In a keynote speech at a two-day online RCGP conference, Professor Martin Marshall warned that 'the dilution or loss of the relational element of general practice would damage the quality of patient care, the efficiency of the NHS, and the specialty of general practice'.
He paid tribute to 'the heroic efforts of GPs and our teams' during the pandemic - and said the profession should enjoy the praise rightly coming its way for its role in a COVID-19 vaccination campaign that had delivered a first dose to more than 13m people UK wide by the end of 9 February.
Professor Marshall said it was 'likely that general practice will remain responsible for providing booster doses to our vulnerable patients, perhaps even in the same syringe as the annual flu jab' in future.
But he warned that the necessary focus on tackling the pandemic could be seen to have made general practice 'more transactional and perhaps less patient-centred' - arguably accelerating a trend 'driven by rising workload, performance-managed contracts and the protocolisation of care, as well as by societal and demographic changes' in recent decades.
The London GP argued that for general practice, relationships with patients were as 'important as a scalpel to a surgeon', pointing out that continuity of care was strongly linked with improved patient satisfaction and experience, compliance with medical advice, better health outcomes and low mortality rates.
'If relationships were a drug,' the RCGP chair told delegates at the online event, 'NICE and other guideline developers would have to mandate their use. But relationships, and the ways in which we build and utilise them, aren’t drugs, so we don’t talk about them very much.'
Professor Marshall said relationship-based care could be maintained despite challenges for general practice, including a landscape changed by increasing practice size and the rise of remote consultations.
Remote GP consultations
Remote consultations were not 'inevitably' a threat to relationship-based care - but GP training must develop to build techniques for enhancing relationships through remote consultations, Professor Marshall said. Meanwhile, he rejected calls from health and social care secretary Matt Hancock for GP consultations to be remote by default in future.
'As a college we don’t agree,' the RCGP chair said. 'We don’t want to turn the clock back, we know that remote consultations have a role to play in the emerging general practice landscape – some patients prefer them, and so do some GPs.
'But, if there’s one thing I’ve learnt during the course of the pandemic, it’s that it’s much harder to build a relationship with a patient, to establish trust and empathy, through a remote consultation. And without that personal connection, without knowing the person behind the symptoms, it’s harder for GPs to do our jobs.'
Policymakers could be persuaded by clear evidence that 'continuity leads to lower costs; lower use of EDs; reduced likelihood of being admitted to hospital', the RCGP chair said.
Continuity of care
He argued that relationships were fundamental to effective general practice and should be designed explicitly into future models of primary care - but called for more work to understand how relationships should work for different patient groups, and for research to investigate whether relationship-based medicine could function sometimes in the absence of continuity of care.
Professor Marshall said: 'Relationship-based care is a fundamental feature of effective general practice and I think that our ability as GPs to deliver it is at risk. And the less opportunity there is to utilise relationships, the less practitioners and patients experience it, the less it will be valued and the more it is at risk. So I think there is a urgency in our need to address the challenge.
'We need to make it clear that there’s nothing soft about relationships and our interest in relationships isn’t yearning for a lost and never to be rediscovered past. Relationship based care is deliverable despite the many challenges we face.'