General practice is changing, and this change needs to happen thoughtfully and strategically

30 July 2021

We used to joke that GPs worked to the John Wayne contract - a GP’s got to do what a GP’s got to do. All-things-to-all-people is another way of describing our job description.

But with constrained resources people are asking whether the expert general medical generalist, increasingly part of a multi-disciplinary team, should focus on areas of work where we have the potential to add greatest value. Clever economists tell us we should be ‘working to the top of our license’, though they have little understanding of what we do or what our license should look like.

Nevertheless, we are now seeing GPs focusing their efforts - on triage because GPs are good at managing risk and making quick decisions; on managing complex biopsychosocial problems because we are experts in complexity; on adopting a more strategic role in population health because we know our communities.

No one pretends that this shift in ways of working is straightforward. If we’re spending more time with complex problems, we need to see fewer patients for longer. If we are taking on new roles, we need more training. If we are segmenting our work, then we need to have a better understanding of how to differentiate between a simple problem and a complex one. And if we aren’t seeing patients for blood pressure and medication reviews, we need to understand the impact this has on how we build trusting relationships and accrue the credit which we draw upon when patients re-present with complex problems.

General practice is changing, and this change needs to happen thoughtfully and strategically.

Latest updates from your College

Action Plan for General Practice in England

Yesterday we launched our five-point Action Plan for Recovery to address the workload and workforce crisis we're experiencing in general practice. While this is specific to England, the issues are relevant across the UK, and our Devolved Councils are also working hard to lobby on these areas. See our full press release.

General practice has been running on empty for too long. Our plan offers the new Health Secretary, Sajid Javid, and just-announced new NHS England Chief Executive, Amanda Pritchard, constructive solutions to the problems that have beset general practice for more than a decade. Our proposals not only have the potential to improve our working lives but safeguard the care of patients for generations to come.

I spoke to BBC Radio 4's influential Today Programme (about 45 minutes in) outlining our case, and our plan has been covered comprehensively in the Guardian. We have also created a campaign letter to enable people to write directly to their constituency MPs.

Our profession was struggling before the pandemic, and the pressures we are working under have been further exacerbated by it. We simply do not have enough GPs, or other members of our team, to meet the needs of our growing and ageing population and its increasingly complex health needs.

I was also interviewed for Channel 4 News' Fourcast podcast, where Health Editor Victoria Macdonald described general practice as 'the forgotten frontline' acknowledging that "90% of people's access to the health service is through their GP". It's an important point: too often the perception is that pressures in the NHS are confined to hospitals. They're not, as we know too well, and I hope our advocacy work this week goes someway to making this clear.

National Training Survey

This week, the GMC published the results of the 2021 National Training Survey, which provides valuable insights into the experiences of GP trainees and trainers.

It’s clear from the survey that GP training itself remains excellent. Trainees are particularly positive about clinical and educational supervision, as well as overall satisfaction, teamwork and curriculum coverage. Similarly, among trainers, areas such as overall satisfaction, supportive environment and resources for trainers were seen as very positive.

However, it will come as no surprise that the survey also shows significant areas for concern. Trainer feedback on workload was the most negative of any specialty, and 55% of GP trainers and 44% of all trainees felt their work was emotionally exhausting to a high or very high degree. Perhaps, most significantly, burnout risk among both trainers and trainees has risen significantly since 2019. Among GP trainers, 13% are at high risk of burnout, up from 9% in 2019, while for trainees, high burnout risk has almost doubled from 7% to 13%. While overall burnout risk remains low compared to other specialties, this trend is deeply concerning, and highlights the urgent need for action to support general practice to recover, as laid out in our new action plan for general practice.

The full National Training Survey results can be found on the GMC website. You can read our response.

Kailash Chand tribute

We were deeply saddened to hear of the death of Kailash Chand, College Fellow and BMA stalwart.

He had a huge impact on general practice, not just in his community in Tameside, but as a staunch campaigner for primary care and the NHS.

The tributes we've seen in recent days are a testament to how much he was loved by his community, his profession and beyond. Our thoughts are with his family and friends.

Professional Standards Working Group

The RCGP Professional Standards Working Group is being established following a review of the College’s (post CCT) professional standards function and the identification of the need for a group to provide support and expertise on all aspects of this work.  

We are seeking three specific roles for the working group: a GP with a primary care leadership role, a GP with an extended role and a GP with a responsible officer role. If you are interested, please see RCGP Vacancies or contact Mat Lawson for further information.

Inspire Awards

Nominations are now open for the Inspire Awards 2021. Tell us about the outstanding colleagues you know who have gone above and beyond in their work during the last year.

These awards now include the Vibrant Faculty awards, so if you think your Faculty deserves to be recognised and celebrated, tell us your story today.

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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