Maureen Baker

Not such friendly banter? GPs and psychiatrists against the systematic denigration of their specialties

It’s just banter. That’s how people justify denigration of one medical specialty by another, and that’s what the majority of medical students believe; all specialties go through it and all specialties do it; it’s character building; it’s just a bit of fun.1 But one consequence is that medical students are being put off entering certain specialties because of the stigma attached to them.1 This is dangerous. It has been shown that this adversely affects two specialties more than others: general practice and psychiatry.1 And if we don’t have enough GPs or psychiatrists, the NHS will certainly fail, and it will be our patients who suffer most. All in the name of ‘banter’. Humans are complex, both in body and mind, so we need different medical specialties. We need people to look after our hearts; specialise in our skin; physically fix us, with tools, when we are broken. But as we strive for parity of esteem between physical and mental health, we need people to understand our minds, and vitally we need people to oversee the ‘whole person’, dealing with health conditions before they become too serious, and appropriately navigating patients through the NHS. It has been shown that denigration leads to medical students rejecting certain specialties.1 With general practice and psychiatry repeatedly shown to suffer most denigration, it’s safe to assume that these are the specialties most negatively impacted. This correlates with figures from Health Education England (HEE). In 2015, 604 GP and 91 psychiatry placements were left unfilled: the highest of any medical specialties.2 In general practice we are expecting improvements this year, partly due to the …

Manifesto for a healthy and health-creating society.

Brexit and the troubled state of the NHS call for re-thinking the UKs approach to health. The EU referendum vote reveals deep social divisions as well as presenting the country with important decisions and negotiations about the future. At the same time, health problems are growing; the NHS faces severe financial constraints and appears to lurch from crisis to crisis, with leaving the European Union likely to exacerbate many problems including staffing issues across the whole sector. However, new scientific developments and digital technology offer societies everywhere massive and unprecedented opportunities for improving health. It is vital for the country that the NHS is able to adopt these discoveries and see them translated into improved patient care and population health, but also that the UK benefits from its capabilities and strengths in these areas.

Time to put patients first by investing in general practice

General practice is the cornerstone of the NHS, dealing with 90% of all patient contacts in our health services and helping to ensure the delivery of safe, effective patient care.1 Yet in recent years concerns have been mounting that a number of pressures facing GP surgeries are pushing UK general practice to breaking point. A central part of the problem is that practice workloads have been rising relentlessly for some time. NHS England estimates that surgeries in England dealt with 340 million consultations in 2011 to 2012, up from around 300 million in 2008 (the last year for which the most robust data is available).2 Anecdotal evidence, and the findings of a poll commissioned by the Royal College of General Practitioners (RCGP) in 2013, suggest that most GPs are now dealing with a workload of 40–60 patient contacts every day.3 Despite this growth in demand, general practice has suffered from a chronic lack of investment over the past decade, with its share of UK NHS spending now standing at a record low of 8.39%. In 2011 to 2012 around £8.7 billion was spent on general practice in Britain (including both local and national contracts, but excluding prescription costs): almost three-quarters of a billion pounds less, in real terms, than in 2005 to 2006. This represents an 8% drop at a time when the overall NHS budget in Britain has increased in real terms by 18%. General practice in Northern Ireland (for which comparable …

Morbidity matters: challenges for research

Multimorbidity is an immediate and expanding challenge for many health systems, including the NHS. It can be defined as the coexistence of several chronic diseases or medical conditions in one person. It is increasingly common among older people, as effective interventions reduce fatal events but increase the prevalent disease population, and life expectancy of the general population continues to rise. As a result, multimorbidity is now a fundamental care issue that presents a number of complex challenges for health systems, patients, and clinicians to address. Almost one-in-three people in the UK — or 15 million individuals — have a long-term condition (LTC). Half the population aged >60 years now has a LTC. Those with LTCs account for half of all GP appointments and 70% of inpatient bed days. It is estimated that treatment and care of these patients account for 70% of the acute care budget in England; over two-thirds of NHS expenditure for one-third of the population. Those with LTCs are also likely to have a lower quality of life.1 On Friday 7 November 2014, the National Institute for Health Research (NIHR) and Royal College of General Practitioners (RCGP) jointly hosted the Multimorbidity Research Workshop at the RCGP, attended by more than 50 leading experts in the field of complex LTCs. The aims of the workshop were to identify challenges to research on multimorbidity and to prioritise research questions for research funders that may improve patient experience and management in primary and hospital care. Professor Chris Salisbury, chair of the Scientific Foundation Board of the RCGP, set the scene with a presentation on ‘Challenges for Research: What are they and how can they be addressed?’ Although GPs, as expert medical generalists, are more likely to take a holistic and comprehensive view of patient care, even in general practice …

What can science contribute to quality improvement in general practice

Over many decades practitioners and academics working in general practice have built a strong reputation for their commitment to developing innovative approaches to improving the quality of patient care. The orientation of these initiatives has evolved over the years. Until the 1980s, providing high quality patient care was primarily reliant on the personal motivation of individual doctors to achieve explicit standards of practice.1 These standards were maintained through a commitment to education and training, and their attainment rewarded by peer recognition, for example by membership or fellowship of professional bodies. From the 1980s until the early part of this century, the emphasis shifted from individuals to teams and the narrative changed from the relatively static orientation of attaining standards to the more dynamic one of continuous improvement.2 Guidelines were developed that had to be delivered by multidisciplinary teams, multiprofessional audit was encouraged, team-based significant event analysis become common, methods of process improvement developed in the manufacturing sector were introduced into practices, and team-based financial incentives were designed and implemented at scale. Over the past decade the focus has shifted again, this time to levers for improvement that operate at a health system level and which place the locus of control more with policymakers and system leaders than with individual professionals or clinical teams. Performance management, competition, transparency, regulation, and legislation have been introduced as ways of potentiating the established professionally-led methods, or replacing them when they are deemed to be failing. In this article we describe what we see as the next phase of the ‘improvement journey’ for general practice, a phase that builds on the strengths of approaches currently being used, and attempts to address their deficiencies. We propose that this will place a stronger emphasis on the role of science — the science of improvement — …

Academic general practice: supported by the RCGP.

This article1 by one of our esteemed former presidents and academic leaders sets out the history and continued challenges in ways we all recognise, but we want to challenge some claims made in the article. We disagree that the RCGP no longer inspires GPs. We are constantly working to engage with our members and non-members at all stages in their career. The NHS …

GPs and the Ebola patient: working safely in primary care

There is a strong probability that sporadic cases of Ebola virus disease will be seen in the UK over the coming months. Primary care guidance has changed, taking a different direction and risk assessment to previous versions,1 particularly in respect to the management of patients who self-present to services. All services require a safe system of working to protect staff (Box 1). Staff engaged in briefing and rehearsing what might happen and how a patient would be received and cared for, will feel more confident and it will help to alleviate their anxieties in dealing with a challenging situation.2 Box 1. ### Features of a safe system of working

Communicating in a crisis: the H1N1 influenza pandemic

In 2009, with the influenza A (H1N1) virus, commonly known as swine flu, the world experienced the first influenza pandemic of the 21st century and the first for 40 years. For the vast majority of GPs and other health professionals, this has been the first experience of pandemic flu in our professional lifetimes. Compared to the influenza pandemics of the previous century, its impact has been relatively mild. However, it has been bad enough, with over 400 deaths in the UK and many thousands of people having been admitted to hospital or to critical care units. In the UK, we were fortunate that the pandemic waves occurred over the summer and autumn rather than at the time of peak winter activity in the NHS, but even so services were hard pressed in general and many general practices and primary care out-of-hours providers, especially in ‘hot-spot areas’, found they were stretched to the limit. Given that there are no guarantees that it will be 40 years or so until the next influenza pandemic and also that a future pandemic virus might well be more virulent, it is imperative that professionals and policy makers examine our recent experience and identify what went well, and more importantly, what needs to be improved to allow us to best meet the challenges of the next flu pandemic, or other major public health crisis. One area for reflection is that of professional communications. The article by Caley et al illustrates the difficulties experienced by GPs in the West Midlands …

Continuity of care: still important in modern-day general practice

Continuity of care has always been at the heart of general practice. Patients who receive continuity have better healthcare outcomes, higher satisfaction rates, and the health care they receive is more cost-effective.1,2 The Royal College of General Practitioners (RCGP) has always advocated for continuity and has previously produced a paper on the benefits of continuity of care, and subsequently the Continuity of Care Toolkit .3 In the upcoming RCGP paper Continuity of Care in Modern Day Practice (available soon at http://www.rcgp.org.uk/policy/rcgp-policy-areas/continuity-of-care.aspx) the College asks to whom continuity is most important in modern-day general practice, and how can it be realised in the face of changing demographics, work patterns, and the introduction of new models of care. The GP Patient Survey shows 52% of patients in England had a preferred GP.4 Seeing a preferred GP, however, is particularly beneficial for certain patient groups and a balance needs to be reached between patients who prioritise access to any GP for short-term illness, and those who would rather wait to see their preferred GP for issues they consider more serious. Those living with multimorbidities, older people, those with mental health difficulties, and patients receiving terminal care have all been shown to derive particular benefit from receiving continuity of care. According to RCGP analysis, the number of people with one long-term condition in England alone is expected to rise from 1.9 million in 2008 to 2.9 million by 2018.5 Alongside an ageing population, the demand for continuity is set to be greater than ever in the 21st century. The current lack of GPs and funding into general practice has obvious implications for realising continuity of care. Across the UK, all four nations are calling for an increase in the number of GPs. In England, the recent announcement of …

RCGP’s reply to medicine and the media article on industry sponsorship

I am disappointed and rather surprised by your article about the Royal College of General Practitioners’ annual conference.1 To say my speech was “largely overlooked” is incorrect—it received considerable coverage from national media on the day of the …