Professor Kamila Hawthorne speaks at College conference

Croeso i Gymru!

Welcome to Wales!

Bore da, Gynhadledd. Mae hi'n bleser bod gyda chi yma yng Nghasnewydd.

You can read her speech in full here:

Good Morning, Conference. It is such a pleasure to be here with you in Newport.

As many of you know, I’ve been a GP in Wales for 31 years – most recently in the Valleys. So I’m delighted that we are holding our very first annual conference in Wales, the country which many of us regard as the birthplace of the NHS. Nye Bevan grew up 23 miles away in the mining town of Tredegar where, in the 1930s, a community-funded healthcare scheme provided medical care to 95% of the town. It inspired him to ‘Tredegarise the rest of Britain’ and provided the model on which the NHS was built. There is no better place for us to meet!

This is my last conference as Chair of RCGP and it feels an appropriate time for reflection, as we stand on the brink of seismic change for general practice across the UK. For me personally, it has been a great honour to represent you – but looking back, the last three years have been challenging.

All around the country I meet GPs pushing themselves, day after day, to look after their patients in the face of ever-growing demand and an unsustainable lack of capacity. We face enormous challenges and there are no quick fixes to any of them, but despite that, I remain passionate about unlocking the potential of primary care and optimistic that it can be done. I firmly believe there is more room for HOPE now than when I first stood before you.

When I took office, in November 2022, we were coming to the end of the revolving door of Conservative Health Secretaries. For me, that meant two in 18 months…

A new government last July brought yet another incumbent to the post. Wes Streeting attended our conference in Liverpool last year and committed to working with us to rebuild general practice. He has launched the Red Tape Challenge which promises to reduce our burden of bureaucracy and has also pledged to merge the GMC Consultant Specialist Register with the GP Register, at last affording us parity with our hospital colleagues.

We welcomed his approach, but with caution. Although we get on well, we know from bitter experience that we must judge our politicians not by their words but their deeds.

Now we have the NHS 10 Year Health Plan. Although it only applies to England, discussions are also underway in Scotland, Wales and Northern Ireland about neighbourhood working and about the future model for primary and secondary care. As a college, we welcome a national strategy which values primary care and puts GPs centre stage but GPs must be decision-makers at all levels of any new structure.

Our most recent Member Survey shows that many of you are worried about the neighbourhood health services proposed in the Plan – concerned about GP shortages, increased workload, unclear funding plans and the future of GP partnerships. I understand that apprehension completely. When your workload is like a river that never stops flowing, no matter how hard you work, no matter how many hours you put in, it is difficult to have the mental capacity even to think about long-term strategy.

And many who do grapple with it say they are caught between hope and scepticism. They’re hopeful because the aspirations in the 10-Year Health Plan make sense. They are sceptical because they have heard similar hopes expressed before. I don’t need to remind anyone here that government rhetoric has too often been about moving care out of hospital and into the community while the funding has gone in the opposite direction. And if you have lived through past reorganisations that have brought more disruption than benefit, you have every right to be wary.

So why do I have hope that this time will be different? Over the last year I have been encouraged that ministers seem keen to listen to RCGP and to take note of our recommendations.

One way to judge whether our voice is really being heard is to consider whether our key demands are being adopted as government policy. Let’s look at two important issues…

The first is close to my own heart. As a College, we asked for a review of the Carr-Hill formula before the last election and I repeated that demand at our conference a year ago.
I have spent my career working with deprived communities in Manchester and Cardiff and more recent years, in the Valleys. I am deeply concerned about the need to funnel more resources into areas of greatest deprivation – I’ve seen at close hand, practices in deprived areas going to the wall.

So, we are encouraged that the Secretary of State has committed to reviewing the Carr-Hill formula. This is after years of lobbying. I’ve come to realise that influence is a slow burn…

The second issue is about the distribution of funding between secondary and primary care. It is an outrage that general practice receives less than 10% of the total NHS budget while providing the vast majority of patient contacts. Worse still, it is inexcusable that our share has been falling, despite an ever-increasing workload.

After years of campaigning, we’re pleased that the 10 Year Health Plan promises to reverse this trend, so that the ratio of NHS expenditure on hospital care will FALL with ‘proportionally greater investment in out-of-hospital care’. (See page 135!). We accept there cannot be an overnight transformation, and take heart from the promise that this will happen by 2035.

But the devil is always in the detail. After years of underfunding, we need a sustained increase in core funding and we are calling for a primary care investment standard that mandates yearly funding increases…

If GPs are to provide expanded services to patients as part of the new Neighbourhood Health Service model, it’s a no-brainer that we will need many more family doctors. The new NHS 10 Year Health Plan promises thousands more GPs.

We obviously await the forthcoming NHS 10 year Workforce Plan for confirmation but we take heart from the direction of travel. Remember that, just over a year ago, under the previous government, we were still facing proposals from the first Long-Term Workforce Plan to increase GP numbers by a paltry four per cent compared with a projected rise in hospital consultants of 49%.

Almost 10,000 of you supported the College’s protest and wrote to the Secretary of State. Well, your lobbying seems to have worked! Thank you!

…

Already, the number of newly qualified GPs is up significantly. We estimate that almost fifty per cent more GPs will qualify in 2025 than in 2019. This sounds encouraging but, as always, we have to dig beneath the surface to understand what’s really going on…

The paradox is that newly-qualified GPs tell us they are finding it hard to get jobs. We know patients are crying out for appointments and GPs cannot keep pace with demand. So why aren’t practices snapping up the new recruits?

One experienced GP explains why her practice isn’t recruiting. They are all working flat-out and have recently lost a part-time GP, but the partners decided they couldn’t even afford to replace this post let alone take on more GPs. The reason? The increased cost of the National Insurance rise which she says amounts to around £40,000 a year for the practice. So with rumours circulating of further hikes that would likely impact partners, ahead of next month’s budget, we say – please, Rachel, no more!

This same doctor tells us that the main problem her partnership faces is a simple question of supply and demand. They just don’t have enough GPs to cope with the demand generated by the complex needs of their patients. She routinely spends 8 hours over the weekend catching up on the clinical admin she cannot complete in working hours. Sadly, this GP feels she has been living with low level burnout for years and all that keeps her going now is the thought of retirement.

This is a CRISIS for our profession. Of course, we welcome the extra numbers of GPs – but we have to make sure that practices have additional ring-fenced funding to employ them. This is why it’s so important to have a Primary Care Investment standard.

What is absolutely clear is that we need to recruit more GPs and work harder to hold on to those we have.

And so, we’re asking members to sign our new letter to Wes Streeting, calling on him to make sure the forthcoming 10 Year Workforce Plan isn't another missed opportunity, and instead delivers a clear roadmap to train, recruit and retain the GPs we desperately need.

This is not just about the impact on us – crucially, it is about the impact on our patients.

In our recent survey 74% told us that patient safety had been compromised by workload pressures. Fewer than 39% said they had enough time during consultations. And more than half reported that their own mental health had declined in the last year. It’s hard to find a GP who doesn’t feel they have to cut corners…

Perhaps it is no surprise that so many GPs plan to leave the profession and that the biggest cause is stress. Not retirement but stress. It is such a waste to lose experienced GPs and I have been explaining this to government for the last three years. At least now I’m told they understand the issue, but I still haven’t seen enough movement to redress our retention crisis…

Those who stay at the coalface can’t go on like this. I know what it’s like. You arrive in the morning to an inbox of 60 blood and radiology tests to check, 120 prescriptions to sign off and numerous letters from hospital to process. To say nothing about the unpredictable questions about a novel medication or AI software. And you can never get through those tasks before the first patients arrive. Once your appointments begin you have to make sure the stress doesn’t leak into your interactions with patients and you try to do what a good family doctor has always done. You focus on the person in front of you.

But if they want to discuss more than one problem with you, you have a choice. You can either say no and stay on schedule or you listen to them and overrun. Either way, you feel you are failing. Often, you would like to talk to patients about lifestyle changes and promote prevention, but there’s so rarely time. One young GP says how rewarding it is when someone comes in with a single condition - a dodgy shoulder, for example, but you manage to find a way also to discuss his weight and his drinking. Sadly, he says, there is rarely time for those conversations… You are always running against the clock. And when your morning surgery is over, your inbox has magically replenished itself so now you have new admin tasks on top of the ones you couldn’t finish first thing…

I said at the outset there were no overnight solutions to the problems we face. Wes Streeting says he has spent his first year in office listening to GPs. The fact is, we still have a lot more to say! And we look forward to putting our concerns to the Health Minister later today…

We all know that good intentions alone won’t deliver good outcomes and that a great vision doesn’t guarantee a great NHS. However, without good intentions and without a vision, we have no hope. And a vision which favours community health care above hospitalisation and champions prevention above sickness is one I can certainly buy into.

I am hopeful but mine is a hard-headed hope. I am well aware of the struggles to come. But the hope I hold is inspired by our members. We are innovators and we are already ahead of the curve..

Look, for example, at Primary Care Sheffield which manages nine GP practices and serves 45,000 patients, many living in the most deprived areas of the city.

They believe there is a wealth of expertise trapped in individual GP practices and their model allows that expertise to be spread right across the city through at-scale services – whether it’s sexual health, mental health or neurology – in so many areas, GPs with extended roles can play a vital role. Patients access services faster, hospital waiting lists are reduced and GPs can develop a portfolio career.

In Scotland and Wales, Deep End practices not only pool resources in deprived areas, they also pioneer solutions to the health inequalities they witness daily.

And in North London, the Brondesbury Medical Centre is leading the way in continuity of care. They have assigned all housebound patients to a single senior GP so the same person always visits them. And extra funding from an NHS England pilot has allowed them to roll this out to cancer patients too and to those with the most complex needs.

…

The government often speaks of the need to bring back the family doctor. We say the family doctor never really went away, it’s just that the role has evolved.

When I look at my own practice, I think of a young person with severe mental health problems and I know it’s critical to build up a relationship of trust not just with her but also with her family.

Some 17 years ago, Don Berwick, an adviser to President Obama, a lifelong admirer of the NHS and a Bevan Commissioner here in Wales, addressed this conference. He talked movingly of the admiration he felt from childhood for his father who was a GP in rural Connecticut. Everyone knew his Dad, and he knew everyone’s medical secrets. And in his community he seemed omniscient. But Don Berwick went on to talk of how unrecognisable a GP’s role would now seem to his father. Where once the doctor said ‘I know’, now the doctor says ‘I can find out’.

The fact is, we can do so much more than when I first became a GP. Then, patients died much younger – threescore years and ten was thought to be a good old age. Today the challenge is to extend healthy life expectancy. The job has also become more collegiate as GPs lead large clinical and admin teams. Technology has changed so much, and AI will bring about another revolution. I’m looking forward to the day when I can tell a patient what medication is likely to be the best for them, from knowing their genome structure!

As everything changes, there is one constant - Don Berwick told his audience that the essentials have not changed. In his words ‘it is still our privilege to enter the dark and tender places of people’s lives where still, trust abounds when human beings turn to us in their pain…Still we have a duty to meet and our quiet promises to keep: to bring comfort. And still there will be thanks’…

I know it sometimes feels thank-less. But I’m reminded of something else that GP who is limping towards retirement also says keeps her going. It’s when someone comes into the surgery and tells her ‘you saved my life’. An early diagnosis that comes from a desire to solve the puzzle of a mystery illness, from the innate diligence of a good family doctor, from the principle that you give your patients the respect that you would like another doctor to afford you. Whatever the pressures…

I truly believe that if we can get the new neighbourhood services right, working closely with GP partnership-based surgeries, we will be better able to meet the needs of our ageing and multi-morbid patients. Better preventative care would keep them healthier for longer, and out of hospital. As GPs, we could have the job satisfaction of continuity of care, of working alongside our patients, of a portfolio career if we want it, and an opportunity to offer new services to meet the varied needs of our patients.

When I look back to 2022, we were still dealing with the aftermath of Covid. There were endless stories in the press vilifying GPs and patient satisfaction was in decline. Today the press is much less hostile, the public have a better understanding of our challenges and patient satisfaction is improving. The 2025 GP Patient survey shows public satisfaction has improved across all metrics, including access. This matters…

Many people have asked me what my abiding recollection of this time as Chair will be. So many things have happened, the good, the bad and the ugly! But the lasting lesson is something I learned as a GP too – never close the door on anyone who disagrees with you. Offering them an alternative view has really worked in my experience.

At the end of November, my successor, Professor Victoria Tzortziou Brown, will begin her term of office. I know I leave you in extremely capable hands and I wish Victoria the very best of luck.

Both Victoria and I know that the College is nothing without its members and there has never been a better time to be part of our diverse college community. Better still, apply for College Fellowship – it’s now free – and help shape the future of RCGP and general practice…

Before I finish, I would like to remind you of the power of hope. Back in 1948 when Nye Bevan believed it was possible to provide free universal health care, to many people, that vision seemed impossible. After fighting a war, the country was bankrupt and broken, but what he created was a health service the world had never seen before. At its heart, a simple principle. In his words, that ‘No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means’. And for all its imperfections, the NHS has been a symbol for almost 80 years of what is best about the United Kingdom.

Nye Bevan also said that ‘The NHS will last as long as there are folk left with the faith to fight for it’. Every day that you turn up at your practice… you are keeping the faith. You are the custodians of the nation’s health.

No-one should pretend the future will be easy. They say that hope is the ‘the thing with feathers’. That’s not how I see it. I think hope has to be hard-boiled or it’s worthless. I look at our members – at those whose professional satisfaction comes from being the family doctor, at those who want to develop specialist skills, at those young people who want to bring their energy and passion to general practice and at those GPs who want to lead the new Neighbourhood Health Services. I look at you and I know my hope is well founded…

Diolch yn fawr bawb!

Thank you everyone!

Mwynhewch y Gynhadledd, a dewch i ddweud helo!

Enjoy the conference, and come to say hello!