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.

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.

The RCGP AGM

It’s been another exhausting two weeks, the culmination of which was the RCGP AGM in London. The AGM was, as ever, a fantastic opportunity to highlight and reflect upon all of the excellent work that goes on in College.

The AGM is always an odd time, as it combines the welcoming of new members with the departure of old friends, and this year was particularly poignant, as we said goodbye to David Haslam and Maureen Baker, who left their offices as President and Honorary Secretary respectively.

The College owes a huge debt to both David and Maureen, who have worked tirelessly above and beyond their duties.

David has the distinction of being one of a small band of College members to have served both as Chairman of Council and President; he has carried out the role of College President with great charm and charisma, a crowning achievement at the end of many years of service to the College.

A particular highlight of the AGM was the unveiling of David’s presidential portrait. David’s diplomatic skills are legendary, and it is perhaps this trait that the portrait best captures. It’s an excellent likeness, and the skills of Bing Jones, the artist, are to be commended. What’s also interesting is that Bing is himself a doctor, and divides his professional time between work as a portrait painter, and as a doctor in blood and bone marrow transplantation.

Our new President and Honorary Secretary, Iona Heath and Amanda Howe are already embracing their new roles with energy and enthusiasm.

As we welcome new members, it is interesting to see that the average age of the Council continues to decrease. This is an exciting time for College, and I for one am looking forward to what this continuing injection of youth and energy will bring in the future.

I recognise that the first years after training can be a difficult time for new GPs. They may find themselves working in an unfamiliar practice and may miss the guidance of a trainer, and peer support from their VTS group which they enjoyed as an AiT. The College is working on a new initiative called First5 which will support new GPs from completion of training to the first point of revalidation at five years. There are five pillars to First5 which are: connecting with college, mentoring and peer support, help with revalidation, career guidance, and continuous professional development (CPD).

The idea of First5 was suggested by Dr James Parsons, South Yorkshire AiT rep, was developed by the AiT committee in 2008 and was recently supported by College Council. This is a major project for us which is being taken forward by a First5 task group led by Dr Clare Gerada, Vice Chair of Council. Dr Clare Taylor, Chair of the AiT Committee has recently been appointed as First5 CPD fellow. Her role will be to identify the specific CPD needs of First5 and to develop CPD materials and resources to address these needs. I will keep you updated on our progress with this exciting new project.

Like many of you, my attention this week has been focused on the plight of those caught up in the flooding in Cumbria. In this difficult time I urge you all to spare a thought for all of those who have been affected, and for the GPs who are coping with these adverse conditions. It has been particularly impressive to see GPs setting up temporary surgeries and ensuring that the disruption to patient care remains at a minimum. Our own Mike Bewick, the Medical Director of Cumbria Primary Care Trust has been heavily involved in the relief effort and has been keeping us informed of events.

I am really impressed with the hours that Mike and his colleagues have put in – GPs always rise to the challenge as professionals when needed – well done to all of you.

The effects of climate change on health is a huge challenge that we as GPs cannot afford to ignore. I must commend Tim Ballard, the RCGP Sustainability Lead; at the College we are embarking on an ambitious programme to take a critical look at the environmental impact of our activities and how to decrease our carbon footprint. The decisions being taken about any relocation from Princes Gate to a new HQ will have at their heart the sustainability of either a new build or an adaptation of existing premises.

GPs can make a difference to this daunting problem. Some of the actions we can take to help our patients now have the added co-benefit of helping with carbon reduction. Examples include encouraging more walking and less car use and decreasing the amount of red meat in the diet, to name but a couple.

We are in the privileged position of being highly valued by the population and through this we have an opportunity to take a lead and make a difference. Not only will our patients listen to us about their health, they are also likely to take a lead from our wider concerns and take note of our personal actions.

I’ve spent the last two weeks on something of a whistle-stop tour of the UK, visiting and speaking at a number of RCGP Faculties up and down the country. My travels have seen me as a far and wide as Glasgow, Edinburgh, North Wales, Dorset and London. It is always so interesting and valuable to see first hand the College at work at a local level.

This month I also attended the Proprietary Association of Great Britain Conference on Self Care – the resounding theme of which was changing the culture of dependence in the NHS. For the first time the conference was co-sponsored by the RCGP and it raised some very important points, particularly on the navigational role of GPs.

Very often these days, and rightly so, patients come to their GP pre-armed with information they have downloaded. What is crucial is that, as GPs, we take a guiding role, as is the very ethos of General Practice, to direct patients to information that is credible and evidence-based.

The conference report and a podcast of views from the speakers (including myself) can be found at http://www.pagb.co.uk/

I would also like to point you, and your patients, in the direction of The Hippocrates Prize. The Prize, supported jointly by the Warwick Institute of Advanced Study and the UK national Fellowship of Postgraduate Medicine, is a new international poetry competition, on the theme of poetry and medicine, with an Award fund of £15,000. More information can be found at http://www.hippocrates-poetry.org/