Our hidden role in just keeping vulnerable patients going should be another entry on the long list of 'business as usual' general practice

30 April 2021

A GP recently described to me how almost every week for more than a decade, she’d seen the same young woman in her Wednesday morning surgery. The woman was a single mother, had been sexually abused as a child and frequently self-harmed. The weekly meeting, which the GP described as 'just a supportive chat’, kept the patient going.

But then the GP went on maternity leave and two months later the woman took an overdose and was found dead by her six year old son. 

In The Mystery of General Practice Iona Heath describes how one of our roles as GPs is to witness our patients’ suffering. This might sound a bit philosophical to anyone who isn’t a GP but for some of us and for some of our patients it’s as practical as you can get.

Witnessing suffering isn’t a role that’s itemised in our contracts, or set out in Standard Operating Procedures. But our hidden role in just keeping vulnerable patients going should be another entry on the long list of 'business as usual' general practice.


Latest updates from your College

Speaking out against workload pressures

Data published by NHS Digital yesterday, reflects how GPs and our teams are currently working: harder than ever. The profession delivered five million more consultations in March this year than in February - three million more than in March 2019 - and this is on top of our work leading the COVID vaccination programme, with 75% of vaccinations delivered in primary care in England.  
  
We've also seen data from Pulse magazine today, highlighting that 800 GP practices have closed over the last eight years. Some of these are likely to be mergers, or practices working in different ways, but some will have been forced to close. This is yet another worrying indication of the severe pressure general practice is under - and the need for it to be addressed. 
  
The College is demanding urgent action to address the intense workload and workforce pressures we face in general practice, pressures that have only been exacerbated by the pandemic. We need to see comprehensive plans to protect GPs and our teams from burning out and address the largely 'undoable' workload we all face on a daily basis. I’ve written an Opinion piece about this in the Express and our calls have been featured in the Mail, Pulse and GP Online. You can also read our responding statements from yesterday (29 April) and today (30 April).

Simon Stevens, Chief Executive of NHS England, doesn’t have a GP background but I’ve been encouraged by his understanding of general practice and the role played by GPs in keeping the rest of the NHS functioning - which is why I’m disappointed to hear that he’s standing down in July.

Simon has been a great ally of the College and our profession, once famously stating 'there is arguably no more important job in modern Britain than that of the family doctor'.

You may not have agreed with everything Simon has done at the helm of NHSE - and as a College we have challenged him on many occasions - but running NHS England is a hugely challenging job, and Simon was an architect of the GP Forward View, which pledged both funding and staff for general practice.

In the political world where platitudes and spin are rife, he has never shied away from difficult conversations and always tells it as it is, even when the message is not what we necessarily want to hear. 

We wish him and his family well for the future.

He has set a clear direction for general practice and his successor must ensure there is continuous and consistent funding to support it and the work of frontline GPs.

Pandemic situation in the Indian sub-continent

It’s hard to find the words to describe the terrible pandemic situation in India and the wider Indian subcontinent. The scenes you will have seen on the news are incredibly difficult to witness.
  
The College has many links with India, many of our international members live and work there, and many UK members are from or have family living there. Our thoughts are with you all.
   
Through our membership of the Academy of Medical Royal Colleges, we have signed up to this statement on vaccine equity (103 KB PDF), calling for the Government to release 30% of its pre-purchased COVID-19 vaccine orders to countries least able to secure supply.  
 
The pandemic is, by definition, a global health crisis, and we will only truly get out of it by working together, helping each other, and vaccinating as many people as possible, right across the world.
 
Council Member Narveshwar Sinha is working to help colleagues in India by setting up a helpline. He’s keen for anyone who wants to help or make a contribution to his efforts to contact him directly.

Myanmar

The situation in Myanmar and the effect on healthcare and our GP and other medical colleagues in the country continues to deteriorate. Doctors who are on the frontline of the situation face challenges dealing with gunshot wounds and many other injuries. As a College, we have joined a number of medical organisations in signing a statement convened by the BMA, condemning the violation of medical neutrality provider. You can read about it in the BMJ.
    
Sonny Aung, who has been involved in our projects and volunteer activities in Myanmar for a number of years, attended a Parliamentary briefing on Myanmar this week. He gave a presentation on insights into the longstanding health partnerships between the UK and Myanmar, highlighting the RCGP's work in the country.

COVID-19 Resource Hub

At the beginning of the pandemic, the College set up a COVID-19 Resource Hub to support and keep GPs up to date with the ever-changing guidance facing us. Its focus is on the provision of GP wellbeing resources and ‘condensing’ complex and lengthy clinical guidance into practical tips to help busy practices in their care of patients in these most difficult of circumstances. 
   
It's been updated almost daily and yesterday, the hub - which the College has made freely available to all GPs and healthcare professionals - was visited for its millionth time.
   
This is a fantastic achievement, and what the College is all about - providing educational and practical resources to help you through some of the toughest times you are likely to face in your career. Thank you to Dirk Pilat, Toni Hazell, Kevin Barrett and the whole eLearning team, the numerous contributors to the platform, and to Vice Chair for Professional Development Michael Mulholland for leading this piece of work at College Officer level.

Wider Practice Team consultation

One of the papers for discussion at our next Council meeting in June will explore the advancement of the general practice Multi-Disciplinary Team (MDT), with a particular focus on 'enablers'. 
  
We’d be interested to hear about what has been helpful in supporting the MDT model in your practice, and what challenges you have experienced.  
  
Mat Lawson, Head of Professional Standards, would be grateful to receive responses by 9 May 2021. Please do feel free to forward this message to colleagues.


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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