Viewpoint: More trust and less red tape must define post-COVID GP world, says RCGP chair

A high-trust approach to regulating GPs has paid dividends during the COVID-19 pandemic, says RCGP chair Professor Martin Marshall. Writing exclusively for GPonline, he argues that keeping red tape to a minimum in the post-pandemic world is key to making general practice 'doable' again.

RCGP chair Professor Martin Marshall (Photo: Pete Hill)
RCGP chair Professor Martin Marshall (Photo: Pete Hill)

At the beginning of the COVID-19 pandemic, the swiftness with which general practice changed our ways of working to safely provide care to our patients was remarkable.

Initially, GPs and patients alike referred to what life would be like after COVID-19 as ‘returning to normal’. More recently, many of us might have noticed a change in the language used.

As we’ve all adjusted to accommodate social distancing and lockdown measures, the assumption that things will return to the way they were has shifted. Instead, we hear about a merge of life as we knew it, but incorporating lessons learned throughout the pandemic. I’ve often heard this referred to as ‘some sort of normality’ - a term that reflects the desire to move on, while acknowledging that some of the changes we have seen have had a positive impact.

GP workload

This extends to general practice. From speaking to GPs, I don’t get the impression that colleagues have the desire to return completely to the way things were before the pandemic.

If we cast our minds back to five or six months ago, the workload in general practice was unsustainable. I gave many an interview describing the role of a GP as ‘undoable’.

Many experienced GPs were retiring early and reporting to the RCGP that they were leaving the profession because of the bureaucracy and red tape that consumed hours of their time: time they would rather spend with patients.

Today, the college has published ‘General practice in the post Covid world’, outlining the challenges and opportunities for general practice post-pandemic. One of the key features is regulation.

Trusting GPs

The fact is that throughout the pandemic, general practice has functioned well with less regulation. GPs and our teams have demonstrated that we can be trusted to deliver high-quality, safe patient care without having to tick as many boxes to prove it.

Even though we have been carrying out most of our appointments remotely, many colleagues have actually reported that the extra time they have to spend with patients is positively impacting not only the doctor-patient relationship but their sense of job satisfaction. This is very different to what the Health Foundation's report on GP satisfaction with their roles found just weeks before lockdown was introduced.

While we recognise that there is an important place for regulation of GP practices, particularly in identifying those that are struggling and offering them support, more than 95% are rated good or outstanding. These practices just don’t need to go through box-ticking exercises with little to no patient benefit.

General practice is now at the stage where clinical workload is moving towards normal levels, and we expect it to escalate further as the focus of managing the virus continues to shift from secondary care to the community - and GPs take a lead role in managing the aftermath of COVID-19, such as the predicted surge in mental health issues, and so-called ‘long-COVID’.

Reducing bureaucracy

With this in mind, it's essential GPs' time isn't taken up with bureaucracy. The pandemic has provided us with evidence that workload in general practice can be reduced by removing contractual and regulatory compliance activities. In order to facilitate this long-term the college is calling for:

  • The introduction of new approaches to intelligence-led monitoring of the quality and safety of care, minimising the administrative requirements on practices particularly in countries which have low-trust systems of assurance.
  • Contractual requirements, such as QOF and QAIF, to focus on high-trust approaches to assuring or improving quality with low administrative requirements.
  • The implementation of a new yearly appraisal system across the UK, minimising pre-appraisal documentation and the administrative burden on GPs and focusing on wellbeing, reflective practice and development.
  • The rapid review of requirements for returning GPs to reduce the administrative requirements for GPs to get back into the workforce, including keeping them on medical performers lists for longer with greater flexibility, underpinned by further investment to support and incentivise their return.

As patients' first point of contact with the health service, GPs have played a vital role throughout the pandemic in ensuring that hospitals were not overwhelmed. Being a GP can be the best job in the world but it’s imperative we are trusted and given the time to provide the best possible care to our patients.

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