Reducing complex issues to binary opinions is easy, entertaining but cheap

8 January 2021 

A wit once commented that the world is divided into two sorts of people; those who divide the world into two sorts of people and those who don’t.

We seem to live in an age where there’s more people in the former group than the latter. So many of the big issues that face us are argued in black and white terms - lockdown or let COVID rip; spend our way out of a recession or austerity; science or religion.

But we don’t live in a black and white world, we live in a colourful grey one. Reducing complex issues to binary opinions is easy, entertaining but cheap. So, it was good to hear Elif Shafak, the wonderful Turkish-British novelist, talking about uncertainty on the radio the other day. She reminded us that people who are sure of their views often fail to listen, that in so many areas of life strong views are a sham. She advised that for many of our decisions we must trust our instincts and follow our intuition rather than seek the ‘right’ answer. And she reflected that whilst uncertainty can be scary and exhausting, artificial certainty is scarier.

In so many ways a GP’s view of the world, captured for all to hear.

Latest updates from your College

Cutting red tape for retired GPs

There’s no doubt general practice needs a larger workforce to achieve the challenging but necessary COVID vaccination targets, and the College is campaigning hard to ensure that the thousands of retired GPs who want to return to the frontline aren’t inhibited by unnecessary bureaucratic red tape.

Following the Opinion piece I wrote in the Daily Mail last week (unfortunately, we had no influence over the headline), we were pleased to hear the Prime Minister acknowledge the need for this to be quickly addressed - and the Health Secretary confirm in the Commons that some of the more dubious documentation would no longer be needed for retired GPs and other returners to the NHS who want to help with the vaccination effort. We’ve clarified that returning GPs don’t have to go via the bureaucratic NHS Professionals route and can apply directly to vaccination centres where local lighter-touch processes are in place. The College will publish a simple employment check list for these centres in the next few days.

Vaccinating 2m people a week simply won’t be achieved using the already stretched general practice workforce alone - even including retired GPs - and the College is therefore calling for any healthcare professionals who are willing and appropriately trained to be able to join the effort. Earlier this week that we heard the Vaccine Minister say pharmacists will be involved in the CVP and we’ve welcomed this announcement.

The situation is urgent, and we need all hands on deck. Myself and many of the College Officers have been making this point in the media over the last few days, including on the BBC 6 O’Clock News, Financial Times, The Times, Telegraph and Daily Mail

Appraisal suspension

We heard some positive news from NHS England yesterday evening that appraisals will in effect be suspended until 31 March, unless requested by a GP - something the College has called for following discussion at RCGP Council in November, given the intense pressures we’re all facing.

In some areas, Responsible Officers have suspended appraisals with the option for those who want to opt-in to an appraisal as a confidential discussion and an opportunity to signpost ongoing support if needed.

In other areas, the offer of an appraisal remains possible for all doctors, but it's fine if your circumstances making opting-out more appropriate for you.

NHS England say: "the balance... is between the need to make space for a doctor to get on with their professional workload and the benefit of taking time out for appraisal to help manage that workload."

Only you can judge what is best for you, but if you do decide to go ahead, use the 2020 process and remember that it should take you less than thirty minutes to prepare.

Workload prioritisation

While we’re working so hard to deliver the COVID vaccination programme, expanded flu vaccination programme and the care and services our patients rely on us for, something needs to give, and we heard from NHS England this week that we should start de-prioritising non-essential work (102 KB PDF).

We're working with the BMA to update our workload prioritisation document (357 KB PDF). It’s due to be published imminently and we hope you find useful when making decisions about what you can realistically do, and what you need to put on hold at this this difficult time. It’s not designed to be prescriptive - it’s important that decisions are made at a local level, to best meet the needs of local populations.

What we’re trying to get through in our media messaging is that while some non-essential services, such as routine health checks, might be suspended, general practice continues to be open, as it has been throughout the pandemic, and if patients are sick or concerned they should seek medical assistance.

Vaccinations for healthcare staff

NHS England issued its Operational Guidance: Vaccination of Frontline Health & Social Care Workers yesterday.

This document provides guidance on the process by which NHSE plan to ensure as many healthcare professionals as possible are vaccinated against COVID-19, in a timely manner, in line with JCVI’s priority list.  

The College will continue to work with NHS England to make certain that frontline general practice staff are vaccinated and therefore protected against COVID-19 as GPs and our teams continue through the next few difficult months. This includes the returning vaccination workforce who need to be vaccinated swiftly in order to be ready to deliver the expected increase in vaccine supplies early next month.

Vaccine supplies

The roll out of the Oxford/AstraZeneca vaccine in general practice really is going to be a game changer, and it was encouraging to see this start yesterday. I get the sense amongst those of you involved that there is huge enthusiasm to get on with it and protect our patients - thank you.

However, you can only ‘get on with it’ if you have supplies of the vaccine, and we’re aware that some practices have not had deliveries, or had scheduled deliveries changed without much notice. This should not be happening - it’s an added strain to an already tense and demanding situation, and confusing and disappointing for our patients.

We do understand that this is a huge challenge for NHS England - and that this is a new and complicated vaccination programme, and there will be teething problems. But we have spoken out this week, simply calling for practices to be communicated with clearly and reliably about their vaccine deliveries, that they are given as much notice as possible about deliveries, and last minute changes are minimised.

Please take a look at our comments in The Times, Mail on Sunday, Press Association, iNews and the Sun. You can also read my Opinion piece in the Mirror (63.9 KB PDF) on what general practice needs to make the CVP a success.


On Wednesday night I joined our latest #RCGPLIVE panel, hosted by Vice Chair for External Affairs Gary Howsam and featuring the JCVI’s Deputy Chair Professor Anthony Harnden, BMA GP Committee Deputy Chair Dr Mark Sanford Wood, RCN’s Public Health Lead Helen Donovan, and Royal Society of Pharmacists’ Director of England, Ravi Sharma. The topic was the vaccine.

We managed to cover several topics including but not limited to the vaccine rollout; government targets; the need to reduce the bureaucracy of getting returning GPs into the vaccination workforce; and the crucial role that the entire general practice team plays.

We discussed at length prioritisation of recipients of the vaccine in which the Deputy Chair of the JCVI said that practices should be prioritising outreach to vulnerable groups or hard to reach groups within the JCVI age bands - in the context of whether BAME patients should be included on the JCVI’s prioritisation list. We’ve been lobbying hard for this to be made explicit and are grateful to Anthony for his support.

There’s been a lot of debate on the prioritisation of vaccinations. This Vaccine Priorities document from the COVID-19 Actuaries Response Group gives some more insight into the rationale of the current process which you may find helpful.

We also discussed the decision to cancel patients’ second doses of the Pfizer vaccine and concentrate on ensuring as many people as possible get the first jab - something I know many members found hugely frustrating (and a lot of hard work) at the start of the week. I wrote to you all about this on New Year’s Day, so won’t repeat myself but you can read my message.

The full RCGP Live event is available on YouTube if you want to catch up on the discussion. 


As we see the number of cases of COVID increase, it’s important that the profession is aware of the risk of silent hypoxia in those with the virus. Having the ability to measure oxygen saturations at home is essential as evidence shows that identifying silent hypoxia at an early stage reduces morbidity and mortality. The ‘COVID@home’ oximetry programme has been launched to support primary care professionals.

A webinar is being held by the College and the Academic Health Science Networks on Tuesday 12 January at 13:00 and I’d encourage as many people as possible to join. We’ll be covering emerging evidence, the models of care available and how care can be provided practically. Register now.

BBC survey for Black, Asian and minority ethnic doctors

We’ve been approached by the BBC to assist with research looking into the experiences of Black, Asian and ethnic minority doctors throughout the pandemic, including the impact it has had on their mental and physical health.

Anyone interested is invited to answer a short, anonymous questionnaire, before 31 January 2021. We are told that the data will be held in accordance with GDPR rules and will not be forwarded on within or outside of the BBC. The findings will be used to inform a report for the BBC's national TV, radio news programmes and online platforms.

For further information please feel free to contact Amara Sophia Elahi at the BBC.

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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