Three years as Chair of the RCGP like 'walking a tightrope in high heels'

Over the past three years Professor Helen Stokes-Lampard has visited all 31 faculties of the RCGP in the UK and Ireland and is still feeling 'energised'.

With a month to go as Chair of the College, and despite the frantic pace of the job inevitably taking its toll, the GPs she has met on those visits have consistently renewed her enthusiasm for the role, and for general practice.

‘I have met the most energising people – the most remarkable GPs and their teams – and have been universally uplifted by mixing with these innovative, creative and passionate people.’

A more difficult task has been to build robust working relationships with policy-makers and stakeholders in the furnace of national politics - especially with a new health secretary taking office and a rapid turnover of health ministers during the past 18 months.

‘I have spent three years feeling as if I am walking a tightrope in high heels. It’s the ultimate balancing act.’

The College view on Brexit

One particularly challenging issue rose from within the College itself. In November 2018 the Council voted to oppose Brexit and instead backed a second referendum, fearing that leaving the EU would undermine its aim to foster the highest possible standards of general medical practice.

'The Brexit vote was personally one of the most difficult situations to deal with because I had my own views on how strong a stance the College should take. But as Chair, I’ve delivered Council’s message and lobbied on that basis.'

Her previous life as Honorary Treasurer of the College was a ‘huge advantage’ in preparing for the role of Chair but she says nothing could have prepared her for the diversity of views she then encountered from both College members and external sources ‘on just about everything’.

And as a high profile media representative of the medical profession, her views and those of the College have been under scrutiny 24 hours a day.

Social media, trolls, and vaping

‘Calling out fake news, hyperbole and hysteria, has been a very rewarding part of the job because some people and lobbyists do not like the truth or the facts.

‘Though one big thing I have learned is to sit on my hands when it comes to certain issues on social media because to engage with the trolls only adds validity to their views – but that does not mean the criticism has not still hurt me.’

A case in point was the early debate around the benefits of vaping: ‘I took the considered view that, because we did not have robust safety evidence, we should not be prescribing vaping on the NHS. However, we could tell patients that it was an awful lot safer than smoking.

‘I had a lot of criticism in all media from people who later turned out to be lobbyists and pressure groups dressed up as doctors and patients. But the view I took has since been borne out by the recent scares about vaping in the USA.’

Fit For The Future

One of her flagship projects has been the development of the College’s vision document for general practice – Fit For The Future – that was published in May 2019 following widespread consultation with GPs, patients and other stakeholders. A key expectation is that the standard consultation time will rise to a minimum of 15 minutes.

Not surprisingly, the College foresees a larger role for technology in the general practice of 2030, and GPs taking a more consultant-style role as the leaders of a wider primary care team.

But will the advent of individual patient dashboards, genomic medicine and population-based healthcare, change the role of the GP from personal clinician to distant scientist?

Tech tsunami continues

Professor Stokes-Lampard is adamant that while the ‘tech tsunami’ of digital innovation continues, the standards of basic NHS technology and communication channels must be made a top priority.

‘In my own practice it takes me 17 minutes to login on a Monday morning and if I get through the morning without my computer crashing it’s been a good day’.

There is also a decidedly pragmatic approach to the sacred cow of continuity of care: ‘We have to reserve continuity of care for patients who will really benefit from it. In the modern world we cannot give it to everyone, every time’.

Likewise, the rise of video consultations and the influx of new prescribing roles into general practice, are tackled upfront as issues to be managed rather than feared.

‘There is a lot of anxiety about potential role substitution, which would not be helpful - if we need more GPs we have to train more GPs. But task substitution is a good thing that helps us to spend our time more effectively.’

Likewise: ‘Video is an upgrade from telephone consultations, not a downgrade of face-to-face consultations.’

Face-to-face interaction 'irreplaceable'

For Professor Stokes-Lampard, whatever the changes technology will bring, face-to-face contact with patients will remain the defining quality of the GP role.

‘The personal interaction between GP and patient will never be replaced. We need to be able to look deeply into someone’s eyes and see the pain and what’s truly hiding there.

‘Much of the art in general practice is in that bond we develop with patients, and the ability to draw out what’s truly going on and what really matters to them.

‘All the technology and science will help us to be better diagnosticians and better prescribers but the art of general practice will still be in the face-to-face interaction.’ 

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