We’ve got to get better at making the case for relationship-based care

26 June 2020

I worry about whether general practice is really understood by politicians and policy makers.

In recent years they’ve been more receptive to the case that investment in general practice is investment in the whole of the NHS.

But what will happen in the post-COVID era? Will they go back to a preoccupation with hospital beds? Will the inevitable economic crisis hit pledges to invest in a larger general practice workforce?

We need to keep up the pressure, keep talking about the strengths of our specialty. So here’s the first of a few mini-blogs making a case for general practice, starting with relationship-based care.

If the trusting relationship between a patient and a health professional were a drug, we would marvel at its effectiveness and NICE would mandate its use in every consultation.

When I’m seeing a patient who I know and who trusts me, research evidence suggests that, in comparison with a patient with whom I have no relationship, the patient will be more satisfied, more likely to engage with my advice, more likely to disclose their concerns, more likely to take up preventative and health education offers and less likely to attend the Emergency Department or (for older patients) be admitted to hospital.

They are even, remarkably, more likely to live longer.

But the therapeutic relationship, the beating heart of general practice, isn’t a drug so instead of being celebrated it is too often ignored.

Worse than that, it’s being systematically designed out of everyday clinical care. The focus on transactions and the emphasis on efficiency is having the opposite of the desired effect – a less effective and a less efficient health system.

We’ve got to get better at making the case for relationship-based care.

COVID-19 update from your College

Update from College Council

Last Saturday, I chaired the College’s first ever virtual Council meeting where we had several productive, relevant, and forward-thinking discussions.

Proceedings started with an emergency motion brought by NE London Faculty calling on the College to do more to support our colleagues from Black Asian and minority ethnic (BAME) communities.

It asked for a clear, visible statement of support for the Black Lives Matter movement and commitment to tackle structural racism across society.

The motion gained overwhelming support from Council, and we heard emotive and powerful accounts from members, some of whom shared their first hand experiences of racism.

What also came through strongly was that a statement alone would not be enough - and that it must be accompanied with action. This is what I was mindful of in my previous statement at the start of June.

Today we are publishing what I hope you will feel is a clear and strong statement of the College’s solidarity with our BAME members - and a commitment to do better to represent them.

We have also escalated work on our BAME Action Plan. You can get a sense of some of our aspirations in the statement, and we have already started work to achieve these.

The full Action Plan will be publicly available in draft form over the summer and published after September Council.

Thank you to NE London Faculty for bringing such a vitally important issue to the table, to Council members for speaking so frankly as part of the discussion and to NEL Faculty and members of our BAME group for their input into our statement.

I recognise it is just a starting point, and we have a long road ahead, but as a College we are committed to playing our part in bringing about the change that desperately needs to happen.

Most of the rest of the agenda focussed very much on COVID-19: the general practice response to the pandemic and the lessons that we can learn to evolve the profession in a post-COVID world.

We had an insightful debate covering regulation and the need for a move from tick-box accountability to a system that has higher trust in GPs (see my Just Saying from last week); patient access and whether the largely remote and total triage ways of working we have adopted over the past few months have a place post-pandemic; and how COVID-19 has highlighted more than ever the importance of robust primary care.

Our service must be central to the NHS’s recovery plans as things start getting back to normal.

We plan to publish our paper on this topic and subsequent lobbying activity imminently, so watch this space.

RCGP makes headlines

On Wednesday, I signed an open letter to leaders of all political parties on behalf of the College, and with several other medical leaders, which was published in the BMJ earlier this week.

We’re calling for a forward-looking review into the UK’s preparedness for a potential second wave of COVID-19, with an initial assessment published by August.

We don’t want this review to be about attributing blame but rather about learning from our experience over the course of the pandemic, and identifying what we can do differently to ensure we are properly prepared, should we experience local spikes of the virus or a second wave.

I spoke to BBC Radio 4’s Today Programme - my seventh appearance on the flagship political show this year - as well as BBC News Channel, CNN, Sky News, ITV News and LBC, discussing the letter. My comments also appeared in The Financial Times, Reuters and The Independent.

Vice Chair for Membership Mike Holmes also spoke to Talk Radio and joint Hon Sec Jonathan Leach was interviewed by BBC local radio.

Jonathan and I (as well as the College’s excellent Medical Director for eLearning, Dirk Pilat) also featured in The Sunday Times discussing the work the College is doing to support GPs in preparing for an increase in patients presenting with mental health conditions, such as PTSD, post-COVID.

This is such important work, and I was pleased to see it getting a national profile. I also spoke to Sky News about it.

The resource is just one of a huge library of resources we have developed during the pandemic to support GPs and practice teams to deliver the best possible care for patients throughout the COVID-19 pandemic.

Another important update this week has been to our shielding guidance, following the announcement that the restrictions for shielding patients will be eased further from 6 July, with the programme ‘paused’ from 1 August.

Finally, I know many of you were incensed by a question that was asked at the final COVID-19 press conference on Tuesday suggested that our A&E colleagues were under increased pressure because people haven’t been able to see a GP during the pandemic.

This is a persistent and infuriating claim that is not only wrong - and demoralising given all the hard work you are doing - but confusing for our patients.

We have been working hard throughout COVID -19 to get the message across that general practice is open, and will continue to be so. Read my response.


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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