Is it my imagination or have the heated discussions about mode of consultation in general practice cooled off a bit?

28 January 2022

Is it my imagination or have the heated discussions about mode of consultation in general practice cooled off a bit?

The proportion of face-to-face consultations in general practice has stabilised in recent months at just over 60% - a bit higher for nurses and a bit lower for doctors. The College has resisted calls for a target ideal because what matters is local flexibility around the needs and preferences of patients and the capacity of practices. We came at it from a pragmatic perspective – the introduction at scale of remote care was always going to be a practical as well as a cultural challenge for patients and practices, so just back off, we said, and give practices space to learn how best to do it.

There’s another reason for backing off from public spats with politicians and journalists; I’m not convinced that the availability of face-to face-consultations is really the issue. Of course face to face appointments are essential and of course we’ve learnt we can provide more care remotely than we ever thought possible before the pandemic. And of course patients and clinicians will quickly get used to different ways of operating, in the same way as we all got used to remote banking and online shopping. But the friction that we’ve seen is not a technical argument about the relative merits of remote versus face to face care, it’s an emotional appeal by many of our patients for a return to a more personalised service.

Patients need care that’s accessible, from a team they are confident in and a clinician they know and trust. The unwillingness of policy makers to address the longstanding workload crisis in general practice means that despite the amazing efforts of most practices to keep an over-loaded system running, patients are often not getting the personalised care they need.

That’s the problem that needs sorting.

Latest updates from your College

Mandatory Covid vaccinations for healthcare workers

I was interviewed on BBC Radio 4's Today Programme on Saturday about a possible delay to the introduction of mandatory Covid-19 vaccination as a condition of employment in the NHS. My comments were subsequently picked up by other media, including BBC 10 o’clock News and Sky News.

I want to make clear first of all that the College is pro-vaccination, and always has been. We would like to see all healthcare professionals, indeed all eligible people, vaccinated against Covid-19.  But we have always opposed Covid-19 vaccinations being made mandatory for health and care staff – in common with many other health organisations.

As the mandatory vaccination deadline for NHS staff is rapidly approaching, we are extremely concerned about the significant implications this will have on an already stretched and understaffed workforce. That’s why I have been publicly supporting a delay to allow greater time to address concerns and hesitancies that unvaccinated people working in the NHS may have and encourage them to get vaccinated. This also creates a window of opportunity for government to revisit whether mandating Covid-19 vaccinations is necessary at all.

I'm confident that the vast majority of staff in general practice have been vaccinated. However, losing even a small number of highly-trained colleagues at a time when we are already working under intense workforce and workload pressures, would have serious implications for the profession and our patients.

You can read the College’s response to the Department of Health’s consultation on the issue on the website.

It was informed by a survey of members that highlighted significant concerns about the workforce implications of such an initiative. Thank you to everyone who contributed.

Consultation numbers

The latest general practice consultation data for last December once again shows the fantastic work you’re all doing for your patients, in the face of huge challenges. 
You and your teams delivered 25 million patient appointments in England - higher than the same month pre-pandemic – and not taking account of the exceptional work done to deliver the Covid-19 booster campaign.  
With this data in mind, the total number of appointments carried out in 2021, when taking into account multiple mass vaccination drives that you and our teams have led, comes to an amazing 367m. Well done to you all.

Updates to our Covid Resource Hub

The College’s Covid-19 Resource Hub continues to be updated regularly. Recent updates include Top tips on new treatments for COVID-19, which can be found both in our Essential guidance and General clinical management sections. Many thanks to eLearning Clinical Fellow Toni Hazell for her work developing this excellent resource.

Continuity of care and dementia

This week saw the publication of a compelling study on GP dementia care co-authored by former College Chair Sir Denis Pereira Gray and published in the College’s own British Journal of General Practice. Denis is a researcher at the St Leonard's Practice in Exeter. The study, which was widely reported in the media, found that continuity of care for dementia patients is highly valued by patients and GPs. This will likely come as no surprise to GPs, and the study adds strong evidence to the growing research base linking relationship-based care with better outcomes for patients and more effective use of NHS services.
Our response highlighted the challenges GPs face in delivering continuity of care: particularly intense workload and workforce pressures; and the focus of policy makers on access over effective personal care. But we made clear that GP teams are striving to address this by delivering continuity of care in innovative ways, such as working to build trusting relationships between different members of the practice team, not just the GP.
Read more about the College’s work on invigorating relationship-based care.

Solidarity with Myanmar

The College’s London headquarters will be illuminated in red on Tuesday, 1 February, to mark the first anniversary of the deadly coup in Myanmar and to honour the 279 health professionals who have been arrested, injured or lost their lives.
This non-political gesture is part of a whole day of events organised by Health Partnerships for Myanmar and THET Partnerships for Global Health to focus attention on the catastrophic impact the coup is having on health in the country. 
Other medical Royal Colleges and health organisations across the UK are also taking part, and from 10am–2pm on Tuesday, the Myanmar diaspora community in the UK will be holding a peaceful demonstration in Parliament Square to raise awareness of the ongoing situation.
The College has a long association with Myanmar and, in unity with our colleagues from the Academy of Medical Royal Colleges, spoke out in strong condemnation of the coup.
This powerful blog post was written in May last year by Dr Sonny Aung, a member of East Anglia Faculty and one of the College’s International representatives. It’s well worth a read.

One Day Essentials online conference on Mental Health | Tuesday 1 February 2022

Join us for this informative one-day conference featuring expert speakers covering a range of mental health topics designed to support GPs improving patient care. Topics include: 

  • Mental and physical comorbidity
  • Recognition, diagnosis and management of people at risk
  • COVID-19 and mental health
  • Bipolar disorder
  • Perinatal mental health
  • Staying well - practitioner and practice health
  • Supporting patients with mental health problems in primary care

More information is available on the RCGP website.

Vacancy: Primary Care Development programme, Medical Director

Deadline: 5pm, Wednesday 2 Feb

The Primary Care Development programme is currently looking for a new Medical Director to lead this innovative and rewarding area of the College's work. 

The PCD programme is a peer-to-peer service supporting general practices across the UK with a wide range of services. For more information please see our RCGP PCD webpage.

We are looking for a currently practising GP with experience in leadership at both a practice and at CCG or ICS level to help shape the future strategy and direction of the programme as well as support the team with the delivery of current work. 

For more details and to apply, please see the RCGP vacancies page.

International Practitioner Health Summit 2022: The Wounded Healer

Thursday 17 - Friday 18 March 2022; 30 Euston Square, London OR Online

College President Dame Clare Gerada is also Medical Director for the NHS Practitioner Health Programme and would like to let you know about their forthcoming hybrid CPD certified conference, which is open to all healthcare professionals. It will have an opening address from Professor Chris Whitty, Chief Medical Officer for England and Ruth May, Chief Nursing Office for England. Delegates will also hear from medical authors, Rachel Clarke, Adam Kay, and Yumiko Kadota about their Covid experiences. Breakout sessions for all delegates will cover topics including: International treatment models and responses, the epidemiology of distress, mental health outcomes for distressed doctors, and happy workplaces for trainees. For those who attend face to face you will be able to access an extended choice of workshops and plenty of spaces to come together. 

Join in as we learn how to give ourselves the time, space and tools we need to keep well and stay well and look to the future to deliver and develop services that will meet the needs of our entire workforce.
For the full programme and to book, visit the Healthcare Conference website

Sustainable asthma care

The RCGP has long-recognised the impact that climate change has on the environment and the adverse effects it can have on patients' health – and we are committed to doing what we can to promote sustainability, both in College buildings and across general practice.

I’d like to highlight an event hosted by the Academic Health Sciences Network on ‘Reducing the environmental impact of asthma’, on Tuesday 8 February, 10:30am-12 noon.
This educational session, aimed specifically at general practice prescribers, will look at the delivery of high quality and low carbon asthma care, and provide support to implement the targets set out in the Investment and Impact Fund (IIF) that will return in April 2022. Register on the website.
You might also be interested in this BBC interview with Sheffield GP and RCGP Council member Aarti Bansal on green asthma prescribing.

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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