The importance of maintaining a high trust ethos when managing professional activities

15 May 2020

I met with both Secretary of State for Health and Social Care Matt Hancock and leader of the opposition, Sir Keir Starmer, this week, giving me the opportunity to praise GPs and our teams during this pandemic at the highest levels.

It also gave me the opportunity to voice our frustration with aspects of the government’s COVID-19 testing efforts. We need to move from trying to hit arbitrary targets to having a comprehensive plan that is joined up across health, social and community care, including care homes.

I also met with Matthew Gould, Chief Executive at NHSX. The forthcoming COVID-19 contact-tracing app they are developing is being presented as a key component in the government’s test, track, and trace approach to the next stage of tackling the pandemic.

It’s an interesting and innovative approach – but it won’t work in isolation. It needs to be one part of a wider strategy to lifting the lock-down (tech-enabled, good old-fashioned public health, in fact). And there are many unanswered questions that we have raised around ethics, practicalities, and whether GP records will be linked with testing results.
We’ll keep you updated with any developments.

Shifts in workload as we assess the future

Continuing my reflection of COVID-19’s impact on general practice and how it will change our work in the future, I am particularly struck by the dramatic reduction in administrative workload since the outbreak. The College’s Research and Surveillance Centre shows it is down 28% on this time last year.
This is partly the result of less time spent on compliance with contractual obligations across UK, especially in England, where Quality and Outcomes Framework (QOF) still remains and where a high-trust rather than box-ticking checking approach has been adopted during the crisis.
We want to maintain this in post-pandemic general practice, and we are making a strong case to government about the importance of maintaining a high trust ethos when managing professional activities – and highlighting that the high costs of these compliance activities could be more beneficially invested into direct patient care.
The pandemic has also seen the postponement of appraisal for most doctors until the end of September. We know from surveys that GPs understand the important role of appraisal but are pressured with the heavy workload and provisions that these tasks require.

We now have a unique opportunity to ensure that appraisals post-COVID are focused on the support and wellbeing of clinicians. For that to be truly effective, there will need to be a dramatic reduction in the burden of the pre-appraisal documentation. Led by the Academy of Medical Royal Colleges appraisal lead, our very own Susi Caesar, the RCGP are already working to try to make this a reality.
As we develop our vision for what general practice will look like after the pandemic, we have held a series of virtual meetings to try and gather input and information from our Council members, as well as our Patient and Carers Participation Group, RCGP Committees, Groups and Faculties, and interested members.

These have been incredibly insightful, covering a broad range of topics, including how to harness the benefits of the ways we are currently working; moving forward with workforce expansion to meet future patient needs; and minimising regulation and bureaucracy to improve workload.

We’re also calling for written responses from all of you to our consultation. For more information, please see the consultation response form. The deadline is Monday 18 May.

Workplace Based Assessment for ST3s

I mentioned last week that we are working exceptionally hard to develop a new recorded assessment as a temporary replacement for the Clinical Skills Assessment during the pandemic, to enable our current cohort of ST3s to gain CCT as planned this summer.
This week, we have updated the guidance on Workplace Based Assessment requirements during COVID-19 for those ST3s who have not yet taken the CSA and/or Applied Knowledge Test but who have had a previous ST3 Educational Supervisors Review. We have developed this guidance with COGPED – the educational body for Postgraduate GP Directors – and there’s also a useful FAQ.

Meeting with Faculty Chairs

The disruption to GP training during COVID-19 – and its impact on our trainees – was also one of the issues on the agenda for our regular Zoom call with Faculty Chairs on Wednesday. These are hosted by our Vice Chair for Membership, Mike Holmes, which I join in to update Faculty leaders about the College’s response to COVID-19, as well as giving them a chance to ask questions and raise any concerns. 
We talked a lot about the future of the College – and the profession – after COVID-19 and how we might adapt in order to provide the best support possible to our members locally. 
There was a lot of constructive thinking and challenge – and lots to reflect on and take forward.

All our Faculties have faced – and are still facing – huge challenges as the pandemic has meant that all face-to-face CPD events have had to be cancelled and all Board meetings are now remote. However, our Faculty Chairs remain resolute and I thank them all on behalf of the College for the time and commitment they continue to invest in ensuring that our local ‘voice’ is a strong one.

South Yorkshire North Trent Faculty AGM

Talking of remote meetings, I was delighted to join the South Yorkshire and North Trent Faculty AGM by Zoom last night for a superb meeting that was intellectually stimulating and good fun too!
Thank you to Chair Karen Forshaw, Provost Amar Rughani and all the members for their warm welcome, and for speaking with such passion. SYNT is such an inspiring example of local member activity and long may this continue.
Thanks also to Karen for her work with the media. She’s been working hard to highlight the role of GPs during COVID-19 and her regular ‘diaries’ on BBC Radio 5 are brilliant!

#RCGPTogether webinars

Elsewhere, Vice Chair Gary Howsam, and I hosted the first #RGGPTogether LIVE webinar last Thursday, which focussed on innovation and technology advances in general practice during the pandemic. This is also something I’ve spoken to GP Online about this week, with a particular focus on the impact of remote consulting on relationship-based care.
Thank you to everyone who submitted questions during the live Q&A, which is available to watch back.


More than 70 people joined us live and the recording has since been streamed over 600 times. The next #RCGPTogether LIVE will be next Wednesday, 20 May at 19:00. The topic will be mental health and wellbeing and RCGP President Amanda Howe will chair.

World Family Doctor Day

Talking of Amanda – immediate past Chair of the World Organisation of Family Doctors (WONCA)  – this coming Tuesday is World Family Doctor Day. 
This year’s theme – not surprisingly – is ‘Family Doctors on the Front Line’ and the 150 countries around the world where WONCA has members will be sending stories of their experiences as to how COVID-19 has altered how we work as GPs. 
Our work with WONCA helps the world to see the value of general practice, and to support its development as a key part of an integrated, cost-effective and high-quality health service. So, on this day, let’s celebrate our efforts – not only in the UK, but worldwide!

Taking time for yourself

Finally, the recent weeks and months have been relentlessly full of new and unprecedented challenges and pressures. We must ensure we are getting some well-deserved respite from this, and using annual leave is a good opportunity to refresh and take time for yourself. 
It is so important that we maintain good health and wellbeing, and I would encourage all of you to update your membership records with your mobile number, so you can receive our new wellbeing text message service, which aims to support and promote self-care to all our members.

Thanks again for your brilliant work serving your patients and communities.

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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