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.