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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)

  • heather,

    no

    anonymous salaried!

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  • Im sorry to disappoint you, Heather, but those of us in the real world, at the coal-face, dont see any of the things this organisation does, other then its grip on obtaining CCT (meaning it can charge what it wills for exams with no transparency at all).

    Like it or not, whatever the college does can and will be made political by mr junt, as he tries to pull the wool over the eyes of our population. Therefore the college needs to take a leaf out of the book of RCPCH who at least have been vocal against cuts and the changes and seems to be sticking up for its members.

    What does 500-odd quid get you, these days? Where is the transparency in this organisation?

    And as I said to maureen, when she was chair - the rcgp need to do something to make working life better - if it doesnt whats its point, other then to drop straight after you get your cct?

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  • Article nicely illustrates RCGP mentality; we at the RCGP know best, and anyone who disagrees is not just wrong but stupid or incompetent.
    Fortunately I have managed 25 years so far without giving the RCGP a single penny; the savings have been far better spent on funding child's University fees.

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  • Well said Heather. Whatever its faults the RCGP is one of the crowning achievements of British general practice and something we should all be immensely proud of. Its future and the future of general practice is in the hands of your generation. The alternative vision is that conjured up by comments from Pulse readers as shown above whose ignorance, bigotry, prejudice and general nastiness is something more appropriate for the Daily Mail. Just remember that the emptiest vessels make the most noise, and the combined contribution to the wider profession of these commentators is likely to be zero or less. Keep it up- the rest of the profession needs you!

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  • Whatever.
    The system is broken. In my are the poorest in England there are no recruits.
    There is indemnity, vicuious and unfair scrutiny, and insane demand driving the few dedicated remaining people out.
    So I'm , to use the colleges words, ideally placed to ignore the ivory tower RCGP .

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  • Simon Sherwood @ 10.29 exactly

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  • Given that the RCGP is utterly crap at representing GPs, and more importantly this is not its' raison d'etre, could it kindly stop doing it please?
    If the RCGP wants to cuddle Jeremy Hunt or perhaps some trees that he may hide behind then let me make it clear that it is not working on MY behalf.
    If any of you RCGP blowhards fancy doing some politics please join the BMA instead and at least you'll get a bit of training in PR and damage limitation.
    Heather- I defend your right to say things- but what you say is totally naive and patronising- you have some growing up to do.

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  • I disagree, RCGP is run for the benefit of its officers and hangers on, ordinary members especially outside London get bugger all for their membership subs,
    If you are a luvvie of the college congratulations, your OBE is in the post otherwise a useless redundant organisation for 99% of its members....

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  • David Banner

    I find the comments on here denigrating Heather's opinions because of her youth both ignorant and patronising. Being over 50 doesn't make my views any more or less valuable than her's.
    For the record I disagree with her article (and posing with JH showed astonishingly poor judgement in these politically charged times, a real "let them eat cake" moment of madness)

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  • From your article it would appear you have aspirations to rise to top of that greasy pole to top RCGP
    Good luck to you and your idealism but many of the coal face GP's find the College completely irrelevant in their lives as the journal is gargage by and large and for me personally they offer nothing to improve my daily grind yet cost a fortune

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