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.

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 Breast Cancer Care Carol Concert

 

Photograph © Matt Banks

It’s been an intriguing, and emotional week, with a number of clinical and political issues being brought to the fore.

It’s always nice to get an evening away from College, and a poignant highlight this week was attending the Breast Cancer Care Carol Concert at St. Paul’s Cathedral. It was an exceptionally moving evening, punctuated with some beautiful singing from the choir and 14-year-old Faryl Smith. Jane Hinnrichs, the Chair of Trustees for Breast Cancer Care gave a truly inspirational talk. In it she spoke about what it is like to live with breast cancer. It was incredibly moving; her story of living with breast cancer since 1994 resonated deeply with me, and felt very similar to the story of my own family.

I have also been actively involved with a contentious and emotive issue – that of the appalling treatment of children and young people in immigration removal centres. The College and I have been in discussions with the Royal College of Paediatrics and Child Health, the Royal College of Psychologists and the Faculty of Public Health, and have put together a joint statement recommending that this shameful practice is brought to an immediate end.

Dr Les Ashton and Dr Jane Roberts have been leading the work of the RCGP on this issue, and I commend the hard work and commitment they have shown.

As a civilised society, we cannot sit back and allow these practices to continue – they are unethical and unacceptable. Reading the testimony of children who have been detained in these centres upset and angered me. Children should not be asking, as one girl did, “Why do they have to put us in cages?” One child described the process of being taken into custody: “We were sleeping and the officers came. It was scary and mum was crying.”

This outrageous practice has attracted a lot of media attention, as has the joint stances of the Royal Colleges and the Faculty of Public Health. I spoke about child detention on BBC Breakfast last week, and echoed the call to bring child detention to an immediate end. While I do not usually watch my own interviews, I was proud to bring attention to this horrendous story.

I must thank the hundreds of you who responded to the questionnaire I circulated from Professor Mike Richards. Your excellent submissions on the role of the GP in early diagnosis have now been sent to the DH for consideration. Professor Richards’ responses were published in the December edition of RCGP News, and I’ll keep you informed of progress.

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.