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.

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.

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.