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GPs buried under trusts' workload dump

Sorry to disappoint, but RCGP isn't run by a cabal of government quislings

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With the passing of another week on social media comes another epidemic of College Dysmorphic Disorder: the fixed collective delusion,of those desperately seeking external validation of their decision to stop paying membership fees, that their former College, RCGP, is run by a shadowy cabal of Government quislings intent on bringing about the demise of UK General Practice, rather than being a group of well-meaning if occasionally misguided people who share the same propensity to human error as the general population.

This week, Helen Stokes-Lampard’s crime was to have the audacity to meet the Secretary of State for Health and – shock horror! – pose, smiling, for a photograph with him. In the feverish climate of GP social media, this was apparently tantamount to her serving him a three-course romantic meal on the rooftop terrace of 30 Euston Square then working through the Kama Sutra with him.

Don’t get me wrong: I recognise that RCGP isn’t perfect, and the College seems to have a knack for PR own-goals, from colouring books to discounts on caviar, Champagne and polo tickets. I understand that many members feel that the College is doing too little to help as workload spirals, indemnity costs soar, and the recruitment crisis means that many surgeries are chronically under-doctored. There are many GPs – particularly those outside of London, who are geographically as well as metaphorically remote from 30 Euston Square – who feel that the College does little other than running an expensive exam and distributing chocolate coins.

Given that most GPs would rather do a PR exam without gloves than be seen dead next to Jeremy Hunt - let alone sporting a broad smile – the picture of Stokes-Lampard was jarring. But for the many members that want their College to exert influence at the highest level, Jeremy Hunt coming to 30 Euston Square, the heart of general practice, and pretending to ‘heart GP’ was a publicity coup. How do the naysayers think Stokes-Lampard should be communicating with Hunt – via telepathy? Snapchat, perhaps? If we want RCGP to stand up for general gractice, its leaders need to lobby politicians, and inevitably that requires face-to-face meetings. If we want politicians to listen to GPs’ voices, we need our representatives to engage with them, building the kind of professional relationship which gets things done. Some social media pundits have suggested that Stokes-Lampard should have refused to pose for a photo, but what would that overt hostility have done to their working relationship?

April’s furore over ‘House of Lords-gate’ is another case in point. For years, exhausted, burnt-out GPs have been warning that their workload is unsustainable. The independent contractor model of general practice is nothing if not efficient. The buck stops with GP principals, who stand to lose their business and, potentially, their home if the surgery fails. Market forces are at work. Young doctors, faced with the prospect of 14-hour days and potential financial ruin, are increasingly choosing salaried or locum positions rather than the risks of partnership. Surgeries are merging and federating to escape the inefficiencies that face small businesses.

In this context, it hardly seems controversial that Stokes-Lampard told the House of Lords that the current model of General Practice is “not likely to be fit for the long-term future”. Yet, because it was her that said it, predictably she was torn to shreds on social media – without any hint of irony, by many of the same people who have been loudly forecasting the demise of the current model of general practice for years.

Stokes-Lampard is a shrewd political operator who has been holding high office since before she was on the GMC register – she has ascended rapidly from President of her medical school’s Students’ Union, to GP trainees’ representative on RCGP Council, to Honorary Treasurer and then Chair of Council – and I suspect she is well used to taking criticism. But her trial by social media illustrates a wider point – that in modern medical politics, it’s not what you say that matters, but who you are. And right now, there are a group of GPs who feel so angry and disillusioned by RCGP that they will reflexively attack anything the College says or does.

RCGP must reflect on this and try to learn from it. More could be done to ensure that grassroots GPs feel the College is listening to them. When the College makes policy on significant issues which will affect all GPs, why not consult the wider membership? A membership-wide consultation exercise was held to determine the RCGP’s policy on assisted dying – why not take the same approach to other major issues, like skill mix in primary care (do GPs really want to be supervising an army of physician’s assistants?) or whether general practice should stay within the NHS? Additionally, at present, draft papers are not made public until they have been approved by Council, which makes it difficult for the wider membership to enter into dialogue with their Council representatives prior to decisions being made. Although great strides have been made in opening the workings of RCGP Council up for greater scrutiny, and the recent advent of live-Tweeting captures some of the flavour of discussion, the minutes of Council are neither timely nor detailed, conveying little of the nuance of debate, so grassroots GPs cannot see why College reaches the positions it does.

I must declare an interest – I am on the RCGP’s Associates in Training Committee, sit on my local RCGP Faculty Board, and am in a relationship with a member of RCGP Council (who is an advocate of transparency), so I couldn’t be more of a ‘College person’ if I tried. I see myself as a ‘critical friend’ of RCGP and am involved with the College because I think it does a lot of good already and I want to work within it to make it better in future. And I fail to see how it is anything other than positive that the College is respected enough by Government to be able to invite Hunt to their headquarters and lobby him.

I understand that many grassroots GPs are angry, but let’s focus on the right target: the Secretary of State for Health who is starving Primary Care of resources, not the woman who happened to be photographed next to him while fighting for that to change.

Dr Heather Ryan is a GP registrar in Liverpool. You can follow her on Twitter @DrHFRyan and view any conflicts of interest here.

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Readers' comments (39)

  • Cobblers

    Her prose is somewhat larger than her experience and lacks the ability to use her ears twice as much as her mouth.

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  • The last RCGP chair said "it has never been a better time to be GP". This was used by the then PM and health secretary to their advantage many a time. Now that he has the photo, Hunt will go on about when he went to the RCGP and talked to the grassroots GP (SIC), say what he wants and the average daily fail reader will just accept whatever he says. WE ARE DOOMED and losing the PR battle while having a PR done to grassroots GP's. Well done RCGP. The naive bloggers will support you whatever you do to get to where they want.

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  • 'the fixed collective delusion,of those desperately seeking external validation of their decision to stop paying membership fees'

    There is a great Michelin starred restaurant in a Surrey village that I took my wife to for many times less than the money I saved from leaving the RCGP. The experience was easily enough validation for me!

    I think this article is looking for external validation far more than many who leave the RCGP!

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  • Life will be a lot easier if we learn to divide responsibility like this:
    1. RCGP is about clinical standards and promoting quality practice / training, and ultimately Specialist Status. Please get on with all these. If have been listening to the Essential Knowledge Update podcasts: OMG what drivel. If we had a good RCGP, then NICE would be out of business: THEY should be writing the guidelines themselves. Why has no-one challenged NICE on their conflict of interest (clinical standards "dictated by those who pay for them").
    2. BMA are the ones who need to go to guns on our working conditions, pay, and overall NHS funding. They are the ones we should be targeting to avoid any smiling in front of Ceremy Junt.

    Lets keep it clean and tidy.

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  • ^^^^this

    You are a brave girl Heather but I think the article is worth writing

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  • Hi Heather. Interesting article, but at times a bit too keen to portray those who criticise the College as all cut from one cloth and as fundamentally wrong / misguided / misled. That of course is what you accuse those same people of doing. I undoubtedly fit some bits of the stereotype you set out, but have praised the RCGP when it does something sensible, as last week when John successfully lobbied against knee-jerk support for the PA role. One of the problems with the approach you take is that you rather alienate people like me who do try to praise as well as criticise by implying the criticism is OTT.

    When you say "I understand that many members feel that the College is doing too little to help as workload spirals, indemnity costs soar, and the recruitment crisis means that many surgeries are chronically under-doctored", I found myself wanting to know what you think? If you disagree, then it would be more interesting to argue the toss over what the College has actually done on workload, indemnity costs, etc - because ultimately that is what determines the validity or otherwise of criticism of the College.

    Finally, I must pick you up on "April’s furore over ‘House of Lords-gate’". This bears directly on me because I wrote to Pulse at the time and was directly involved in criticising the College's approach. My criticisms of your piece would be:
    (1) You conflate "workload" with "work models". Yes, lots of us have been saying workload is unsustainable: that is entirely separate from the way primary care is run. The workload is a function of external influences on GP (training, recruitment, pay, GMS/APMS/etc contracts, pensions), where the model is how organisations form within those constraints to deliver care. Put simply, highlighting excessive workload seeks from the College concrete steps to reduce that workload, not for them to say 'oh well, it's probably doomed, so we'll say that to the HoL'.
    (2) You don't discuss a major strut of the criticism, which is the glaring COI Clare Gerada, in particular, had advocating a model of care which she has set up as a private company which she runs.
    (3) You also don't discuss why a College which is constantly banging on about its membership figures didn't bother to consult that membership, at all, before condemning a model of working which, if it suddenly stops, would as you say likely make a lot of partners personally bankrupt.

    You make some excellent points about how disillusioned many members feel, and I hope there, at least, the College listens to you.

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  • Great piece which, if the outcome is cementing ones place in the organisation, has been immensely successful. Wonderful.

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  • I'm afraid I think the article risible, and in my view it veers dangerously close to sycophancy, with a junior committee member defending the supreme leader. Echos of the Trump White House. Yuk.

    I would agree with those who say the RCGP has understandable but disproportionate importance to trainees right up until they get their CCT, at which point the wise trainees cancel their subs and spend the dosh on something pleasurable and designed to enhance their resilience. A spa day, perhaps. HSL cannot compete with a hot stone full body massage.

    Compare for a moment. the performance and output of our fellow royal colleges to the RCGP. Have you read the BJGP? Embarrassing.

    Those of us many years outside training don't give a monkeys about the college or its officers. We long since stopped listening, and emphatically they do not represent me.

    I am responsible to my patients, my colleagues, my family and myself.
    I am regulated by the GMC.
    I am represented in negotiations by the BMA.
    I am defended by the MDU.
    I have no connection at all with the RCGP and am left wondering what they are for.

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  • Vinci Ho

    Admire your audacity to write this but these are words I would like give you:
    It is only a fine line between politically correct diplomacy and dangerously flawed hypocrisy.
    Politics is about convincing the public as well as your colleagues only with political sensitivity and wisdom .
    And an institution needs to define its telos , purpose.
    Hence , the arguments about justice/justification are so often about arguments of telos , which then reflect the conflicting notions of virtues honoured and awarded by the institution.
    Ultimately, every political move is about expedience, nothing more , nothing less.
    I have never been a member of RCGP......

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  • AlanAlmond

    Social media isn't reality. Don't get confused and assume just because lots of people are saying something in your self selected little on-line bubble that this is generalisable to the wider group as a whole. This is the great error of our time, the ghettoising of opinion fuelled by social media.
    I find it depressing that one of the central pillars of this article is a reaction to the writers experience of her own self created on-line life. This is the new normal and I find it sad - regardless of the points being made - right or wrong

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