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.