Health impact must be top consideration for Rwanda policy

29 April 2022

‘The only thing necessary for the triumph of evil is for good men (sic) to do nothing’.

That’s what Edmund Burke, the 18th century statesman and philosopher, is reported to have said. The words have been used to critique the response to the rise of fascism in Germany and Putin’s war against Ukraine. And I want to apply it to the deportation of migrants to Rwanda. Or at least I think I do.

Most people I speak to are shocked by the government proposals. But I’ve been surprised how few critics of the policy have spoken out against it - with notable exceptions such as the Archbishop of Canterbury – and by the silence of the institutions which have a responsibility as guardians of our country’s values. I desperately hope that this isn’t because we’ve become fearful of speaking out about controversial issues.

My public silence results from a tempering of my initial visceral reaction by a realisation of how ignorant I am about this complex area. We know from similar policies in other countries that refugees and asylum seekers who are detained and deported experience significant mental and physical health problems and abuse. Many GPs know from their own experience how vulnerable and how distressed these people are. And we see how many of them have already been exposed to unimaginable horrors and how many experience post-traumatic distress.

That much is clear but we don’t know what impact this policy will have on these health issues. We don’t know for certain what kind of environment refugees and asylum seekers are being deported to, or what services or support they will have access to.  And we don’t know whether the policy will deter people traffickers, or stop refugees dying at sea.

There are many unknowns. What is known is the potential impact this policy could have on people’s physical and mental health – and that needs to be top consideration if the policy is to be implemented.


Latest updates from your College

End of the road for the workforce planning amendment

It was frustrating, once again, to see MPs vote down the amendment to the Health and Care Bill, made by the House of Lords, that would force them to take workforce planning in the NHS more seriously.

We need a comprehensive workforce plan, and we need it as a matter of urgency.  Sincere thanks to the more than 2,000 of you who used our campaign action to write to your MP, urging them to support this important amendment, which had the support of more than 100 health organisations, two former NHS Chief Executives and a former Health Secretary.

Whilst this might be the end of the road in terms of amending the Bill, it's certainly not the end of the fight to make it clear to Government that we need more GPs, more nurses, and more healthcare professionals in general practice, and across the NHS, to make sure the service is sustainable for the future, for patients.

HRT shortages need quick resolution

The College is very concerned by the continuing disruption of supply of HRT, and has been clear in the media that this issue needs to be resolved as quickly as possible, as reported by The Guardian, the Independent, and the Daily Mail.

These shortages began last year with patches and are now affecting transdermal gels including Oestrogel. GPs have worked incredibly hard ensuring personalised choice of HRT medication with an exponential increase in demand over the last few years. As a College, we highlighted some time ago, the risk to the supply chain.

For women at higher risk of VTE, transdermal products are preferred, but there are other transdermal products we can use instead of Oestrogel and it is important to remember that oral medication is appropriate for many women where VTE risk is not a significant concern.

The British Menopause society has produced excellent information to enable us to choose alternatives to the medication out of stock – and an update on the HRT supply issues. Next week we’ll be publishing a statement on menopause which will provide more information on how we can improve the care of women with menopausal symptoms. 

Patient record access: update

Following our recent engagement with NHSEI over their plans to automate patient access to their GP record, I can now tell you that we have had confirmation that general practice will be given a minimum of 8-weeks notice before automatic access is switched on. This is a small but hopefully helpful window which will allow time for practices to prepare and to read the update to the RCGP Patient Online Toolkit which will be published in the coming weeks. 

For clarity, this means that no changes will take place in April as previously suggested by NHSEI. While there are significant risks associated with automatic access which require careful management, there is also evidence for the benefits of patients having access to their records and the RCGP has always been clear that we support this principle.

We are continuing to discuss with NHSEI the exact process for rolling out automatic access and I will keep you updated as this progresses.

Setting out my vision for general practice at Pulse LIVE

I spoke at Pulse Live on Monday where I repeated my call for an urgent injection of resources into our profession if we want to prevent a situation where general practice is increasingly become privatised, similar to what we have seen with dentistry. I described this as ‘a very real threat,’ a comment reported by The Times , the Daily Mail and the Sun.

I also took the opportunity to outline the College’s five principles of general practice moving forward: the need to upscale; more multidisciplinary working; smarter use of technology; increased integration with and support from secondary care; and finally, that GPs should be involved in population health.

One Day Essentials | Ear, Nose and Throat

Thursday 23 June - Online via Zoom, 09:00-17:30

This conference is designed for the busy GP, with great discounts for RCGP members. We’ll provide you with practical knowledge and skills that you can apply in day-to-day general practice. Expert GPs, GP trainers and consultants will look at different ear, nose, throat and sinus conditions, as well as dizziness diagnosis and management, and red flags. Through interactive learning, you’ll access key updates and evidence, with plenty of time for questions.

Register here


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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