College Chair Kamila Hawthorne addressed members this morning at the RCGP annual conference
Publication date: 19 October 2023
College Chair Kamila Hawthorne addressed members at the RCGP annual conference in Glasgow this morning.
You can read her full speech here.
Good morning, everyone, and a very warm welcome to the 2023 RCGP annual conference.
My name is Kamila Hawthorne, and it’s my privilege to address you as your Chair of Council.
However, before I get started, I would like you to join me in a minute’s silence to show support and solidarity with all of those who are victims of the Middle East conflict.
Our hearts go out to all those directly affected by this devastating situation.
To those of you here today and our many College members who have family and friends in the region.
And to our healthcare colleagues who are trying to do their jobs in the most terrible conditions imaginable.
I’d like to begin by telling you a little bit about me.
I’m delighted to be the first working GP in Wales to become chair. I’m equally delighted to be the College’s first-ever South Asian woman chair.
We’re an increasingly diverse membership, which is a real strength, and one of my great pleasures is to be able to show that I have a professional and personal life that I know chimes with many of you.
I’ve been a GP for 35 years now, working in Nottingham, Manchester, Cardiff and now in Mountain Ash, in the Welsh Valleys. My research and clinical working interests since 1991 have been in health inequalities and access to health services, with a focus on diabetes. And as I’m sure we all are, I’m passionate about supporting patients to get the care they need, particularly the most vulnerable.
As a salaried GP in a deprived area of South Wales, I’ve seen how general practice has changed in recent years - especially the tsunami of work that landed on us a few months after the first Covid lockdown. In all my years as a family doctor I’ve never seen anything quite like it.
What I’m most worried about is that the most valuable thing we can offer as GPs is in danger of being lost – time to care. Time to listen to our patients, understand a little about their lives, and see the wider issues that have led to their health problems. Seeing people as people, with hopes and dreams, lives to be lived as best they can, with their families, in their communities – not a collection of symptoms with a chatbot approach to diagnosing and treating them.
Let me tell you about Jim, a man in his early 60s, who I saw for the first time a few months ago. He has COPD and heart disease and came to see me with shortness of breath and a non-productive cough. While I examined his chest, he began to tell me about his daughter, who had been hospitalised with cancer during the first lockdown. He hadn’t been allowed to see her due to COVID restrictions and found out via a phone call that she had died of Covid, contracted in the hospital. He had carried this burden for 18 months, unable to articulate his grief or confide in his wife or surviving daughter. Of course, the examination stopped while I listened – the medical intervention happened anyway but he needed to talk to a trusted person confidentially and pour his heart out.
This act of “bearing witness” has huge value for our patients, but it’s vastly underappreciated by government. They don’t see it, have no way to measure it, and don’t realise what will be lost if general practice flounders. Our tried and tested approach to our patients is an integral part of primary care. It’s why the public talks about ‘my doctor’ rather than ‘the doctor’.
While being chair is an immense privilege, I’m under no illusion about the challenges of leading the College as GPs struggle with arguably the toughest workforce and workload pressures in the history of our profession. I know how concerned you all are – I share those concerns.
There’s no doubt that general practice will be a key battleground in the run-up to the next general election.
The last thing we want is for general practice to become a political football, with parties of all persuasions kicking around vote-winning promises about tougher access targets that will be undeliverable without addressing the root cause of workload and workforce pressures. It will be difficult to stop this from happening and we need to be in a strong position to resist it.
That’s why the College has produced a Manifesto so that we can clearly tell politicians, and the public, what we believe is needed to bring about effective, long-term change.
While I’m delighted that we’re launching the Manifesto here in Glasgow, you might ask why we’re launching our health policy asks for England at a Scottish conference. We’re a UK college, and the issues we’re facing as a profession are affecting us all – we’re asking all of you for your support. We must fight our corner together, as one.
Given this may be almost the last chance I’ll have to speak to you directly before the next election, I want to use the opportunity to do three things:
Firstly, to examine the issues we’re facing, and share the College’s calls as set out in our Manifesto.
Secondly, to share some of the fantastic work that GPs across the UK are doing, despite the challenges we face.
Thirdly, to invite you all to get involved. I want to mobilise membership to come together and fight even harder for our patients and the future of our profession.
The RCGP Manifesto isn’t just for College Council to use; it’s for all of us. The biggest challenge we have is getting decision-makers to listen – really listen – and we all have a responsibility to ensure our voices are heard.
Because I’m convinced that the solutions to our problems don’t lie with politicians, but with those who have dedicated their professional lives to caring for patients. The answers, I would argue, lie with us.
So, what are the issues that concern you the most?
If I say: impossible workloads, unnecessary bureaucracy, increasing focus on access targets without the GPs to meet those targets, and lack of understanding of the responsibilities of running practices – all against the backdrop of relentless “GP bashing’’ in some of the media – am I in the right ballpark?
Every year the person who gives this speech says something along the lines of: “It’s never been tougher for general practice.” I suspect this has been the case going back right to the founding of the College in 1952 – in fact, I’ve seen it in some of the published speeches from decades ago!
Criticism of general practice is nothing new. Year after year, we’ve acknowledged the growing difficulties in our profession, but the current landscape is unprecedented.
The world is rapidly changing with AI, new medical technology and scientific discoveries – often outpacing the ethical frameworks that should accompany them. We face huge social, environmental, and economic challenges, with climate change impacting communities worldwide, a cost-of-living crisis, growing health inequalities, and sectors – including healthcare – striking on a regular basis. We are all affected by this uncertainty and change.
Amid these challenges, the NHS is facing the gravest obstacles in its 75-year history, and general practice stands on the brink of an existential crisis.
It’s quite simple. For many years, the NHS hasn’t had the uplifts in resources, upkeep of estates or necessary workforce planning that it has needed, and it has been subjected to one major reorganisation after another – certainly all through my professional lifetime of nearly 40 years. And it doesn’t show that it values its workers. Over and over, it over-promises and underdelivers – not a good way to earn trust.
Many of the structural seismic shifts are short-term and poorly thought through, often with no piloting or evaluation. And that fantastic long-term motivation to really do something for the people of the UK that Aneurin Bevan showed at the birth of the NHS, has been lacking – only the next election counts.
So where does this leave us, as GPs?
Demand far outstrips capacity in all areas of the NHS, but especially so in general practice, and despite expanding the number of training places, more GPs are leaving the profession than entering it. If the Government doesn’t start focussing on retention and changing the conditions GPs are working under, soon those additional trainees will be entering a wasteland, as so many experienced GPs will have left.
At the last election, the government promised the public that it would increase the number of general practice consultations per year by 50 million, and the number of GPs by 6,000. It has done the former but failed dismally to do the latter. Now the recently published NHS Long Term Workforce Plan says we need 12,000 more GPs. Is this another “pie-crust promise”, “easily made, easily broken” like all the others?
Access is an issue not because of GPs refusing to see patients.
Rather, the demand for our services has surged significantly, and we now handle over five million more appointments per month than in December 2019.
It’s alarming that nearly 1,000 fewer fully qualified, full-time GPs are shouldering this burden.
The average number of patients per GP in England has skyrocketed to a staggering 2,300, adding an extra 159 patients per GP since December 2019.
When I first became a GP in 1988, it was normal for a full-time GP to have a list size of 1,600-1,800 patients. How things have changed.
Not only have our workloads snowballed, but the nature of appointments has become increasingly complex, with a growing number of patients requiring care for multiple chronic conditions. Many of us are grappling with burnout, low morale, and a sense of moral distress when we are unable to provide patients with much-needed access to care.
It's understandable why politicians are fixated on patient access, but it’s far too narrow a focus. It’s a symptom of a wider problem – a lack of investment and planning in the GP workforce that has gone on for years.
While on the treadmill of patient numbers, we have as a result, had some of the lowest satisfaction rates with service access on record – and this often has the consequence of making it sound like GPs and their teams aren’t doing enough, affecting patient confidence and support. It’s a vicious cycle.
And in fact, this impression that GPs aren’t seeing enough patients face to face has been shown to be false. Research carried out by NHS England itself, published in September, showed that GPs are flexing with patient requests and offering the best options for care depending on the issues they present with.
Yet this seems to go ignored – still we’re accused of not doing enough! Press coverage of a recent Nuffield report accused us of being a profession of part-timers. The sad fact is that the job of a full-time GP is now largely unmanageable, and even working what is called “part time” in general practice usually means working what would normally be considered by other people as full-time.
Arbitrary access targets make good soundbites and might win votes in the short-term, but our patients and our GPs deserve better.
My message today to any future government, regardless of what it looks like, is: the destruction of general practice and the demonisation of hard-working GPs and their teams must stop.
It’s denigrating and demoralising for existing GPs.
It deters trainees and would-be trainees from choosing GP specialty training and becoming GPs.
And it’s deeply damaging to the unique and trusted relationship that we have with our patients.
We need respect to be restored to general practice, not just for our profession and our patients, but for the future of the entire NHS.
Oscar Wilde’s story, ‘The Happy Prince’ makes me think of the NHS and our role as GPs. The happy prince was a statue put on a pedestal from where he could see his city and all the worries and woes it contained. He persuaded a passing swallow to peel off his gold leaf and jewels to give to the poor, and eventually the townspeople realised how dowdy he looked, pulled, and melted him down. I sometime reflect that’s part of our role – witnessing what is happening in our communities and doing our best with inadequate support to help them. And if people think the NHS is in a bad state now – stripped of its gold and looking dowdy – I’d invite them to consider what it would be like without general practice at all. (I certainly don’t want us all to be melted down!)
Because family medicine isn’t a conveyor belt for patching people up and sending them on their way. People are wonderfully complicated, and their health needs are equally complex, increasingly so. We need time to care. My consultation with Jim wasn’t done in 10 minutes, and neither was my consultation with Mair.
Mair was a grandmother, a heavy smoker with postmenopausal bleeding. As we discussed her treatment, she told me her son had died a few years previously in a road traffic accident. Her daughter-in-law wouldn’t allow her access to her grandchildren and there were ongoing court cases about her son’s accident. I could completely understand why she continued to smoke, and why she hadn’t presented earlier with the bleeding.
I know we all have similar stories about the importance of that personal connection, “to cure sometimes, relieve often and comfort always,” as Hippocrates said. This is what’s being eroded and what we’re in very real danger of losing if we carry on as we are.
A healthcare system established 75 years ago can’t fully meet the demands of today, and I don’t think any of us are denying that change and reform are necessary. The issue is that current attempts to shore it up aren’t succeeding, and it needs far more resource.
We need to move politicians and the public away from outmoded expectations of what we should do and how we should do it. We need to convince them that to get the best from GPs, they need to stop riding roughshod over us and to start listening.
We need to be instrumental in shaping a primary care system that is adaptable, innovative, technology-driven, and properly funded and equipped.
At the grassroots level we’re seeing some remarkable innovation and I believe there is an opportunity for us as a profession to step in with the solutions. I don’t believe the sad ending of “The Happy Prince” is the end to our story.
We are leaders of population health. We are innovators. We bear witness for our patients. We are family doctors.
And politicians who underestimate us do so at their own peril.
The College’s stance
This is fighting talk, but words alone won’t bring the change we need.
Advocating for our profession, engaging in crucial conversations with politicians, NHS leaders and the media, and campaigning tirelessly for the resources we need – as your Chair of Council, these are my top priorities.
We have been working hard to highlight to politicians just how bleak the workforce and workload crisis we are facing is. It’s thanks to this tenacity that general practice was the only speciality mentioned in the NHS long-term workforce plan. In the years ahead we may finally start to see the vital growth in workforce that we need, but we know that there is much more that needs to be done now to ease the shortage of GPs and our impossible workload.
We urge all the political parties to wake up to what is really happening in general practice and invest in practical solutions that will actually work.
These are outlined in our Manifesto – our “Seven Steps to Rebuild General Practice and Save the NHS”:
- Firstly, to protect patient safety, there should be a national alert system to flag unsafe levels of workload, like that in operation for hospitals, with a nationally agreed framework to allow practices to access additional support when they are in danger of being overwhelmed.
- Second, we need fairer resource allocation from the NHS budget to provide the care that we know patients need. Simply pledging to deliver more care in the community is not enough – this must be underpinned by tangible commitments to provide the funding and resources that are necessary to enable this.
- Third, as part of this a review of all funding streams is needed, to channel more support to deprived areas to help tackle health inequalities. We know that practices in our poorest communities have 14% more patients per GP and they get 7% less funding to cope with the additional pressures. This needs to be addressed.
- Fourth, we must see bold action to increase the number of GPs. This needs to include a new and improved ‘one stop shop’ national retention programme, backed by enough funding to make a real difference to GPs lives at all stages of their careers. At the same time, we need to see investment in training capacity to make sure we can continue to recruit more GPs in the future.
- Fifth, workload also needs to be better controlled, with clearer rules to prevent general practice becoming the backstop for all the tasks that are not being done elsewhere in the patient journey, and less time spent on unnecessary bureaucracy.
- Sixth, a high proportion of International Medical Graduates are coming to join us as GP trainees; we must welcome them and look after them better, including continuing our campaign for a guaranteed right to apply for permanent residence in the UK when they finish their training.
- Seventh, and finally, it is crucial that a future government invests in the infrastructure of general practice. We need modern, fit for purpose buildings to deliver patient care, to house our expanding teams, to utilise new tech and deliver on our sustainability goals.
This is a non-exhaustive list, but I hope it gives a flavour of what we’re calling for, to bring about positive change. There is still much work to do.
Examples of innovation
Success is not dependent on the College alone. All of us have a role to play in shaping the future of our profession.
Despite the challenges we face, there are so many glimmers of light. Glimmers, that if adopted more widely, have the potential to transform general practice and patient care.
GPs are at the forefront of driving advancements in primary care, and I’m convinced we have solutions to many of the problems we face. There are examples of awe-inspiring work being done across the country, and I’d like to share just a few of these to demonstrate how we can empower ourselves to bring about positive, lasting change for our patients.
Dr Priya Kumar has used funding from her ICB to reduce the health inequalities gap in her practice locality in Slough. Knowing that she has a high proportion of South Asian patients, with a high prevalence of Type 2 diabetes and all that goes with it, living in multi-generational households, she has used locality data intelligently to identify those families who don’t attend surgery, but who need ongoing care. Visiting targeted homes, she can attend to three generations in one call – providing vaccinations, healthy lifestyle advice, medication reviews and managing chronic illness.
Dr David Unwin, based in North West England, has also been working with patients with Type 2 diabetes. Using expertise developed with his wife, a psychotherapist, he has developed highly successful motivational interviewing technique to persuade his patients to alter their diets drastically to lose 10-12kg. Now 25% of the patients on his diabetic register are normoglycaemic and take no diabetes medications, and many of the rest are on dramatically reduced regimes.
Dr Gillian Orrow realised some years ago how much social factors in health were affecting her patients in Horley, and with seedcorn funding from her ICB, started making links to community and voluntary organisations, catalysing a variety of different activities aligned to local need - such as walking groups for South Asian women, and Friday evening games for adolescents to help keep them off the streets.
Call to action
I could easily stand here and list examples for the whole duration of conference. We know what we’re doing, and we know what works. As a College, we need to identify all this good work, and make it possible for others to adapt it for their own localities, rather than continually reinventing the wheel.
Our challenge now is to be vocal – to work together to advocate for ourselves, for general practice, and for our patients. It’s my job as your Chair of Council to lead the charge, but there’s strength in numbers. Change – and the right change – isn’t happening quickly enough, so we need to try a different approach.
That’s why I’d like to finish with an invitation – or rather, a plea – to you all.
As GPs we need to mobilise – engage with our local MPs, share our Manifesto with them, invite them to attend our Parliamentary reception, and if possible, to visit our practices to see and to talk about the issues we’re facing – the workload, the workforce shortages, the stagnant, inflexible funding, the bureaucracy, the increasing morbidity in our communities, and the future needs of our patients and how we would like to care for them. I know this is a big ask, which is why the College has developed resources to make it easy for you to do this. Just go to our website, enter your postcode, and it will produce a ready-made email which you can edit and send directly to your MP with one click of a button.
Another thing I’d encourage you to do is to maximise the potential of college membership. Join virtual groups on our RCGP Forum, share good practice and offer advice to those who would like to replicate what you’ve done for their own practices.
You, our members, are our biggest resource. I think there’s a lot we could do for each other within our membership network. There are over 54,000 of us – that’s a lot of brainpower, expertise, and experience.
It’s great that we are all together in conference here, but the conversation shouldn’t end tomorrow. Rather, it should be the beginning. Let’s keep on networking, sharing, talking – and acting.
When I became Chair in November last year, I made a commitment to do everything I could during my tenure to represent the views of frontline GPs across the UK. Before I end, I want to restate that commitment.
Our patients deserve excellent care, and you, our members, deserve to work in a service that is appropriately funded, that supports you to do the best job you can, and that values you and protects your own health and wellbeing.
I will do everything possible to make sure our professional voice is a strong one and to ensure that politicians, policymakers and influencers, including the media, understand and appreciate the work that GPs do; the importance and quality of the care we deliver to our patients; and the immense contribution we make to the wider health service.
Thank you for all that you’re doing. Thank you for being here, in Glasgow. And thank you for taking the time to care.
RCGP Press office: 0203 188 7659
Notes to editors
The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.