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At the heart of general practice since 1960

RCGP needs to create a clear vision to help unite the profession

Dr Jason Sarfo-Annin

Last month I started training to become a GP. Being interested in health policy, I have long had questions about policy development and outcomes relating to primary care and how various organisations and committees influence these. For the past year, I have been spending time trying to better understand these bodies. It has involved speaking to GPs, reading policy documents from NHS England, reading blogs and articles from publications such as Pulse and following GPs and GP groups that are active on social media.

What I have found most striking is the depth of hostility towards the RCGP. Most specialties have gripes with their respective Royal College or Faculty. Many of these complaints are common to all, such as criticism of London-centrism or how college officers appear not to spend enough time carrying out the day job. But I’m unaware of any other speciality that has ‘grassroots’ movements to try to work as a bridge between doctors on the ground and people who hold office at their Royal College. The inference is that the college doesn’t do that job well enough on its own.

I appreciate there is much behind this anger that is historical, and much that I will not fully appreciate until I am doing the job post-CCT. But I do get the impression that a key driver of this hostility is an apparent lack of vision. By this I mean overarching vision of the future of primary care that GPs broadly buy into. For example, how should a high quality primary care service be best delivered to the public? Should there be regional variation? How much variation is appropriate? How can the challenges of patient multi-morbidity be met? How do we best train doctors to become GPs? What is the academic evidence base for these positions, and if lacking, how can the evidence be best generated to prove or disprove any assumptions made?

Navigating these questions is difficult. Answers to such questions from the Government, and arms-length bodies such as NHS England or Health Education England will vary depending on their priorities – and may not align with the views of GPs or even the public. Nonetheless, these are organisations the RCGP must work with to deliver tangible outcomes - whilst being at the mercy of political willingness of these organisations to engage and form helpful policy. Furthermore, the College has to represent a very broad church in the GP profession. GP partners. Salaried GPs. Locum GPs. Part-time GPs. Full-time GPs. GPs with specialist interests. Academic GPs. Rural GPs. Urban GPs. Naturally there will be differences of opinion. To my eyes, it is easy to appreciate why many want to protect the partnership model, but also just as understandable why some are laissez-faire about the idea of it ending.

Overall the situation for the RCGP feels like that of a political party that has lost its way with an important part of the electorate it so desperately needs to be truly successful. As proven by many political parties, such a situation is salvageable. It requires a critical mass of individuals working together within the College, rebuilding that connection with ordinary or jobbing GPs. Unfortunately, this takes time to achieve, requiring tough decisions on internal structure, policy and future direction – decisions that will inevitably create friction. It also needs a message discipline not just in what people say but in what they do – especially difficult when errors can have damaging consequences for the College’s rapport with GPs.

As a new GP trainee, I know I don’t yet have the experience, authority or agency to suggest the path that the RCGP should choose. But what I feel can say is that, without unity amongst GPs and their representatives, general practice will struggle in the long term. Given that a well-functioning primary care system is pretty much a pre-requisite of an effective universal health care service, the consequences of the specialty failing are enormous.

To achieve that unity we really need a clear and cohesive vision from the College and its membership. I don’t know if my reasons for entering general practice and my future expectations of the specialty are at odds with the future that our leadership or the generality of GPs want to see. Trainees need to know what this vision is at the point of entry into a VTS. Without one, there is a path to further division within the specialty in the years to come.

Dr Jason Sarfo-Annin is an NIHR academic clinical fellow and GPST1 in Bristol

 

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Readers' comments (10)

  • The profession is to far gone to save.You can try but don't expect a miracle.Within eight years the boost we had in 2004 will be on it way out.End of universal healthcare.The college has blood on it hands for what has happened.

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  • Azeem Majeed

    Thank you Jason. An excellent article.

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  • The problem is that the College is not there to represent our political needs. I left the college about 12 years ago when is started mucking around doing this - and doing it particularly badly.
    If it stuck to its intended purpose of education and research and did this well, then that may actually be more helpful to us all.
    For all its warts it is the GPC that represents us politically, and if we all start factioning off then we will be about as much use as the People's Political Front of Judea (or is that the Judean Political Front?)

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  • Knowledge is Porridge

    The GP training portfolio convinced me the college is a waste of time, subject to a passing fashion for reflective learning.
    We live in a digital world, where IT literate trainees should be collaboratively mapping a way through national guidelines, local pathways and daily clinical uncertainty.
    Instead they are made to write private entries into an ePortfolio, shared with a trainer, but effectively pushing their creativity into a toilet, ready to flush at the completion of their training.

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  • Cobblers

    Jason, I read your article and thought about what your future might be. Just from inference I can see you eventually avoiding coalface GP and settling on more 'Policy Twonk' stuff and 'Meetings'.

    Having said that I can feel other's hackles rising that I should not criticise our junior colleagues. It is not a criticism, call it reading the tea leaves. :-)

    GP, as current, is due a revolution not evolution. The RCGP is part of the problem as being the establishment. There will be a night of the long knives at some point and serious change will happen.

    I look to Northern Ireland GPs who are further on in the process but they have political inertia at the moment.

    Or maybe Kim Jong-Un will emulate WOPR as in 'Wargames' and ask us if we want to play a game. And we won't worry about GP then.

    (/cheerful)

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  • I think the main divide is between 'normal' GP's and the academic-regulatory complex.

    They simply don't understand each other.

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  • Thank you, Azeen. An excellent and feliticitous comment

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  • Oh Jason

    Just started I see;

    There is a great deal for you to read,however your basic premise that the college has no clear vision is utterly wrong,if nothing else it has vision,clear unequivocal,well explained

    The problem is that it is so ghastly you are in personal denial as to what it is.You are certainly not going to agree to it.Nobody agrees to it.

    Enjoy

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  • 'There will be a night of the long knives' - I think perhaps you should research the origin of your comment and reflect.

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  • Good questions.

    I personally feel that the colleges aims are similar to any large organisation. Those aims are to create in it's own image to potentiate and strengthen itself.

    The hostility, I think, in no small part comes from the fact that many consider the RCGP model or blueprint to be at best flawed.

    The feeling is that change is long overdue and what is being offered is rearranging deck chairs on a rapidly sinking Titanic.

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