Keeping the flames of Bevan’s aspirations alive

6 May 2022

In 1948 Nye Bevan, Minister of Health in the post-war Attlee government, described his pride in the newly established National Health Service: ‘Despite our financial and economic anxieties, we are still able to do the most civilised thing in the world—put the welfare of the sick in front of every other consideration’.

In 2022 Charlotte Augst, Chief Executive of National Voices, described the reality nearly 75 years on: ‘Patients can no longer be confident that their needs will be met. This is a profound failure of our commitment to the social contract’.

It’s tough for today’s NHS staff, desperately trying to keep the flame of Bevan’s aspirations alive. Does government feel sufficiently responsible as the current custodian of his ambition?

Latest updates from your College

GP pressures

The latest GP consultation figures show yet again that GPs and our teams are continuing to work exceptionally hard, delivering more than 30m patient consultations in March - higher than the same period pre-pandemic, and with 44% of appointments taking place on the same day they were booked.

The data gave us another opportunity to reiterate the point that general practice is a team profession. Sometimes a GP is not the most appropriate healthcare professional to meet a patient’s health needs and working in multi-disciplinary teams frees up GPs’ valuable time to see those patients who most need our medical expertise.

The data also shows that almost 40% of patients were seen for longer than 10 minutes in general practice, which is why the College has called for 15-minute GP appointments as standard - although more simple conditions can obviously be dealt with more quickly.

The data for March 2022 is further proof that GPs and our teams are doing a very good job in difficult circumstances. We reiterate our calls on the government to honour its promise of 6,000 more GPs and 26,000 more members of the wider practice team by 2024 so that we can continue to deliver the care our patients need. You can read our full response here.

GP-patient ratios

New research published by the Lib Dems shows that on average every GP is now responsible for 2,200 patients.

I took the opportunity to once again stress how rising patient numbers and increasing complexity of care being delivered in general practice – coupled with a shortage of GPs – has impacted on the GP to patient ratio over recent years. General practice is under doctored, underfunded, and overstretched, and while the problem is nationwide, these figures show some areas are feeling it more than others as they face greater difficulties recruiting new GPs.

As GPs working to do our best for our patients, we are just as frustrated as patients when we hear about difficulties accessing services. We want to be able to consistently give patients the timely, appropriate and high-quality care they need, regardless of where they live. But the intense workload and workforce pressures we and our teams are facing is unsustainable. Good progress has been made to recruit newly qualified doctors into general practice, but when more GPs are leaving the profession earlier than planned, often to protect themselves from burnout, we're fighting a losing battle.

On top of my call on the Government to deliver on its key manifesto promise on GP numbers, I said that we also need comprehensive plans to keep highly trained, experienced GPs in the workforce for longer, and this needs to start by addressing unsustainable workload and giving GPs more time to care for patients. 

HRT shortages

Some of you will have seen the latest Channel 4 programme on the menopause this week. Please be reassured that we are working closely with the Royal College of Obstetricians & Gynaecologists, the British Menopause Society, and others to coordinate our approach to the menopause based on the best evidence available and in line with NICE guidance.

While we collaborate to finalise our joint position on this, we can offer the College’s official statement on the menopause to help guide you, which covers best care, testosterone prescribing and the HRT shortages.

With the new HRT Tsar now appointed by the Secretary of State, we hope that the supply issues will be resolved swiftly. As a College we will continue to ensure that your voice is heard at the highest level, promoting the excellent work GPs are undertaking and the huge increase in prescribing for women that we have led over the last few years.

Speaking up for GPs in the media

On Monday I was interviewed on BBC Radio 4’s Today Programme, BBC News, and Sky News reacting to new NHS statistics that show record numbers of patients were referred for cancer care in the last year. I highlighted the huge efforts of GP teams to identify and care for this influx of patients coming forward with potential symptoms of cancer. I drew attention to the consequences of this increased pressure on services, with more patients facing longer wait times to receive diagnostic tests and treatment.  I made it clear than in addition to more GPs and wider members of the practice team, we also need more radiologists, surgeons, and other members of the oncology team, so we collectively have the capacity to deliver timely care to the growing numbers of patients that need it.

Over the bank holiday weekend, The Times published my letter about the new NHS Digital figures on consultation length. I made clear that five minutes can occasionally be adequate for a patient with a simple condition but most often, patients need more time, which is why 39% of consultations last longer than 10 minutes – and why we need more GPs and more members of the practice team.

I was a signatory to another letter published over the weekend in the Daily Telegraph in response to a column describing the NHS as ‘feckless’. Along with Chris Hopson, chief executive of NHS Providers and Matthew Taylor, chief executive of NHS Confederation, I emphasised that NHS staff across the service are working harder than ever in very difficult circumstances

I was interviewed by the Independent in a wide-ranging piece on NHS pressures, and press campaigners Hacked Off have published my opinion piece on the unwarranted criticism of GPs by certain sections of the media

Spring General Meeting and William Pickles Lecture

The RCGP Spring General Meeting (SGM) and William Pickles Lecture takes place on Friday 13 May 2022, both in person at 30 Euston Square, London and online. The SGM gives you the opportunity to find out more about the work of your College, and our challenges and achievements as well as the opportunity to question your elected Officers on their work.

The William Pickles Lecture celebrates the achievements of an RCGP member in the field of medical education. This year Prof Vijay Nayar will be speaking on the topic of Levelling Up Medical Education - Getting Comfortable with being Uncomfortable.

Updated PEP guidance for chickenpox and shingles

The UK Health Security Agency (UKHSA) has updated its advice on post-exposure prophylaxis for chicken pox and shingles infection for high risk groups including susceptible immunosuppressed individuals and pregnant women.

Recent evaluations have shown antivirals are equally as effective than the previously recommended varicella-zoster specific immunoglobin (VZIG) for these high risk groups.

The UKHSA is therefore advising healthcare professionals that antivirals are the PEP treatment of choice for all immunosuppressed individuals and pregnant women, regardless of stage in pregnancy.

Green respiratory care

It was World Asthma Day on Tuesday and Dr Veena Aggarwal, a GP trainee in South West London and the Chief Sustainability Officer’s Clinical Fellow in the Greener NHS team, has written this excellent blog, signposting to lots of useful resources for GP teams on sustainable respiratory care.

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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