Professor Martin Marshall interview: general practice is turning a corner

'It's an exciting time for general practice,' says RCGP chair-elect Professor Martin Marshall. 'We've been through a hellish time and it's still under a lot of pressure, but I think we're turning a corner.'

Professor Martin Marshall (Photo: Grainge Photography)
Professor Martin Marshall (Photo: Grainge Photography)

Judging by his comments, it would be fair to say that Professor Marshall is optimistic about the future of his profession. His wide smile and relaxed manner - quite possibly the side effects of a recent holiday - seem to underline his positivity about general practice and its direction of travel.

As he prepares to take over from Professor Helen Stokes-Lampard in November, Professor Marshall says he is excited to begin his new role, insisting that ‘there’s no more important time to be a professional leader’.

His optimism is based largely on increased support from the government. The new five-year GP contract is set to increase practice funding by almost £1bn - alongside a further £1.8bn for primary care networks (PCNs) - as part of changes being introduced under the NHS long-term plan.

GP funding

This investment is an indication that the government is finally beginning to understand the importance of general practice, he says. Meanwhile, Professor Marshall says a growing number of medical students choosing to enter general practice provide another reason to be cheerful.

But the incoming RCGP chair is under no illusions - he knows there is still a mountain of problems facing the profession.

Just last week it was revealed that England’s NHS had lost nearly 600 full-time equivalent, fully qualified GPs over the past 12 months. High workload, punitive pension regulations and overly burdensome admin were all blamed for the slump.

Meanwhile, almost 100 GP partners are quitting each month as many opt for early retirement.

In light of these difficulties, particularly around retention, Professor Marshall recognises that general practice needs to change and says one of his primary objectives will be reducing workload pressure on clinicians.

GP workload

‘At the moment, the pressure that general practice is under is truly enormous [and] when you put clinicians under that type of pressure it’s a very difficult job to do.

‘That’s one of the reasons why it’s taking some time for us to turn the corner in terms of retaining and recruiting new people into general practice [and we won't achieve change] until we address workload.'

Professor Marshall says the RCGP has already explored ways of minimising GP workload, looking at different working patterns, shifting administrative tasks and lobbying against unnecessary bureaucracy, but says fewer consultations per day has to be the future.

The goal, he says, is that ‘every time a GP sees a patient, they feel that they have done a good job [and] they don’t feel frustrated or that they have been restricted by resource issues that many of us feel at the moment’.

PCN impact

The RCGP chair-elect is convinced that primary care networks (PCNs) can have a positive impact - in particular through the additional 20,000 allied health workers promised for the NHS as part of their development, including physios, social prescribers, pharmacists and others.

With the government struggling to recruit the extra 5,000 GPs it has promised, Professor Marshall says PCNs could offer an alternative fix to stretched services.

‘We have to be realistic and accept that one of the solutions [to capacity issues] is a wider primary healthcare team, so I think the investment in that is exciting and has real potential.

‘It means that GPs are going to have to think carefully about their role, their role in the team as expert medical generalists, but I think that provides an opportunity for general practice to develop.’

He says PCNs will help neighbouring practices work more collaboratively, but warned the core principles of general practice, such as developing strong relationships with smaller communities, must remain.

Community

‘We have to remember that the core delivery unit of general practice is the practice and it needs to remain as that - small units with staff who are known by the local communities, who have some sort of responsibility and commitment to their community.

‘But at a higher level, the kind of things that can be done at a community population health improvement level, the kind of efficiencies that can be made through working more closely together are really exciting.’

Earlier this year, NHS England set five core targets for PCNs to achieve by 2023/24, which included dissolving the divide between primary and community care and growing the wider workforce. A recent survey by GPonline found that over half of GPs thought PCNs would fail to achieve any of these targets, with many saying the new structures would create additional work for GPs.

Professor Marshall believes PCNs can deliver on these goals, but admitted performance would vary across England.

Collaboration

‘I think on the basis of history it’s going to be challenging. Areas that have a history of collaborative working will find these changes quite easy, but we all know there are some parts of the country where neighbouring practices haven’t talked to each other and that’s going to take some time.

‘It’s naive to think that the kind of changes we are expecting PCNs [to deliver] will happen by default if you just give them money and tell them to do it. In my experience, that isn’t the case. [They need] the resources, expertise and training to develop.’

Another positive feature of PCNs, he says, is their role in helping to bring through the next generation of GP leaders. He admitted that it was important this new wave of leaders weren't 'sucked into the bureacracy of the NHS' by spending too much time in STP meetings, adding: ‘Our challenge as a college is to maintain their enthusiasm...we need to support them.'

The evolution of general practice over the coming years is sure to be shaped at least in part by emerging technology, with video consultation services such as GP at Hand and LIVI growing fast.

Technology

Professor Marshall says he recognises the ‘enormous potential’ of technology, particularly around assisting with time consuming administrative work. But he warned that technology must be used to support existing services, not undermine them.

‘Our view as a college is that, as general practice changes, we have to make better use of technology. But that should only happen within established practices.

‘So if we take online consulting as an example, general practices will provide a portfolio of access points for their patients, some of which will be face-to face, some on the telephone and some will be online.

‘What we are concerned about is the private sector coming in and slicing off parts of general practice or perhaps only delivering care to specific sub-groups of the population, particularly the worried well, using resources and damaging the established model of general practice.'

Professor Marshall will be taking up the top job at the RCGP with his profession under huge strain. Transmitting his enthusiasm and optimism to GPs as a whole could be key to making sure that as general practice turns the corner, it does so in the right direction.

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