Saturday 24 June 2017

Notes from RCGP Council meeting 24 June 2017

Physician Associates

Council did not approve the following draft position:
The RCGP is committed to working with governments across the UK, physician associates and our members to ensure that physician associates in general practice work safely and effectively as part of a GP-led multidisciplinary team to support and provide continuing, high-quality, integrated patient care. Physician associates should be seen as new members of the clinical team, complementary to GPs, rather than a substitute for them.
I made the following points:
Having canvassed opinion on this matter, I can say there is still considerable anxiety amongst GPs on this matter. Hearteningly, some critics have latterly been working with physician associates and found that, with tightly defined roles, they are valuable members of their team.
It is vital that the optimum role of physician associates in general practice is defined carefully, as well as resolving issues including regulation, standardisation of training, continuous professional development and revalidation.
There is much anxiety about the role of physician associates in general practice, how efficiently they consult, and how burdensome it will be for GPs supervising them in terms of time and carrying risk.
By virtue of medical undergraduate training, on-the-job acute hospital experience and GP specialist training, GPs are second-to-none amongst professionals at managing undifferentiated presentations.
The literature I have found demonstrates that PAs are at best as cost-effective as GPs (without considering costs of supervision) when consulting a pre-selected, less complex cohort. Indeed, that cohort (triaged by receptionists) was also less affluent, which reinforces concerns about accentuating health inequality.
I would suggest that our position make reference to cost-effectiveness rather than just effectiveness and that any impact on colleagues (thinking about costs such as time and risk) be fully mitigated.

RCGP Sponsorship Policy Review

In response to a paper setting out the terms of a review of RCGP's sponsorship policy, I made the following remarks:
I am uncomfortable at the proposed distinction between commercial and non-commercial sponsors. I am reminded of the aphorism "The road to hell is paved with good intentions." Many organisations, both commercial and non-commercial, have laudable intentions, regardless of funding.
It is more important to look at the objectives of corporate sponsors: if their objectives could benefit from a change in clinical practice by RCGP members, we must ensure that that objective is aligned with policy previously agreed by Council and that RCGP retains editorial control.

RCGP Leadership Strategy

I welcomed the proposals to ensure the delivery of leadership, management and business skills during GP training. I asked how it would be funded (and was advised some funding would be sought from the King's Fund) mindful that there might be other priorities for any RCGP funding.
I sought reassurance that any leadership, management and business tasks assigned to trainees would be of high educational value and I questioned whether that included minute taking (as suggested in the paper).

Report of the Overdiagnosis group

A report was received from the overdiagnosis group of their excellent work over the last 3 years. They call for training for College employees to ensure that the 5 tests of overdiagnosis be applied consistently and rigorously to all College policies, that evidence-based medicine and shared decision making should be given higher priority in all medical undergraduate and GP education, and that the Overdiagnosis group should work more closely with the RCGP Clinical Priorities programme.

Screening not recommended by the UK National Screening Committee

Council received an excellent paper describing the ethical difficulties surrounding screening (testing apparently healthy individuals) which has not been approved by the UK National Screening Committee. There was a difference of opinion between one Council member who suggested that screening of individuals at their request, or of high risk populations at the discretion of local clinicians should not be discouraged. In contrast, the view of the authors of the paper remains strongly that patients should only be offered the choice of cost-effective tests.

No comments: