What are the responsibilities of a civilised society?

25 September 2020

Years ago I was working in California where I met a woman who had diabetes and a gangrenous foot. She was told that she needed a forefoot amputation but she didn’t have health insurance and could only afford to have two toes amputated.

The wound didn’t heal and after months of distress she ended up with a below knee amputation. I was horrified and returned home even more passionate about the NHS.

Recently I heard about a patient who has lived in this country for 30 years with chronic renal failure and who had been on thrice weekly dialysis. Then the hospital discovered that he was an immigrant and ineligible for free NHS care.

He couldn’t afford to pay and he was told that his GP would monitor his renal function and re-refer for dialysis when his potassium was raised. The GP tried to intervene but to no avail. The patient feels rotten and attends his local emergency department frequently.

What are the responsibilities of a civilised society? And what role should we as doctors play in advocating and caring for those with greatest need, particularly at a time when the COVID crisis has shone a light on health inequalities?

I’m proud of the work that GPs do in supporting and advocating for those with greatest need and I’m delighted that last week our College Council was so enthusiastic about a paper on health inequalities prepared by Carey Lunan, Chair of Scottish Council, and the RCGP Health Inequalities Standing Group and presented by Victoria Tzortziou-Brown, Joint Honorary Secretary.

There’s work to do and we are taking a lead.

Latest updates from your College

COVID-19 update

It’s been made clear to us officially this week that a second wave of COVID-19 is a case of when and not if, and I’m sure you all saw clips of Chief Medical Officer, Chris Whitty, and Chief Scientific Officer, Sir Patrick Vallance, and their stark projections of what might be to come in the weeks ahead.

They stressed that tackling the virus is everyone’s responsibility - and we support this outlook. It is essential that people continue to strictly follow Government advice including social distancing and good hygiene measures.

As GPs, we see probably more than any other medical specialty the health impacts of socioeconomic factors such as unemployment, economic uncertainty and poverty.

There is clearly a delicate balance to be struck between mitigating the spread of COVID-19 and protecting jobs and the economy - these are not decisions I envy politicians having to make.

What is clear is that key to avoiding a devastating second wave will be an effective test, trace and isolate system. We’ve written to Head of NHS Test and Trace, Baroness Dido Harding, this week highlighting how the current system is leading to a reduction in capacity in general practice as GPs and practice staff are forced to isolate whilst awaiting tests.

We were pleased to hear that GPs will now be prioritised for tests, along with other NHS staff, but once issues with capacity and logistics are addressed, hopefully prioritisation won’t be as much of an issue. You can read about our letter in The Guardian.

We also saw the long-awaited launch of the Test and Trace app yesterday. By all accounts it is easy to use, and has the potential to intuitively alert people about interactions they have had with unknown members of the public, for example, on public transport or in restaurants, who later develop symptoms and report via the app.

It sounds like lessons have been learnt from piloting the app and that they’re being addressed, including concerns about privacy.

This is encouraging but the app must be seen as part of the overall test and trace programme - not a silver bullet. It mustn’t replace human contact tracing: the two methods need to integrate smoothly to avoid people receiving excessive alerts and conflicting isolation advice. Find out more.

Finally on COVID, as we head into a busy winter in general practice, many of us will increasingly see children presenting with sore throats and other symptoms that resemble COVID-19.

Our new top tips provides clinical guidance relating to children and young people and gives advice on how to carry out consultations.

It’s now live on the website. We’ve also signed up to this statement through our Adolescent Health Group which Chair of the group, Marian Davis, has written about in the BMJ.

Flu

GP practices across the country have started flu clinics over the last couple of weeks - many being facilitated in ways that are quite unfamiliar to practice teams and patients.

Ensuring as many people as possible are vaccinated, particularly those in at risk groups, will be essential this winter, especially whilst trying to help control a pandemic. We’re already hearing feedback that supply is not meeting demand, particularly in terms of the expanded cohort of patients who are eligible for a free vaccine this year.

We’ve reiterated our calls for assurance that there are enough vaccines to go around - and for guidance as to who to prioritise, outside the at risk groups, if there isn’t.

Let us know how you’re tackling the largest and most complicated flu vaccination programme. Joint Hon Sec Jonathan Leach was at the Stoke Prior Surgery last weekend.

They vaccinated 640 people and have another similar day planned for the week after next. Share your photos on Twitter, if appropriate, using #RCGPTogether live and tag @rcgp.

Here’s a reminder of the guidance we’ve produced on delivering mass vaccination programmes during pandemics (732 KB PDF).

Council summary

There were some excellent discussions at RCGP Council last week covering topics from the College’s Equality Diversity and Inclusion commitments and CPD strategies to our work to ensure the College is as sustainable as possible.

We had a stimulating debate on health inequalities, as mentioned in my Just Saying above. Thank you to RCGP Scotland Chair Carey Lunan and joint Hon Sec Victoria Tzortziou-Brown for bringing that paper.

There were diverging views around what the GP’s role should be to address social determinants of our patients’ health - some thought GPs had a moral duty to get involved, others advised caution about over-medicalising social inequality. Many were somewhere in between. We’ll be taking Council’s comments on board and publishing a paper shortly.

You can catch up on Council discussions on Twitter using #RCGPCouncil.

Assisted dying legal challenge

You may have read in the trade press that the College is facing legal action over Council’s decision, following consultation with our members, to retain our position to oppose a change in the law on assisted dying.

As this is a legal matter, we are limited as to what we can share, but we have issued a response.

Clinical advisers network

I joined a meeting of the RCGP Clinical Adviser Network, yesterday. This network is a fantastic resource for the College, made up of more than 130 passionate GPs from across the UK, with both generalist and specialist interests, who volunteer their time to influence national clinical policy and the future of General Practice.

The RCGP Clinical Advisers have been key to directing the College response to COVID-19, in particular in supporting the rapid turnaround of NICE COVID-19 guidance and on our work on care homes, and they continue to be integral to our influential clinical policy work.

During 2019-20, 96% of the clinical policy consultations that the RCGP Clinical Advisers Network were part of made a direct change to UK national policy and guidance.

The programme is open to all GPs across the UK with a license to practice. See more information and how to join the network.

Memcon Excellence awards

We’re delighted to have won two Memcom Excellence awards for Best Campaign on a Shoestring for our parkrun practice partnership and for Best Member Engagement Strategy for our RCGP Plus programme.

Our Annual Conference was also highly commended for Event of the Year.

Telephone Consultation Skills and Triage Skills Training

This popular course is now available delivered in small groups online. This practical day will give you realistic tools and techniques in telephone triage and consultations by using interactive exercises, real calls, group work and plenary talks to improve your confidence and skills in this area. New dates are available online.


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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