General practice will continue to adapt but is open, has been open, and will stay open

27 November 2020

This week I was reminded by a friend of the Stockdale Paradox: "You must never confuse faith that you will prevail in the end - which you can never afford to lose - with the discipline to confront the most brutal facts of your current reality, whatever they might be." A philosophy that Admiral James Stockdale attributed to his survival as a POW in the Vietnam War.

As GPs we know 'the current reality' of suffering that Covid has sadly brought to our communities, our colleagues, our friends, and our families. We know our working lives have changed so much that some have wondered whether we’re practising 'call centre medicine', with new modes of consulting, a new exam, and our new language of 'COVID secure', 'PPE', 'donning and doffing'. Our new mindset has become ‘is it safe to approach’ applied to all human interaction and not just resuscitation.

And yet it was with a renewed faith that I left our Council meeting last Saturday having heard our commitment to relationship-based care for patients, diversity within our College and care for our colleagues.

I remembered that the reality of general practice during COVID doesn’t make daily news briefings but is understood by those working in and using our services. In the midst of the pandemic, the values and standards of general practice haven’t changed: we continue to consult, to treat, to investigate and refer, to hear our patients' stories and share their experiences. We have strengthened relationships with individuals and provided vaccination for our communities. And we hope too, trusting in science, for the time when we can meet again face to face with friends and colleagues to share our experiences and learn together.

Until then, we hold to the reality that general practice will continue to adapt but is open, has been open, and will stay open, meeting daily the needs of our communities.

Cum Scientia Caritas.

Post written by

Dr Michael Mulholland, RCGP Vice Chair (Professional Development)

Michael Mulholland is a GP at Unity Health, a five-site practice for 22000 patients across the Buckinghamshire and Oxfordshire border where he has practised for nearly 20 years.  

He also works for Health Education England with roles in GP training, Quality Improvement and workforce planning. Within the RCGP he has been part of the GP at Scale programme and a GP Forward View Regional Ambassador.

He was elected to the post of Vice Chair (Professional Development) in November 2018.

Latest updates from College Chair Martin Marshall

November Council

We had a number of stimulating and useful discussions at RCGP Council on Saturday,  covering topics from GP appraisal (see below), relationship-based care, and the College’s response to the COVID-19 pandemic.

Invigorating relationship-based care in general practice is my enduring priority for my three-year tenure as College Chair. Council heard heartfelt speeches from members on the importance having strong relationships with patients in order to help them do their job, and insight into how this can be delivered, given the pressures you’re all working under.

There was also discussion of our activity during the last two months on COVID-19. An action was taken away to raise the profile of our lobbying work on issues facing GPs from Black, Asian and minority ethnic communities and we’ll keep you updated on our progress.

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

College calls for suspension of GP appraisal during COVID-19

Another rich discussion at Council was about GP appraisal, and specifically whether it should be suspended during the COVID-19 pandemic.

The process was suspended at the start of the first national lockdown, following calls from the College, and as a result of discussion at Council, we have called for it to be suspended again.

We were pleased to see the 'light touch' approach to appraisal when it was re- introduced, but it is clear from member feedback that there is still not the capacity in the system to do what needs to be done over the next few months. When we’re identifying work that can be scaled back to allow GPs to deliver the expanded flu vaccination programme, take a leading role in the COVID-19 vaccination programme, and continue delivering the vital services patients rely on us for, it makes sense to start with non-essential administrative tasks.

We know many GPs find appraisal a helpful and supportive process, and we’ve been clear that access to appraisal should remain for those who want it.

We also heard news from the Department of Health and Social Care in England this week that a new drive to reduce unnecessary bureaucracy and learn from the positive changes seen during the pandemic has been launched. The College welcomed this announcement as a move towards the higher trust, reduced 'tick box' system of regulation we have been calling for.

Spending review

On Wednesday, Chancellor Rishi Sunak set out what the government will spend next year in the 2020 spending review. As to be expected, it was very much focussed on the pandemic response and associated economic crisis, but a number of significant commitments for the NHS were made and the College will push for this funding to be spent in ways that will ensure general practice is sufficiently supported.

The Spending Review was the subject of our latest RCGP Live webinar last night where Vice Chair for External Affairs Gary Howsam chaired a discussion between former GP and Health Select Committee Chair Sarah Wollaston, former MP and GP Paul Williams, the BMA’s Krishna Kasaraneni, Health Foundation’s Becks Fisher and Simon Gregory from HEE.

There were interesting discussions on how short-term funding isn't always helpful, the public health funding gap, the impact of Brexit, the lack of funding for HEE and how parliamentarians understand funding. You can watch the whole thing back now.

The Oxford vaccine

This week the University of Oxford announced interim trial data for its candidate vaccine, ChAdOx1 nCoV-2019. The data showed that the vaccine is between 70-90% effective at preventing COVID-19.

This is encouraging news, especially as this vaccine is now the third vaccine we're hearing about which is showing good results. From a general practice point of view, this vaccine seems to have fewer logistical challenges than the Psizer/BioNTech and Moderna vaccines. And whilst delivering it at scale, in parallel with the expanded flu vaccine programme, will be a challenge, this seems to be the most suitable to be delivered at a primary care level, so far.

It’s important to note that no vaccine has been approved by the regulator yet, and safety as well as efficacy is obviously vital. Once it’s been approved we’ll be sharing details of how the various vaccines will be rolled out, in order to best ensure everyone who wants a vaccine gets one, starting with those most vulnerable.

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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