Reflections on my last out of hours session

14 January 2022

This Christmas I did my last out of hours session, ever, a 13-hour daytime shift in an Urgent Care Centre. As I drove home exhausted, I reflected how things had changed since my first GP on call 32 years ago. Back then I was on a one in seven rota –holding the bleep for 24-hours. Day and night, armed with an A to Z and Gladstone bag, I would traipse the estates of South London, struggling to find the right home as the door numbers were never sequential. Most problems related to acute conditions – infections, renal colic, and, given the area I practiced, patients with sickle cell crisis. I had access to an intermediate care facility – low acuity beds. So elderly patients who were ‘just off their feet’ or needing palliative care could easily be admitted for a two-week stay.

This Boxing Day was very different, much harder if I am honest. Not just because I didn’t know the patients but because they had problems not easily solved by a course of antibiotics or simple pain relief. Most, even those in care homes, could have benefited from intensive nursing care. I needed specialist advice. Neither were readily available. I was tested to the limits of my competence. The work at base reminded me more of a shift in Accident and Emergency than the Saturday emergency surgery I remembered. General practitioners are now pulled in many directions to offer our clinical expertise.

Now might be time to review our role in urgent and emergency care and we might want to consider that we can serve our patients better by stepping back into our consulting rooms (virtual or real) delivering what we know works and provides better outcomes, that is continuity of care.

Happy New Year,
Clare

Dame Clare Gerada, RCGP President and GP in South London

Updates from College Chair Martin Marshall

Advocating for general practice

With public focus shifting away from Covid-19 momentarily, at the College we’ve been working hard to keep the pressures facing general practice firmly in the media and politicians’ conscience.

The Guardian reported our concerns on Monday that efforts to recruit the 26,000 practice team members promised in the Conservatives’ 2019 manifesto needed to be stepped up. Our analysis found that around 9,500 full-time equivalent staff members, directly delivering frontline patient care, have entered the workforce since the pledge was made. This is progress, but not quite where we’d like things to be, particularly as we already know the concurrent target of 6,000 more GPs by 2024 is not on track.

Last night I was interviewed by ITV Tonight, ITV’s flagship consumer affairs programme, about the pressures general practice is facing at the moment. I made clear the impact pressures are having on the mental health and well-being of GPs and our teams, as well as the knock on effects on the rest of the health service. Thank you to Amir Khan, a College member and great advocate for the profession, who hosted the programme and gave a really balanced and insightful account of the issues facing both general practice and our patients.

Honorary Secretary Michael Mulholland also shared a day in his life in practice in the Daily Mirror. He outlined how general practice has changed during the pandemic, with increasing numbers of patients presenting with mental health issues and practice staff increasingly having to put up with criticism about remote care stoked by some parts of the media and some politicians over the last year. He also shone a light on the recruitment issues we know are being felt across general practice. You can see some highlights here.

Finally, I just wanted to mention that we briefed politicians ahead of a Westminster Hall debate in Parliament on GP access. Concerns were raised by MPs about constituents who were unable to secure swift GP appointments, but there was wider recognition of the challenges in general practice and that more needs to be done to support GPs and our teams. Minister with responsibility for primary care, Maria Caulfield, stated that ‘we owe a huge amount to GP staff for their efforts throughout the pandemic…they have been absolutely outstanding.’

Updated isolation guidance

Earlier this week, the Government published new guidance relating to health and social care staff (in England) who develop symptoms or test positive for COVID. COVID-19: management of staff and exposed patients or residents in health and social care settings. In the best interests of keeping the wider practice team and patients safe, we recommend that GP practices carry out a risk assessment before arranging return to work for staff members once the isolation period has ended.

Yesterday, it was announced that from Monday (January 17), self-isolation could end after five days following two negative LFT tests We will share any updated guidance for healthcare staff as soon as it’s available.

Practice teams in Scotland, Wales and Northern Ireland should keep referring to Health Protection Scotland, Public Health Wales, or Public Health Agency in Northern Ireland for country specific advice.

Extension of deadline for 2022 Conference abstracts

The deadline for submission of ideas for the opportunity to present at the RCGP Annual Conference in conjunction with WONCA Europe taking place 29 June to 1 July 2022 at Excel London has been extended until 23:59 (GMT) on Monday 31 January 2022.

Please note the various submissions rules on the website ahead of making any submissions.

Submit your idea here.

InnovAiT webinar

I’ll be in conversation with former Council Member and founder of eGPlearning Hussain Gandhi, also known as Dr Gandalf to his followers on Twitter, for an ‘Ask me Anything’ webinar for InnovAiT, the College’s journal for GP trainees, next Tuesday 18 January at 6.30pm.

The interview will explore the role of the Chair of Council - but is also likely to look into the unique challenges general practice has faced during the pandemic, the ways GPs and your teams have stepped up, and how the College has supported members throughout.

The livestream will be going out to the InnovAiT YouTube channel, Facebook page and Twitter page - and the audio will be copied over to the RCGP InnovAiT podcast.

Please join us and share details amongst your networks.

Covid testing in GP records - update

Following the government guidance changing to state that confirmatory PCR tests will no longer be required following a positive lateral flow test result, you may have seen that all reported positive LFT results have begun flowing into GP systems.

We have been in communication with DHSC and NHSD on this and understand the benefits of continuing to collect data to ensure practices have a record of patients who have reported a positive test. We are assured that no action for these results is required by practices.

Please note that for now it will not be possible to distinguish between assisted and self-reported lateral flow test results, although this technical capacity is being developed. You will be aware from the government guidance that PCR testing will still continue for people with symptoms, those requiring Test and Trace support payments, requiring PCRs for research or surveillance studies or those most at risk of becoming seriously ill from Covid-19 who would benefit from urgent therapeutics treatment. More information on testing here.


Post written by:

Dame Clare Gerada, RCGP President and GP in South London

Having first trained in psychiatry at the Maudsley Hospital, Dr Clare Gerada followed her father’s footsteps and became a general practitioner, working in her practice in South London for more than thirty years.

Over this time, alongside her clinical practice, she has held several national leadership positions including in 2010, Chair of the Royal College of General Practitioners, only the second women in its 55-year history to hold this position.  She has led the way in reforming how drug users are managed in general practice and was awarded an MBE for his services to medicine and substance misuse in the 2000 Birthday honours.

Since she has also led the development of a service for doctors and dentists with mental health problems, establishing and leading NHS Practitioner Health since 2008. This has been, not only a world first, but massively impactful, particularly on young doctors and consequently on the patients they look after and the teams in which they work.The service was awarded Outstanding by CQC rating in March 2019. Currently Clare not only still leads NHS Practitioner Health but has, in 2020 established a service for problem gamblers; Chairs the newly formed registered charity, Doctors in Distress, is co-chair of the NHS Assembly.

In 2020 she was made a Dame in the Queen’s birthday honours, making her, we believe, the first Maltese woman to receive this honour.  In November 2021 she became the President of the RCGP (only the second women to hold both Chair and President of the College in its 70 year history).  She is a highly respected NHS professional, whose views are listened to by NHS professionals and patients alike.

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