Sunday, 25 September 2016

Notes from RCGP Council meeting 23 September 2016

Hustings for Vice Chair (External Affairs)

Four candidates are standing for election: myself, Gary Howsam, +Jonathan Leach and Martin Marshall.
This was my pitch:

So why should you vote for me as Vice Chair (External Affairs)?


Over the years, College has been phenomenally successful in raising standards in General Practice such that GPs rightly enjoy unprecedented levels of respect from colleagues, patients and policy makers. Under Maureen’s inspiring leadership, we have won the argument for new investment into General Practice. In the challenging times we now face, we are now all too well aware of the need to ensure that new resources reach beleaguered grassroots GPs.

As such, it has never been more important for College to be outward-looking. As Vice Chair (External Affairs), I will continue to support our dialogue with policy makers. Engaging the support of patients and carers will be vital and I look forward to liaising with the Patients and Carers Partnership Group to this end.

One key relationship for College is that with the BMA, especially in ensuring that GPs benefit to the max from GP Forward View. Naturally, the two organisations have different voices, which has the potential to be confusing for our members. We already have close ties with the BMA, LMCs and GPC, at Faculty, Council, Officer and staff levels and I will seek out new opportunities for even closer liaison.

I was elected to Council with a mandate to improve transparency and to close the gap between what we promise on behalf of GPs and the resources available. I championed our new policy to allow tweeting of Council meetings and sharing of draft papers. As Vice Chair, I will be better placed to advance both of these priorities. Not only will I continue looking for practical ways to improve the transparency of College to our members, but I will also explore ways to improve communication within Council between meetings, to assist you as Council members as you liaise between central College and the members you represent. Drawing from my experience on the Overdiagnosis group and positive reports from other committees, options might include an email discussion channel which Council members can dip in and out of when time and interest permit.

What personal qualities and experience will I bring to the role?


I am completely committed to College, having been active first at Faculty level and latterly in Council ever since I became a GP 12 years ago. I have a variety of experience of General Practice as a trainer, a locum, a salaried GP, a clinical assistant in secondary care, a medical director of a walk-in centre and as a partner of one of the first superpartnerships. I have worked in urban and rural settings and with affluent and deprived populations. As such, I can relate personally to the challenges faced by members working in each of these settings.

You will know that I have long been a keen user of social media. I helped to set up Resilient GP and, more recently, GP Contract Forum. The relationships that formerly isolated GPs can now form with colleagues online has become a strong force. Inspired by the enthusiasm of Helen our next Chair and Maureen and Clare before her, I am keen to continue with attempts to harness this force to engage with and consult our members better than ever before.

Thank you for listening and, in due course, voting for me! If you have any suggestions, do please get in touch. As your Vice Chair, I will always be open to new ideas so as to ensure that College thrives and, in the words of Terry Kemple, General Practice never finds itself in the doldrums again.

Council members will vote for the next Vice Chair (External Affairs) between 26 September and 14 October. Please contact your Council or Faculty rep asap and ask them to give me their first preference vote!

Perinatal Mental Health position statement

I applauded a paper by Judy Shakespeare et al. on perinatal mental health, excellent in part because of the perinatal mental health toolkit available on the RCGP website, which looks like a fantastic resource for GPs and their patients. I was also pleased to see its call for commissioners to improve perinatal mental health services.

I called for the wording of one of the "key messages for GPs" to be adjusted. It currently reads:
"Many women are reluctant to disclose perinatal mental illness. However, if a woman does disclose problems this is a 'red flag'; it is possible that she is unwell, and the GP should explore in detail before reassuring or normalising her feelings."
Given that sifting normality from illness is the essence of general practice, I felt that this wording was not helpful. Furthermore, the evidence cited in the paper suggested that there are actually more false positive diagnoses than missed diagnoses (for adults with depression in primary care).

The wording of this "key message" will be adjusted accordingly.

Direct election of Chair of RCGP

Dom Patterson and +Margaret Mccartney proposed that the Chair of RCGP should be elected directly by the membership. Council were not happy to accept this principle in advance of a detailed proposal but Chair-elect Helen Stokes-Lampard promised a working group to explore ways to improve engagement of Council with members.

Role of homeopathy

Having rejected homeopathy in November 2015, Council rejected a rebuttal paper prepared by the Faculty of Homeopathy. Council's view was so clear that a vote was called very swiftly. Had there been more of a debate, I would have highlighted that the view of the vast majority of our 50,000 members regarding homeopathy was very clear. In contrast, the Faculty of Homeopathy include only 101 RCGP members. Furthermore, the grade of evidence cited in their rebuttal paper was much weaker than that presented by the RCGP Overdiagnosis group in November.

General Practice at Scale

I was concerned that the recommendations for larger GP organisations contained within this paper prepared jointly with the +Nuffield Trust did not include good evidence of benefit, nor were uniquely applicable to larger organisations.

For example, e-consultation software and telephony were cited as examples of demand management. I am not aware of any robust evidence that such systems reduce demand. They are also not unique to large organisations: only last week, I was working at a practice with a patient population of 6,000 which operated a "total telephone triage" system.

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