Interview with Professor Clare Gerada: Fighting for general practice

Outgoing RCGP chair Professor Clare Gerada tells Marina Soteriou about turbulent times.

When Professor Clare Gerada leaves her post as RCGP chairwoman in November, she won't be forgotten in a hurry. Her three-year tenure has been nothing if not eventful.

The college was for a long time the sole medical establishment voice against former health secretary Andrew Lansley's NHS reforms in England. She admits this left her 'bruised' and exhausted.

But Professor Gerada continues to speak out. In her final year as RCGP chairwoman, she has warned that general practice is in 'crisis' and challenged health secretary Jeremy Hunt to deliver 10,000 more GPs and major investment in the next decade.

She also questions whether plans to make named GPs responsible for care 24/7 can work.

'The vast majority of our work is self-limiting illness in the young. It is a good idea to improve continuity of care for the elderly and we have said that, but it is not going to be achieved without more GPs,' she says.

Despite the hard knocks, standing up against the Health Act is one of her proudest moments, she says, alongside securing an agreement to extend GP training to four years.

Professor Gerada admits she has received several offers of work as her time at the RCGP draws to a close. Surprisingly for someone who says 'the government doesn't like me', she has accepted a role at NHS England.

Transformation

Her new title is clinical chair for primary care transformation in London. The one-year post is meant to take up one day a week, but she admits it is taking up more than that.

So why did someone so critical of the government's NHS policies take up this role?

'Because I'm a Londoner,' she says in a mock Cockney accent. 'It hits my two twin passions of London and general practice.'

She has already courted controversy by suggesting that GPs' independent contractor status should be relinquished to achieve integration of primary and secondary care.

The proposals appear to go beyond ideas for integration and changes to GPs' role set out in a landmark report earlier this year on the college's vision for general practice in 2022.

She says: 'I believe general practice is the answer, the solution. But I also believe that we are hoist by our own petard by having independent contractor status.'

Integration

She advocates creating what she has dubbed 'integrated provider co-operatives'. Her vision is to bring primary and secondary care providers together with a pooled budget, with GPs employed as 'not-for-profit shareholders'.

Professor Gerada's faith in this model is absolute. 'It is the only option,' she argues. She claims the NHS reforms have wasted £3bn, led to fragmentation and wasted three years' momentum on integration.

She only has 'two months left of freedom', she jokes, referring to her impending NHS England role.

After walking briskly through the RCGP's labyrinthine central London offices barefoot, mug of tea in hand, to find a quiet spot for the interview, she adds: 'I am mature enough to understand I will have less ability to speak out.' But she adds: 'People know my values - an NHS publicly funded, free at the point of use.'

Professor Gerada's high profile has prompted speculation she may end up in the House of Lords. She doesn't rule out accepting a peerage but adds: 'I think I am more likely to go to the Tower of London.'

Political scars

Being outspoken has affected her and her family, she says, with one newspaper printing pictures of her house on its front page.

'The Health Act made me butt up against constant argument, which was bruising. Because nobody else at the time was speaking out, I was left very isolated and our college was left very isolated.

'I haven't been forgiven by certain people in the DH, who have accused me of attacking individual politicians. I never attacked them.'

Two hours after the Health Bill received royal assent, she was gripped by flu that knocked her out for weeks. 'I think it was exhaustion. It was the physical manifestation of how exhausting the whole process was.' She believes if other royal colleges had voiced their opposition sooner, the reforms would not have made it on to the statute books.

Royal colleges should not be afraid of being involved in politics, she says. 'Health is political. It is not party political - it is political. The medical profession is a trusted voice and I am not sure the public know what we feel as a collective.'

She recognises the support she had from the RCGP. 'This college was spectacular - the membership, the staff. In a way they allowed me to speak on their behalf, they supported me, they responded to surveys.'

New era

RCGP chairwoman-elect Dr Maureen Baker will be a 'formidable' successor, she says. Workforce, workload and morale will dominate her term, she predicts, warning that GP burnout is a major concern.

But Professor Gerada believes things will change for the better: 'I think we need to give GPs hope and to tell them it is a fantastic job, and hang in there, it will turn around.'

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