Interview: 'We must not forget the personal cost of change in the NHS'

Professor Helen Stokes-Lampard reflects on her second year as Chair of RCGP Council.

RCGP chair Professr Helen Stokes-Lampard (Photo: RCGP/Grainge Photography)

Professor Helen Stokes-Lampard may be chair of the RCGP and a seemingly constant presence in the nation’s media but she is still very much a practising GP.

She uses that lived experience to directly reinforce the lobbying that she undertakes on behalf of the profession with the politicians, strategists and stakeholders, who can often hold the future of general practice in their hands.

One of her stand-out, personal moments of the past year has been the ‘painful experience’ of merging her partnership in Staffordshire with a neighbouring practice - a challenge that many GP colleagues are also now facing across the UK.

When the IT provider brought forward the installation date for their new computer system, the practices had to merge several months earlier than planned.

‘It was so rushed and also happened to be in the middle of the winter crisis. It brought home to me, in a very real way, the personal cost of change - even for the best of reasons and with colleagues that you know and trust.’

Ten months later and the merger is working well: ‘On paper it’s an unqualified success but the scars of that process will live with me for a very long time. And several highly valued members of our admin team left the practice because they had felt too much personal hurt to continue.

‘That does not mean that we should not take on these challenges but we need to be aware of the pain that can be caused. We need to be having honest conversations about the cost and benefit of change.’

Remarkable year

Professor Stokes-Lampard’s second year as Chair has been ‘intense’, with the 70th birthday of the NHS, a new secretary of state for health, the ten-year plan for NHS funding and the prospect of Brexit becoming ‘uncomfortably real’.

The use of new technology in healthcare has also developed at pace but often with unintended consequences for the profession that have overshadowed the potential benefits for some patients.

‘The power of disruptive innovation is also suddenly looming large, and services such as GP at Hand are raising all sorts of questions about the GP contract and the model of general practice for the future.

‘So it’s been a remarkable year. It’s been a very powerful journey for me. The landscape is shifting so swiftly and things have moved further than I thought they would.

‘But conditions for the profession have not improved substantially. There are improvements going on but GPs are still not feeling it in any meaningful way.’

There have been ‘moral victories’ to celebrate, not least the lifting of restrictions on the number of doctors entering the UK and the promise of state-backed indemnity for GPs announced at last year’s RCGP Annual Conference. But the GP Forward View (GPFV), with its promise of a £2.4bn investment in general practice by 2020/21, has failed to live up to expectations.

‘GPs are still feeling demoralised and under pressure. And we are still haemorrhaging GPs - we have not yet arrested the bleeding. NHS England has delivered on most of its promises but the biggest failure has been on the GP workforce and that has undermined much of the other good work that’s been done.’

While NHS England is on target to meet its original funding pledge, the College now believes that an extra £2.5bn a year is required to ensure that the benefits are felt on the frontline.

The additional funding would take total annual spending on general practice to £14.5bn a year - 11% of the NHS budget. Under current plans the proportion of NHS funding spent on general practice could fall to 8.9% by 2020/21, lower than it was before the GPFV was launched.

Vision for general practice

But Professor Stokes-Lampard is buoyed by the GPs and teams who she meets on her travels around the UK and who share her optimism for the future, despite the hurdles still to be negotiated.

‘It’s been a frantic year but also at times very satisfying. I have been constantly uplifted by the passion and innovation of colleagues around the UK, and vastly reassured by the next generation of GPs that the future of the profession is in good hands.

‘There are more GPs in training than ever before and training places are being filled up across England. So it’s great that junior doctors are not being put off by the negativity around general practice at the moment.’

Putting the joy back into general practice has always been a key part of the Chair’s mission: ‘I’m not using the word "joy" in a trite way. It’s about taking meaningful satisfaction in a job well done, a job that is important and useful. And as I go around the country I sense now that, despite the issues facing us, people are less embarrassed to talk about their job being satisfying.’

Professor Stokes-Lampard began her tenure in November 2016 with a clear modus operandi. ‘My plan was to be 90% proactive and 10% reactive. But the reality has been more like the reverse.’ Now she is approaching the last of her three years in office with the aim of creating a major new vision for the future of general practice, firmly rooted in the needs of College members.

‘The consultation is under way and nothing is off limits. It’s not a small-scale vision. It’s what we want to aspire to, in the UK and worldwide, so that healthcare professionals feel nurtured and sustained throughout the whole of their careers.

‘We are being realistic but as a College we have to be aspirational. I want us to be the architects of the future, not just passive recipients of other people’s ideas.’

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