GP News

Latest News from the Royal College of General Practitioners
https://www.rcgp.org.uk/
Updated: 21/08/2019 12:17

Disingenuous to suggest GPs are shirking responsibilities to patients, says RCGP

"We want our patients to be able to see a GP or member of the practice team when they need to - and it is as frustrating for us as it is for them when they have to wait too long for an appointment. Indeed, it is testament to the hard work and dedication of GPs that we are consistently rated as highly-trusted amongst patients, despite this. "On occasions when practices are closing during routine hours, it is not time 'lost' to patients, it is usually time spent conducting telephone or online consultations, or making home visits - or some of the other many vital tasks that GPs and our teams are required to do, such as complying with mandatory or statutory training. "It is also more likely that it is 'branch' practices that are affiliated to larger sites that have regular closing hours - or very small practices that are forced to close due to staffing shortages. In either case, adequate cover arrangements will always be put in place for patients who need urgent care and, wherever possible, patients are fully informed well in advance, and explanatory messages are posted on websites and surgery answer machines.  "The introduction of Primary Care Networks in England should make it easier for GPs to optimise what they can do within routine hours - and we have already seen a significant drop in practices temporarily closing over the last year, which coincides with the period they have been introduced. "But what is really needed to ensure we have a robust general practice service, is not criticising hard-working GPs and our teams for temporarily closing our surgeries without really understanding the specific reasons why for each site, but to invest in our service and grow our workforce, so that we don't have to."  

System-wide approach to tackling falling childhood vaccination rates welcome, says RCGP

"Vaccinations are simple, easy and highly effective health interventions and in most cases, they protect for life. Across the NHS we are doing a good job of getting this message across to patients, and in the UK we actually have high take-up rates of many vaccinations. "But we are still suffering from the now entirely debunked MMR scandal of the nineties, and it is potentially disastrous that as a result so many young people are now susceptible to serious, often life-threatening infectious diseases, such as measles, that we could have completely eradicated in this country if this had never happened. "People who were not vaccinated as children need to understand that it is not too late to have their MMR jab and we would urge them to do so. "We welcome that the Government is addressing the falling take-up of childhood vaccinations seriously - and are particularly pleased to see that they are involving social media companies in their strategy given the deeply concerning and misleading school of thought, especially prevalent online and across social media, that casts doubt over the safety and effectiveness of vaccines. "It is not just the responsibility of GPs and other healthcare professionals to combat anti-vaxxer propaganda, everyone has a part to play: health, public health and education bodies; but we also need technology companies to take responsibility and tackle negativity and confusion around vaccination information."

More targeted approach to health checks welcome, but method needs careful consideration, says RCGP

Professor Stokes-Lampard said: "The College has questioned the benefits of blanket health checks for everyone over a certain age for a long time - so a more targeted, evidence-based approach is certainly a positive step forward. "However, while the focus on only offering health checks to certain groups at risk of certain conditions is a move in the right direction - we need to ensure the methods used to determine who should be invited for one are properly thought through and based on rigorous evidence. "The College has already expressed its concerns around the unintended consequences of widespread whole genome DNA testing to determine whether a patient has a genetic disposition to certain conditions. While more targeted predictive genetic testing is an important step forward, there are many issues to be explored in this review. "We need to consider, for example, the increased workload for GPs and healthcare professionals across the NHS as patients want to discuss their genetic results; the huge ethical and financial implications of suddenly knowing what health conditions you may be more susceptible to; and patients being worried about any health concerns that are identified but of dubious personal impact, or where nothing can be done to improve the prognosis. "It is essential that any new approach to health checks is subject to rigorous evaluation to ensure its safety, accuracy, and benefit for patients' health. We also need to ensure that for digital or online services being promised, GPs and their teams have the technological resources and training to manage these and prevent additional strain on a profession already facing such intense resource and workforce pressures."

Patients need to know where to turn when they're ill, says RCGP

Professor Stokes-Lampard said: "We understand our patients' frustrations when they cannot secure a GP appointment when they need one, and GPs and our teams share their concerns. "However, patients should only ever go to A&E in an emergency – if they need to see a GP urgently, they should always be able to through our routine service, urgent treatment centres, and the GP out of hours service. We are working incredibly hard to ensure this happens, and this is reflected in the most recent NHS figures. "What this research highlights is that more public education is needed so that patients know where to turn when they become ill – and it gives useful insight into where this could be directed for the best possible impact. "The internet can be a great source of knowledge on health conditions and advice on what forms of self-care might be possible, and when seeking advice from a healthcare professional is necessary - but we would urge patients to only use reliable UK-based websites, such as NHS.uk, as many sites will contain non-evidence-based material. "We would also remind patients that they can speak to a pharmacist or ring the NHS 111 for help if they are unsure whether a visit to the GP or A&E is necessary. "As NHS GPs, we desperately want to be able to provide the necessary levels of high-quality care that our patients expect - and deserve – and which in turn will help ease pressure on other healthcare services. But as patient numbers rise, and health conditions become more complex, we are under more pressure than ever and are significantly understaffed so improvements simply cannot be achieved without significant investment into our profession."

Important for parents to understand antibiotics are not the answer to many common childhood illnesses, says RCGP

She said: "GPs are acutely aware of the potential dangers of prescribing of antibiotics when they are not absolutely necessary – and how this can contribute to growing resistance to these important drugs, which is a global concern. "This research drives home how important it is for patients – and particularly the parents of young children – to understand that antibiotics do not work for every infection and should not be prescribed for the most common childhood conditions such as colds, coughs, ear infections or sort throats which are usually caused by viruses. "There is a very difficult balance to be struck as antibiotics can be lifesaving drugs for severe infection related conditions such as sepsis – but instances where children who have an infection really do need antibiotics should be relatively uncommon. We would certainly welcome more research into rapid, definitive tests to establish if an infection is viral or bacterial - and for GPs to have easy access to them - which would certainly help in these situations. "Ultimately, parents know their children better than anyone and if they are concerned about a persistent medical problem or illness then they should see their GP. But we would urge them to trust their GP if they advise that antibiotics are not necessary. "GPs are highly trained prescribers and will not suggest any course of medication unnecessarily. Antibiotics will only be prescribed for patients of any age in situations where this is appropriate, and as determined by a full assessment of the patient and their medical history."

Promises of more GPs must be delivered to avoid waiting times getting worse, says College

She said: "Our patients should be able to see a GP when they need to – and the fact that this is becoming increasingly difficult is frustrating for GPs and our teams, as we know it is for them. "When patients need to see a GP or member of the practice team urgently, we are working incredibly hard to ensure they can get access – and this is reflected in the most recent NHS figures. But people are waiting too long for routine appointments, and the concern is that non-serious conditions might deteriorate, or patient's give up trying to see the GP and we miss signs of serious illness early when it could be dealt with simply and more cost-effectively in primary care. "The College has long been raising the alarm about escalating resource and workforce pressures in general practice, and the negative impact this is having on our patients. GPs and our teams are making more consultations than ever before – more than a million a day across the UK – but as our population grows and more people present with multiple conditions, we desperately need more GPs and more time to give our patients the care they deserve. "We have had some very welcome promises of investment in our service and more GPs and members of the practice team across the four nations of the UK - these must be delivered urgently and in full, or waiting times will get worse, ultimately jeopardising the care we are able to deliver for patients."

More resources needed to properly support patients with asthma, says RCGP

She said: "It's deeply concerning to hear that the death toll for asthma, a manageable long-term condition, in England and Wales is the highest it's been for a decade – and it is right that addressing this should be a priority for the Government and the NHS. "Asthma is a common condition in general practice and GPs and their nursing teams understand the importance of carefully managing patients with asthma, including through the use of personal asthma action plans, as well as encouraging patients to undergo regular reviews. "It is also vitally important that patients understand their own treatment and how to properly use equipment, such as inhalers, peak flow meters, and spacer devices - and GPs and our teams play an important role in ensuring patients of all ages feel more confident about managing their asthma appropriately and effectively. It is also essential that patients always have access to their prescription medication and do not allow inhalers to run out or expire before they ask for replacement prescriptions. "The College has created several eLearning resources to support GPs in identifying, treating and managing asthma, and it is a key condition in the GP curriculum that all trainee GPs must demonstrate competence of before they are able to practise independently as a GP in the UK. "Ultimately, we need more GPs and more members of the practice team so that we can spend longer with our patients with asthma. "That's why we need to see more investment injected into primary care, the delivery of the NHS Long-Term Plan, and further details about how the proposals in the interim People Plan will be achieved, to ensure GPs and our teams can continue to provide the comprehensive care our all of patients, including those with respiratory conditions, need and deserve."

RCGP welcomes pledge to overhaul GPs' pension arrangements

"General practice is currently facing intense workforce pressures and current pensions arrangements are exacerbating these, so it is good to see the Government taking this issue seriously. "If implemented correctly, the changes announced today are welcome - but many experienced GPs are already, and quite understandably, reducing the number of patIent-facing sessions they work and are unable to take on additional teaching duties because of how this will adversely affect their pensions and taxation situation, so it is vital that changes are applied swiftly. "At a time when GPs and our teams are really struggling with escalating workload, and with inadequate numbers of staff to safely undertake it – and our patients  are waiting longer for an appointment as a result – we need to be doing everything we can to keep hard working, experienced GPs in the profession, and hopefully today's announcement is a step towards that."

GP practices supported to recommend active lifestyles to patients and staff with launch of new UK-wide Active Practice Charter

One in four people say they would be more active if it was recommended by a GP or nurse New toolkit will support GPs – who are short on time – to bring up activity in conversation with patients and achieve Active Practice status It will benefit the approximately 8,000 GP practices in the UK, by raising awareness of the simple changes that can be made to improve the physical and mental wellbeing of patients and staff, such as signposting to local exercise classes or partnering with a nearby activity provider. The ground-breaking Active Practice Charter builds on an existing initiative where GP practices have been encouraged to develop closer links with their local parkrun to become certified 'parkrun practices.' The Active Practice Charter – which is supported by National Lottery investment from Sport England – outlines the key principles of what it means for a practice to be 'active', and the steps GPs and their teams can take to get there. To become an 'Active Practice' and receive a certificate recognising their status, surgeries will demonstrate that they have taken a number of steps, including: Increasing physical activity in patients and staff Reducing sedentary behaviour in patients and staff Partnering with a local physical activity provider to support the practice to get more people active Research shows that doing regular physical activity can reduce the risk of coronary heart disease and stroke by as much as 35% and decrease the risk of early death by as much as 30%. However, the UK population is around 20% less active than during the 1960s and physical inactivity is a significant financial burden, estimated to cost as much as £7.4 billion each year, including £0.9 billion to the NHS alone. One in four patients say they would be more active if it was recommended by a GP or nurse.1 And while many GPs already promote physical activity in their surgeries, some identify barriers to prescribing exercise or discussing physical activity – for example, not having enough time in the consultation to have effective conversations with patients. This is why the Royal College of General Practitioners and Sport England have also launched a Physical Activity and Lifestyle toolkit to help practices achieve Active Practice status. It contains a comprehensive selection of condition-specific, professional-facing information documents that can be used to help all healthcare professionals – including the Moving Medicine website, a step by step guide to conversations with patients about physical activity. Dr Andrew Boyd, RCGP Clinical Champion for Physical Activity and Lifestyle said: "Busy GPs can't be expected to do everything when it comes to getting the nation more active, but we can play a vital role in starting the conversation with patients. "By making small changes in our own workplace – using standing desks, encouraging active transport for staff, and partnering with local physical activity providers, for example - we can demonstrate to patients that being more active is good for everyone's physical and mental health." Sport England's CEO Tim Hollingworth said: "Physical activity has a key role to play in helping people manage and improve their health and wellbeing. As trusted sources of information, GPs and practice teams have a real opportunity to start discussions that help it become the new normal in their community – for prevention as well as treatment. "This toolkit will help busy GPs talk to patients about getting active and recommend local opportunities as part of their routine practice. We're delighted to be celebrating those GP practices who are promoting active lifestyles to patients and staff through the Active Practice Charter." Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "All GPs know that encouraging patients to be more active can have huge benefits on their health and wellbeing and, in some cases, drastically improve conditions such as diabetes and heart disease. "But having the time to advise patients on lifestyle in the current 10-minute consultation can be a huge challenge, especially when there are often so many other things we need to discuss and when this probably wasn't the reason the patient has made the appointment – so taking a practice-wide approach to encouraging healthier lifestyles, for all of us, is a great idea. "I'm delighted to see this project come to fruition and hope it helps practices up and down the country, including my own, further promote the truly life-changing health and wellbeing benefits of physical activity and keeping an active lifestyle." The RCGP Physical Activity and Lifestyle Project is led by RCGP Clinical Champions, Dr Zoe Williams and Dr Andrew Boyd, who promote healthier and more active lifestyles in their GP surgeries. How to get involved GPs can visit the Active Practice Charter Site to find out more and work as a practice to develop plans to become an accredited practice.  The Physical Activity and Lifestyle Toolkit can be downloaded to help healthcare professionals embed physical activity within the conversations they are having with patients where appropriate.  Healthcare professionals can access Public Health England's Physical Activity Clinical Champions Training to receive face to face training on embedding physical activity within their everyday work. To find out more or to book a session contact: physicalactivity@phe.gov.uk 1 Health Survey for England 2008: CVD and risk factors adults, obesity and risk factors children

CBT shown to be effective for insomnia but access issues need addressing, says RCGP

She said: "Insomnia can cause huge distress and frustration for patients, and can have significant long-term health implications. "For many patients, sleeping tablets can seem like an obvious treatment option, but they are not usually effective for more than a few days, and GPs will only use them as a last resort after alternatives have been explored due to the risks of addiction and tolerance. "Cognitive Behavioural Therapy (CBT) tailored to insomnia has been a first-line treatment option for some time, and we know many patients have found it beneficial, so it is really positive that its effectiveness has been shown by this research today. "Unfortunately, access to treatments such as CBT in the NHS can be extremely difficult to come by in the community and are very variable across the country. This needs to be addressed, firstly by realising the pledge made in NHS England's GP Forward View for every GP practice in the country to have access to one of 3,000 new mental health therapists by 2020/21 and by the provision of many additional psychologists trained to deliver CBT. "Other measures patients with insomnia can take to improve their condition include practising good 'sleep hygiene' before they go to bed, for example limiting the amount of alcohol and caffeine they drink, as well as identifying lifestyle factors that might be causing stress or anxiety. "Achieving parity of esteem between physical and mental health is an enduring priority for the College and we have developed resources to support GPs and other healthcare professionals to deliver the best possible care to our patients with mental health conditions, including insomnia."

College sets out priorities for new Prime Minister

In her letter, she calls on Mr Johnson – who in his inaugural speech as Prime Minister said that it is his job to make sure people don't have to wait three weeks for a GP appointment – to deliver on previous Government commitments to recruit 5,000 more GPs, and take action to retain existing family doctors in the profession, so that patients can get a GP appointment when they need one. She writes: "General practice is the first point of contact with our health service for over a million of patients every day – in turn alleviating pressures across the rest of the NHS – but it is under immense strain…we are at least 6,000 GPs short in England." Prof Stokes-Lampard also highlights to Mr Johnson the College's concerns around the negative impact a no-deal Brexit will have on the sustainability of the NHS, and the care patients receive. She writes: "We cannot risk the potential disruption caused by a no-deal Brexit. This could hamper the recruitment and retention of vitally needed NHS staff, and lead to uncertainty over the mutual recognition of professional qualifications, which enable us to recruit doctors from the EEA. She also cites 'serious concerns' around patients' access to medicines, devices and radioisotopes – and that a hard border in Northern Ireland would cause significant damage to cross-border healthcare arrangements and disruption for patients and healthcare professionals in the region. The RCGP officially opposes the U''s exit from the European Union following a decision by its governing Council in November 2018. Finally, in the letter Prof Stokes-Lampard takes on Mr Johnson's reported comments calling into question the value of the Soft Drinks Industry Levy and other so-called 'sin taxes'. She writes: "Given the current obesity crisis, it is vital that we adopt and maintain a society-wide approach to preventing ill-health… [the levies] have widespread support across the health sector and rolling them back could have a devasting impact on public health – potentially harming millions of people." Commenting on why she wrote the letter, particularly around concerns for the health prevention agenda, Prof Stokes-Lampard, said: “We are facing great uncertainty as a society, something that is causing huge amounts of anxiety amongst GPs, other healthcare professionals and our patients as we face the bleak prospect of a no-deal Brexit, and the adverse impact it will have on our NHS. "But one thing that is certain is that we are already in the middle of an obesity crisis, which is putting both our patients' health at significant risk and the health service under incredible pressure. It is therefore vital that the new Prime Minister and his government keep prevention at the heart of the health policy agenda. "The College is deeply concerned that Mr Johnson has previously called into question the effectiveness of the sugar tax - and other so-called 'sin taxes' - and our concern has been heightened by the publication of the prevention paper this week that seems to abandon an extension of the sugar tax to milk-based drinks and sets out no clear plans to reverse cuts to public health services. "This all falls far short of what is required to make lasting and significant change, and we fear that initiatives that we have previously welcomed are being watered down or simply withdrawn. "It is a fact that our patients are exposed to unhealthy lifestyle habits daily – smoking and drinking in soap operas and dramas on our TV screens, advertising for unhealthy diet options and unrealistic expectations of body image on social media. We need to see the government taking more action, not less, to tackle 'un-healthiness' in our society, which is already putting immense strain on our NHS. "Initiatives, such as the sugar levy, have received a huge amount of support from health experts across the health service - and evidence shows that they work. Rolling them back will almost certainly have a devasting impact on public health in the long term – potentially affecting millions of patients."

Not possible to deliver truly holistic care in 10 minutes says College

She said: "It has been clear for some time that the standard 10-minute appointment is no longer fit for purpose. As GPs, we want to be able to deliver truly holistic care to our patients after considering all the physical, psychological and social factors potentially impacting on their health. "But when you consider that very few patients now come to us with just one health-related condition, and that we are increasingly up against the clock in consultations, this is simply not possible and in some cases it could be unsafe. "We know that GPs and our teams are working under intense resource and workforce pressures and as a result, hard-working, experienced family doctors are burning out, and leaving the profession earlier than they would have done. These must be addressed, not just to keep general practice – and the wider NHS – sustainable, but for our patients' safety. "We have called for 15-minute appointments as a standard, with longer for those patients with complex health needs who need it. But with GP workload soaring, falling numbers of family doctors, and patients waiting longer for appointments, we need more resources and an expanded workforce to make these longer consultations feasible – otherwise it will only add to pressures and serve to undermine patients' ability to access the care that they need."

Same-day pharmacy consultations could help relieve GP pressures, says College

She said: "Introducing a greater variety of roles into the general practice team and making the best possible use of primary care professionals in the community is key to helping relieve the intense resource and workforce pressures facing GPs, and ultimately ensuring our patients get the care they need when they need it. "Pharmacists are highly-trained healthcare professionals who already advise patients with a host of minor illnesses that don't necessarily need the input of a GP, recommend suitable over-the-counter medication and self-care treatments, and play an important role in medication management on a daily basis. In doing so, they are vital to delivering patient care in the community and alleviating pressures in general practice. "However, whilst this new scheme is welcome, it is not a silver bullet to addressing the pressures in primary care. Pharmacists – or any other primary care professional – must not be seen as substitutes for GPs, so efforts to recruit more family doctors, retain the existing GP workforce, and make it easier to return to practice after a career break or period working abroad must continue and be redoubled."

Martin Marshall named new Chair-elect of RCGP

The two other candidates in the election, independently conducted by UK Engage, were Professor Simon Gregory and Professor Kamila Hawthorne. Martin Marshall is a GP in Newham, East London, and Professor of Healthcare Improvement at UCL. He has been the College's Vice Chair for External Affairs since 2016 and in previous roles has experience of working in government and the charity sector. Professor Marshall said: "I am honoured and humbled to be elected as the next Chair of the RCGP and will do everything I can to represent the views of frontline GPs across the UK. I have a passionate commitment to the values of the NHS, and to patient care, and our professional voice is central at this time of great change. "I would like to thank my fellow candidates, Simon and Kamila, for running such a dignified campaign, and the members of Council who have put their trust and confidence in me. "I would also like to pay tribute to our current Chair, Helen Stokes-Lampard, who will leave such a strong legacy for me to build on." Unlike other Medical Royal Colleges, the RCGP has a Chair and a President. The Chair of Council is the leader of the College and sets its strategic direction and policy. The President is the 'constitutional' head of the College. The two-year post is currently held by Professor Mayur Lakhani who will be succeeded by Professor Amanda Howe, also in November 2019.

Patient satisfaction results are 'testament to the incredible efforts' of primary care teams, says College

She said: "It is testament to the incredible efforts of GPs and their teams that patient satisfaction in general practice has remained so high – especially given the intense resource pressures currently facing our profession and the strenuous circumstances our colleagues are working under. "The fact that 95% of patients say they have confidence and trust in the healthcare professional they saw, and 94% say their needs were met when they last visited their local practice, is something we, as a profession, should be very proud of. "However, the knock-on effects of the pressures currently facing general practice are still clear, and patients are finding it increasingly difficult to access the services they need, when they need them, and this must be addressed as a matter of urgency. "GPs are seeing more than a million patients a day across the UK, but this increase in patient demand is not being met with adequate levels of resourcing and staffing, leaving patients waiting longer for appointments and some GPs burnt out, which ultimately puts patient safety under threat. "Today's results show how much general practice is valued, and rightly so, but also how important it is to protect our services and make sure that everyone, regardless of where they live, is guaranteed to get the care they need and deserve, every time they need it. "That's why we need to see more resources and funding reaching the frontline in general practice, including effective implementation of the NHS Long-Term Plan, and more details about how the aspirations in the interim People Plan will be achieved through a clear, costed action plan, to ensure GPs and our teams can continue to deliver the best care possible to patients."