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.

Revalidation Update

Many of you will be aware that revalidation has hit the headlines again this week, with the publication of a letter from the new Secretary of State Andrew Lansley to Peter Rubin, chair of the GMC – a copy of this letter can be found here.

Regardless of what you read in the newspapers, revalidation is moving forward and I believe that the Secretary of State’s letter is a constructive addition to the debate. As you know, the RCGP has been working very closely with the GPC, and other stakeholders. I have been out and about around the country, most recently at a session with defence service doctors, and I always bring back good questions, even if I don’t know the answers when I’m there! A lot of the work we have been doing recently has focused on GPs who are practising as locums, or working in rural and remote areas. Over the past couple of weeks I have had very constructive meetings with the GMC and I had a positive discussion with medical directors of PCTs on clinical governance, revalidation and a need for continued funding for the Practitioner Health Programme which supports doctors in difficulty last week at the College.

There do seem to be problems in some of the hospital specialties about the standard that doctors will need to meet in order to revalidate, but in general practice we have always taken the view that revalidation is about professional development, and that for revalidation to be a success it will also depend on appropriate clinical governance systems in Primary Care Organisations across the UK, appropriate funding and a solution to the question of remediation.

I have always tried to ensure that the College is open about its deliberations, which is why we have published the guide to revalidation – of which the fourth edition goes live imminently. We want to make sure that revalidation is appropriate for all GPs, regardless of how and where they work.

With that in mind, I support the Secretary of State’s view that piloting should be extended so that we can learn more, particularly about the costs, and how we can make this as bureaucracy-light as possible. It will also give primary care organisations more time to sort out their clinical governance systems and appoint responsible officers. We know that the profession – particularly in some of the specialities - doesn’t feel as engaged as it might; we have benefited from regular meetings with the GPC, who have acted as critical friends – not shy to challenge, but always ready to support when appropriate.

Of course I will continue to update you on progress, and Mike Pringle, RCGP Medical Director for Revalidation, and I will continue to tour the country meeting with GPs and responding to your questions as revalidation moves forward.

The heat is on

Summer has truly arrived, and after the sort of weekend that makes you glad to be alive – sitting in my garden enjoying the sunshine – I’ve spent much of this week in the stifling heat of London.

Unlike the pastoral bliss of Birmingham, the College is sweltering under the heat. The lack of air conditioning, and the resultant awful conditions our staff are currently experiencing, has only reinforced the need to move to more suitable premises.

Fortunately, the first phase in our historic move is just around the corner. From August, and for the subsequent two years from then we shall be relocated to our temporary ‘swing space’ at St Katherine Docks.

The move is beginning to feel very real, and with this comes excitement. However, as with any big change, there will be small sacrifices to be made, and for the two years at St Katherine Docks there will be no overnight accommodation. This will necessitate a change in working practices until we move into the new building at Euston Road, and to address this we are planning a new section of the RCGP website in order to keep the membership and staff alike up-to-date. The site will be live from the middle of June.

I urge all of you to submit entries for the new RCGP Caring About Carers Award - run in partnership with The Princess Royal Trust for Carers - which was reported in this month’s RCGP News. We GPs play a vital role in encouraging carers to look after their own health, as well as providing support to help them in their caring role, so I urge all of you to take part. Nominations for the award close on 11 June, and more information is available at http://www.rcgp.org.uk/.

The Spring Meeting earlier this month went brilliantly well, and I enjoyed immensely Sir John Tooke’s fascinating lecture on the personalisation of diabetes care. It was really great to see so many new members and fellows, and their families, and I was so impressed that so many doctors are so keen to get involved. It makes me feel really proud that we’ve managed to promote this initiative, and in doing so become a more inclusive and welcoming college.

You may have seen an article recently in Pulse about the shortage of doctors putting themselves forward for RCGP Fellowship. Fellowship is a wonderful thing: it’s an indicator that of a doctor providing high quality general practice above and beyond expectations. I’d urge all of you who have been a member of over five years to put yourselves forward. I was humbled at the Spring Meeting to be shaking hands with men and women who’d done such wonderful things in clinical care and research, and was so pleased that, through fellowship we can recognise and thank them for their hard work. The College draws its strength from the quality of its members and fellows, and because of them it is a force for good, a force for a change, and a source of the clinical leaders the NHS needs.

The Lib-Con Coalition

This is my first message since the General Election, and the formation of the new UK Government. The makeup of the new blue-and-yellow, Lib-Con health team for England is becoming clear. Congratulations to Andrew Lansley, who has become Secretary of State after many years in the shadowing role.

Andrew has an incredible knowledge of the NHS and healthcare generally, and over the last few years I have spent a lot of time talking to him, his team and indeed, as you know, to the health ministers in the old Government. I look forward to working with new team.

I am very pleased that the new administration is continuing to promote our vision of the role of the GP – Andrew really does understand the role of the generalist and we both share a belief that GPs should be leading at all levels in the NHS and take more responsibility for commissioning care.

As you know, we have been promoting the role of GP federations. I believe that federations will play an increasingly important role in the NHS, with GPs working collaboratively to provide a wider range of services in their communities, and to move more care out of hospitals. I want to make it clear in this message that we support the continuation of small practices, because the evidence is that the patients like small practices, and we know that the quality of care can be excellent, continuity is important to patients, and that patients like the personalised care that they provide. Practices working more closely together in federations – whilst not losing their identities – will allow more care to be provided closer to home. It will also help us address the issues of access to GPs and provide a solution perhaps to the practice boundary issue.

With this in mind I hosted this week a working meeting on federations, which will be reported in Pulse and RCGP News over the next few weeks. Laurence Pike, a GP in Lincolnshire described how Lincolnshire GPs had grasped the nettle and taken control in their local area, including their local community hospital. In doing so, he said, they’d revolutionised the service available to patients in their rural area. The federation in Croydon, led by Agnelo Fernandes, has made brilliant advances in a totally different environment. As you will be aware, Agnelo’s federation is a HSJ prize-winner for his work on improving patient access to diagnostics.

I was thrilled to hear at that meeting of the commitment and leadership of a number of GPs, and I was pleased that the NHS North West CEO, Mike Farrar, had become a strong advocate for GPs taking this federated agenda forward. We also have strong support from the NHS Confederation.

I am really optimistic for the future, particularly as my conversation with the new Secretary of State this morning reconfirmed his support for the leadership role of GPs, for federations, and for moving care closer to home.

The Daily Mail, however, appears to be at it again: last week, they were really good at helping me debunk the myths surrounding celebrity diets (my daughters were amused to see my health advise alongside pictures of Gwyneth Paltrow and Jennifer Aniston), but on today’s front page they led with an inflammatory piece about GPs out-of-hours care.

Because of my interest in out-of-hours care, and the report I co-authored with David Colin-Thomé for the last Government, I have kept close interest in how we can improve the quality of care for patients. I spoke to all of the political parties before the election and as you know, the College continues to be involved in DH discussions on out-of-hours and improving out-of-hours training. Andrew Lansley’s position – he assures me – is the same as ours. We both believe that doctors working in and out of hours in the UK must speak English of an appropriate standard. He also agrees that GPs should be involved in commissioning care out of hours. He reiterated his belief that GPs should not be forced to work out of hours if they do not want to, but hoped that more would want to get involved once they had more say in the commissioning of care and the design of services.

As I have said for many years, the key to the success of the NHS is to get GPs in leadership positions, locally, regionally and nationally. As GPs we have a good idea what patients need. I believe that with appropriate support we are capable of commissioning better services for our patients. This includes out-of-hours care. All of you will recall in our manifesto a call for:

“Better round-the-clock care for patients
Every patient deserves high-quality care in and out of hours. GPs must be more involved in local decision making and in the commissioning of out-of-hours services to deliver the highest-quality care around the clock.”

I look forward to working with the new health team in England, and continuing to work with the health teams in the other countries on other important aspects of our manifesto in the months and years to come.

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.

Election Day

Picture by: Ian Britton - FreeFoto.com

Election Day is finally here and whatever the outcome, it has been one of the most exciting build-ups I can remember. We will of course work with whichever party is in power in Westminster and whichever parties are in charge of health in Scotland, Northern Ireland and Wales.

My job as Chairman is a huge responsibility and while it’s not (quite) on the scale of leading a major political party, working with the parties has given me a lot more empathy with their leaders and I now understand that however hard you try, you can’t get it right all the time

A good example came last week when I represented the College at a joint conference with the King’s Fund and the Royal College of Physicians on the future of the NHS. It was a stimulating event, attracting a very influential audience, and I used the opportunity to talk at length about the role of the GP at the centre of the NHS, quality general practice, and the need for strong GP leadership and for a call for better integrated care across the specialties.

The general consensus was that whatever the outcome of the election, the NHS is stuffed financially for the next few years, but that GPs are best placed to lead the health service through the turbulent times ahead and that we can be relied upon to run cost-effective services without damaging the quality of patient care.

So you can imagine my dismay when I logged onto the website of GP newspaper and saw the story RCGP Chairman urges GPs to ‘grow up’ on pay. My presentation had been completely ignored in favour of one line on GP pay, which is not the business of the College in any case.

Clocking up the amount of media that I do, I’m usually laid back about the odd misquote here or there. I appreciate that journalists have their job to do and that positive stories about general practice don’t always create the best headlines - but this time I really saw red.

In their defence, the journalists at GP moved swiftly to print a clarification which is now online and will be printed as a letter in next week’s issue, but as far as I’m concerned the damage has been done and I can only apologise to any of you who have already read or will go on to read the story.

To set the record straight, I do think that GPs are now paid "appropriately" and so we should be, after years of being underpaid and underestimated for the work we do. I also believe that we should grow up, but by that I mean “grow into” the role of NHS leaders determining our own way ahead, rather than being passive receivers of what others are doing.
We have overwhelming evidence, most recently from the Commonwealth study and the American College of Physicians, that we have the best primary care system in the world, so why-oh-why is this always overshadowed by how much we are paid?

We can sit back and feel got at or we can choose to rise above it. It’s ironic that when the chips are down, the profession seems to come into its own and we just get on and do the best we possibly can for our patients while the voices of doom resonate around us.

Today has been a busy one so far and I spent this morning at the Department of Health talking about the need for GP leadership at all levels. By the end of today, we should have a new Government and whatever its complexion, we need to use this as an opportunity to show our mettle and demonstrate how GPs can steer the NHS through the choppy waters of the next few years, without our patients noticing any detrimental difference in the care they receive.

Aboard the HMS Victory

© The British Postal Museum & Archive (BPMA)

The general election is almost upon us, and we’ve seen history being made with the three main party leaders debating on live television. There has also been the first health husting, with the three people who want to be secretary of state for health in England - Andy Burnham, Andrew Lansley and Norman Lamb. It’s absolutely becoming clear that the big issue, whichever country in the UK you live in, is how that country’s NHS can move forward with dramatically reduced resources.

I believe that the solution is to put the GP at the centre of the NHS, and I also believe that as GPs we have a responsibility to stand up and be counted – we need to demonstrate leadership, locally, regionally and nationally after the election. All of the political parties have been talking about primary care and the importance of the role of the GP. In England, the emphasis is on commissioning. As GPs we all know that we focus on the needs of our patients – that’s when we are at our most effective. It is encouraging to hear so many politicians talking about our federated model and it’s been really interesting to hear the differences of thought across the UK.

I am pleased to say that there are a few GPs standing for Parliament – including one of our examiners in Devon – and I watch with great interest to see how they get on. It’s a shame that Howard Stoate, who was an examiner with me a few years ago, has decided to stand down after being an MP for Dartford. He’s made a great contribution to the Health Select Committee to keeping the profile of general practice up in parliament and championing the needs of the public. He’s also been really helpful in getting the College into parliamentary meetings and to be taken seriously at the Health Select Committee. Thank you, Howard.

Last week I fulfilled a boyhood dream – being able to explore that amazing, historic ship HMS Victory. It was a great privilege to be invited to speak and dine with the doctors from the Royal Navy at their base. We discussed the future of General Practice and revalidation. The more I meet up with our colleagues in the defence services, the more I admire the work they do on our behalf, in very difficult circumstances around the world. As you will be aware, my own practice has a role in the care of defence personnel in Birmingham and is closely linked in with Sellyoak where our excellent defence service doctors look after very badly injured soldiers. It was great to meet up with my great friend, Surgeon Commodore Noel Bevan, Surgical Commander Marcus Evershed, Surgeon Captain David Brown, and their colleagues. I learned such a lot from talking over issues with them and sitting in a small workshop on consent and confidentiality. They have special issues regarding revalidation, and I came back thinking more and more that revalidation really is about professional development and needs to be a straightforward activity for GPs, low on bureaucracy, high on education and focussed on the special work that every GP does.

Tuesday was the Fourth Annual Partnership Conference of the College, the King’s Fund and the Royal College of Physicians. The theme of the conference was ‘How can clinicians improve services for patients in a cold financial climate?’ There are no easy answers of course, but one thing is for certain; the future is clearly going to be one where GPs lead in partnership with our specialist colleagues. We are presented with an opportunity when the new Government comes into place – to assert the role of GPs at the heart of the NHS – but to do this we need to be positive, constructive medical leaders providing solutions at all levels.

I also want to mention the College’s International Team, which continues to do some excellent work. We have recently signed an agreement granting MRCGP[INT] accreditation to the Egyptian Family Medicine Fellowship degree; and I would like to thank all of our international colleagues – lead by Professor Val Wass and John Howard – who work tirelessly to raise standards around the world.

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.