GPs care about inequalities and want to focus on those with greatest need in their communities

5 June 2020

As a College, we haven’t said anything on social media about the #blacklivesmatter movement or the appalling death of George Floyd and the aftermath that we are seeing in the US, and across the world. We don’t want to make statements without substance or without action.

Deeds not words: Emmeline Pankhurst’s mantra.

All forms of racism are abhorrent and inequalities must not be tolerated. In general practice, we see inequalities on a daily basis, not just in practices like mine in East London but across the whole of the UK. The inequalities have never been more apparent than during COVID-19. And we are not simply referring to our patients and communities: 12 doctors have died during this pandemic, 11 BAME. Who said that COVID-19 was a great leveller? It isn’t.

This week we’ve seen a report by Public Health England into why black and ethnic minority people are disproportionately affected by COVID-19. It raises more questions than answers. It did not, for example, take into account social factors such as type of work which we know have an impact on health outcomes. We await the next report from PHE - and its recommendations about what we can do to make a difference.

In the meantime, the College is committed to addressing inequalities of all kinds, however challenging the task. It was a GP after all, the late great Julian Tudor Hart, who in 1971 first drew attention to the Inverse Care Law. Sir Michael Marmot addressed our Annual Conference last year with a hard-hitting description of what he thinks needs to be done and what isn’t being done to address health inequalities. At the end of the presentation he received the longest and most heart-felt ovation I have ever seen at any conference. Take a look at RCGP Scotland Chair Carey Lunan’s recent interview with Michael.

GPs care about inequalities and want to focus on those with greatest need in their communities. That is why the College is now actively promoting the public health or community health model of general practice, alongside our commitment to biomedical and psycho-social care, building on what we are learning from the COVID crisis. We have a role to play and we’re ready to play it.

It won’t be easy. It should be, but it won’t be. As a College we value all our members, regardless of their race, gender, sexuality or any other of their protected characteristics, equally. And as GPs, we do the same for our patients.

As always, take care of yourselves and your families and thank you for all you are doing for your patients in these difficult times.

General Practice after COVID-19

General practice post-lockdown is occupying a lot of College thinking and we are already having regular discussions with a wide range of political and policy stakeholders across the UK.

On Wednesday, the College Officers and I had a productive meeting with Sir Simon Stevens, Chief Executive of NHS England, which covered remote consulting, reducing bureaucracy and the public health aspects of general practice.

I have also been invited to sit on the Clinical Oversight Group of a new NHS@Home initiative to provide remote monitoring services that will enable personalised clinical support to be delivered virtually in the setting of a patient’s home.

At the first meeting, I emphasised the importance of a strong evidence base to underpin this work and the need for technology to be driven by patient need, not the other way round. This week also saw the first meeting of a new ministerial working group, chaired by England’s primary care minister, Jo Churchill, to discuss ‘recovery, reset and renewal’ in general practice after COVID-19.

Shielding patients

Along with a number of measures to ease lockdown, the Government announced a modest relaxation of restrictions for shielding patients on Sunday. The changes outlined are reasonable when you consider the positive benefits for shielding patients’ mental and physical health – something that has been of great concern for many members. However, it is important that patients understand the changes are relatively minor and that we’re certainly not at a point where lockdown is over. Read my full response.

While the changes aren’t drastic, they have caused confusion among patients and the profession. I have raised both privately and publicly my concerns and frustrations about the lack of communication with GPs - and the College - ahead of this announcement being made. Ultimately, we are the ones providing care to shielding patients, some of our most vulnerable, and we need to be properly informed, so we can provide them with the best possible advice and care.

Exam update

Earlier today (5 June), our first ST3s started using the new IT system supporting our new Recorded Consultation Assessment, which we are introducing as a temporary replacement for the CSA during COVID-19.

Developed in partnership with FourteenFish, this is a major achievement, especially as the College has had only a few weeks to create a completely new assessment that is robust enough to demonstrate the high standards of clinical competence required for patient safety in general practice.

We’re sending out regular communications to all trainees on all aspects of the exam – there’ve been three this week – be sure to keep up to date.

The RCA will run until at least December 2020 and it is unlikely there will be any move away from it until August 2021 as any change to assessment methods will need to be communicated to trainees well in advance. The booking window for the July sitting of the RCA will open on 11 June and the national Statutory Education Boards that oversee GP training across the UK are implementing a prioritisation system to ensure that those who are due to complete training at the beginning of August have the opportunity to complete on schedule.

We have also confirmed that the fee for the new RCA will be £1050. This is cheaper than the CSA, and reflects the fact that the direct cost of running this examination will be lower, in the main part because we will not need to use the examination circuit or role players. However, there are still significant delivery costs, not least the need to double mark this exam to ensure reliability. The College remains committed to our principle, set in 2007 when the new MRCGP was introduced, that we will not make a profit from the exam. For those who paid to sit the CSA in March, April or May, and carried their fee forward, we will begin to process the refunds with immediate effect and get the payment to you as soon as we can.

We are extremely grateful to all our trainees for their continued commitment and understanding during this difficult and worrying time. COVID-19 has caused significant disruptions to GP training and we are working hard to ensure that those ST3s who were due to CCT this summer will be able to exit training within roughly the same timeframe as they would have normally.

Support our work on patients’ transition from paediatric to adult services

The RCGP has been working with the charity Together for Short Lives to produce eLearning resources to improve the transition from paediatric to adult services and care, for young people aged between 14-18 with severe health problems and life-limiting illnesses.

We are reaching out to you and your practices to help us with this project by identifying young patients with a number of life limiting conditions and engaging with them to see how prepared they are for the switch to adult services. It’s something many find tough, and something that isn’t always adequate.

If you’re interested in signing up your practice, we have produced a toolkit to explain how you can help. Your input will inform a number of eLearning tools and resources to sit on the College’s Online Learning Environment.

Volunteers' Week

As National Volunteers’ Week draws to a close, we’d like to personally thank the College’s incredible volunteers and officers for all the time they give and the work they do to support our members, the wider profession, and patients.

We’ve been going through some of the toughest times many of us can remember and working in the NHS, GPs have been at the heart of it. It’s been inspiring to see so many volunteers come forward as part of the COVID-19 response, providing assistance to those who need it, including GPs on the frontline.

We couldn't do what we do without you. Thank you.


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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