On her last day as president of the RCGP, Dr Iona Heath has lost her voice. Yet even at the level of whispers she speaks with real conviction about the Government’s failure to safeguard the morale of GPs.
Funding cuts, the NHS reforms and now the proposed revamp of the GP contract have all been blows to the profession’s morale, she says – and she fears these issues could prompt weary partners to retire or young trainees to head overseas.
‘If you damage morale further – for example, by imposing a contract – you are likely to see departures,’ she says. ‘If you’re 58, why would you hang about if life is getting more and more difficult?
‘It’s the responsibility of those charged with the stewardship with public service to foster the morale of public servants,’ she adds. ‘Successive governments have been lax in that imperative.’
Now retired clinically – she was a GP in Kentish Town, north London, for 35 years and made her name writing on ethics and the core values of general practice – Dr Heath has served as the college’s president for the past two years.
It’s a largely ceremonial role, but one she has been widely acclaimed for. And as well as being uncompromising in her criticism of governments past and present, she doesn’t shy away from highlighting areas of general practice that need a redesign.
Chief among these is out- of-hours care, she says, where GPs need to do some ‘creative thinking’.
‘The contract in 2004 where GPs lost responsibility for out- of-hours care has been a very serious issue for patients,’ she says. ‘I think as a profession we see the benefits of continuity of care all the time, and yet we don’t extend it into out-of-hours care.
‘There will have to be some move there because people don’t get the best care out of hours if they see someone who is not familiar with them.’
She adds that the increasing scaling up of general practice has particularly dangerous implications out of hours. ‘We have out-of-hours services that cover huge populations where nobody knows who they’re talking to or who they’re dealing with.’
Instead, she advocates small, local out-of-hours rotas – although not a return to the pre-2004 system.
‘There is a generation of doctors who came into general practice precisely because they didn’t want to do out-of-hours, and that is a problem,’ she says.
Dr Heath is handing over to her successor Professor Mike Pringle at a time when there are both causes for celebration and concern at the college.
Its bid for four-year training – hailed by RCGP chair Professor Clare Gerada as a ‘gift to future generations’ – has been accepted by the Government, and the college is thrashing out funding details.
But elsewhere the RCGP has come under attack. Its decision to help the Government explore how to give patients electronic records access by 2015 was recently denounced by one senior GPC member as ‘politically naive’ for allowing extra work to be foisted on GPs.
‘It’s wonderful,’ says Dr Heath with a wry smile. ‘You can be criticised for opposing the Government and then you’re criticised for “getting into bed” with them.’
And then there’s the legal threat the RCGP is facing over the high failure rates of international GP trainees in the MRCGP exam.
A question about this draws a stern intervention from the college press officer. All she can say is that the RCGP expects ongoing research from King’s College London into the performance of international trainees to produce only ‘subtle’ results.
A fire alarm signals the end of the interview with Dr Heath, who was described as a ‘hero’ during Professor Gerada’s speech at the RCGP annual conference. Her successor will hope to receive such accolades – though he might have to help put out a few fires first.
Dr Iona Heath on…
Continuity of care
‘Young, fit patients are not interested in continuity of care. They want an immediate service from the first doctor they can see in a convenient time. Fair enough. But as soon as someone has a significant health problem, continuity of care becomes really important for them.’
‘Care becomes proportionately much more difficult the more different providers there are involved. If you get physiotherapy from one provider and tests from another – how does that lead to continuity of care?’
‘People in partnerships are more committed to the practice, to the area and to their patients, and so you get better continuity of care. If you’re just a paid employee, why would you hang around if things get difficult?’