Giving evidence to House of Commons Health Select Committee during COVID-19

1 May 2020

This morning I gave evidence to the House of Commons Health Select Committee. It was wide-ranging, and I had the opportunity to talk about the excellent work that is happening in general practice during this pandemic, not just treating people with COVID-19 symptoms, but those with unrelated conditions and illnesses, as well. I stressed how innovative and adaptable our profession has been, and how it is vital that we retain some of the technological advances that have been made post-COVID. More about that later.

RCGP Chair at the Health and Social Care Committee to give evidence on COVID-19 - 1 May 2020

GP trainees

Concerns around the future of our ST3 trainees who have had their training suspended as a direct result of the pandemic were also raised at the Committee.

Earlier this week, I wrote to Jeremy Hunt, Jo Churchill, the Primary Care Minister for England, and various MPs to explain our current position 

Our Chief Examiner MeiLing Denney, Vice Chair for Professional Development Michael Mulholland and the exams team are working flat out to reach a solution as quickly as possible. 

As I’ve said many times before, whilst we are responsible for running the exam, many of the important decisions that need to be made to resolve this issue fall outside the control of the College.

The GMC have made it very clear that CCT and entry onto the GP register will not be possible without passing the MRCGP, so this week I wrote to trainees with the news that we have now committed to running the Applied Knowledge Test in July.

We also had our weekly meeting with all the organisations involved in GP training and assessment across the four nations this afternoon, during which we presented a number of options for assessment of clinical skills, in line with trainees’ desire to have some flexibility.

The group is close to achieving a consensus on the best way forward and I will be writing to trainees with further details of how the preferred option will work and what will be required as we develop the detail.

Vulnerable patients in care homes

Something else that has dominated the airwaves has been care in care homes, where many of our most vulnerable patients live. As we know, care homes have been badly affected by COVID-19 – the extent to which is emerging with better testing in the community, and the inclusion of community deaths in the daily statistics.

The focus on care homes is welcome, not least because it highlights several areas that must be addressed short-term and long-term – most obviously the historical underfunding of this vital care sector. I’d like to take the opportunity to thank you for the work you are continuing to do delivering care in your local care homes, in particular during the crisis when you are having to use unfamiliar approaches in such distressing circumstances. Your efforts mean that patients continue to receive the treatment and care they require. We’ve published a position statement on the GP’s role in delivering care to patients in care homes, which you can read in the FAQ section of our website.

RCGP Chair Martin Marshall appeared on Channel 4 News on 23 April

We received some very positive news this week, with the announcement that controlled drugs, such as morphine, for people at or nearing the end of their lives can now be repurposed in care home and hospice settings. This is something the College has been lobbying for – most recently with our letter to Home Secretary Priti Patel last week, which was featured on Channel 4 News and in the Financial Times – and will make a genuine difference for our patients, and those trying to source the appropriate medication for them. The rule change doesn’t cover people living in their own homes, so there is still work to do, but this is a significant step forward.

We’ve also co-produced a document (86 KB PDF) outlining priority medicines for palliative and end of life care during a pandemic. It sets out the first and second choices for these medicines and aims to enable the NHS to conserve supplies, switch to alternatives drugs when required and minimise waste. I hope you find it useful.

The future of general practice

Perhaps it feels premature to look to the future, but we need to do so. COVID-19 has had a dramatic impact on the ways we work in general practice. It is clearly ongoing and very much at the forefront of our minds and work - but it’s useful to reflect on the positive and negative consequences of the pandemic.

Despite all its harm, COVID-19 has presented an opportunity for general practice to test out potentially beneficial processes and ways of working. It has shown that GPs and our teams are flexible and able to adapt quickly to change. We are making better use of technology, triaging patients and utilising remote consultations via telephone or video.

Many clinicians will have welcomed the introduction during the crisis of a higher-trust, lower-checking ethos which has resulted in a reduction in time spent on tasks such as contractual compliance and both organisational and professional regulation. General practice has also been more heavily involved in activities which might loosely be classified as ‘public health’, such as community health planning and clinical pathway redesign. And there has been an increase in the engagement in community-based research - vital in minimising the damage caused by the pandemic.

None of this would have been possible without your swift adjustment to these new ways of working, so thank you.

The next step is to look for general practice to identify, develop and embed the positive changes being implemented as a consequence of the crisis, and discard those that were necessary during the crisis but might be damaging if maintained.

The College has launched an initiative to engage a wide range of people in a consultation about the post-COVID future of general practice. The hope is that it will encourage us all to rethink what is important and use the COVID-19 crisis as an opportunity to proactively improve our specialty. Watch out for more information about how to contribute to this work.

Thanks to GP returners

I’d like to take this opportunity to extend my gratitude to the thousands of you that have offered to return to practice to aid the crisis. Although the demand for support may currently seem slightly diminished, this pandemic is a ‘marathon not a sprint’, and I can assure you that your reinforcements are greatly appreciated now and will be essential during future phases of COVID-19. I hope that your return to general practice, will remind you how brilliant being a GP is, and may perhaps encourage you to continue to contribute when the crisis is over.

Yvonne Carter Award Winner

Finally, I am delighted to announce this year's Yvonne Carter Award Winner, Dr Sarah Mitchell from the University of Sheffield. The award recognises excellence in early career research and the judges were impressed with Sarah’s focus on palliative care and end of life care and her strong leadership in this area. Congratulations to Sarah on this fantastic achievement.

Post written by

Professor Martin Marshall, Chair of RCGP Council

Martin Marshall is a GP in Newham East London and Professor of Healthcare Improvement at UCL, Programme Director for Primary Care at UCLP Partners. He leads Improvement Science London, an initiative to promote and embed the science of improvement across the health service and academic sectors. He is immediate past Vice Chair (External Affairs) of the RCGP.

Previously he was Director of R&D at the Health Foundation, Deputy Chief Medical Officer for England and Director General in the Department of Health, a clinical academic at the University of Manchester and a Harkness Fellow in Healthcare Policy.

He has been a GP for 28 years. He is a fellow of the RCP and FPHM, and was a non-executive director of the Care Quality Commission until 2012.

He has over 200 publications in the field of quality of care and in 2005 he was awarded a CBE in the Queen's Birthday Honours for Services to Health Care.

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