The pandemic has been a great un-leveller

30 October 2020 

Apparently the British economy is booming. Really. Well, some sectors are anyway. Following the expected collapse in spending during the first lockdown, on average people are now spending more on household appliances, furniture, cars and houses.

On average. Those who’ve already got household appliances, furniture, cars and houses are upgrading. Those who haven’t aren’t. And those who haven’t are the same people who have a higher prevalence of mental health problems, poorly controlled long term conditions, and poverty-related illnesses. And they’re more likely to have poor outcomes if they catch COVID.

Another example of the pandemic as a great un-leveller. Economists in HM Treasury might have an uncharacteristic smile on their faces but the NHS, general practice in particular, is seeing the impact on our most vulnerable patients and is picking up the pieces.  

That’s why our College is increasingly vocal about our work on health inequalities.

Latest updates from your College

Lockdown 2

Yesterday, as we all know, England entered another national lockdown. Both the health and socioeconomic impact of this measure will make it a testing time for many patients, and we will continue to be at the forefront of offering them support - particularly to those who are extremely clinically vulnerable to COVID-19.

A widescale shielding programme isn’t being introduced, but there have been several changes to the list of who classifies as extremely clinically vulnerable, and they are being asked to take extra precautions to keep safe. Given the impact shielding had on some patients’ physical and mental health, this is a sensible move. GPs have been written to about the support and advice we can deliver to these patients - there are also resources on the College’s COVID-19 resource hub.

I know from speaking to members that workload is escalating - and our own data from the Research Surveillance Centre show the same. We’re also awaiting details around the forthcoming COVID-19 vaccination programme and what the role of general practice will be in delivering it. Despite the massive challenges, like the GPC we think that general practice should play a central role in delivering the programme. In the meantime, we’ve produced some new workload prioritisation guidance (356 KB PDF) for general practice to help you make local decisions based on local circumstances during this challenging time. Thank you to Vice Chair Gary Howsam for his work on this.

I am encouraged to hear GPs and our teams receiving some overdue gratitude. This letter from Health Minister Jo Churchill, struck the right note, reiterating what this College has been trying to make clear about the efforts of general practice throughout the pandemic. I was also pleased to hear NHS England Chief Executive Simon Stevens thanking you for your efforts, particularly around delivering the flu vaccination programme, at the press conference with the Prime Minister on Wednesday.

General Practice is Open

While restrictions vary across the UK,  general practice services are available for patients in all four nations, albeit being delivered differently than usual. The College has published resources for GP practices, which you can download and share on whatever channels you have, to help make this clear to patients.

Despite our workload pressures, and official advice for patients to 'stay at home and protect the NHS' we don’t want patients who are sick or concerned about their health to put off seeking medical care. And we want them to know what to expect when they do get in touch.

I spoke to Sky News and LBC about this, and our message was covered by BBC News, including the Today Programme news bulletins, The Sun and Mail Online, and BBC Radio 4’s Today Programme.

Our new campaign resonates with the NHSE&I and PHE campaign Help Us Help You messaging around NHS Access launched last month. The next phase of the campaign is to remind pregnant women about the importance of attending check-ups and contacting their midwife or maternity team with health concerns. Find out more.

RCGP Veteran Friendly Programme

In the lead up to Remembrance Day on 11 November, I’d like to remind members of the College’s Veteran Friendly Practice initiative, which was paused due to COVID-19 but is now up and running again.

It’s a fantastic scheme that aims to address the unique health needs many veterans have. Since its launch in April 2019, 800 GP practices across England have been accredited to better identify and treat veterans and refer them to dedicated services.

More information on the programme and how to apply for practice accreditation can be found on our Veteran Friendly practices web page.

To learn more about the challenges facing the veteran population in England, particularly during the pandemic and what the RCGP is doing to help support practices care for veterans, listen to this RCGP podcast with GP and RCGP Veterans Friendly Practice clinical champion, Brigadier (Retd) Robin Simpson, Ashley Winter and Matthew Boulter.

New gender variance on eLearning courses

The College has produced two new eLearning courses for GPs on delivering care to transgender and non-binary patients. The first course is on the management of the adult transgender patient in primary care, and the second is on gender dysphoria in young people in primary care.

This is such an important area of medicine and one that evokes polarising opinion amongst patients and healthcare professionals alike. These modules aim to support GPs to navigate this complicated medical landscape based on evidence. Thank you to Sam Hall and Rafik Taibjee, authors of the first module, Margaret McCartney and Richard Byng, authors of the second, and Dirk Pilat, Toni Hazell and Jonathan Leach for overseeing the project.

These two new modules, funded and developed by the RCGP, sit alongside our suite of LGBT+ eLearning resources launched last year, commissioned by the Government Equalities Office as part of their LGBT Action Plan.

The College has also developed a position statement, published June 2019, on the GP’s role in caring for gender-questioning and transgender patients.

Virtual yoga for GPs

GPs are renowned for putting their patients’ health ahead of their own - but it’s so important to look after ourselves however we can. One way is through exercise and our Clinical Champion for Physical Activity and Lifestyle, Zoe Williams, is offering free virtual yoga classes every Monday 18:30 - 19:30 from to 11 January 2021. All ability levels are welcome. Register now.

NHS Looking After You Too initiative

I’d also like to flag the NHS Look After You Too coaching support service for GPs and primary care staff, to ensure you feel supported at work and can maintain good psychological wellbeing.

Coaching appointments are available Monday to Friday between 08:00 and 22:00 and provide an outlet to offload experiences and develop practical strategies to help manage the demands of working frontline during the pandemic. More information and registration.


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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