General practice is evolving faster than ever before, says RCGP chair

General practice is changing faster than ever before - but only a larger workforce can help the profession respond to chronic excess workload, RCGP chair Professor Martin Marshall has warned.

RCGP chair Professor Martin Marshall (Photo: Pete Hill)
RCGP chair Professor Martin Marshall (Photo: Pete Hill)

In a keynote speech at the 2021 RCGP annual conference in Liverpool, Professor Marshall said the past 18 months had been 'massively challenging' for everyone in general practice - paying tribute to GPs who lost their lives working on the frontline during the COVID-19 pandemic.

General practice 'got on with the day job' - transforming at pace how services were delivered to protect patients and maintaining care for the most vulnerable - while politicians and the media focused on intensive care units, he told the conference.

Practices continue to manage the long-term effects of the pandemic, he said, supporting patients whose treatment is delayed by the NHS backlog and those with long COVID alongside other care. The COVID-19 vaccination campaign, meanwhile - hailed this week by MPs for redeeming 'persistent failings' in other parts of the UK's pandemic response - succeeded largely because of the efforts of general practice, the college chair said.

Vilification of GPs

Describing general practice as 'phenomenal', he condemned as 'unfair, demoralising and indefensible' the 'widespread vilification of hardworking GPs and our teams' that has been linked to a surge in abuse directed at primary care staff.

Professor Marshall hit out at the 'so-called support package for general practice in England' announced by the government - warning it was 'most definitely not the answer to the challenges that we face'.

He acknowledged that many in general practice had been struggling to maintain optimism even before the pandemic - but told the conference: 'Ours is not the first generation to feel this way.'

History shows governments take a long time to realise that 'a crisis in general practice quickly leads to a crisis in the rest of the NHS', Professor Marshall said - and it was 'frustrating that this has happened yet again' despite warnings for over a decade.

He said expanding the GP workforce was essential to solving the problem of 'undoable workload' - and that in the short term, measures to cut back the bureaucratic burden for general practice could support the profession to deal with surging demand.

Evolution of general practice

But he said that 'evolution of general practice is now happening at a faster pace than has ever been seen in the past' - and argued that while many of the changes taking place were simply inevitable, they could provide an opportunity both to improve patient care and the working environment for GPs.

Professor Marshall identified five key trends that could reshape general practice over the coming decades - 'increased scale, increased multidisciplinarity, a stronger patient voice, a more significant public health role and greater integration'.

He told the conference: 'I recognise that there are some GPs who don’t like some of the trends but I think most are inevitable and that if we’re clever we can make them work to the advantage of our patients and our specialty.'

He said the college was working to develop a better understanding of the 'evolving role of the GP within a multidisciplinary primary care team' - arguing that although the traditional GP role was efficient, it was becoming 'less and less deliverable' in the face of rising demand.

Traditional role

'The traditional model of GP-as-all-things-to-all-people was an efficient model - surprisingly so to economists who talk about us "working to the top of our license" with no understanding of what we do or what our license should look like,' the college chair said.

'But when demand outstrips supply the traditional model is becoming less and less deliverable in most practices. We are now seeing GPs focusing on those areas of work where they can add greatest value - triage because we’re good at managing risk and making quick decisions; managing complex biopsychosocial problems because we are experts in complexity; and adopting a more strategic role in improving the health of our communities.

'So a growing number of GPs are attempting to create space by spending less time on the more transactional presentations that used to occupy much of their time and in doing so are starting to free up time to focus on the areas where they can make a greater difference.'

He said the shift was complex and would require more training - and changes in training - for GPs as they adapt. But he added: 'These aren’t easy questions but practices around the country are finding answers. That’s what general practice does; driven by our deeply embedded values we adapt, we evolve, we innovate.

'And that’s why we should all be confident about the future of our specialty and our patients can be confident about the future of their care.'

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