Friday 21 September 2018

Notes from RCGP Council meeting 21 September 2018

I spoke to three agenda items.

Trustee board

As I frequently do, I raised two questions relating to confidential trustee matters.


In response to a paper from RCGP Clinical Champion for Sepsis, Simon Stockley, I made the following speech:
My first exposure to the sepsis awareness campaign was when I was lambasted on Twitter by one of the leading lights of that campaign, a medical colleague, for having the temerity to question the utility of the alarming prompts that appear on SystmOne whenever one so much as types the word "fever". I am pleased, therefore, that College have identified sepsis as a clinical priority, and I am grateful to Simon Stockley for his more nuanced approach.
Other than turning off the computer prompts, my response to the sepsis campaign has been to attempt to measure and document physiological variables more often, and I'm sure many colleagues do also whenever their clinical judgement leads them to suspect a patient with infection is severely unwell. Indeed, I accept that this aids communication of urgency to ambulance services and hospital colleagues.
It has been argued that documenting physiology when one does not suspect severe illness can later aid one's defence if severe illness subsequently develops. However, given the vast number of presentations of infection in general practice, to do so every time would have major resource implications.
I strongly doubt that, contrary to intentions stated in the clinical spotlight survey, 62% of adults presenting to their GP with coryza or paronychia, for example, have their respiratory rate quantified and documented. To do so reliably would require a systematic approach, such as for all patients to be assessed by a health care assistant before seeing the GP - an approach that actually worked well in the walk-in centre I used to direct, but requires a team of HCAs and twice as many consultation rooms.
Simon acknowledges the challenges of paediatric pulse oximetry. Are we really saying that any practice without adequate pulse oximetry equipment is unsuitable for assessing babies?
Rather than mandating sepsis training and the calculation of a sepsis score for every patient a GP sees, this is an opportunity for College to support its members by commending their unique skill in distinguishing between patients with unpleasant self-limiting illness and those at risk of septic shock and many other life-threatening conditions. Let us highlight the advantages of documenting physiology but also celebrate GPs' expert clinical judgement, born of years of training and experience. Whilst recognising that nothing short of a crystal ball will infallibly identify the patient that will become severely ill, we should state clearly that a GPs' clinical judgement alone is adequate.
We should develop a position statement on sepsis. It should aim to support the assessment of the acutely unwell but also protect GPs' clinical judgement from unjustified criticism.
 Council decided that RCGP should not develop a position statement on sepsis.


I seconded a motion calling on RCGP to warn of the health consequences of Brexit.
The country voted for Brexit partly on the basis that, according to the now infamous bus, the NHS would be better off to the tune of £350 million per week. The NHS' 70th birthday present was said to be funded from the Brexit dividend; perhaps it is no coincidence that this apparent largesse was actually less than the historic average annual uplift in NHS funding.
It is now becoming clear that Brexit poses challenges to our patients that were either not apparent at the time of the referendum or, if the UK crashes out of the EU with no deal, will not be addressed.
Charged as College is with maintaining the highest possible standards in general medical practice, it is our duty to call attention to these risks for the benefit of both sides of the Brexit debate: Remainers may use this new information to support calls for a fresh referendum; Brexiteers can push for other solutions to be found to these challenges. As such, this motion represents a constructive contribution to the wider debate and does not compromise College's political neutrality.
The BMA and other medical bodies have already set out concerns in relation to Brexit. Our charitable objectives oblige us now to do likewise, for the benefit of general medical practice and our patients. I am grateful to colleagues in the Midlands for drawing this motion together in a way that we can support and I encourage Council to do so.