Public engagement in health service recovery

26 June 2020

Continuing my theme of finding the silver linings during the pandemic, this week I'd like to reflect on public engagement and public valuing of the NHS.

I'd also like to update you on the work that we are involved in around the recovery of the NHS in Scotland.

We are very clear that a pan-NHS response is required for post-COVID recovery, and on the need to ensure that actions taken to recover one part of the system do not destabilise other parts.

Throughout these discussions, the need to support and protect general practice, and our patients, is foremost in my mind.

The national conversation

When we launched our policy report, From The Frontline, in June of last year, we included a chapter on the Patient Voice.

Patient involvement is vital to the development of a health service that is fit for purpose and meets the needs of patients.

Ensuring lay representation in service design - and recovery - is not without its challenges, but it is so important.

RCGP Scotland is committed to encompassing the patient voice in its work and has a patient group for this purpose.

Chair of P3 Patient Participation Group, Sonia Cottam, has been active during the pandemic in delivering public messaging through social media to reassure patients that general practice is open, but that it needs to be used wisely.

One of our key asks in From the Frontline was around the pressing need for a national conversation about safe and sustainable NHS usage in the face of rising need, expectation and demand, set against a backdrop of chronic workload and workforce issues.

Our call was for this to be a cross-party endeavour, led jointly with healthcare professionals and patient groups.

Changing models of primary care

While this call has not yet been delivered and we continue to press for action, we have made some progress on one of our other key asks. This was to work collaboratively with Scottish government and health boards to develop a public education campaign about how to understand and make best use of the changing models of primary care.

The landscape of primary care has changed rapidly over the last few years, with expansion of multidisciplinary teams (both in practices and the wider community) and enhanced roles for practice receptionists to provide more of a 'care navigation' role.

We know from our 2018 RCGP member tracking survey that patients were regularly reporting frustration and confusion in trying to understand and make best use of these new models of care, and that practices were feeling unsupported in helping patients to understand the changes which were often met with resistance.

Using the NHS wisely

Following a joint letter from RCGP, the BMA, and the Primary Care Clinical Professionals Group last year, we were grateful for the cabinet secretary’s formal support of such an initiative, and as a College, we have since been actively involved with discussions and workshops led by a communications agency to help shape this work.

Since the COVID-19 outbreak this work has understandably been paused. However, the need for a realistic conversation with the public about how to use the NHS wisely has never been more important and we will continue to press for this to be restarted in the months ahead.

The capacity across all our systems is likely to be significantly reduced for some time, underlining the importance of targeting our finite NHS resource according to clinical need.

There are a number of campaigns planned, revisiting some of the messaging in the RCGP '3 before GP' campaign, and promoting the launch of the enhanced Pharmacy First campaign, which will see additional roles for community pharmacy colleagues in managing minor ailments.

No matter when someone presents to the system, be it general practice (in or out of hours), NHS24, or the emergency department, this signposting needs to be consistently applied to allow everyone to get linked in with the right person, in the right place, at the right time.

We really are all in this together.

Over the past few months, we have witnessed an outpouring of public gratitude towards the NHS.

This has been apparent in the millions of pounds raised for NHS charities, the thousands of people who stepped forward to become NHS volunteers and the weekly Thursday evening claps on streets across the UK.

We need to harness this positivity and ensure that, as services begin to recover, the public continue to show their support through helping them to understand how they can best use NHS services, thereby supporting all parts of the health service to recover sustainably.

Health service recovery

Of course, throughout the pandemic, general practice has never closed.

We have remained open to our patients throughout this period, including on public holidays, providing non-COVID care in new and innovative ways, and reaching out to our most medically and socially vulnerable patients.

Our workforce has also provided the majority of staffing for the COVID-19 community pathways, has undertaken the vast majority of the complex and sensitive shielding work and associated care planning conversations, and has continued to provide urgent physical and mental health care throughout.

Our work in general practice may not be ‘shiny’ and high-tech, it may not hit the headlines in the way that other parts of the service do, but it is essential for NHS sustainability and is hugely valued by patients.

I am very proud of the work that we have been able to do, under extremely challenging circumstances, to keep our patients - and the wider NHS - safe.

Growing workload demands

As discussions continue at a national level around reopening services, I am clear about the workload demands that are already likely to fall to GPs and our teams in the coming months as patients live with the lasting medical, psychological, social and financial effects of COVID-19.

We are already beginning to deal with the backlog of problems that many of our patients have carried through the lockdown period and planning how we catch up on work that has had to pause, such as screening and management of long-term conditions.

We must ensure that any approach to reintroducing services is guided by accurate evidence of which services are most urgently required and is also considered through a whole-system lens, as we can’t do this alone.

It is clear that the 'new normal' in healthcare delivery will be very different to how it was before, partly through necessity and partly through design.

I will continue to work with colleagues across healthcare and with the Scottish government to ensure that the needs of general practice are recognised and elevated as we manage moving through this recovery period, alongside the needs of other frontline services that are also concerned about safely managing demand, such as our colleagues in emergency medicine. 

Richard Scott Lecture

Finally for this week, I wanted to let you know that the annual Richard Scott Lecture, which the College is hosting jointly with the University of Edinburgh and the Royal College of Physicians of Edinburgh will be taking place virtually on Thursday 2 July at 18:30.

This year’s lecture will be delivered by Professor Sir Michael Marmot and will be followed by a Q&A session.

The topic is ‘Social justice, health equity, and Covid-19’. I am delighted to be delivering the closing remarks for what is set to be a great evening. You can register for free now.

As part of the RCGP Health Inequalities Standing Group, we have also been working hard on various workstreams designed to highlight and bolster the role of general practice in mitigating against worsening health inequalities, and we were delighted that one of our jointly authored papers was published this week in BJGP Life.

Additional resources are imminently due to be added to the health inequalities section of the College's COVID-19 resource page - watch this space.

Post written by

Dr Carey Lunan, Chair RCGP Scotland

Dr Carey Lunan is a GP partner in one of Edinburgh's Deep End practices and is the current Chair of RCGP Scotland.

Prior to this, she held the role of Executive Officer for Patients and Public and Interface working. She also sits on the RCGP Ethics Committee.

Her priorities during her time as Chair include a focus on practitioner wellbeing, improving the interface between primary and secondary care, and growing and retaining the GP workforce.

She has made tackling health inequalities a high priority and has consistently called for the need to engage the public in a national conversation about the realistic role of the modern NHS and the importance of collective social responsibility.

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