A call for clarity for GPs on testing, tracking and tracing

22 May 2020

First, the exam which continues to be a major focus of our efforts.

Work to develop our new assessment to temporarily replace the Clinical Skills Assessment of the MRCGP exam continues at speed. This is now known as the Recorded Consultation Assessment (RCA).

Earlier today, we wrote to trainees with details of our new candidate handbook and examination policy, outlining the changes and requirements that have been brought about as a result of COVID-19.

Following a competitive tendering exercise, we have appointed FourteenFish to develop a bespoke IT system to securely record and store video and audio consultations.

We are working hard to make the new system live for candidates to use from early June and the RCA will be the method of assessing consultation skills within the MRCGP for at least six months.

It also includes the latest information on additional sittings for the Applied Knowledge Test and latest guidance on Workplace Based Assessment, developed in partnership with COGPED.

College drives calls for clear plan for testing in the community

Elsewhere, whilst COVID-19 testing in hospital settings appears to be largely sorted, there is still no clear strategy for testing in the community.

I have written to Matt Hancock, Secretary of State for Health and Social Care, calling for a move away from hitting arbitrary targets to a comprehensive plan that will test the right people at the right time and ultimately avoid a second wave of infection. 

You might have heard me speak about this on BBC Radio 4’s Today Programme on Saturday morning (9 mins in).

I called for clarity for GPs on who should be tested and how often – as well as reassurance that delays in getting testing results will be addressed, and that work to improve the accuracy of the current test is ongoing. From your feedback, I know these are key issues for members.

I also called for more detail around the forthcoming track and trace system – increasingly likely to be central to any easing of lockdown measures, including opening schools – specifically what contribution GPs might reasonably make.

My comments also appeared on the BBC, the Guardian and in The Financial Times this morning.

Perhaps as a result of the letter and media work (politics works in mysterious ways…), on Monday I was invited to meet with Baroness Dido Harding, recently announced lead for the Government’s test, track and trace programme and Nikita Kanani, the NHS Director of Primary Care.

We had a positive discussion and our thoughts about what a good system needed to look like (more than just an app) were well received. I also had a constructive meeting with Matthew Gould, NHSx CEO, about the app and where it fits within a wider track and trace strategy.

The speed in which these meetings happened, and the way in which our concerns and ideas were received, confirmed that the College is a trusted and influential player in the development of this work. I’ll keep you posted as we find out more.

GPs in care homes

In my media interviews, I frequently - and unfortunately - find myself having to defend the brilliant care most GPs provide to patients in care homes. You can read my recent letter to the Daily Mail.

Given the age and vulnerability of the people who live in care homes, the devastating impact of the virus is not a surprise, though the scale of the crisis has highlighted that care homes have not been a priority for successive governments – and this must be addressed.

We all recognise that is our duty as GPs to deliver care to all our patients, particularly those who are most vulnerable. We mustn’t let the politics of the situation call this into question.

We need to be confident that when we look back on the pandemic, GPs’ commitment and integrity in this area will be clear for all to see.

So many GPs and their teams are going above and beyond, and I was heartened to hear earlier this week that 100% of care homes have identified a named clinical lead in England after what NHSE are calling a ‘record uptake’. 

This coming Wednesday, 27 May at 3pm, the College is hosting a webinar on primary care in care homes during COVID-19. Chaired by joint Hon Sec Jonathan Leach, it will share examples of current good practice and collaboration between primary care and care homes and discuss resources to support virtual ward rounds.

You can register now and I’d encourage you all to join to take full advantage of the Q&A session. If you are unable to attend, the session will be recorded and shared afterwards.

Vital primary care research

The COVID-19 pandemic has exposed health inequalities across age, ethnicity and socio-economic divides.

Last Friday The Lancet published a study using data from the College’s Research and Surveillance Centre, led by RSC Medical Director Simon de Lusignan. It showed, for the first time regarding COVID, that within a community setting, these inequalities are stark.

As the NHS recovers from the pandemic, GPs will play a crucial role in mitigating the effects of the worsening heath inequalities – and understanding this data, will be vital in informing our response. 
The RSC, based within the University of Oxford, is busy working on the PRINCIPLE trial, which is conducting studies into treatments for COVID, and will likely be integral in testing vaccines further down the line.

More than 1,200 practices are now signed up to the RSC, but the more data we have the better, so please register your practice.
Of course, the RSC is not the only organisation conducting research into COVID-19.

I’m sure you’ve all been experiencing increased demand from different sources to provide patient data to support COVID-19 response.

NHS Digital has also been legally directed to collect and analyse data for the duration of the COVID-19 emergency period and have issued a Data Provision Notice (DPN).

We, along with the BMA, asked NHS Digital to find a practical solution that reduces the administrative burden and risk for GPs as these data requests are being processed, allow our teams to focus on providing patient care.

The GPES Data for Pandemic Planning and Research (COVID-19) will be collected from GP systems fortnightly, all data access requests will be processed by NHS Digital.  As part of that process, they will consult with representatives from the College and the BMA on all requests before sharing data.
I’d encourage you to register your participation on NHS Digital’s Calculating Quality Reporting Service in the usual way, to comply with the DPN as this sets out what data is being extracted and for what purpose.  
The College’s Health Informatics Group, chaired by the brilliant Marcus Baw, are currently in the process of determining who will be the College representatives for this consultation work, which will be remunerated. If you have an interest in research, privacy and GP data, please email policy@rcgp.org.uk.

Finally, the Officer Team and I are always keen to meet as many members as possible via the College’s Faculty network, and the wonders of technology allow us to do this remotely during these difficult times. If you do have a forthcoming event and would like one of us to join, please let us know.
Thanks for all the work you are doing and will undoubtedly be doing over the Bank Holiday. I hope you manage to get some downtime.

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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