Good morning Conference
It’s wonderful to be back in the remarkable city of Liverpool. It’s my third and final conference
as your chair of the Royal College of General Practitioners.
On Saturday, I’ll properly introduce you to my excellent successor, Professor Martin Marshall. But today, I want to reflect on the state of general practice, the positives and the negatives in the context of the wider NHS, how far we’ve come, and where we’re heading.
And I’m going to throw out a few challenges to you – our fabulous members - but also, to the powers that be.
Now we are meeting together at the college’s most family-friendly conference in a spirit of celebration and joy. It's half-term for many of our GP families. So, today I want to talk to you about two games - Jenga and Lego.
Both familiar to us all, both use standardised blocks. But the aim of each game is fundamentally different. One seeks to joyfully create, the other creates instability.
One nurtures co-operation and collaboration, the other competition and adversity…oh, and I should just add, this conference is not sponsored by any particular toy manufacturers!
I’ll come back to the games…but let’s face it, we are living in tumultuous times. Interesting, but certainly tumultuous.
My entire tenure as your chair has been dominated, politically, by Brexit. And we still don’t know where we’re going with that.
Politics is ever-increasingly polarising. Political parties are splitting. Not just in the UK, but around the world. Our nation is divided. And in quite a nasty way. There is a distressing lack of civility, a lack of respect, a lack of professionalism.
But where the NHS is concerned, while people will disagree on what it should do, how it should be run,
how much funding it should receive... one constant in this chaotic world that we are living in is that the NHS matters, it must be protected.
Foundation of the NHS
And general practice is the foundation of our NHS. That certainly hasn’t changed in the three years I’ve been chair, or the last 71 years since the birth of the NHS, for that matter…
Indeed, I clearly remember my predecessor Maureen Baker describing general practice as the dam that holds back the flood water and protects the rest of the NHS.
The events at Whaley Bridge this year brought that speech back to me vividly - the devastation if that dam had not held does not bear thinking about.
When I took up this role I pledged to hold the government to account on its promises of more resources for general practice. More GPs. More members of the practice team. And the hundred or so other pledges in the GP Forward View.
And, of course, to actively support the chairs in the devolved nations to achieve similar promises for Wales, Northern Ireland and Scotland.
But, I was also on a mission to bring a bit more joy to our profession. Being chair of this college has been an absolute privilege.
One thing I have particularly enjoyed has been getting out there, meeting as many of you as possible. At all stages of your careers and I am delighted to have visited every faculty during my time as your chair.
That’s every region of the UK - from Land’s End to the Shetland Islands. I have met thousands of remarkable GPs and practice staff in every type and scale of organisation…and I am consistently overwhelmed by your energy, your passion, and your dedication to patient care.
But… GPs, particularly newer ones, often ask me what is the college for? What has it ever done for us? Well, of course today I have to start with our award-winning conference, bringing us all together - to challenge each other - and learn from each other.
Our massive free CPD offering has more than 500 e-learning resources - podcasts, blogs, and educational libraries, highly-acclaimed toolkits. Making sure we all have the resources we need.
What about our policy, campaigns and clinical work? This year alone our brilliantly diverse council
comprised of grassroots GPs from around the UK, has led the way by passing position statements
On subjects diverse as the care of transgender patients, artificial intelligence, non-evidence-based screening and genetic testing.
Identifying the key issues and clarifying the situation, so that you know where you stand
and then lobbying for improvements.
The hundreds of national consultations we submit every year ensuring the GP voice is heard in the development of guidelines and policies, the tens of thousands of print and broadcast media mentions we secure every year, defending the profession when we are under attack, making sure everyone knows about the pressures we are facing.
But also reassuring our patients. Cutting through the ‘fake news’ and adding authority to coverage about health and medical research. Getting our point of view out there and changing the narrative.
Our world-class examination and ever-evolving curriculum, ensuring GP training is of the highest quality – and that every GP entering the workforce is competent and safe and of course, lobbying hard to save our international trainees and GPs from inappropriate deportation!
There’s our publications – the world-leading British Journal of General Practice, Innovait for trainees and GP Frontline. AiT and First 5 groups, awards, research funding, bright ideas, quality improvement tools.
Our amazing faculty network and devolved councils - all offering local support, mentoring, and guidance
An ethics committee, overdiagnosis group, rural forum, health informatics group, and a host of other interest groups, with more to come.
Our work to promote equality, diversity and inclusion. This year saw our first official presence at Pride events across the UK.
Our environmental sustainability work. We’ve just set up a new climate change task force, we're a member of the UK Health Alliance on Climate Change and we promote the Green Impact for Health Toolkits.
Then don’t forget our international work - now spanning over 100 countries. Globally promoting excellence in general practice and primary care and the positive impact it has on patients’ health.
This year, we signed a memorandum of understanding with the World Health Organisation – the first of its kind for a Medical Royal College, committing to help train medical educators in some of the neediest parts of the world.
A cost neutral initiative allowing us to share our remarkable skills and talents as expert medical generalists and educators and do our part to help narrow the gap between the number of trained healthcare professionals the world needs, and what it has. That’s a gap predicted to reach 18m by 2030 - 18m.
So, you get my drift…your college is doing an awful lot. For you…and for our patients.
I’d now like to take a moment to look back. It was from this stage two years ago that I introduced you to my lovely patient Enid, and the concept of Enid-shaped care.g
And the idea that loneliness and social isolation can have an adverse impact on health akin to a chronic long-term condition. I spoke about the need to reinvigorate professional satisfaction in general practice, to allow us to deliver truly holistic, person-centred care.
I said that if you give us enough time, enough resource and enough professional freedom…we will give you great general practice. The profession and policy makers embraced the concept.
And truly holistic care. Person-centred care that the RCGP had long been championing, went mainstream. We brought together people from across society to discuss what needs to happen to tackle loneliness and social isolation.
And we developed loneliness manifestoes in all four nations. And we then saw the introduction of a Minister for Loneliness – and a cross-government loneliness strategy.
As part of that, a pledge for general practice to have access to 1,000 link workers or social prescribers – and since July this year, we are now seeing them employed in our practices. And I am thrilled to have been asked to lead the new National Academy for Social Prescribing in the coming months.
Then last year, in Glasgow, I spoke of the impending tech tsunami. The challenges and opportunities that health-related tech can provide. The challenge to us as professionals, to be evidence-based in the way we use and adopt new innovations.
To be wary of the evidence vacuum surrounding exciting sparkly new innovation. That we need tech that works for patients and also makes our lives easier. I challenged policy makers to make good choices that are not to the long-term detriment of the NHS. And I challenged tech providers to work with us, work with the NHS.
From that the college developed our technology manifesto, All Systems GP…And we obtained clear promises from our secretary of state that every practice will have access to fibre-optic broadband by 2020. And £50m committed by Welsh government to transform digital health and care in Wales.
The College speaks, and we get action. And I’m proud of that. So, where have we got to in the wider health sphere?
The GP Forward View, with its pledges of £2.4bn pounds extra for general practice and 5,000 more GPs
has been incorporated into NHS England’s Long-Term Plan. And this has huge additional promises for primary and community care – £4.5bn extra a year to be precise.
It speaks the language we relate to – the need for improvement in health inequalities, to address the social determinants of health, and prioritise the needs of the most vulnerable.
Then we had the visionary new GP contract in England, five years of stability and real growth, underpinned by mature, professionally-led quality improvement aspirations. Finally starting to replace ‘box ticking’ QOF, rewarding collaboration over competition and targeting our energies on those who need them most.
We have seen the introduction of a state-backed indemnity scheme for general practice, in England and Wales. Something the college – over successive chairs and alongside our BMA colleagues,
has pushed hard for.
In fact, it was announced by then secretary of state Jeremy Hunt at our conference here in Liverpool two years ago. We have seen steady, but significant, increases in the numbers of junior doctors choosing to train in general practice.
Breaking all records. We now have more GPs in training than ever before – around 12,000 across the four nations of the UK. In fact, 3,500 entered GP training this year in England alone. That is wonderful –now we just need to get that total to over 5,000 a year!
We’ve successfully pushed forward the agenda to achieve recognition of general practice as a medical specialty. Whilst the full merging of registers will take legislation – and let’s face it, there is not much prospect of that outside Brexit for some time.
GP specialist role
We have persuaded the GMC to co-sign a statement with ourselves and the BMA confirming that GPs are specialists. True, important and overdue acknowledgment of the value and skill that expert medical generalists bring to medicine and patient care. We must always be proud of doing what we do as GPs
We must never be made to feel inferior – far from it – I’m a GP, what’s your superpower?
And we are seeing a slow but steady improvement in morale amongst our members according to our regular survey tracking attitudes in the profession.
The pieces of the jigsaw are fitting together…or to go back to the Lego on the table by working together and collaborating with colleagues across health, in conversation with government and decision makers.
We are getting there. The future is taking shape…and it is a brighter future. A future that will be shaped by our college’s vision for general practice Fit For The Future. Work that more than 3,000 of you contributed to. And now it's yours to own and use.
Don’t be fooled that it seems simple – I’d say it’s deceptively simple. It clarifies that we will be working in larger groups with more diverse teams of colleagues. Others will do tasks that we might have once done
– we call it task substitution. But they won’t replace the complex role of the GP.
Task substitution is welcome, role substitution? Well that is a fool’s errand. The vision articulates the need for investment in IT and infrastructure as well as educating the whole primary care workforce. Things that together will allow us to spend longer with our patients, to deliver the holistic expert generalist care they need from us.
The 15-minute consultation must become the minimum standard time we allocate to face to face interactions. Giving us more time with the patients who really need us. Patient-centredness will mean we will prioritise continuity of care.
It’s not an outdated anachronism. It is important, it works and we must strive to retain continuity for our patients who truly will benefit from it. Not because it flatters our egos to see patients that know and who trust us – but because it’s good for patient care, it reduces inappropriate referrals, reduces investigations and improves outcomes.
Historical developments pitted us against our secondary care colleagues - in competition
but the new contract, formation of PCNs or working in clusters and proposed legislation changes are all about collaboration...rewarding the Lego builders, not the Jenga players.
We’re making progress. But we’re not there yet. Yes, you our members are telling us you are more optimistic. But you are also telling us that the workload is still unmanageable. That many of you are working unsafe hours – and it’s taking its toll on your own health and wellbeing.
Many of you are scared about the impact this could have on your patients. Yes, we have promises for more investment into general practice – and there are very welcome signs this is finally getting to the frontline.
And many of you are still telling us that running a practice is unsustainable. That you are planning to hand back the keys and that you plan to leave the profession sooner than you would have done.
Yes, more GPs entering the profession, but still more are leaving it. Progress has simply not been made in building the GP workforce. We have fewer full-time equivalent GPs than we did when the 5,000 pledge was initially made and many of our patients are waiting longer for a GP appointment as a result.
So, this is my call to government: Do not rest on your laurels. The nation worships the NHS – we have seen from the recent party conferences that all major political parties recognise this. And both our health secretary, and head of the NHS have repeatedly talked of general practice as its bedrock.
Do not take us for granted. Do not make any rash decisions about our service or introduce gimmicks or arbitrary targets that might be vote winners, but would ultimately set back general practice for 20 years. That would make the promises to stabilise and grow our profession defunct. That would make our vision of general practice just a pipe dream.
The prime minister Boris Johnson stood on the steps of Number 10 on his first day in office and pledged to tackle three-week waits to see a GP. We welcome that but it must be done the right way.
History has taught us that access targets in general practice do not work. We must learn from those lessons. Not repeat them. We must first be offering what our patients need, not what politicians want.
If unrealistic targets are imposed on our profession it will crumble and if general practice crumbles
patients won’t be able to see a GP, at all. The best way to improve our patients’ access to a GP is to invest in our services, invest in our workforce and invest in our structures, trust us to be expert medical generalists and do what is best for our patients.
We want to work with you constructively, collaboratively. The strides we have made over recent years gives me great hope for the future of general practice and patient care. Let’s continue to work together like Lego builders.
I’m now coming to the end of my term in office and I will be passing the baton to the excellent Professor Martin Marshall and our wonderful officer team – all frontline GPs from around the UK.
But I want to finish today with a few of my own thoughts about the future and pose a few challenges to decision makers – and to you. After a seriously dismal few years I honestly see a very bright future for our profession.
Amazing young energetic leaders are emerging, our next generation are as passionate and dedicated as our founders were – and they need support and encouragement from us ‘older’ – or should I say ‘experienced’ – GPs.
Let’s nurture them and give them permission to be creative and flexible. Let’s not hold them back with the ways ‘we used to do it’ – because the world is changing. We will always be compassionate clinicians
– with excellent patient care at the heart of our actions. And GPs will always be trained in the art and science of general practice.
But their training must be based in general practices for the great majority of the time, not in hospital posts for years on end. And the wider team must also be better trained, our allied healthcare professionals and non-clinical colleagues need to be better supported and empowered to reach their potential too.
I need to sound a note of caution about the evolving landscape. There are very real threats to truth,
threats to our integrity and threats to our professionalism. One vital role for our college and my successors must be to continue to call out untruths and non-evidence-based initiatives. To promote and keep reminding the profession that our Latin motto – Cum Scientia Caritas - that’s compassion underpinned by science, exemplifies that we are scientists first and foremost.
We need good, independent evidence to guide our steps – not fake news or hyperbole. We need to remain strong in the face of criticism – especially from those with vested interests. But, we also need to call out inappropriate negativity in our own ranks. To challenge those trolls whose jaded cynicism seeks to drag down colleagues. It is fine to disagree with each other - it should even be encouraged in the spirit of healthy debate. But let’s have some civility about it.
Let us celebrate and encourage the enthusiasts for our discipline. And help guide their steps, not clip their wings.
So, back to the games…With a Jenga-style future NHS, the harder we work, the more fragile and divided our system will become. The inevitable outcome is structural failure… as you can see!
But Lego represents a future NHS where we are all seeking to improve to collaborate…we may each bring just a block or we may bring a sophisticated organisation. But we need to co-operate. In a nation torn apart more than ever we need our profession united. We are at the dawn of a new era.
So, mine is a message of hope with just a note of caution. What will not change in the future, is the doctor patient relationship – we are so loved and trusted by our patients, despite the turmoil in the NHS.
We deserve to take pride in our amazing work and celebrate our success! General practice is the most amazing medical discipline. And you are all utterly outstanding professionals.
Thank you, thank you all.