course.

RCGP in the media

GP teams have been rightly praised for their role in the Covid-19 vaccine rollout. Our Vice Chair Gary Howsam commented on a job well done that GPs can be proud of, as reported by the BBC.

Our comments on the findings of new BJGP research into breast cancer appeared in the Mail.

RCGP also mounted a strong defence of GPs as new appointment data was released. We pointed out that GPs are delivering more consultations overall than the same month pre-pandemic, as reported in The Telegraph.

The College also commented in The Telegraph on the detectability of Covid-19 without testing.

MyRCGP App

We've just updated the MyRCGP app for RCGP members. Keep up to date with the latest College news, plus manage your account, access podcasts, screencasts and toolkits, find the latest courses and events - in one location. Download the app.

Message from the UK Health Security Agency

We’ve been asked by the UKHSA to share the following on an outbreak of extensively drug resistant (XDR) Shigella sonnei that has been detected in the UK.

62 cases of XDR S. sonnei have been detected in the UK since 4 September 2021. The outbreak is predominantly driven by sexual transmission in gay, bisexual, and other men who have sex with men (MSM). Cases in this outbreak have been detected in locations throughout the UK.

The outbreak strain of S. sonnei is resistant to all first line agents used for treatment for prolonged symptoms or severe Shigellosis. GPs (or Emergency Care physicians) play a key role in early detection of infection as cases may not recognise sexual transmission as a cause of their gastroenteritis and may present to primary care instead of sexual health clinics.

It is advised that a sexual history is taken in male cases presenting with acute gastroenteritis and a stool specimen for microbiological culture and antibiotic sensitivity is taken as soon as possible in MSM. Confirmed cases should be discussed with the microbiologist if treatment is indicated.


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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