NHS reform puts GPs in firing line, says Gerada

When Dr Clare Gerada entered the RCGP leadership race, Gordon Brown was prime minister and current health secretary Andrew Lansley was driving his 'NHS Yes' election battle bus.

Dr Clare Gerada: 'My main concern when it really boils down to it is that GPs will be blamed for the shortages of resources in the NHS' (Photograph: R Clayton)

In the seven months since she was announced as the successor to outoging RCGP chairman Professor Steve Field, a new government has taken office, and the NHS has started to grapple with plans for radical reform.

Navigating the college and the profession through changes set out in the White Paper will be a major preoccupation for Dr Gerada, who becomes RCGP chairwoman on 20 November. But she is determined it will not be the defining issue of her three-year tenure.

She has a host of ambitions for her time as chairwoman, but there is one theme that runs throughout: support.

It's hardly a surprise. Dr Gerada's CV is heavily punctuated with work on assisting the profession.

She has led the college's ethics committee, established its substance misuse unit and, more recently, headed up the practitioner health programme - a service for doctors with mental health or addiction problems in London.

Support during revalidation
As RCGP chairwoman, Dr Gerada is keen to ensure GPs are supported during revalidation, which should be rolled out on her watch in 2012.

Between now and then, her main aim is to ensure there is a robust parallel system of remediation in place.

'I see doctors in my everyday clinical practice who struggle because of the complexity of what they have and because of their workload,' she said.

'I would hate to think we are adding additional burden through revalidation that will make more doctors struggle.'

Despite her desire not to let the NHS reforms define her role, Dr Gerada is keen to protect GPs. She fears GPs' 'professionalism' will be undermined as patients and the public begin to blame them for the cuts and lack of resources in the NHS.

'I know how that might sound among all the other concerns that people might have, like the any willing provider policy, the market and the cost,' she says. 'But my main concern when it really boils down to it is that GPs will be blamed for the shortages of resources in the NHS. And what we will see initially is GPs being corralled into commissioning groups and we will see a loss of freedoms for GPs, particularly around prescribing and referrals.'

Dr Gerada thinks getting patients onside is one way of protecting the profession from criticism.

Patients as advocates
She says the RCGP will begin putting out educational material for GPs about how they can better involve patients.

'Patients will be our best advocates,' she says. 'When GPs are having to make harsh cuts, which inevitably they will have to, if they have patients onside they will be protected.'

Dr Gerada has already started work to establish an RCGP centre for commissioning, which will provide support and educational materials for GPs.

It was created to help all GPs, but will particularly target younger GPs, she says.

She is keen to ensure new GPs have the same leadership opportunities as previous generations in commissioning, education, training and politics.

'If we do not tap into the energy and intelligence of the generation behind us, general practice will lose out,' she says.

But Dr Gerada also wants to use her three years to create more partnership opportunities for young GPs and says she hopes to work with the BMA to ensure this happens.

'We can't turn the clock back and I don't think we can have the partnerships that were there from days gone by.

'But I don't think that means that we can't create leadership positions and career opportunities for the next generation of doctors,' she says.

Much has been made of the fact that Dr Gerada is the first woman to lead the RCGP in 51 years. While she thinks this is significant, she is keen to assert that she will 'not bring gender issues into everything'.

But she aims to ensure women have opportunities for leadership positions even if they look to take them on later in life than some men.

No sexism or ageism
'We need to make sure we don't have sexism or ageism and they make opportunities for women to play a full part at that age.'

But Dr Gerada also thinks women should take responsibility and not put unreasonable demands on the workforce.

'Not all women can work just term time, not all women can take all school holidays off. We have to be mindful of that,' she says. 'If women abdicate that responsibility then I worry about moving the profession forward.'

Delivering her wide-ranging aims in the context of a wholesale reorganisation of the NHS may be tough, but Dr Gerada says she is fully prepared to 'take on battles' and speak her mind to ensure the profession is not damaged or undermined.

That may be just as well, because general practice could be in for a rough ride.

Watch Dr Gerada set out her views on revalidation, her aims and concerns about splits in the profession

  • Lead the RCGP through White Paper reforms and shape how the reforms are implemented.
  • Maintain generalism.
  • Support doctors generally and help them through revalidation and transition to commissioning.
  • Give young GPs the same opportunities as previous generations had.
  • Continue the campaign to extend GP training to five years.

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