My last post as Chair

This is my last post as Chairman of Council, and I write it with great sadness. The last three years have been the most wonderful time; it’s been a great privilege to travel the length and breadth of the UK leading the College. But the real privilege has been being able to meet GPs across the country; in practices, out of hours centres and at meetings. It’s been wonderful to see the great work that people do across the country and to hear just how GPs are working with their patients and the public. It has also been great fun to engage with managers, nurses, physios, and even journalists and politicians!

My beautiful leaving gift - thank you

The feedback I’ve had from patients and the general public about the care GPs provide has been excellent. I have, of course, had to answer some criticisms, which usually arrive in the form of an email or a letter, but occasionally I have been confronted in public meetings or in the media. I hope that I have been able to put forward the view of general practice in a constructive way, promoting high-quality care, but also acknowledging that as professionals we would like to provide the highest quality care that we can and that we are not complacent. I have tried to be clear about our professionalism; we all want to do the best for our patients and, given the appropriate resources and support I am sure British general practice will continue to go from strength to strength.

I’ve had a fantastic team within the College who I will miss greatly. I’ll miss the staff, and the GPs, all of whom I have thanked personally in my AGM speech, which you’ll find on the College website shortly.

I’d particularly like to say thank you to the brilliant press team that we’ve got; Gillian Watson, Heather Whitney and Charlie Breslin. And of course I’d like to thank Gillie Lyons, who’s been a wonderful support to me over the last three years, and has kept me sane when all hell has broken loose.

I’ll miss them all.

The future is bright: General practice is definitely at the centre of the NHS. As you will have picked up from my emails, and from meeting me, I am an eternal optimist. I believe that with strong GP and clinical leadership we can really improve the care for our patients and make a massive contribution to improving the public’s health across the UK.

So with these optimistic words, I wish you the best of luck for the future, I thank you all, from the bottom of my heart for your support, and challenge, over the last three years which has helped me personally and professionally in leading the College. I will continue to support the college, to support general practice, and promote the key role of the generalist in whatever I end up doing in the months and years to come.

Of course, you haven’t seen the last of me, and I’m going to continue to blog here once I’ve had a bit of a rest.

With very best wishes, now and for the future,

Steve

My penultimate post as Chair

Time and tide wait for no man, and though the last week of my tenure as Chair is approaching fast, I have still been able to attend some truly remarkable events over the last few days.

It was lovely to make my last trip as Chairman to Scotland to celebrate the work of my good friend Ken Lawton, Chair of Scottish Council, at the end of his excellent three year term. He’s been a wonderful supporter and has really led the Scottish Council with great skill and wisdom. Ken’s gala dinner also included giving awards to deserving GPs in Scotland. Meeting the winners was a wonderful experience and it was great to talk to GPs who continue to provide extremely good care in what are often very challenging circumstances. It was also good to see Bridget Osborne and David Johnston, Chairs of Wales and Northern Ireland Councils respectively. All three have contributed to the UK College as well as their own more than anyone knows. I am pleased that Ken will continue to serve the College as Deputy Chair of the Postgraduate .
Professional Development Board

I have worked hard to ensure that we have had the very best GPs, and the very best GP organisations re-engage with the College. Indeed I hope when I stand down in a weeks time I will have left the College in a stronger place, and I am particularly pleased for example that we have been able to elect Martin Marshall, former Deputy Chief Medical Officer and GP academic, as Chair of our Ethics Committee; Val Wass, Dean of the University of Keele Medical School, as Chair of International; Amanda Howe as Honorary Secretary; Helen Lester – one of the brains behind QOF, as Chair of CIRC.

As Clare prepares to begin her tenure, Has Joshi is stepping down as Vice Chair, and I am grateful for all of his dedication and hard work. In their places, we’ve got two wonderful new vice chairs – Nigel Mathers and Janet Hall - whose injection of new energy into the team will be a great support for Clare. Not only have we managed to appoint fantastic people, but we’ve also engaged better with key organisations including our colleagues taking forward research in the Society of Academic Primary Care, and the Primary Care clinical societies.

I am a firm believer in the doctrine that in order to lead you need the best people around you, not to be surrounded by yes men who will agree with you no matter what, but those who will challenge you and make you think carefully about the decisions you make. I have taken this from the writings of Abraham Lincoln and, most recently, John F Kennedy. I think the College Council and the Officers are stronger than they’ve ever been – strong leadership is team leadership – and the College is in very good hands. I’ll say more about that in my last email which will reach you after the AGM on Friday.

Nigel Sparrow’s excellent work leading the Professional Development Board has included the educational sessions on work and pensions. So far, 2700 delegates have been trained since the workshops were launched last year, which is excellent news for Nigel, his team, the delegates and their patients.

I believe that encouraging people to stay in work, and getting people back to work quickly is good for them, their families and the economy in general. Unfortunately we haven’t managed to radically change behaviours as yet – but we will carry on encouraging the benefits of the fit note.

It's now been more than six months since the fit note was introduced and I'd like to remind GPs about the impact it can have in helping people get back to work. The fit note is an important tool that clinicians can use to provide advice to patients, and their employers, on how a health condition affects their ability to work and what practical steps might be taken to help them work as they recover. The knowledge that work is generally good for health and wellbeing has been available for several years now and it is important that we ensure our practices use the evidence and make best use of the potential the fit note has to improve the health and wellbeing of our patients. The DWP worked in partnership with the college to develop guidance for the fit note, and if you have not read it already I would recommend it to you - it can be viewed online at
www.dwp.gov.uk/fitnote

GPs interested in learning more about dealing with health and work in consultation may want to attend the RCGP 'Health and Work in General Practice' training. (Find out more and register online at www.rcgp.org.uk/news_and_events/courses__events/health_and_work_training.aspx)

I am very pleased to tell you that e-GP, the curriculum-based e-learning programme developed by the College in partnership with e-Learning for Healthcare, has won a silver award at the prestigious e-Learning AGE awards. These awards are highly regarded in the e-learning industry and the awards ceremony was held in London last Thursday. e-GP won a silver award in the category of Excellence in the production of learning content - Public Sector. Other award winners in the 'excellence in content' categories included British Airways, Marks & Spencer and Volkswagen Group. The Royal College of Anaesthetists won a bronze award for their e-LfH project.

I would like to thank Ben Riley, our Medical Director of e-Learning, Bill Reith, as Chair responsible, and the staff team for all the hard work that they have put into this project. I am often told that it is a fantastic resource for GPs, and it is wonderful that this has been so publically recognised. Ben in particular has worked extremely closely with our partners, e-LfH, as well as with all of the editors and authors who have provided the content which has been judged to be of such excellent quality.

More information about the awards can be found on the e-Learning AGE website: http://www.elearningage.co.uk/winners.aspx

Last Monday night I had the great privilege of attending the Pride of Britain Awards, for which I was on the judging panel. The Awards really are a fantastic event, recognising the remarkable achievements of real people who strive to improve the lives of those around them, and I was in awe of all of the award winners. The ceremony, hosted by Carol Vorderman was fantastic, and it would be a lie to say that I wasn’t a little bit starstruck meeting a cavalcade of famous faces.

The experience of judging the winners with Simon Cowell was surreal to say the least, but I did find myself making an unexpected comparison; he has such an incisive mind, he makes a diagnosis and he comes up with a treatment – just like a GP. Unsurprisingly, we agreed on all counts(!) It was also nice to discuss the achievements of these inspiring people with my fellow Baggies follower Adrian Chiles.

I will continue to keep you updated here once I step down from office.

My next email to you will be my last as Chairman of Council. Until then, as ever, I and the College really do value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

The importance of research

I had expected that, as I approach the end of my tenure, my diary commitments would begin winding down. This, alas, was not to be and this week has been as busy as ever.

But nevertheless, my time as Chairman will soon be at an end, and I have been thrilled with how Clare Gerada has been taking forward so much crucial College work. Her work on Commissioning in particular has been invaluable, and it fills me with confidence to know that the College will be in her capable hands.

Last week I had the great honour and pleasure of giving the David Bruce Lecture to the Army Medical Services at the Royal Military Academy in Sandhurst. I gave an academic lecture celebrating general practice and focused on the critical role GPs can play in the care of the most vulnerable people in our society, particularly the homeless, travellers, sex workers and refugees.

As someone who has a great interest in history, to give the David Bruce lecture was a particular treat. Sir David Bruce started off his career like me, working in a warehouse in Manchester before going to medical school! He was a GP in Reigate and then joined the Army. He investigated and treated Malta-fever (later named Brucellosis after him). He identified the cause of sleeping sickness and saved countless lives by introducing typhoid and tetanus inoculation for the troops in the First World War. What a man!

Giving the lecture also gave me an opportunity to once again thank the army medical services for their hard work, commitment and bravery in looking after our troops both in Iraq and Afghanistan. I am always so humbled by the skill of our military colleagues who work in difficult, often frightening circumstances, and I was grateful for the opportunity to speak to them.

This week I was called to give evidence on commissioning to the Health Select Committee. Of all the times I have been called as a witness to the Health Select Committee, this was probably the most difficult and challenging I have experienced; the commissioning agenda is in many ways polarized, and it was apparent to me that there was a degree of political point-scoring taking place. If you would like to read the transcript, or watch the video of the evidence session, then they are available through the parliament website; I think you will find it interesting viewing, not least because as it highlights the value of open questions – there were very few of them! The video is a good teaching aid for trainees which will work as a trigger for discussion – also giving evidence was the excellent Richard Vautrey from the BMA.

You can read the transcript and view the video here: http://www.parliamentlive.tv/Main/Player.aspx?meetingId=6842

Dr Knut Schroeder, a GP and Fellow of the College has produced a new publication Diagnosing Your Health Symptoms for Dummies which I want to bring your attention to. This new guide has been endorsed by the College as part of our ongoing agenda of helping to empower patients and their families. I have been quite vocal on the issue of public health, and really believe that giving patients the information and support needed to make informed decisions about their own health and the healthcare they receive is a vital to improving the public’s general health. This guide is an accessible way to help patients to begin to take control of their own health, and I’d urge all of you to take a look.

On Wednesday night I hosted a working dinner for College Officers and the Society of Academic Primary Care. Throughout my time as Chair I have worked to create stronger links between the College and our academic colleagues. I am pleased that College has re-engaged with the academic departments – I felt that we had drifted apart and wanted to take the chance as Chairman to work more closely with the GPs and the many other professionals who research in primary care – this isn’t just about GPs.

We have seen an extraordinary few years of research which will make massive difference to patients’ lives, one recent example being Willie Hamilton’s excellent award winning study into identifying early symptoms of ovarian cancer which I believe will lead to the earlier diagnosis by GPs of what has been called the ‘silent killer’. Willie is I guess a modern day David Bruce.

Research, academia and evidence-based practice are all important parts of the work that all medical professionals do, we just sometimes fail to recognise that we are an academic discipline – all jobbing GPs across the country aim to provide the highest quality evidence based care for our patients – we need to value and celebrate the work of our colleagues who produce that evidence. Our RCGP Clinical Innovation and Research Centre at the College (CIRC) is becoming enormously influential, and our Conference this year had more clinical and academic sessions than ever before.

I want to thank CIRC for their continuing support; I and the College continue to advise the Government and our four health departments on clinical matters, and a lot of the information we use comes directly from CIRC and the academic departments. I’m always hugely impressed with their abilities; I’ve often had to request up-to-date information which I’ve received at the drop of a hat, and much of our success is owed to their hard work.

Yesterday I attended our MRCGP Examiners’ Annual Conference in Stratford-upon-Avon, which is an opportunity to meet with another group of GPs who are committed to raising standards. Again, I have been hugely impressed with how the exam has been developed over the last year, and with the continuing academic rigour with which it has been approached.

The Primary Care Federations Toolkit

Yesterday, we saw the launch of the College’s Primary Care Federations Toolkit.

This Toolkit provides a really useful compendium of practical advice for existing and fledgling Federations, drawing upon the experience of Federations so far. With the brilliant support of The King’s Fund, The Nuffield Trust and Hempsons Solicitors, and under the leadership of Maureen Baker it is goes further than our original vision and is given the timely momentum created by the White Paper in England. Clearly Federations are not just for England, they are an excellent model for practices working together to provide high quality care wherever you work in the UK or even further afield.

In the years since we published the Roadmap I have watched with interest to see the ways in which so many of you, and your practices have embraced the idea of Federations, and the range of federated models that have emerged. I have also had the privilege of visiting some of them to pinch ideas and watch them win national awards.

Many of you are already working in Federations and I know that even more are actively considering coming together in this way. I really believe that Federations, as providers of services, can work well alongside Consortia, and that the opportunities for Federations to maximise benefits for patients are enormous.

Have a look - I recommend the Toolkit as an essential resource in taking general practice forward to the next level.

You can have a look at the Toolkit here: FEDERATIONS TOOLKIT



© Justin Grainge Photography (2010)


I also spent yesterday morning at the launch of the Dementia Action Alliance and the National Dementia Declaration, which maps out the huge challenges currently presented to our society by dementia, and some of the outcomes the Alliance, of which the College is a member, is seeking to achieve for patients with dementia and their carers. It was fantastic to hear one of my real heroes – Tony Robinson – speaking passionately about the need to better support patients with dementia; he challenged the minister Paul Burstow who responded with strong words of commitment and by also signing the declaration!

I am so proud that the College is one of the forty-five organisations that make up the Dementia Action Alliance; there are 750,000 people with dementia in the UK and this number is set to grow to over one million people by 2025. And while the financial cost of dementia in the UK is £20 billion each year and growing, still there remains a disparity in the quality of care patients receive across the country.

The overuse of anti-psychotic drugs in the treatment of patients with dementia – the ‘chemical cosh’ – has been one of the central causes of concern in treating patients with dementia. I don’t believe that its simply about GPs over prescribing as some of the newspapers have claimed. It’s more complicated than that. We need a whole new look at how patients with dementia are managed, how patients that live in care homes are looked after; better training for care home staff, medicines reviews with pharmacists, better and rapid access to specialist advice and support, as well as more time for GPs. But we do need to ensure that we are all up to date in the management of patients who have dementia - an important aspect of our CPD.

I have given a number of media interviews on this, ranging from BBC’s Panorama (to be aired next week) and the Daily Mail, to ITN Lunchtime News today and, as you may have seen reported in the media today, the Alliance has pledged to cut the over-prescription of these drugs, and to reduce the number of dementia sufferers confined to hospital beds.

This pledge is part of the seven main recommendations marked out in the Declaration, which exist as the basis for a ‘national action plan’. These recommendations are designed to improve the overall quality of life for patients with dementia and their carers, and include giving patients more control over decisions; helping them to feel valued and understood; enabling them to remain part of a community and keeping them safe in the knowledge that research is continuing.

As you can see, dementia is an issue that the College takes very seriously, and I would like to commend the continuing dedication of Professor Louise Robinson, our Clinical Champion for Ageing and Older People, and of Susan Went, who is leading intercollegiate work in Healthcare Quality Improvement for care homes between the College, the Royal College of Physicians and the Royal College of Psychiatrists.

You can read the letter here: LINK

You can read the Declaration here: LINK

As always, both I and the College value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

Best wishes,



Steve

White Paper Supporting Consultations

As you know, we started our consultation on the Government’s White Paper last week. I want to thank those of you already taking part. Your responses are invaluable, and will enable us to formulate our response to the Department of Health.

The RCGP is a UK College, indeed we are an international College, and although the White Paper legislation will affect only England, I really do encourage members from around the UK and beyond to consider the implications and to take part. Only this week I had some very helpful feedback from a member in Europe, who was keen to be kept informed as developments unfold. Your thoughts, concerns and examples of good practice, wherever you are in the UK are always gratefully received and fully considered.

Some of you have expressed concern about the potential impact on our most vulnerable patients, and I want to draw your attention to an initial equalities impact statement on the DH website:

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117350.pdf

It’s been a huge week media wise, particularly surrounding the King’s Fund’s call for GPs to take a more active role in maternity care. The findings were disappointing, but confirmed what we already knew - that the role of GPs in maternity care has dramatically declined over the past 30 years to the extent that there are some areas of the country where it is now practically non-existent.

I said that the best way forward is to establish effective maternity care teams in which GPs play a key role along with midwives, consultants and other healthcare professionals. This would obviously require significant changes to the way in which maternity care services are currently organised and we are already working with our colleagues at the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to see how we can deliver more effective and seamless care for pregnant women and their babies.

Today was the first meeting at the Department of Health looking at the new Public Health White Paper for England – indeed it was the first time anyone from the College had been invited to a meeting to discuss public health – usually we have to remind people that GPs have a key role in public health alongside our specialist colleagues.

There are big opportunities to take forward the public’s health agenda now that a new public health service is being set up and our public health colleagues will be based in local Government, but I fear that if we’re not careful commissioning groups will feel that public health is being covered by someone else.

What I said to our colleagues today was that public health and population health is important to GPs, and must then also be important for commissioning groups. I guess the Health and Wellbeing Board will be very important. There is some brilliant work going on around the country being led by GPs, an excellent example being the Big Bolton Health Check, which has made a real difference to patients’ lives.

To that end, I’ve been trying to raise the profile of public and population health with GPs and the important role of GPs with others, and a series of talks and a number of articles. You might be interested to know that in the Observer on Sunday there will be an opinion piece in which I will talk more about the importance of individuals taking more responsibility for their health and for the health of their children.

I hope you will be interested in an article I have co-written with Professor Roger Boyle, the DH clinical director for cardiovascular disease, for the BJGP, called ‘cardiovascular disease beyond the QOF’. You can read some of Pulse Magazine’s coverage of the article at:

http://www.pulsetoday.co.uk/story.asp?sectioncode=19&storycode=4125548

Here at Princes Gate, most of our kit is now boxed up and the rooms are emptying in advance of our move at the end of next week. The team here are developing a comprehensive communications plan to keep you fully informed on how to get in touch with us, and how to make arrangements for accommodation.

Orchestrating the move has been a mammoth exercise, and I do hope that the move will result in communication inside the college improving; it’s been very difficult working in poor accommodation, spread across four sites. I’ll certainly miss staying in the college; things really won’t be the same, but I think it’s for the best and is part of the story of the College’s growth.

Our future address will be: 1 Bow Churchyard, London EC4M 9DQ. The new switchboard number will be 020 3188 7400 and our new fax number will be 020 3188 7401.

As always, I value your opinions and feedback enormously – wherever you live and work – and I urge you to get in touch if you have any comments or questions for me.

White Paper Consultations

I’d like to begin this message by thanking the many hundreds of you who take the time to write back, sharing examples of good practice and letting me know your concerns. I try to respond to all of the emails I receive, but it does take a while when there are so many! I also want to apologise to those of you who are fed up with hearing from me – but I really do feel that it is important to keep you informed of what is going on.

It’s the feedback I receive from you that enables me and the College to act on your behalf, and I want to assure you that I do to relay your concerns to the Department of Health, and that you are being heard.

I really do believe that 2010 will stand apart as a year of great change for the NHS, for GPs and for the College. Whilst the attention over the last few weeks has been on England, I am well aware of developments in Wales, Scotland and Northern Ireland, and am conscious that my recent newsletters have been rather Anglo-centric. I am sorry, but I do believe that even those of you from outside of England should be aware of what is going on, and in turn, I welcome your feedback and encourage your active participation in the consultations.

With the release of each new paper, the Government’s future plans become increasingly clear, but I want to remind you that these are consultation papers, and the Department of Health and the Health Ministers want feedback from us all.

The suite of four consultation papers that will inform the White Paper have now been released, and are listed below:

• Transparency in outcomes - a framework for the NHS
• Increasing democratic legitimacy in health
• Commissioning for patients
• Regulating healthcare providers

Also in the bundle of papers, but not a consultation document in itself, is the Arm’s-Length Body review. In it there is some good news, but it also raises a number of questions. There is an issue that we might have missed if we hadn’t read the full detail of the paper – that being the abolition of the Council for Healthcare Regulatory Excellence. I believe that we mustn’t have GMC fees going up to fund a body that we don’t need anyway. I will certainly be making this point in my own feedback.

This is one of the many examples of something that seems so small, but actually affects all of us in the profession. If the majority of you look at all of these papers thoroughly and respond in some way, then nothing will be missed.

The College consultation on the White Paper document is now open, and I very much encourage you to give us your views. The White Paper is a big document, and of course invites views on the principles and framework of general practice; the detail, and specifics, will follow next week when our consultations on the four DH consultation papers will be opened.

Formal weekly updates on the progress of the White Paper will be available on the RCGP Website from today.

On the subject of change – this week Hilary De Lyon, our Chief Executive, announced her departure. While I am sure you will join me in congratulating Hilary in being selected for training for Ordination in the Church of England, the congratulations go hand in hand with sadness at her leaving. Since she joined the College in 2002, Hilary’s leadership, vision, warmth and enthusiasm, among her many talents, have been invaluable.

It’s been an extremely busy time media-wise. I took part in a webinar hosted by the Health Service Journal on the White Paper. Some interesting issues were debated with Steve Smith, CE of Imperial Healthcare. If you want to watch the debate it is available here.

Dr Mark Porter also visited my practice and did a nice piece on Radio 4’s Case Notes which went out on 21 June at 4.30 which you can hear here.

Lastly, I’ve been contacted by a journalist who is keen to speak to any GPs who have used webcams to carry out remote consultations with patients. If you’ve been involved in any work in this area and are happy to discuss the pros and cons of this type of consultation, please contact Heather at the RCGP Press Office.

As always, I value your opinions and feedback enormously – wherever you live and work – and I urge you to get in touch if you have any comments or questions for me.

The White Paper

I think it would be fair to say that the last ten days have been defined by the release of the White Paper. This is one of the biggest, if not the biggest, changes to the structure of the NHS since it was formed. We are awaiting the publication of five accompanying papers, which are due out by the end of next week.


The White Paper, Equality and excellence: Liberating the NHS, was launched at Downing Street last week – I had the privilege of attending and being able to speak to the Prime Minister and the Secretary of State about the paper. I must say that I got the sense from our new PM that he really does believe that putting GPs and other clinicians in charge of the NHS will deliver a less bureaucratic and better quality service. Both he and the Secretary of State expressed ambition for the NHS to be a more patient focused, more personalised system with GPs right at the heart of everything that happens. I know people may be sceptical, but David Cameron did say that the NHS is his number one priority – time will tell- and of course the financial squeeze could have a bigger impact on health than we can see, but, I came away thinking that we do seem to have the politicians at the top of government supporting GPs – and they have gone public too!

It was also interesting that they both talked about the influence of the Liberal party on their original plans, and the need for much more patient and public engagement in commissioning. It was a good opportunity to talk to the whole ministerial team and the senior civil servants without the gaze of the publicity machine, and to share concerns as well as discussing the opportunities.

I believe that the White Paper presents a real opportunity for GPs and for our patients. Over the past three years I’ve met with politicians from all political parties and have given them critical feedback when needed, as well as congratulating them when appropriate. I have known Andrew Lansley for some time, meeting with him and his shadow team on a regular basis and I know that these plans had been developed before the country plunged into the current financial crisis. Contrary to the belief of a few our colleagues that I have met around the country, I do not view these changes as a ‘stitch-up’, with politicians setting us up to fail, rather than they are desiring to give GPs more influence. I won’t stop giving the government critical feedback and challenge when needed, and I will continue to feedback from you to the civil servants and politicians as I have been doing over the past three years. I have sometimes had over 2,000 responses from you all, for which I thank you for – I read them all – thank goodness for long train journeys!

I have every confidence that our GP colleagues across the country will get involved with the consultation and provide their invaluable input at this crucial time. We met with Laurence Buckman and Richard Vautrey from the GPC last week to discuss the White Paper and other issues we continue to discuss developments with other organisations, including the medical Royal Colleges.

What we have seen so far leads us all to believe that GPs in England might at long last gain real influence to control budgets and commission services, enabling patients to receive high quality care and better continuity of care. We obviously need to study this in great detail but I hope we can provide our influence so that GPs can at long last take centre stage in the running of the health service.

The Outcomes Paper was released on Monday, and the Commissioning Paper just came out yesterday, so we’ll be ploughing through the fine detail of both of these important documents. The Outcomes Paper indicates to me that our practice accreditation programme will be something that will help GPs across the country.

I acknowledge that most GPs will want to continue providing high quality care wherever they live in England, whilst some GPs will want to become more involved. Clearly, we need to learn lessons from the previous attempts at commissioning and fund holding but GPs will want to work with specialist medical colleagues, nurses and, indeed, supportive and high quality managers to make this happen.

I believe that with collaboration with our specialist colleagues, nurses and other professionals working in primary care to tailor services appropriately for patients, and given the right resources and support, we CAN deliver an effective and cost-effective NHS.

Amanda Howe, our excellent Honorary Secretary, will be leading a full consultation on the entire White Paper, and Clare Gerada and I will be starting a more formal email, in addition to this one, to give you factual information as we did with pandemic flu.

But of course, all GPs still have the day job to think about. I am thrilled that the Health Work and Wellbeing initiative is gathering pace, and I am delighted that so many GPs have put themselves forward to contribute to this invaluable scheme. I am delighted that Dame Carol Black’s independent Review of the health of Britain’s working age people has such an impact on improving the lives of people in work, and in helping people get back to work.

I spoke to Carol yesterday; the early evidence from the Post Office and other big employers is that most GPs are continuing to fill in the new Fit Note as though they were sick notes, but in some areas there has been a more radical change. I ask you to think about the Fit Notes when you fill them in; it’s important to try to keep people in work if we possibly can – it’s better for their health, and it’s better for the economy.

I wanted to give you an update on the move from Princes Gate, to explain how our interim and long-term plans will impact on you as members.

As you know, Princes Gate has now been sold and the new building at Euston Square – which is to be developed into a world-class facility – has been purchased. The improvement works and refurbishment that will take place mean that we will not be able to move into our new permanent home until Summer 2012, so, as you have seen in RCGP News, in the meantime we will be based at Bow Churchyard, in the City of London.

I want to take this opportunity to assure you that members' subscriptions will not be used to finance the move or the refurbishment to Euston Square. There is a capital appeal to raise additional funds for Euston Square (over and above the proceeds from the Princes Gate sale). Many of you have already approached the College asking how you can make donations, all of the information on which can be found at www.rcgpfundraising.org.

We all know how stressful moving can be, but the move should not affect your ability to contact the College when you need to. The details, such as our new phone numbers, will be sent to you as soon as they are confirmed. I will, of course, keep you posted on all the changes before they happen.

I want to offer my sincerest congratulations to David Sowden, who has become chair of the Conference of Postgraduate Medical Deans of the United Kingdom, and I wish him every luck in this new role.

As always, I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me. Sincere apologies for to those of you from Wales, Northern Ireland and Scotland and indeed those international members from around the world – I value your thoughts too wherever you live and work.

Revalidation Update

Many of you will be aware that revalidation has hit the headlines again this week, with the publication of a letter from the new Secretary of State Andrew Lansley to Peter Rubin, chair of the GMC – a copy of this letter can be found here.

Regardless of what you read in the newspapers, revalidation is moving forward and I believe that the Secretary of State’s letter is a constructive addition to the debate. As you know, the RCGP has been working very closely with the GPC, and other stakeholders. I have been out and about around the country, most recently at a session with defence service doctors, and I always bring back good questions, even if I don’t know the answers when I’m there! A lot of the work we have been doing recently has focused on GPs who are practising as locums, or working in rural and remote areas. Over the past couple of weeks I have had very constructive meetings with the GMC and I had a positive discussion with medical directors of PCTs on clinical governance, revalidation and a need for continued funding for the Practitioner Health Programme which supports doctors in difficulty last week at the College.

There do seem to be problems in some of the hospital specialties about the standard that doctors will need to meet in order to revalidate, but in general practice we have always taken the view that revalidation is about professional development, and that for revalidation to be a success it will also depend on appropriate clinical governance systems in Primary Care Organisations across the UK, appropriate funding and a solution to the question of remediation.

I have always tried to ensure that the College is open about its deliberations, which is why we have published the guide to revalidation – of which the fourth edition goes live imminently. We want to make sure that revalidation is appropriate for all GPs, regardless of how and where they work.

With that in mind, I support the Secretary of State’s view that piloting should be extended so that we can learn more, particularly about the costs, and how we can make this as bureaucracy-light as possible. It will also give primary care organisations more time to sort out their clinical governance systems and appoint responsible officers. We know that the profession – particularly in some of the specialities - doesn’t feel as engaged as it might; we have benefited from regular meetings with the GPC, who have acted as critical friends – not shy to challenge, but always ready to support when appropriate.

Of course I will continue to update you on progress, and Mike Pringle, RCGP Medical Director for Revalidation, and I will continue to tour the country meeting with GPs and responding to your questions as revalidation moves forward.

The heat is on

Summer has truly arrived, and after the sort of weekend that makes you glad to be alive – sitting in my garden enjoying the sunshine – I’ve spent much of this week in the stifling heat of London.

Unlike the pastoral bliss of Birmingham, the College is sweltering under the heat. The lack of air conditioning, and the resultant awful conditions our staff are currently experiencing, has only reinforced the need to move to more suitable premises.

Fortunately, the first phase in our historic move is just around the corner. From August, and for the subsequent two years from then we shall be relocated to our temporary ‘swing space’ at St Katherine Docks.

The move is beginning to feel very real, and with this comes excitement. However, as with any big change, there will be small sacrifices to be made, and for the two years at St Katherine Docks there will be no overnight accommodation. This will necessitate a change in working practices until we move into the new building at Euston Road, and to address this we are planning a new section of the RCGP website in order to keep the membership and staff alike up-to-date. The site will be live from the middle of June.

I urge all of you to submit entries for the new RCGP Caring About Carers Award - run in partnership with The Princess Royal Trust for Carers - which was reported in this month’s RCGP News. We GPs play a vital role in encouraging carers to look after their own health, as well as providing support to help them in their caring role, so I urge all of you to take part. Nominations for the award close on 11 June, and more information is available at http://www.rcgp.org.uk/.

The Spring Meeting earlier this month went brilliantly well, and I enjoyed immensely Sir John Tooke’s fascinating lecture on the personalisation of diabetes care. It was really great to see so many new members and fellows, and their families, and I was so impressed that so many doctors are so keen to get involved. It makes me feel really proud that we’ve managed to promote this initiative, and in doing so become a more inclusive and welcoming college.

You may have seen an article recently in Pulse about the shortage of doctors putting themselves forward for RCGP Fellowship. Fellowship is a wonderful thing: it’s an indicator that of a doctor providing high quality general practice above and beyond expectations. I’d urge all of you who have been a member of over five years to put yourselves forward. I was humbled at the Spring Meeting to be shaking hands with men and women who’d done such wonderful things in clinical care and research, and was so pleased that, through fellowship we can recognise and thank them for their hard work. The College draws its strength from the quality of its members and fellows, and because of them it is a force for good, a force for a change, and a source of the clinical leaders the NHS needs.

The Lib-Con Coalition

This is my first message since the General Election, and the formation of the new UK Government. The makeup of the new blue-and-yellow, Lib-Con health team for England is becoming clear. Congratulations to Andrew Lansley, who has become Secretary of State after many years in the shadowing role.

Andrew has an incredible knowledge of the NHS and healthcare generally, and over the last few years I have spent a lot of time talking to him, his team and indeed, as you know, to the health ministers in the old Government. I look forward to working with new team.

I am very pleased that the new administration is continuing to promote our vision of the role of the GP – Andrew really does understand the role of the generalist and we both share a belief that GPs should be leading at all levels in the NHS and take more responsibility for commissioning care.

As you know, we have been promoting the role of GP federations. I believe that federations will play an increasingly important role in the NHS, with GPs working collaboratively to provide a wider range of services in their communities, and to move more care out of hospitals. I want to make it clear in this message that we support the continuation of small practices, because the evidence is that the patients like small practices, and we know that the quality of care can be excellent, continuity is important to patients, and that patients like the personalised care that they provide. Practices working more closely together in federations – whilst not losing their identities – will allow more care to be provided closer to home. It will also help us address the issues of access to GPs and provide a solution perhaps to the practice boundary issue.

With this in mind I hosted this week a working meeting on federations, which will be reported in Pulse and RCGP News over the next few weeks. Laurence Pike, a GP in Lincolnshire described how Lincolnshire GPs had grasped the nettle and taken control in their local area, including their local community hospital. In doing so, he said, they’d revolutionised the service available to patients in their rural area. The federation in Croydon, led by Agnelo Fernandes, has made brilliant advances in a totally different environment. As you will be aware, Agnelo’s federation is a HSJ prize-winner for his work on improving patient access to diagnostics.

I was thrilled to hear at that meeting of the commitment and leadership of a number of GPs, and I was pleased that the NHS North West CEO, Mike Farrar, had become a strong advocate for GPs taking this federated agenda forward. We also have strong support from the NHS Confederation.

I am really optimistic for the future, particularly as my conversation with the new Secretary of State this morning reconfirmed his support for the leadership role of GPs, for federations, and for moving care closer to home.

The Daily Mail, however, appears to be at it again: last week, they were really good at helping me debunk the myths surrounding celebrity diets (my daughters were amused to see my health advise alongside pictures of Gwyneth Paltrow and Jennifer Aniston), but on today’s front page they led with an inflammatory piece about GPs out-of-hours care.

Because of my interest in out-of-hours care, and the report I co-authored with David Colin-Thomé for the last Government, I have kept close interest in how we can improve the quality of care for patients. I spoke to all of the political parties before the election and as you know, the College continues to be involved in DH discussions on out-of-hours and improving out-of-hours training. Andrew Lansley’s position – he assures me – is the same as ours. We both believe that doctors working in and out of hours in the UK must speak English of an appropriate standard. He also agrees that GPs should be involved in commissioning care out of hours. He reiterated his belief that GPs should not be forced to work out of hours if they do not want to, but hoped that more would want to get involved once they had more say in the commissioning of care and the design of services.

As I have said for many years, the key to the success of the NHS is to get GPs in leadership positions, locally, regionally and nationally. As GPs we have a good idea what patients need. I believe that with appropriate support we are capable of commissioning better services for our patients. This includes out-of-hours care. All of you will recall in our manifesto a call for:

“Better round-the-clock care for patients
Every patient deserves high-quality care in and out of hours. GPs must be more involved in local decision making and in the commissioning of out-of-hours services to deliver the highest-quality care around the clock.”

I look forward to working with the new health team in England, and continuing to work with the health teams in the other countries on other important aspects of our manifesto in the months and years to come.

Thanks as always for your support. I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

Election Day

Picture by: Ian Britton - FreeFoto.com

Election Day is finally here and whatever the outcome, it has been one of the most exciting build-ups I can remember. We will of course work with whichever party is in power in Westminster and whichever parties are in charge of health in Scotland, Northern Ireland and Wales.

My job as Chairman is a huge responsibility and while it’s not (quite) on the scale of leading a major political party, working with the parties has given me a lot more empathy with their leaders and I now understand that however hard you try, you can’t get it right all the time

A good example came last week when I represented the College at a joint conference with the King’s Fund and the Royal College of Physicians on the future of the NHS. It was a stimulating event, attracting a very influential audience, and I used the opportunity to talk at length about the role of the GP at the centre of the NHS, quality general practice, and the need for strong GP leadership and for a call for better integrated care across the specialties.

The general consensus was that whatever the outcome of the election, the NHS is stuffed financially for the next few years, but that GPs are best placed to lead the health service through the turbulent times ahead and that we can be relied upon to run cost-effective services without damaging the quality of patient care.

So you can imagine my dismay when I logged onto the website of GP newspaper and saw the story RCGP Chairman urges GPs to ‘grow up’ on pay. My presentation had been completely ignored in favour of one line on GP pay, which is not the business of the College in any case.

Clocking up the amount of media that I do, I’m usually laid back about the odd misquote here or there. I appreciate that journalists have their job to do and that positive stories about general practice don’t always create the best headlines - but this time I really saw red.

In their defence, the journalists at GP moved swiftly to print a clarification which is now online and will be printed as a letter in next week’s issue, but as far as I’m concerned the damage has been done and I can only apologise to any of you who have already read or will go on to read the story.

To set the record straight, I do think that GPs are now paid "appropriately" and so we should be, after years of being underpaid and underestimated for the work we do. I also believe that we should grow up, but by that I mean “grow into” the role of NHS leaders determining our own way ahead, rather than being passive receivers of what others are doing.
We have overwhelming evidence, most recently from the Commonwealth study and the American College of Physicians, that we have the best primary care system in the world, so why-oh-why is this always overshadowed by how much we are paid?

We can sit back and feel got at or we can choose to rise above it. It’s ironic that when the chips are down, the profession seems to come into its own and we just get on and do the best we possibly can for our patients while the voices of doom resonate around us.

Today has been a busy one so far and I spent this morning at the Department of Health talking about the need for GP leadership at all levels. By the end of today, we should have a new Government and whatever its complexion, we need to use this as an opportunity to show our mettle and demonstrate how GPs can steer the NHS through the choppy waters of the next few years, without our patients noticing any detrimental difference in the care they receive.

Aboard the HMS Victory

© The British Postal Museum & Archive (BPMA)

The general election is almost upon us, and we’ve seen history being made with the three main party leaders debating on live television. There has also been the first health husting, with the three people who want to be secretary of state for health in England - Andy Burnham, Andrew Lansley and Norman Lamb. It’s absolutely becoming clear that the big issue, whichever country in the UK you live in, is how that country’s NHS can move forward with dramatically reduced resources.

I believe that the solution is to put the GP at the centre of the NHS, and I also believe that as GPs we have a responsibility to stand up and be counted – we need to demonstrate leadership, locally, regionally and nationally after the election. All of the political parties have been talking about primary care and the importance of the role of the GP. In England, the emphasis is on commissioning. As GPs we all know that we focus on the needs of our patients – that’s when we are at our most effective. It is encouraging to hear so many politicians talking about our federated model and it’s been really interesting to hear the differences of thought across the UK.

I am pleased to say that there are a few GPs standing for Parliament – including one of our examiners in Devon – and I watch with great interest to see how they get on. It’s a shame that Howard Stoate, who was an examiner with me a few years ago, has decided to stand down after being an MP for Dartford. He’s made a great contribution to the Health Select Committee to keeping the profile of general practice up in parliament and championing the needs of the public. He’s also been really helpful in getting the College into parliamentary meetings and to be taken seriously at the Health Select Committee. Thank you, Howard.

Last week I fulfilled a boyhood dream – being able to explore that amazing, historic ship HMS Victory. It was a great privilege to be invited to speak and dine with the doctors from the Royal Navy at their base. We discussed the future of General Practice and revalidation. The more I meet up with our colleagues in the defence services, the more I admire the work they do on our behalf, in very difficult circumstances around the world. As you will be aware, my own practice has a role in the care of defence personnel in Birmingham and is closely linked in with Sellyoak where our excellent defence service doctors look after very badly injured soldiers. It was great to meet up with my great friend, Surgeon Commodore Noel Bevan, Surgical Commander Marcus Evershed, Surgeon Captain David Brown, and their colleagues. I learned such a lot from talking over issues with them and sitting in a small workshop on consent and confidentiality. They have special issues regarding revalidation, and I came back thinking more and more that revalidation really is about professional development and needs to be a straightforward activity for GPs, low on bureaucracy, high on education and focussed on the special work that every GP does.

Tuesday was the Fourth Annual Partnership Conference of the College, the King’s Fund and the Royal College of Physicians. The theme of the conference was ‘How can clinicians improve services for patients in a cold financial climate?’ There are no easy answers of course, but one thing is for certain; the future is clearly going to be one where GPs lead in partnership with our specialist colleagues. We are presented with an opportunity when the new Government comes into place – to assert the role of GPs at the heart of the NHS – but to do this we need to be positive, constructive medical leaders providing solutions at all levels.

I also want to mention the College’s International Team, which continues to do some excellent work. We have recently signed an agreement granting MRCGP[INT] accreditation to the Egyptian Family Medicine Fellowship degree; and I would like to thank all of our international colleagues – lead by Professor Val Wass and John Howard – who work tirelessly to raise standards around the world.

As always, I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

The Today Programme and a discussion on Detoxing

April has been, as ever, an enormously busy month, but rather than April Fool’s pranks, I was fortunate enough to spend some time with John Humphrys of the Today Programme and the senior team of Imperial’s Hammersmith Hospital. It was really interesting looking at how that hospital has developed – it’s now very high tech, but at the same time, also very patient-centred, and the staff were fantastic.

In addition to giving an interview myself, it was fascinating to speak to some of the patients on the ward about how their lives and their experience of healthcare has changed since the introduction of the NHS; it was really interesting to hear what high value they placed on general practice, and highlighted again the hugely important role generalism and care, given in the community, will have to play in the future. The interview will be spread out over a number of days leading up to the election.

The last couple of weeks have seen a number of successes, the first and most important being the fact that Brussels have decided to bring forward a review of how the UK can assess the skills and language of doctors coming to work here. This is an important turning point for an extremely important issue.

The College’s work on securing better access to psychological therapies continues to make advances, and one of the major successes this month can be attributed to you, the members. We had over 1400 responses from you – thank you. The work of the College, along with the work from a number of other organisations, has secured commitment from all three of the main political parties to improve access to talking therapies following the General Election. This is an incredible development, and one that further highlights the influence we GPs can have if we work together. Many thanks and congratulations to you all.

Work on the new College building is moving along nicely, and I had the exciting opportunity this week to meet with the designers to discuss the proposed state-of-the-art, 350-seater auditorium. The new building promises to provide a magnificent new home for the staff and members of the College, and I am looking forward to it enormously, despite the fact we won’t move until after I have stepped down!

A smaller, but by no means less relevant success was the fact that the Baggies (my football team, West Bromwich Albion) were promoted!

I enjoy my media work enormously, and while it is important to ensure the public are armed with factual information about their health, sometimes giving this information can be a bit of fun. I took part in a debate for BBC Radio West Midlands, my stomping ground, about nutritional detoxes. I went head to head with an expert who talked about, among other things, the ‘Aqua Detox Foot Spa’, which by some apparent magic draws toxins out through the feet. I suggested that human beings had kidneys, which were pretty effective after millions of years of evolution. It was a great opportunity to debunk some of the ludicrous myths that pervade in this multi-million pound industry that, I believe, is frankly something of a con. The point I made, above all others, is that the key to good general health is to eat less, eat better, drink lots of water and get plenty of exercise; the human body is a wonderfully advanced machine, and, providing you give it the right fuel, can detox perfectly well on its own.

Thanks as always for your support. I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

Launch of the RCGP Manifesto

As you will have realised from my previous email, it’s been such a busy couple of weeks with our move from the College building in Princes Gate to Euston Road taking up a lot of thinking time.

In addition we have been working on our manifesto as a way of raising the profile of high-quality general practice and demonstrating once more that GPs are ready to lead and provide solutions for patients, the public and for our National Health Service. We are unashamedly trying to influence whichever party comes into power, in our four home countries.

Further details of how we will be using this – and how you can help us – to raise the profile of high quality general practice in the run up to the election will follow shortly but I wanted you to see it before we issue the press release today.

Our manifesto emphasises the important role of GPs and general practice in promoting the wider public health agenda and we will be using every opportunity to push this, as well as promoting the importance of high-quality care for all through general practice. It was debated at the last College Council and we had lots of suggestions and good ideas which we have tried to condense into the 16 main recommendations.

One of the main calls we make in the manifesto is for improved access to psychological/talking therapies.

Some of you will have seen Sunday’s Observer and BBC News bulletins on psychological therapies. The coverage is the direct result of the help you gave me a few weeks ago when I asked for your views on provision of psychological therapies in your area. Thank you for your support.

Many thanks for your responses – around 1200 of you took the time to reply by filling in the questionnaire and giving us details of what care is like in your locality. I am very grateful. I sent your anonymised comments to Professor Lord Richard Layard, Programme Director for Wellbeing at the London School of Economics, who is leading the campaign to improve access to mental health services for adults and children.

We worked closely with the journalist at the Observer and the news team at the BBC to make sure that we got our key messages across. It was a tricky one because I wanted to say something positive about how the Department of Health in England has invested in improving access to talking therapies while highlighting how the services on the ground vary in quality and in access.

You demonstrated that access for patients is not as good as our patients deserve. - less than 15% of those of you who responded said you could usually access appropriate psychological therapies for adults, with less than 10% saying the same for children. The volume and tone of your e-mails shows the frustration and anger you feel on behalf of your patients.

I tried in the press to assert the patient’s right to nationally-approved treatments, drugs and programmes, recommended by NICE for use in the NHS. I said that I believed that there needed to be better access to psychological therapies and welcomed the substantial investment that has been made over the last few years. I stated our full support for the campaign to ensure that adequate funding continues to go into training therapists, rolling out talking therapies across England and making provision for children.

Richard Layard did the economic analysis and he said: “Mental illness is perhaps the greatest single cause of misery in our country. For those who experience it, the least we should offer is the same standard of care we would automatically provide if they had a physical illness. Politicians who committed to this would receive a huge vote of thanks from millions of families in this country.”

I continue to assert that GPs and the College are willing to provide solutions and by backing the campaign to support mental health, I believe that we are not shying away from our responsibility to speak out with and on behalf of our patients. In this case by working closely with MIND, the RCPsych and other medical Royal Colleges.

We are making it a focus of our conversations with all of the three main political parties. I’m pleased to say that our efforts are having an impact as it seems to be resonating with them all. Our colleagues in Northern Ireland, Scotland and Wales are also doing their bit to ensure that it's high on the agenda across the UK.

I'm planning to invite Lord Layard into the College over the next few weeks for a "policy breakfast" so please let me know if you'd be interested in attending.

Thanks again for all your support – your efforts are very much appreciated and I hope we can achieve some good on behalf of our patients and their families.

The Inclusion Health Report, and a trip to Buck House

It’s been an interesting fortnight – like most fortnights – with a lot of variety.

Last Thursday we hosted the launch of a landmark report, 'Inclusion Health', which looks at the role of primary care in addressing the needs of our socially disadvantaged and harder to reach groups.

New analysis by the Social Exclusion Taskforce in the Cabinet Office and the Department of Health in England shows that despite the progress we have made in healthcare, people such as the homeless, those with learning disabilities, people leaving prison and sex workers, are still finding it difficult to access the services they need, often with life limiting results.

My reasons for wanting to be a GP are the same today as when I was at school – I wanted to make a difference and help people less fortunate than myself. It’s something that’s really driven me throughout my career. Working in a particularly deprived area is so rewarding, but incredibly frustrating. We have lots of disadvantaged groups and I still feel we can do more to reach out and make sure we are providing the care they need and helping them live as long and healthy lives as possible.

We’ve acknowledged the need for clinical leadership and I’m delighted to have been asked to chair the new National Inclusivity Board. We need to think differently about disadvantaged groups and I’m determined that high quality general practice plays a key role in improving such poor outcomes.

Photograph © FreeFoto.com  

Last Wednesday will stand as one of the highlights of my career, and I was enormously humbled and honoured to go to Buckingham Palace to pick up my CBE. It was a wonderful day for both myself, and for my family, who came with me. I must confess that, although meeting the Queen is something that doesn’t happen every day, I was even more excited to meet ex-England football captain Jimmy Armfield, one of my childhood heroes. It’s difficult, when surrounded by people who have done so many great things for disadvantaged people, not to feel like a fraud collecting an honour, but this prize is not just for me, it’s recognition for the College, for Bellevue Medical Centre, and for all of us GPs, and the hard work we do every day.

Last week I was also summoned to give evidence to the Health Select Committee on the use of overseas doctors in providing out-of-hours services. The tragic case in Cambridgeshire served to highlight the unacceptable variance in OOH care across the country, and we must all work together to ensure that, regardless of where patients live, they can expect to receive a universally excellent quality of care from a competent doctor whether it’s day- or night time.

I had some fantastic trainees shadowing me last week, and once again I have been so impressed with the enthusiasm and willingness to learn demonstrated by our Associates in Training. I’ve been trying to reach out to the younger members and it’s been great to see so many take up my offer to spend a day at the college. What’s more, it’s fantastic having these keen, young doctors around, and so rewarding to give them an insight into the other side of general practice.

Thanks as always for your support. I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

The Out of Hours Care Report

The last week has been very busy, both politically at a national level and locally in my surgery, but most of my time has however been focused on the issue of the performers‘ list and Out of Hours provision, following the inquest into the tragic case of Mr Gray. The Coroner was very clear in delivering a verdict of unlawful killing on the Out of Hours doctor Daniel Ubani. This whole case has upset me greatly, and clearly this was an appalling tragedy. I do feel for Mr Gray’s family, and I admire how Stuart Gray, his son and West Midlands GP, has handled himself throughout what must be a really difficult time.

The independent review that I carried out with the Primary Care Tsar Dr David Colin Thomé was published immediately after the inquest. The Minister, Mike O’Brien, David and I were immersed in news and television interviews for most of the day. Most went reasonably well but Jeremy Vine, and then Edwina Currie had a go at me – ‘the good professor’. They seemed to think that we should go back to pre-2004 – complete nonsense. They don’t understand.

It seemed like they were putting all the blame on GPs – you and me – or the GP contract. I tried very hard to say that the contract was needed and how I had spent five or six years working every other night and every other weekend, being exhausted and having to go out and visit people – many of whom didn’t need visiting – children with runny noses and sore ears in the middle of the night. I can even remember visiting an old woman with a chest infection one Christmas to find a GP from another practice in the same bedroom visiting her husband who also had a chest infection!

I tried to point out that the awful case in Cambridgeshire has nothing to do with the contract and that the whole point of moving commissioning to PCTs was that better quality care could be provided across a locality by GPs who are alert and not exhausted both in and out of hours. They completely missed the point, but most of the other media thankfully took a more sensible view.

We conclude in our report that the quality of OOH provision varies across the UK, and made twenty-four recommendations, which include:

• PCTs should review the performance management arrangements in place for their out-of-hours services and ensure they are robust and fit for purpose;
• The Department of Health should issue guidance to PCTs to assist them in making decisions about whether or not a doctor has the necessary knowledge of English;
• The Department of Health should develop and introduce an improvement programme for PCTs to support their commissioning and performance management of out-of-hours services;
• Out-of-hours providers should consider the recruitment and selection processes in place for clinical staff to ensure they are robust and that they are following best practice;
• Strategic Health Authorities should consider how they monitor action taken by PCTs in response to this report and in carrying out appropriate performance management of out-of-hours providers; and
• Providers should co-operate with other local and regional providers (both in and out-of-hours) to share any concerns over staff working excessive hours for their respective services.

The report can be found here

I hope you will have a chance to read the report in full and would be very interested in your feedback – especially as I have to give evidence on the issue to a Parliamentary Select Committee in early March, which is a stressful experience in itself.

I know that all of us GPs want to provide the best quality care for our patients. It’s a real shame that people feel that because of this case we’ve all let our patients down. I hope that some good can come out of this and that we can improve the system to ensure that patients get the care they deserve, night and day, regardless of where they live.

Thanks as always for your support. I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

The end of January

One of the joys of being Chairman of the college is that I am privileged to see how general practice is delivered across the length and breadth of the country (and pinch some of the good ideas for my own practice). There is lots of good work going on, and in particular this week, I was energized by my visit to Tower Hamlets PCT. I met with the directors of the PCT and was impressed by the collaborative work taking place, particularly between their Chief Executive Alwen Williams, Medical Director Doug Russell and their colleagues. Dr Victoria Tzortziou Brown, a member of our council and a local GP, had invited me over. At a time where we hear that the London SHA are coming up with silly ideas of reducing consultation times to eight minutes, it was reassuring that in this PCT they want to support GPs and recognise that spending longer with patients who are complex and have a number of co morbidities is the way forward. It was impressive to see their managers and doctors working together to provide excellent and innovative care for their patients 24 hours a day.

There is a certain irony in the fact that the view from the Chief Executive’s office window is dominated by the behemoth that is Bart’s Hospital. The provision of care is often dominated – both physically and professionally – by the specialists and the specialties, but there is a growing and strong feeling that GPs need to get more involved in commissioning care, so that we can get more high quality care into the community. It seems that this is happening in Tower Hamlets.

On the same theme – I went back to Croydon last week to meet with Dr Agnelo Fernandes, our RCGP Clinical Champion in Urgent Care and was inspired by the excellent work that is taking place. The individual GPs in Croydon and their GP Federation are doing great things, including their award-winning work improving access to diagnostics. The Croydon GP Federation just demonstrates how collaborative work – even across many practices – gives excellent benefits both for individual patients and the population as a whole.

I’ve been doing a number of surgeries this week and I was delighted that a woman we resuscitated at Bellevue managed to get out of hospital and came back to see me. She couldn’t remember any of the drama that unfolded, but she certainly looks better. Her case gave me a real sense of the excellent work that can be achieved when the practice team work together for the benefit of our patients.

Having a relationship with the media has its benefits, and its inevitable pitfalls, and this week I’ve been misquoted a few times in the medical press. It’s unfortunate sometimes that in supporting an idea, you can be misinterpreted. I firmly support the Cancer Reform Strategy, and Mike Richards’ work. But I think that if you look at the statistics – and by that I mean the Cancer Outcomes of one year and 5 years – we can do better. This isn’t an issue about bashing GPs around the head which is how it came across in the press, it’s about everybody doing as much as we possibly can to get patients to approach us when they have relevant symptoms and then either refer or investigate as appropriate and as quickly as possible. One of the things I think is a good idea is the Critical Events Analysis – sometimes called Significant Event – when someone is diagnosed with a cancer. It’s important to ask: Is there anything we could have done better? Could the hospital have worked more efficiently?

The Out of Hours debate continues, and I am hoping that the Report, produced by myself and David Colin-Thomé for the Minister will be published in the next couple of weeks. What has been heartening throughout this debate is how the three leading UK political parties have praised the role of GPs, in and out of hours. There has, however, been a bit of a setback with regard to 5-year GP Training, and there is still some work to do to convince out specialist colleagues that we need longer training to prepare GPs for the numerous extra responsibilities they now take on as more care moves into primary care. The College’s curriculum ensures that good GPs enter practise, but many tell us that they’re not confident in their work and not gaining crucial experience in key areas, for example in the treatment of acutely ill children. But we will soldier on in the knowledge that all of the international evidence agrees that by having the right number of GPs in the right place at the right time, patient care is better and less expensive than secondary- or tertiary-dominated care. These are points that I also raised to the NHS Chief Executive David Nicholson and Jim Easton Director General Jim Easton, who has the remit for finding savings, while improving quality and productivity.

Well, it’s the end of a busy week, I’ve finished this afternoon’s surgery a bit late, but I’m looking forward to a restful weekend, and a win for the Baggies.

As always, I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

New Year

Photograph of Cannon Hill Park © Birmingham Mail

Let me start by wishing you all a very Happy, Healthy and Prosperous New Year. 2010 is already proving to be enormously busy; time has been spent between concentrating on plans for extended GP training, and editing academic papers. I’ve also been spending more time at Bellevue, and have done a number of extra surgeries, due to one of my partners being unwell.

It has been so rewarding to spend more time in the surgery with my friends. In the snow, even Birmingham looked attractive… and having negotiated the ice-rink we used to call the car park, it was great to get into the heat of the surgery.  I had expected that many people would be kept away due to the snow, slush and freezing fog. This proved not to be the case, and already this year I’ve seen a number of seriously ill people presenting complex physical and psychological issues. I really enjoy being in practice and seeing patients; I believe it is so important to keep grounded in surgery, and I feel privileged to work in the busy, inner-city General Practice that is Bellevue Medical Centre.

I received a letter a few weeks ago asking me whether, if offered, I would accept a CBE. I gave it some serious thought and, as many of you may have seen in the press this week, was delighted to accept. My enormous pride and gratitude outweighs the slight embarrassment I am feeling as a result of the attention, and I am very much looking forward the forthcoming trip, taking my family to Buckingham Palace. My mum and dad are really happy, too.

This award is a huge honour, and it’s wonderful to be able to thank to my colleagues; at Bellevue, those I’ve worked with in post graduate medical education, and at the RCGP, my family and the many friends I have made over the years. It is testament to the wealth of advice, encouragement and support I have received throughout my career and it’s a great start to the New Year.

As you know, towards the end of last year I was heavily involved with publicising the scandalous treatment of immigrant children and families in detention centres. The work of the College, and a number of other organisations, has led to this issue garnering extensive media coverage. The campaign seems to be really hitting home, and lends hope that this shambolic and disgraceful practice can be brought to an end as soon as possible.

My focus into the New Year has remained on the welfare of children and vulnerable people: I have expressed my concern at the worrying internet strangling craze that a number of young people have embraced. This disturbing, highly dangerous, risky practice should be avoided at all costs, and parents and GPs need to be aware of it.

I have also spoken out against product placement on television. I am particularly worried about the placement of alcohol and unhealthy foods, not just for children – who can be easily led by advertisements – but also for adults. I think that the argument that products will only be placed in programmes that are not viewed by children – such as Coronation Street and Emmerdale – is disingenuous; the role modelling on sitcoms and soaps is so important; we must protect young people from harmful influences and not fuel the obesity epidemic.

As always, I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.