No matter how well you prepare for becoming chair of RCGP Council, the reality is never quite what you imagine.
When Professor Helen Stokes-Lampard was elected in July 2016, she had been working at the heart of the College for four years as honorary treasurer. She had served alongside Professor Clare Gerada and Professor Maureen Baker as they led the College through turbulent times for the profession.
By the time she took office in November last year, one would have expected her to have witnessed every aspect of this high-pressure role but even she has been surprised by the level of criticism from the more cynical members of the profession.
‘It’s been a remarkable experience but the highs have been higher and the lows have been lower than I could ever have imagined. I’ve never felt more proud of our profession and never felt more humble. But I’ve also felt, metaphorically, more kicked and spat upon than I could ever have expected.’
It’s a striking admission from a figurehead who, on her Twitter profile, describes herself as ‘100% enthusiastic’. What she has learned in her first year, is that while 80 per cent of the role is ‘phenomenal’ the other 20 per cent is ‘really tough.’
‘I am so grateful to the officers and staff, and friends and family who have helped me to keep things in perspective during the difficult parts. And the best bits of the job make it all worthwhile.’
These best bits include her travels around the UK where she sees first-hand how her work can change, or reinforce, opinions of the College for the better.
‘I have done so many talks where people who have been cynical in the past have said they have re-joined the College on seeing how it is positively influencing the profession. Students have told me they have felt confirmed in their choice of career and jaded GPs have been helped back on the road.
‘And I’ve been so privileged to meet so many remarkable people, from patient groups to GPs who have put their heart and soul into the profession.’
Public exposure for the role of College Chair has probably never been greater. The RCGP featured in the media more than 4,000 times last year, with Professor Stokes-Lampard appearing five times on BBC Radio 4’s Today Programme, twice on the BBC’s Newsnight, and on ITV’s flagship political show Peston on Sunday.
‘Media is a substantial and important part of the job, as is social media, because it’s so vital to connect with our members and the public, and we also become a more credible organisation in the eyes of politicians and those that we are seeking to influence on behalf of the profession. ‘Politicians and policy makers take us more seriously if we engage with them in a professional manner. Once you offend these people, the door shuts in your face.’
Tracking the GP Forward View
Securing the GP Forward View and its £2.4 billion funding pledge for general practice was a triumph for the College in 2015 but there is still much work to be done in ensuring the promises are kept. The College’s latest annual review has revealed patchy progress.
‘The good parts of the Forward View are not yet being felt at the coalface. Money has been released but it takes time to filter through to the grassroots where practices are still really feeling the pressure of chronic under-resourcing.
Her own practice in Lichfield, Staffordshire, has seen some extra funding delivered through the contract, and there has been a noticeable increase in the presence of mental health workers locally. Other practices have received resilience funding.
‘I am still a practising GP, and a partner, and that’s what keeps me grounded while I take on this privileged role as head of the College.
‘My own practice is merging with another practice and I see the extra workload and stress that brings, but also the opportunities through economies of scale and diversity. We are also working within a cluster of six practices so I really feel at the heart of the change that’s happening in general practice.’
This personal experience of ground-level general practice adds an extra dimension to negotiations with policy-makers; ‘It’s very powerful because no one can deny my own lived experience.’
In the DH and NHS England, and in the devolved nations, there is now a clear narrative that general practice is ‘the solution’, she says.
‘They have all accepted that we are under-resourced and that change is inevitable and important. And most have accepted that the change needs to be driven by the grassroots, which is significant progress. Although the outputs of that change of thinking have yet to be felt by the majority in general practice.’
Through private conversations behind the scenes, Professor Stokes-Lampard believes that the policy-makers are beginning to understand what is unique and important about general practice.
This approach has played a key part in the College’s lobbying for change on the issue of soaring medico-legal fees for GPs. ‘We have been having weekly communications since January on this issue and have worked behind the scenes making the point very clearly and offering constructive solutions.’
Alongside the Chair’s natural optimism, there is also healthy dose of pragmatism, and a realisation that general practice cannot remain static as the NHS and the wider world around it continues to change at a rapid pace.
‘Historically GPs have been quite isolated in delivering care for their own communities but in this new world the boundaries are much more fluid. We need to collaborate with our neighbours to deliver the services that we cannot deliver on our own.’
One of the casualties of more collaborative working, fuelled by increasing workload and decreasing resource, can be continuity of care for patients. For Professor Stokes-Lampard, necessity means that this traditional feature of UK general practice now has to be focused where it is most needed.
‘We cannot always give people what they want as opposed to what they need. We have to get away from the idea of providing continuity of care in all circumstances. That just results in huge amounts of stress and burn out for those who try to deliver it.’
She takes a similarly practical approach to the acceleration of overseas recruitment to plug the gaps in GP provision across the UK.
‘While not everyone likes that concept, we have to be realistic. As a college we are absolutely clear that we cannot compromise on safety and standards, and we cannot raid countries that cannot afford to lose GPs. But given the rate of burn out we are seeing in the profession, we have to do more.’
Yet despite the challenges facing the profession, and the rigours of her first year in office, the Chair’s enthusiasm for general practice is never far from the surface.
‘In my election speech I said I wanted to put the joy back into general practice and remind everyone that, when the service is properly resourced, how great it can be to be a GP. ‘You just have to remember the last time a patient looked you in the eye and sincerely thanked you for changing their life – that’s the remarkable job satisfaction that we have. We as GPs have a lot to celebrate.’