Friday, 22 February 2019

Notes from RCGP Council meeting 22 February 2019

My apologies but family health concerns required me to leave today's Council meeting early. A fellow Council member has kindly agreed to deliver my response to the Rethinking Medicine initiative:

Thank you for presenting the Rethinking Medicine initiative. I'm not sure I fully understand the objective of this movement. Hopefully that is because it has not been predetermined.

If we are to engage with this process, we must as a College prioritise:
1) equity and safety for our patients, so that the ill who rely on the NHS, and those that need drugs and other healthcare technology who rely on doctors are not disadvantaged;
2) the best interests be of our members, lest they are expected to take on responsibility for things for which they have neither proper resource or influence.

Mention is made of the importance of social interventions. No-one doubts this. The key is how to get the necessary social help to those most in need, regardless of whether they have consulted a doctor, without diverting NHS resources away from the ill.

The top priority areas selected by our members are:
1) supporting GPs with workload
2) restoring the status of general practice
3) the interface between primary, secondary and social care.
The partnership review identified rising workload and shrinking workforce as key issues. We have been worrying about the mismatch between capacity and demand for some considerable time.

Medicine, the NHS and general practice need to be very careful about taking on new responsibilities.

Yes, we need to be payient-centred. Yes we need to stop overusing healthcare technology. But we must also be careful not to medicalise other, non-healthcare interventions.

As Clare Gerada said a couple of meetings ago, until such time as we have more doctors than we know what to do with, doctors should do what only doctors can do.

We may need to Rethink Medicine. We also need to Reassert Medicine.

Saturday, 16 February 2019

My address to #DiscoverGP at Keele University on 16 February 2019

One of the great attractions about General Practice, and rightly so, is the range of opportunities available. This is certainly one of the things that attracted me to General Practice. I like the idea of being responsible for the healthcare of a population, of managing a team, and running a small business. We are very fortunate to be joined by a number of GPs who have rich and interesting careers. I, and they, look forward to telling you all about the opportunities available in General Practice.

One of the attractions of General Practice appears to be the ability to develop special interests. But I am often asked what special interests I have and I always say my special interest is generalism. I decided on General Practice as a career before I left medical school and undertook specialist training during which, yes, I picked up some specialised knowledge, but above all I learnt the skills of generalism, which is sometimes hard to describe but in the context of super-specialisation elsewhere the value of generalism is becoming recognised more and more.

So what do I mean by generalism? This has many facets. One of the most important is the ability to tolerate uncertainty and manage risk. Let me give you a simplified, perhaps slightly exaggerated, example. You go to a specialist with a cough and they will undertake all kinds of tests, maybe a chest X-ray, maybe some blood tests, and the specialist will tell you with certainty what the diagnosis is. “You have an upper respiratory tract infection; we are certain you don’t have pneumonia; you can be reassured.” The only problem with this approach is that it is enormously expensive and doesn’t really help the patient to know with certainty the next day what their diagnosis is. Contrast this with the generalist approach. You come to me with a cough. In a matter of minutes I will ask you a few questions, and - perhaps more for reassurance than anything - examine you, and I will say that you probably don’t have pneumonia, you probably have a viral upper respiratory tract infection, possibly ‘flu, and specific treatments such as antibiotics are unlikely to be helpful. However, if you develop symptoms of pneumonia such as breathlessness, or become concerned about something else, then do come back.

Do you see the difference in approach? Now, I would be maligning the specialists if I pretended they do not use some of these generalist skills, but this is the bread and butter of what we do in General Practice. Disappointingly for our Secretary of State, it’s low-tech, but it’s really cheap, highly skilled, and empowers the patient to diagnose themselves, not only tomorrow, but also the next time they are unwell.

So that is the specialism of generalism. That is what gets me out of bed in the morning. But yes, there are also a range of opportunities in General Practice. Please do come round to each of us in turn to find out about the portfolio that is each of our careers.