This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

Negativity in general practice 'is worst I’ve known', says RCGP chair

Exclusive RCGP chair Professor Helen Stokes-Lampard has complained that the 'negativity' within the general practice profession is the worst she has ever known.

In an exclusive interview with two members of Pulse's trainee editorial board, she said this was 'tragic' because it was putting people off going into 'the greatest job in the world'.

And, although Professor Stokes-Lampard acknowledged that this was linked to lacking resources, she suggested experienced GPs should do their best to try to inspire GP trainees.

She said: 'The negativity is probably the worst I’ve ever known and that’s tragic because it’s putting people off doing what, to my mind, is the greatest job in the world...

'The negativity is a consequence of a whole decade of under-investment and under-resource and so it’s understandable. But it’s not helpful.'

Speaking at Pulse Live Birmingham earlier this summer, Professor Stokes-Lampard suggested that although GPs do need to vent their frustrations, they should do so only when in the company of senior colleagues.

According to Professor Stokes-Lampard, 'we know the pendulum will swing back again' and therefore GPs should 'be inspiring for the future'.

Despite this, Professor Stokes-Lampard did criticise the progress of NHS England's GP Forward View rescue package to date, describing it as ‘really not great’.

An RCGP report concluded this week that the GP Forward View is failing to have a ‘positive impact’ on GPs at the frontline, with it’s commitment to add 5,000 GPs to the workforce by 2020 in need of an ‘urgent rethink’.

But Professor Stokes-Lampard said: 'Being a GP on a good day, in a surgery that’s properly resourced and properly staffed is fantastic.

'That richness of the relationship with patients, what you can do for people and to be part of the community is so amazing. That’s why I do it, and that’s why most of us do it.'

Professor Stokes-Lampard also attempted to reassure new GPs about the future of the profession, saying that 'there’s always been a crisis in general practice' and 'there’s always been GPs frightened about the future'.

'But patients’ need for a trusted health care professional is constant,' she added.

Her words come as earlier this week, Pulse's survey of 282 GP trainees found that nearly 40% of have considered abandoning training because of stress.

Pulse's survey also found that around four in ten GP trainees intend to take on a partnership within five years of qualification, with only one in ten ruling it out at any point.

Professor Stokes-Lampard said: 'I think what will be different is the way that we work. We’ll be working in larger and larger groups... There will be partnerships but that will be one of a range of ways of delivering care.'

 

Readers' comments (48)

  • When will the pendulum swing back the other way? As I've been waiting a long time. And what are you doing to help it swing back, professor?

    Unsuitable or offensive? Report this comment

  • National Hopeless Service

    Moral and negativity has been rubbish for years hence the damp squib of the five year forward view and the BMA damper squib of an urgent prescription for primary care.

    Unsuitable or offensive? Report this comment

  • Maverick

    Just out of interest Prof HSP.... how many surgeries / on calls / patients do you see each week? How much do you pay for your indemnity?

    Unsuitable or offensive? Report this comment

  • Tom Caldwell

    I wonder if that negativity could relate to horrific morale amongst a highly intelligent group of people well used to assessing complex social, psychological, economic, pathological situations and finding route causes/diagnosis/prognosis for them?

    Unsuitable or offensive? Report this comment

  • Helen - bit of a reality check for you.

    The stressed trainees within the Pulse survey didn't quote the negativity amongst senior GPs. They quoted the overly onerous hoops of the eportfolio

    Hoops which the RCGP have started and maintained. Hoops which are making trainees and trainers stressed and for TPDs like me to lose the will to live during summer ARCPs.

    I'd like to think I am a good role model for my trainees by helping them achieve the career and life they want to achieve. I don't think it's because I'm happy clappy.

    Unsuitable or offensive? Report this comment

  • I can see her argument but there is an equally compelling opposing argument that says tell the truth about the worst climate to try to do General Practice that I can remember in over 30 years.

    And just because the previous troughs in morale and conditions did improve doesn't mean that they are going to improve on this occasion.

    Anyway we've just been through all this.

    Unsuitable or offensive? Report this comment

  • Cobblers

    "Being a GP on a good day, in a surgery that’s properly resourced and properly staffed is fantastic."

    She needed to add to that the CQC had disappeared up its own fundament, that the Daily Mail had gone bust, that the Government was paying much more, patients were reducing their demands and that the RCGP had decided to disband.

    And then the GP woke up to the awful reality. Poor pay, excessive demand, low morale and a longing to get to 55 years and retirement.

    WAKE UP. It was a wonderful job but it has been trashed by the RCGP amongst the others.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated

  • Shh...not in front of the children!

    Unsuitable or offensive? Report this comment

  • RCGP*
    +CQC
    +NHSE
    +DOH
    +GMC
    ---------
    = no NHS
    ---------
    *where RCGP is square root of FA

    Unsuitable or offensive? Report this comment

  • Negativity in general practice 'is worst I’ve known', says RCGP chair

    general practice 'is worst I’ve known', says every grassroot GP actually doing the job and unable to leave.

    Are the RCGP actually working GPs? Their view of our working life is not the same as mine. It's &£@t!!!!

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Respect your politically correct comment, Helen.
    But for the logics of debate , one will need evidence(s) to support arguments. In this case , we are looking at the evidence for GP colleagues NOT to be 'negative'.
    Enlighten me please.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    One thing our representatives must decide is whether their organisations should play an effective opposition to this government which has evidently been harming our patients with their policies of austerity, under-investment and neglect of general practice and hence , NHS. Or would they prefer an 'appeasement policy' to let the politicians to destroy what was so called 'jewel of the welfare crown' ? We serve for our patients but we never serve for any politician.
    Opposition or appeasement?
    I know what Churchill would always choose.....,.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    ''Arguments about justice and rights are often arguments about the purpose, or telos, of a social institution, which in turn reflect competing notions of the virtues the institution should reward and honour .''
    Michael J Sandel

    Question here is what is the telos of the college?

    Unsuitable or offensive? Report this comment

  • Dr Lampard tells us that General Practice is the best job in the world, but has devoted her own working life into distancing herself as far as possible from working as a GP. Odd.

    Unsuitable or offensive? Report this comment

  • AlanAlmond

    This comment has been removed by the moderator

    Unsuitable or offensive? Report this comment

  • It's so great that she spends most of her time doing "portfolio" work!

    Unsuitable or offensive? Report this comment

  • Easy to be positive when you do 1 day as week at the coal face ,spending the rest of your time prawn-sandwiching and power pointing.The rest of us are doing 11-12 hour days with little breaks and constant pressure with no time to reflect and when we do, we wonder how can such a wonderful profession and service be made so ball bracingly awful. Sadly nobody will be held to account for this mess.
    It is difficult to be positive when there is nothing to be positive about.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated

  • By the way it looks like if the pendulum swings the other way, we will be so few in number that no one will notice it has because workload will be that great.It is also very likely that the GP in the MRCGP will be virtually non existent.that will mean that the college is likely to crumble and fall.I hope it can cover its mortgage on the white elephant and the redundancy bill of its staff.Maybe you should be like coalface GPS and have a lease or builds/mortgage where you are personally liable, and you should be personally liable for the colleges redundancy bill.That would focus minds a little and help you feel like a front line troop.

    Unsuitable or offensive? Report this comment

  • ***Newsflash***Attention HSL- pendulum is NOT going to swing back anytime soon..... get yourself a financial education and look at the macroeconomic picture in the UK..... again HSL shows a blinkered view, ignores reality on the ground and reveals yet again why she is incapable of delivering.... this is not negativity by the troops its observation of reality. There are 4billion people living in asia, where do you think the next area of economic growth is, the UK? China now moving into aircraft production for example.....wages have stagnated for 10 years, low wage economy, and fewer elites owning everything in the UK. Do us a favour and start campaigning on tax dodging by multinationals involved in UK healthcare, and social inequality and bring pressure to bear on conservative seats and then you actually might get somewhere.... or is a gong more important that your members?

    Unsuitable or offensive? Report this comment

  • Guys
    All that has been said is true,the negativity is based on the evidence;
    1 Never so many real and perceived medical issues
    2 Never so much regulation
    3 Never so many consultants trying to use GP's as their housemen in the community
    4 Never so much documentation or litigation
    5 Never such effective taxation if you include student loan repayments
    6 Never such a bankrupt government outside of wartime
    However let us not forget if funding from the government is impossible there is only one other possible source,private work
    The profession has precious few with the knowledge skills and experience setting up private services
    Before criticising the professor too much remember she may be our only hope

    Unsuitable or offensive? Report this comment

  • The Prof is confusing sine waves with col Ny collapse curves.

    Unsuitable or offensive? Report this comment

  • This comment has been removed by the moderator

    Unsuitable or offensive? Report this comment

  • I believe in being HONEST with my registrars. I try to help them become an excellent GP. BUT explain that even with all the skills and knowledge, working as GP in the NHS will not enable them to fulfil their potential as a GP.They need to understand what factors in their working environment impede their ability to adequately and safely care for their patients.Without this knowledge they cannot make decisions about what /where they will practice when they have completed their training.
    If I was their age I would be looking long and hard at all the systems in other countries to find one which I can practice happily in . It would not be the UK.

    Unsuitable or offensive? Report this comment

  • Improve appraisal . Ns end more resilience packs. Pay more to college examiners to do better jobs. Get your prorities in focus to market general practice or ....

    Unsuitable or offensive? Report this comment

  • I find it a little difficult to see how reducing our funding, reducing our autonomy, increasing regulation and increasing our administrative workload will result in the pendulum swinging back in favour of general practice as a career choice. At the moment, there's little about UK general practice to appeal to graduates who, above all else, want to be doctors.

    Unsuitable or offensive? Report this comment

  • AlanAlmond

    How on earth does this person get to be 'representing' us?
    The role of the RCGP is to set academic standards and guide training. It is not a political organisation. Forever we get lectures from self important RCGP chairs grandstanding their personal opinions. Cant you put a sock in it and concentrate on your job? You have no real mandate to be lecturing your colleagues.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated

  • This comment has been removed by the moderator

    Unsuitable or offensive? Report this comment

  • The point is I think that the RCGP is an organisation that is funded by the poor mugs who take their exam. An exam that has been made longer and harder to pass as the years go by. We are being asked to not put off trainees who haven't yet parted with their money.
    Personally I can't understand why the head of an exam factory thinks she can speak for GPs as a whole, where is her mandate?

    Unsuitable or offensive? Report this comment

  • RCGP should hibernate for few weeks or months. All GPs will forget everything soon. You will be in our good list soon. Just like cqc, before inspection we hated them, if passed we told other people how good we are, and how hard we worked for cqc inspection.
    can pulse write article or do some research how CQC inspectors are helping inadequate surgeries for money. I know conflict of interest doesn't exist for LMC, CCG, Federations and CQC inspectors.

    Unsuitable or offensive? Report this comment

  • Healthy Cynic

    Oh dear Prof. Lampard, looking at these comments your statement seems to have fostered some GP negativity. The worst I've seen in fact.
    Leadership is not about running down your colleagues.

    Unsuitable or offensive? Report this comment

  • Once again RCGP stokes the embers to fire emotions. Somebody does 'elect' these glib talkers who seem to be living on a different planet altogether.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated

  • there are a few simple things that could be done which will cost nil. Scrap eportfolio, simplify appraisal, reduce CQC burden, scrap QOF, spend your time focusing on indemnity issues.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    To Madam ,with love
    (Inspired by Sir Sydney Poitier)
    Dear Chair,
    First of all , you do not need to reflect on this comment as I am never a member but at least I am not anonymous.
    It is my opinion that you were a breath of fresh air when first being elected just over 12 months ago. My expectation was perhaps you could be the charming girl who pointed out to everybody that the emperor was in fact, wearing no clothes instead of new ones. Being disappointed so far , one would still want to give you the benefit of doubt on a learning curve.

    It is a fact that there is much negativity circulating in our profession and will become unhealthy to our young colleagues. To do 'something' about this is politically correct.
    However , there is a difference between treating the symptoms and the origin.Surely ,you are well experienced for this argument as a senior colleague in general practice.
    xxxxxxxxxxxxxx
    ''Every matter has its origin and final form ; every event has its beginning and the end . Only if one understands what comes before and after , the 'great way' is near to be acquired.'' Great Learning
    All these negatives we are talking here did not develop in one day with no explanation. And they are not confined to the older colleagues and those teaching our trainees . Think about how our younger colleagues felt after their defeat by the government on their industrial actions in more than one occasions. We are at war , precisely war of politics , with the government . The day our longest serving health secretary in history said he was not 'picking a fight with GPs' , this war was declared . His infamous comment of underfunding GP was a 'penance' of our contract in 2004 , demonstrated his belligerence towards this profession. Frankly, we are not traditionally trained for fighting a war like this as we only want to look after our patients , rather than involving in politics. Not knowing how to tackle these politicians with undoubtedly hidden agenda(s) had led to this vicious cycle of negativity. We looked up to the ones elected to represent us but they were too stuck in a political ambiguity by a baggage of staying politically correct in front of the public . The words ' no better time to be GPs' were exploited by the previous prime minister in House of Commons and his conclusion was 'crisis , what crisis?' Then our well established medical journal published an academic study of investigating the pattern of mortalities between weekdays and weekends. This was immediately hijacked by our clever health secretary and this provided the basis of the seven days GP opening policy (without extra new
    investment of resources). It is not surprising BMJ is so much politicised and anti-government in tone these days.
    xxxxxxxxxxxxxx
    The ideal politics in a war is the type which requires the least amount of physical conflicts.
    In Chengdu , China , there is a couplet posted on the wall outside a temple paying tribute to the arguably most intelligent military strategist in Chinese history,Zhuge Liang(諸葛亮). Those who had played video games(or watched films)involving the famous Three Dynasties period(184/220-280 AD) would be familiar with him .
    The couplet read :
    ''Playing the mind-games properly , the enemies would self-neutralise by itself .
    It is well known through history that soldiers do not really want to be belligerent.
    Without a throughout analysis of the current circumstances , either a flexible(liberal) or harsh(restrictive) strategy will create mistakes .
    Always rule my country(Shu) with careful consideration, not once , not twice but thrice.''
    The mind games this government had played on us were numerous and it is time for playing ours . The good news is this government is weakening and zombified .
    From Capita to Sustainability and Transformation Plan (STP) , resilience funding to premises support etc , the word hypocrisy only kept repeating itself . The caveat of genuinely hurting our patients has become more and more plausible.The careless whisper of 'Public sector workers are overpaid' revealed the true mentality of a government willing to sacrifice people's well being for better economy and GDP rise.
    Winston Smith worked for Ministry of Truth in 1984 but never really wanted to lose his soul and true identity . He was not allowed to show any negativity towards the establishment and his fate was clearly sealed with a drop of melancholia.
    xxxxxxxxxxxxxx
    Even the government's own propaganda media and organisations have been exposing negative 'facts' .Based on objective facts , we can make subjective comments. I believe that is what we have been doing on this platform, even though you may not like the negative tone of them. Making no mistake , we are not deluded that these comments represent the opinion(s) of the majority. Certainly , we condemn character assassination as it represents verbal abuse and violence. The level of anger and frustration amongst all medical frontline workers is historical and phenomenal . This is also true to those who care about domestic issues and social justice in this country.
    xxxxxxxxxxxx

    Watched The Good , The Bad and The Ugly(1966) again after 40 years. What inspired me the most was the poignant speech of the Captain of the Unionist in last part of the film against the backdrop of the brutal civil war:
    Soldiers on both sides were reek of alcohol and really did not continue fighting. It was only a bureaucratic argument from the 'headquarter' that his army had to defend this bridge connecting to their enemies , no matter how many soldiers died as a result. He wanted to bomb the bridge but he did not have the guts to disobey the higher order. So the Good(Blondie) and the Ugly(Tuco) blew up the bridge and stopped the two sides fighting as they themselves wanted to get hold of some gold coins on the other side of the river. It was all about self interest ultimately whether you were good , bad or ugly. After the bridge was blown , the first person the Good came across was a young , not old , soldier dying of his fatal wounds.......

    xxxxxxxxxxxxx
    As far as those who are still respectably enthusiastic about training our younger colleagues, I quoted what was said in To Sir, with love (1967):
    Barbara Pegg: Well, Sir, you're like us, but you ain't, I mean, you're not. It's kinda scary, but nice. You know what I mean, don't you?
    Mark Thackeray: Well, I... I don't know how to answer you, except to say that I teach you truths. My truths. Yeah, and it is kinda scary, dealing with the truth. Scary, and dangerous...

    Unsuitable or offensive? Report this comment

  • Dear Chair,
    "The THUTH, the whole TRUTH and nothing but the TRUTH" is the basis of HONEST dealings.
    If you did say: "if GPs do need to vent their frustrations, they should do so only when in the company of senior colleagues," then you expect GPs to withhold the truth from their juniors and in effect lure them into a fool's paradise.
    Then, unfounded NEGATIVITY - a well established characteristic of several psychiatric conditions. I presume RCGP is currently preparing (with the help of PULSE-Learning) "Ten Tips to Conquer Negative Thinking" with a 3-hr CPD credit, which will help us enormously to hit impossible targets and meet meteoric indemnity fees.
    I remain your ...etc etc

    Unsuitable or offensive? Report this comment

  • 'We'll be working in larger and larger groups'
    No doubt owned by Branson and other of Jeremy's pals.
    Where does this fit in with GP ethos and continuity of care?
    What conflicts of interest are hiding in the RCGP cellar?

    Unsuitable or offensive? Report this comment

  • I'll try again, as was moderated last time. Apologies. This time quoting directly from Wikipedia, so should not offend:

    'Colony collapse disorder (CCD) is the phenomenon that occurs when the majority of worker bees in a colony disappear and leave behind a queen, plenty of food and a few nurse bees to care for the remaining immature bees and the queen'

    I was just trying to make an allegory for the current situation with the RCGP and the grass-roots GP workforce.

    Unsuitable or offensive? Report this comment

  • might be the greatest job in the world as an acedemic and well paid RCGP chair.. but those of us who have just finished morning surgery at 242pm with pm surgery starting at 3pm arent so happy.. perhaps if the RCGP chair recognised that... id be keener to be a member

    Unsuitable or offensive? Report this comment

  • I'm so upset by this lady that I need a colouring book...

    Unsuitable or offensive? Report this comment

  • she should be pointing out the problems and trying to fix them not glossing over them and asking us to ignore them and not talk about them.
    Very suspicious way to behave. One wonders about the motivation.

    Unsuitable or offensive? Report this comment

  • Cobblers

    Editor's comments

    This comment has been moderated.

    Rather a lot of these.

    Mine was redacted as I referred to HSL as a "dozy bint" in the context of "WAKE UP you dozy bint".

    I suppose bint could be construed as mildly offensive but it is mild and should not be removed.

    Perhaps the editor could write a 'Viewpoint' on what could be considered removable and why?

    Genuine request. am getting cheesed off at the censorship.

    Unsuitable or offensive? Report this comment

  • Whilst I would agree that part of our job is to encourage trainees to experience all that GP can be, I am very concerned about the implication from head of the RCGP that we should mislead trainees with spin omitting the problems. This is not 'fully informed consent'. This is why I left the RCGP, (and had my qualification withdrawn, after I had achieved and paid for it!) - because I appear to have higher ideals and integrity that RCGP do themselves!

    Unsuitable or offensive? Report this comment

  • You can take my letters....but you can't take my...... FREEDOM!

    Unsuitable or offensive? Report this comment

  • But not in the NHS.
    A contract that means that as a contractor if you deliver more, appointments , nursing time etc, that you take home less; is a recipe for ongoing misery.

    Unsuitable or offensive? Report this comment

  • Father to a murdered profession, husband to a murdered vocation. And I will have my vengeance, in this life or the next.
    My name is Maximus. Maximuspissedoffenuf.

    Unsuitable or offensive? Report this comment

  • In response to the interview of HSL by Pulse trainee editors-
    Just realised why HSL is so optimistic- she states she doesnt read anything by anonymous authors. She shows a wonderful understanding as to why NHS professionals often choose to write anonymously these days. Being anonymous doesnt mean that you are making your opinion up, I wonder if she also ignores anonymous whistle blowers? If she does, is that not negligent? and if she doesn't does that not imply a degree of hypocrisy? Also if she's not reading these comments why are they moderated? She just stated that these authors don't exist in her world..... in which case can she be a bit more honest when she states she represents 52000 GPs, she certainly doesnt represent me. And as this is a pseudonym and I therefore 'don't exist' can she bring her total down to 51999?
    Actually, I think her opinion is that ignoring anonymous comments isn't a powerful strategy at all, I think picking up random ones and detailing why she disagrees with them would be more useful at engaging with those GPs who as a group are disengaged from the RCGP, turning around their opinion would be an impressive mark of leadership, her current 'powerful strategy', well anyone can do that. The sticking the head in the sand is not winning over sceptics, merely reinforcing their negative opinion, not of her personally, but of their belief in her ability to make meaningful change for the better. HSL wants people to identify themselves, I understand and respect that other GPs might wish to remain anonymous, given todays political environment so why can't she?
    I found the use of the phrase 'real nastiness and personal vitriol' again a reminder why I use the phrase- 'we choose to be offended'- at her level she shouldn't be taking things personally, and again she seems guilty of hypocrisy for, on one hand, not wanting frustrated colleagues at the coal face to vent in front of their juniors and telling them that they should do it at their seniors, yet on the other hand, when some contributors do exactly what she wants and they express it directly to the top (when comments are directed at her) she ignores it if the depth of frustration felt by the contributor is such that it is expressed with anger/ disrespect? (Even though she also states in this article that she appreciates some members are very angry and embittered) I was taught a long time ago that respect was earned, through action. HSLs views expressed here, and of several of her predecessors,remind me why I lost faith in our leaders and why I emigrated. I am much better off elsewhere than in the UK under the current leadership. How long was I supposed to wait for the pendulum to swing back? (I don't think it will in the next 15-20 years) If HSL couldn't inspire me to stay, how was I supposed to inspire trainees to do what I wasn't prepared to do myself? I led by example.... took action, and left. I could happily persuade young trainees to move to my current practice, I can't recommend they leave to work in the UK.
    On a separate note..... if there were 3 men in that photo shoot would anyone be claiming that women were being under-represented in the RCGP? Not exactly a gritty feet to the fire interview.... more an opportunity to give her views...... again..... Dear Ed, the interviewers asked four questions, but they didn't interrogate the responses given....how about a follow up article asking her to reply to readers comments?

    Unsuitable or offensive? Report this comment

  • The pendulum is no longer swinging. It's being spun around in one direction like a slingshot!

    Unsuitable or offensive? Report this comment

  • Even the cardigan, socks and sandal brigade are suffering a dose of depressive realism. The choice now for the College is their members or the NHSB and as usual they are choosing the NHS.
    Breaks my heart to think of what I could have bought with the 20 or so years of menbership fees I paid before I resigned. Nothing short of a really big pay increase will tempt people back into GP in the numbers required, combined with the workload controls which never materialized from the last contrick. Trouble is nobody would trust them this time even if they did it. Game over.

    Unsuitable or offensive? Report this comment

  • faecal transplant, your pseudonym has cracked me up, made my day. Thank you.

    Unsuitable or offensive? Report this comment

Have your say