Dr Helen Stokes-Lampard interview: GPs must accept that change is inevitable

Dr Helen Stokes-Lampard rushes into a small, hot office on an upper floor of the RCGP headquarters in Euston, central London for a meeting squeezed into a day spent with the future of her profession.

The ground floor of the RCGP building is swarming with new college members attending their graduation ceremony, and the new college chair has been circulating to talk to the new recruits and take part in presentations.

It's hard to say to what extent these young GPs understand that they are arriving in a profession in crisis, or whether they understand the profound changes facing the NHS as they begin their careers within it.

Dr Stokes-Lampard, however, has experienced first-hand the 'difficult, dark times' general practice has been going through. She is determined to 'hold feet to the fire' to ensure that promises of investment in general practice through the GP Forward View are delivered - along with new funding across the rest of the UK - although she is clear that her profession will have to evolve to survive.

GP funding

The Lichfield GP begins her three-year term as the third woman in a row to lead the college after half a century of male chairs, and acknowledges the role played by the first of the trio - Dr Clare Gerada - in 'lighting the spark' that has seen the RCGP move beyond its more traditional, academic role into campaigning hard for funding and support for the profession.

'Clare lit the spark, Maureen Baker went into battle and now the cavalry is coming,' she says. Dr Stokes-Lampard sees her top priority as making sure that the cavalry - largely in the form of NHS England pledges to deliver at least 10% of the NHS budget to general practice by 2020 and a similar promise in Scotland - arrive in time to make a difference.

'Undoubtedly the first priority has to be seeing through the campaign started by Maureen Baker to get more resources and clinicians into general practice,' she says.

'Big wins' in England and Scotland have seen pledges of a £2.4bn rise by 2020/21 in annual GP funding south of the border, and a £500m pledge from the Scottish government. 'We are still seeking comparable promises in Northern Ireland and Wales, but in England and Scotland it's now about holding the relevant bodies to account to ensure that they deliver on those promises so that the hard cash gets to the frontline, because GPs are really hurting.'

She welcomes short-term plans in England's GP Forward View to help struggling practices with funding and management support, premises investment, IT and indemnity costs, but she adds: 'The longer-term promises are that hard cash will come through from the baseline increase to at least 10% of NHS funding. A significant proportion of that has to come through as hard cash.

'Clearly negotiating the terms of that is in the lap of the BMA, but I know that what GPs need is resource that is not tied to new targets or new hoops to jump through.' That funding - or much of it - must come as an increase in practices' core funding, she argues.

GP workload

Any plans to transfer work into general practice must come 'in addition' to the GP Forward View, she adds, and with funding attached. 'If they want to transfer work to general practice, the resource has to follow. We know that general practice can do things more cost effectively than hospitals. It makes sense for patients, it makes sense financially, therefore it makes sense for the NHS. But that equation only works if the resource follows - you can't do this on fresh air.'

But even with extra funding, there just aren't the 'bodies' in general practice to take on more work, she admits. 'We need those bodies, we need more nurses, we need a whole range of allied health professionals, and GPs should be conducting that orchestra to deliver services in innovative ways. GPs must be doing the work that only GPs can do, but if someone can do parts of the job as well as us, we should be welcoming them with open arms. At the moment, all help is gratefully received.'

Along with wider skill mix, GPs have to be ready to embrace new models of care, says the new RCGP chair. Even, she suggests, if that means large private providers winning significant contracts to deliver services at scale in parts of the country.

'Changes are actually necessary for our profession,' she says. 'It is important that general practice evolves to survive. The NHS has never been static and it's naive to think there is going to be one model of general practice for the future.

'GPs need to accept that change is inevitable. We can’t continue the way we are - so many areas have already embraced change and are working constructively with it. Be prepared to have a go at new models.'

NHS privatisation

Our meeting comes just as news emerged that private provider Virgin Care had won a reported £700m deal to take over social care in a part of south-east England. Asked if similar large-scale private takeovers could happen in the NHS - particularly as primary and acute services are integrated into large 'accountable care organisations (ACOs) in some areas - Dr Stokes-Lampard is remarkably sanguine.

Is the prospect of large private providers taking on significant chunks of NHS provision something to be worried about, or just a fact of life? She says: 'It think it is going to be different solutions for different areas, in some areas that is going to be what happens because it’s right for that area.'

Although models of care are not to be held sacred, Dr Stokes-Lampard draws a line in the sand over one thing - the relationship between GPs and patients.

'The doctor-patient relationship, that consultation with the patient does not change,' she says. 'The time you are spending with the patient in the consulting room does not change. Patients need us to be their general practitioners, to be their advocates, to look at their whole physical, social and psychological profile. Outside the consulting room is where the change is happening - the places we refer to, the people we work with, who does what.'

Across England, sustainability and transformation plans (STPs) are laying out exactly what these changes outside the consulting room will look like. The process has been heavily criticised for being carried out under a veil of secrecy - a King's Fund report this month said patients and clinicians had been 'largely absent' during development of the plans.

Health secretary Jeremy Hunt has recently suggested that STPs could be subject to full public consultation, and health minister David Mowat told the RCGP conference that plans could be scrapped if GPs opposed them.

Podcast: What do STPs mean for GPs?

Dr Stokes-Lampard seems confident this was no empty promise: 'We have reason to believe that STPs that don’t involve general practice will be sent back to think again.'

The college has employed ambassadors to 'influence the STPs and try to ensure the voice of general practice is heard in every single one of them.' And she is clear that not only will STPs that don't involve general practice be rejected, they simply won't work.

'You cannot have a sustainable or transformed NHS without primary care being at the heart of it. The NHS is not sustainable without primary care, without general practice, therefore any plan that doesn’t include primary care is doomed to fail - we are the sustainable element of the NHS.'

Despite being prepared to challenge STPs that don't involve GPs, Dr Stokes-Lampard also concedes that to an extent, GPs 'have to get behind them'. She agrees with the analysis of King's Fund chief executive Chris Ham that the NHS simply has no plan B. 'STPs are the only game in town, so whether we like them or not we have got to make the best of it.'

It is this kind of language that leaves the college open to questions over whether its relationship with the government or NHS England is, well, a bit too cosy.

One of the key aims of STPs is to begin to deliver the vision set out six months ago in the GP Forward View - a document that featured the college logo on the front, and which Dr Stokes-Lampard's predecessor called 'the most significant GP deal since the 1960s'.

Dr Stokes-Lampard says that it was a 'courageous step' for the college to be so heavily involved in drawing up the GP investment plan, and argues that 'constructive doesn't necessarily mean cosy' when it comes to its relationship with NHS leaders.

And she defends the significance of the promises set out in the GP Forward View: 'If we get all those promises delivered in hard cash, it will be a tremendous win for general practice. It will be a lot more resource, make no mistake about it.

'Of course it won’t be enough, it will never be enough. The NHS and healthcare could swallow 100% of GDP - demand is phenomenal. But if you go to Wales and Northern Ireland and ask if they would like the Forward View promise, you get the reality of the situation - they are desperate for a similar promise.'

Despite this, she is taking nothing for granted. Among her first acts as RCGP chair will be to commission a 'progress report' to assess whether promises made by NHS England are being delivered, with findings to be published around a year after the GP Forward View was published in April 2016.

Her determination to make sure the bailout funding does arrive is rooted in her own practice's continuing struggle to keep going in the face of the same pressures facing the rest of the profession.

As college chair, Dr Stokes-Lampard will be leaving behind a role she enjoys, leading a medical school's GP training programme, but will retain her partnership at the Lichfield practice where she will work one day a week.

'It's a small, ordinary practice with 8,300 patients. We're not a vanguard, we're GMS, although we are in a federation, and also working with others across a locality.

'Over the last few years we have lost a few of our salaried doctors through ill health or life events, and that has been really hard. I feel the pain of the profession because I am in it. I feel the difficulty of getting in good GPs as part of our team.'

Returning each week to frontline general practice is a vital release from the pressures of leading the college, too. 'It’s important to keep grounded, to see my patients and be part of my community and feel part of it.'

Further priorities for Dr Stokes-Lampard's three-year tenure will include a review of the MRCGP exam - not triggered by any concerns about it, but simply to ensure it remains up-to-date and fit for GPs of the future.

Part of the checklist she has set herself includes reminding GPs about the amazing job they do. Reminding GPs about the joy of a great consultation and the joy their role can bring feeds into mapping out how to inspire the next generation, she believes. The college will also need to work to make sure partnership and salaried roles become more attractive, she adds, and stem the burnout driving doctors into locum roles or out of the profession altogether.

What the future will look like for all those new GPs milling about at RCGP HQ is unclear - and some may well find themselves in what feels like the diametric opposite of Dr Stokes-Lampard's own run-of-the-mill GMS practice. But she is determined that they will have a future, and that the terms on which they engage with patients will be no different to the rules of engagement for the previous generation.

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