Response of GPs and our teams to COVID-19 has been well recognised

7 May 2020

First of all this week, I'm pleased to report a major breakthrough regarding the difficult issues around CCT for our final year trainees who were due to exit their training this summer but whose plans have been severely disrupted as a result of COVID-19.

Yesterday, we announced that a 'recorded assessment' will be used to assess the clinical skills of this cohort of trainees, rather than the usual CSA exam. This is a temporary and pragmatic measure to get us through the pandemic and ensure that as many ST3s can join the general practice workforce as planned.

This decision is the result of weeks of deliberation by a partnership group of the College and all the main organisations involved in GP assessment and training across the UK. I would particularly like to thank Michael Mulholland, Vice Chair for Professional Development, for his remarkable leadership of this work.

Now we have the enormous task of delivering an assessment within a matter of weeks that is reliable and meets the necessary standards of patient safety, and work is already underway in earnest.

We are also committed to running the Applied Knowledge Test in the summer and are currently in talks with Pearson Vue who run the regional assessment centres to ensure that logistics such as social distancing are in place.

There is a lot to organise in a very short time so we ask ST3s - and ST2s who were also booked to do their AKT - to bear with us and we will be writing to you all soon with next steps.

Again, I would like to thank all our trainees for the incredible patience and professionalism they have shown during this incredibly difficult time. Despite the disruption and accompanying worry and uncertainty, the contribution of our trainees to the COVID-19 effort has been magnificent. The future of our profession is obviously in very safe hands.

Adjusting to the new normal

It feels like we're moving towards the next phase of the pandemic. There have been remarkable efforts across the NHS to deal with the acute crisis, and while the focus has largely been on intensive care units and ventilators, attention now seems to now be shifting towards community care. The outstanding contribution that GPs and our teams have made to the effort so far will continue for the foreseeable future. But what does that mean for us?

On a basic level, it simply means we will carry on. We will carry on looking after patients with the virus, be that remotely or face-to-face in COVID hubs and care homes; we will carry on providing healthcare for non-COVID health issues; we will carry on focusing our efforts on those with the greatest need; carry on providing end of life care; carry on with business as usual.

But, that's on a basic level. The reality is we're not merely working as we usually would but rather we've adjusted to a new normal.

General practice is truly remarkable in its flexibility and innovation - and in recent conversations I have had with Jeremy Hunt, Chair of the Health and Social Care Committee, and Simon Stevens, Chief Executive of NHS England, the response of GPs and our teams to the pandemic has been well recognised.

Finding the right balance

As ever, we continue to update our website and COVID-19 resource hub almost daily. This week, I’d like to flag some excellent resources produced by our Health Inequalities Group, which highlight some actions GPs and our teams can take to promote health equity and reduce some of the impact of health inequalities during the COVID-19 pandemic.

I caused bit of a stir this week after I was quoted in a front page article in The Sunday Times, challenging suggestions that over-70s might have greater restrictions put on them when lockdown is eased. Some people gave me a hard time for 'not taking COVID seriously', others (not just the over-70s) praised me for being a 'libertarian'.

My point was simple: age is a blunt measure of risk and our job as GPs is to balance population health needs with the individual health needs of our patients. At the height of the crisis the emphasis has, rightly so, been focused on the population as a whole but as the situation changes, our voice as advocates for individuals will need to be heard.

Most people I speak to believe that our job as GPs is to present information to patients and to support them to make decisions that are right for them personally. The other day an 89-year-old patient said to me 'I know I'm at higher risk if I meet people, but I want to hug my grandchildren', and last weekend I read a newspaper article that stated, 'preserving life isn't the same as living life'. Getting the right balance isn't easy territory but it's what GPs do so well.

Research is vital

Speaking of things GPs do well: research. Now more than ever, research is vital in helping us to understand COVID-19, and I’m proud of the work going on via our Research and Surveillance Centre, not just monitoring and analysing activity in general practice, but playing a leading role in the PRINCIPLE trial, that will hopefully help to find a treatment and eventually a vaccine for the virus.

The Department of Health and Social Care and Office for National Statistics launched a major long-term study to track the spread of COVID-19; gain a better understanding of immunity levels; and find out how many people may have already been exposed.

GPs are being called on to aid this study by informing participants and communicating test results. In doing this, we'll have a duty of care in ensuring patients who may be asymptotic, and therefore surprised by a positive result, to get the support they need. Again, something GPs do so well.

NHS app testing

Elsewhere, we heard some more details about the Government’s forthcoming 'test, track and trace' scheme, with NHSx's new contact tracking app, being tested in the Isle of Wight.

The app may be central to the next stage of tackling COVID-19 and aiding the safe lifting of lockdown restrictions. However, it's important we’re aware of potential limitations: it is thought that the app will need around 80% uptake to be effective; there are questions around its ability to run as a background app; and perhaps most importantly for GPs, is a need for clarification around privacy issues. We also don't know, yet, if or how the initiative, or at least the testing results that come from it, will be linked to GP patient records – you might have seen my comments in The Guardian highlighting how useful this would be to enable us to deliver holistic care to patients.

We'll be keeping a close eye on the details that unfold and, of course, in due time will make our position clear. Huge thanks to Marcus Baw, Chair of the RCGP's Health Informatics Group, for the work he is doing to advise us in this area and other areas relating to information and technology.

Observe GP launch

Finally, and related to our future workforce, I'm delighted that our recently-launched work experience scheme, Observe GP, has already had more than 3,500 sign ups. The initiative offers aspiring medics aged 16 and over insights into general practice via a free online interactive video platform. It's also been accepted by the Medical Schools Council as a suitable element of relevant experience for students applying to med school. It's an excellent scheme, so do share it amongst your networks.

Keep safe, look after yourselves and thanks again for everything you are doing.

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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