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.