The CQC is the independent regulator of health and social care in England. It is an executive non-departmental public body of the Department of Health and Social Care. The CQC monitors, inspects, and rates services, including NHS and private clinics.
Formby GP’s page on the CQC website can be found here.
You can give feedback on your experiences with us – good or bad – via the CQC’s Give Feedback on Care portal.
I just came across something interesting I thought would be worth sharing here. The NHS has a waiting list tracker tool called “My Planned Care”: this means you can see how long you are likely to be waiting for your first outpatient appointment, and for your treatment/surgery, if you have been referred to an NHS hospital. The waiting list figures are grouped by department, so it’s not an exact guide, and for urgent problems you are likely to be seen more quickly than these figures, while for less urgent issues you may be waiting longer.
Here is the page for the Trust which includes Southport & Ormskirk, and here is the page for the Trust which includes Aintree Hospital.
At Formby GP, we can refer into most local NHS outpatient clinics if appropriate. The entitlement to NHS care sits with the patient, not with the person referring, so hospitals can and do accept referrals from private GPs. We have something called an ODS code, which allows the local NHS health bosses to track our referral activity to make sure we’re not doing anything too eccentric!
I hope you’re having a good weekend. We have had a very hectic time recently, so we’ve spent today doing very little. Eddie wanted to play football in the back garden, using the bins as goals; he beat me 10-4!
On Monday we held a meeting of Formby GP’s Patient Liaison Group. Our PLG is a small, friendly group of people who meet every 3 months to give us feedback and help to shape our service. We are looking for new members! If you’d like to get involved, please email us on clinical@formbygp.net so we can invite you to future meetings.
As an additional inducement, we provide refreshments -John thought I’d bought too much food, but most of it went pretty quickly!
We are sometimes asked to prescribe and administer vaccinations privately.
Do drop us an email with your vaccine requirements and we will check them and provide a quote before booking your appointment, so that we can order in precisely what you need when you need it.
Many of our loyal patients choose to have their vaccines with us. Our premises are located opposite Freshfield Station so we are conveniently located for Formby residents. All our vaccines are prescribed by one of our doctors.
We pride ourselves on offering a convenient and obliging service. On some occasions, however, due to the vagaries of VAT rules, we are less competitive for certain vaccines than local pharmacies, so we won’t be offended if you decide to go elsewhere.
October is Breast Cancer Awareness Month, and many well-meaning people – including some healthcare professionals, and charities such as Breast Cancer Now – have been sharing posts about the importance of breast self-examination. Unfortunately, the reality is rather more nuanced than most people realise. Research evidence suggests that breast self-examination does NOT result in fewer women dying from breast cancer, and it can do more harm than good; women who self-examine their breasts are more likely to undergo a biopsy of their breast, but this does NOT translate into a reduction in rates of death due to breast cancer.
For that reason, at Formby GP we do not recommend routine breast self-examination for healthy women with no symptoms. Instead, we would recommend keeping an eye out for any changes (such as a lump in the breast; skin changes; or nipple discharge) and consulting a GP if you notice any of these symptoms. If you have new breast symptoms and are over 30, your GP will almost always do an urgent referral to breast clinic so that breast cancer can be ruled out. (If you are under 30, you may well need referral too, but in some circumstances your doctor will watch and wait first.)
If you’d like to read more about why the evidence base does not support routine breast self-examination, the Cochrane Review is available online here.
Another eventful meeting of RCGP Council – I am lucky enough to have been elected during very interesting times for our profession! Today’s meeting was very special and I am privileged to have played a part in today’s decision by Council to oppose Physician Associates working within General Practice. We did discuss a few other things too, believe it or not!
My husband John was speaking at a conference at BMA House today, so I had company on my trip to London! He was speaking at the sessional GPs’ conference; he gave a talk about how we have set up a private GP clinic which offers ethical, evidence-based care (as opposed to the screening factories and Kenalog-floggers which dominate the private sector currently…).
C64 – Physician Associate guidance for GP practices that employ Physician Associates
This paper was marked as confidential, though the day before Council it was leaked on Twitter (I refuse to call it X 😂), which generated a lot of debate about the now-infamous “blue box” – a grandfather clause which, if passed, would have allowed PAs already working in GP to work beyond the scope of practice guidance if their GP supervisor thought they were competent to do so. Although I had grave concerns about the inclusion of the blue box, my concerns went further than that – the free text analysis of the membership consultation made it patently obvious that many GPs who responded to the consultation felt that there was no role for PAs in General Practice at all, and, when speaking to GPs on social media and in “real life”, that is a view I hear articulated again and again. So, when I spoke, I proposed an amendment. Here is how I spoke to this motion:
I was absolutely horrified to see the final paragraph of the scope of practice guidance. To my mind it makes a mockery of everything we have done thus far – we have gone to considerable trouble and expense to define very clearly a set of red lines and a scope of practice for PAs working in Primary Care. We have gone to the effort and expense of arranging a consultation of our membership to ask them what they think – and the consultation turned up some absolutely horrifying stories of patient safety being put at risk. Colleagues, if we approve the statement in the blue box, then quite frankly I think we will deserve every consequence which comes our way. And consequences will come – a backlash from our members, perhaps even no confidence votes and falling membership numbers. I would argue that we will have wasted our members’ funds if we disregard all the work we have done thus far. We are a charity as well as a membership organisation. Our charitable objective is: “To encourage, foster and maintain the highest possible standards in general medical practice”. We will not be doing that if we approve the statement in box 2. Colleagues, I beg you to vote no to vote 2, for the sake of the reputation of our College and for the sake of patient safety.
In respect of vote 1, I would like to put forward an amendment and I have a seconder for this. The sentence as it is has two parts which are confusing. I suggest we first vote on the sentence “PAs can have an enabling role in General Practice”, then proceed to a vote on the red lines after this. A significant number of our members feel that there is no role for PAs in General Practice as demonstrated by the responses on the survey. Yet we have not asked Council its position on whether the college should support PAs in general practice. This is about patient safety and to ensure we encourage, foster and maintain the highest possible standards in general medical practice.
Kamila, as Chair, suggested that we continue to hear other Council members’ views on the motion as it currently stood, then we would return to the question of my proposed amendment later on. As Council operates under the Chatham House rule, I can’t namecheck individuals, but overall I was really impressed by the calibre of debate and the extent to which Council reps had clearly listened to their electorate.
At the end of the initial discussion, Kamila moved to the question of my proposed amendment. She confirmed that, as it was an amendment rather than a motion, a seconder was not needed. It was at her discretion as Chair whether to allow the amendment, and to her great credit she agreed that we could indeed change the first part of the motion such that we would first vote on whether Council opposed the use of PAs in General Practice, and then we would only vote about whether to reaffirm the red lines if Council did not reject the use of PAs in General Practice.
Council voted to oppose the use of Physician Associates in General Practice – 61% of GPs voted in favour of my amendment – and so a further vote on our previously-agreed red lines did not take place; they still stand from the last time we voted on them.
Given that, despite RCGP’s stance, there will still be some PAs working in General Practice, Council did approve three sets of guidance to support GP practices which do currently employ PAs. These are going to be edited as a result of the discussions today, so they won’t be published for, probably, a few weeks – watch this space!
I am absolutely chuffed to have been a small part of the fightback against this threat to patient safety. I had a lot of help from other Council members, but I’m not sure what those people would be happy for me to say publicly, so I’ll leave them to identify themselves publicly if they choose to. As ever in this role, I am guided by the RCGP’s charitable objectives: “to encourage, foster and maintain the highest possible standards in general medical practice.” Today Council did exactly that.
C65 – Post-election activity and policy asks
This paper wasn’t confidential, so if you’re a College member, do take a look at it in the members’ area of the website. Council members were very supportive of this paper overall. Several speakers praised the paper’s focus on “de-risking” GP partnership; many GPs are deterred from becoming partners because of very real concerns about unlimited liability, being personally bankrupted by being the “last man standing”, and onerous premises costs. There was also an interesting discussion about whether the inevitable direction of travel is that GP surgeries will get bigger – one partner at a small practice spoke passionately about the flexibility and responsiveness of smaller surgeries, and the fact that, for him, working in a small practice means he gets to know his patients better. Another Council member asked whether there is an evidence base to show whether working at scale actually improves outcomes. One Council member spoke movingly about the need to maintain the connection between patients and doctors, and keep alive the concept of “my doctor”.
I spoke as follows:
This is a great paper, and in particular I was pleased to see it spelled out that GPs are avoiding partnership not because they are lazy or selfish, but because the current contractual situation exposes GP partners to huge amounts of personal risk and liability. I think that the College should oppose any move to a fully salaried service – it is not what our members want, it would be incredibly expensive, and although it might paradoxically reduce the average GP’s workload, it would likely worsen the patient experience.
I absolutely endorse the suggestion in this paper that RCGP should support a mixed economy model, and that the College should call for action to address barriers to partnership, such as unlimited liability and the responsibility for premises ownership and maintenance.
Regarding discussion question 2, the enemy of continuity of care is urgent access – there is a need to be pragmatic and balance the two, with urgent care provided by whoever is available, and routine care delivered by the patient’s usual GP. If Wes Streeting wants to bring back the family doctor, he will need to stop berating us if we can’t see all non-urgent presentations same day. My personal experience suggests that it is very possible to deliver continuity of care and relationship-based care. We do this very well at our private practice. We offer continuity within a small team rather than guaranteeing it with one individual, though for non-urgent problems patients can choose to see the same doctor every time. We have half-hour appointments, so we can really build rapport with our patients – not achievable within the current NHS, but it would be a start if NHS GPs had the funding, premises and staffing to offer 15 or 20 minute GP appointments as the default. And one solution for delivering continuity in a profession dominated by part-time working is to buddy up and have small teams – so for example patients may not see the same GP every time, but they could see one of a small team of GPs every time. This system works very well in one NHS surgery I’m familiar with up in the north west – I’d be happy to try to put College staff in touch with the partners there if they want to use them as a case study.
C68 – Council forum options
This is a paper which probably won’t be of much interest to you unless you’re also on Council 😂 Essentially, we discussed potential ways in which Council members might be able to communicate formally between meetings. For informal discussions, we already have an unofficial Council WhatsApp group. The paper outlined various options, including the RCGP Member Forum and an official listserver, and then Council members made various other suggestions, including Signal and WhatsApp Communities. Further work will be done to take this forward. When I spoke on this item, I thanked the RCGP Council Members who administer the current informal group, Sonali Kinra and Victoria Tzortziou-Brown, for their hard work; and I suggested that we avoid moving across to the RCGP Members’ Forum to discuss Council business, because traffic and engagement is currently poor – having looked at it for the first time earlier this week, it appears to be used only by College Officers, RCGP staffers, and a handful of other enthusiasts.
C69a – Report to Council from Working Group on Preparations for the Possible Legalisation of Assisted Dying in one or more jurisdictions of the British Isles
For various reasons I didn’t end up speaking on this paper; and, although C69a is not confidential, there was a related paper, C69b, which was. For those reasons, I don’t plan to write about this discussion here.
C72 – Consolidated management report
Chris Askew gave us an update about his work as Chief Executive Officer of RCGP. I’ve got to say that I really like Chris and I think RCGP did well to recruit him to this role. He’s a really good manager – he welcomes questions and constructive challenge; he makes everyone feel listened to; and he is friendly and personable. I asked Chris a question during this section of the agenda; unfortunately there was a further outage during last week’s SCA. I facilitate half-day release teaching for GPST3s in Sefton and one of our local trainees was affected – she told me that she didn’t know what she was and wasn’t allowed to do in the immediate aftermath of the outage, and she was unsure if she was allowed to phone or email the RCGP exams team because technically she was still meant to be under exam conditions. I asked if the College could provide some kind of guidance for SCA candidates so they know what to do in the unfortunate event that there is an outage during their exam. Chris made it clear that this issue was already on the College’s radar and that it will be looked at.
C73 – Outcome of the 2024 Council elections and election report
I noted that turnout was very low, and that it seems to have been particularly low for the last few years; and I asked whether the move to online-only voting might have affected turnout and engagement. (Until a few years ago, RCGP members had the option to vote by post.) Chris promised to look into whether the drop in turnout had coincided with the removal of postal voting and will let me know.
C77 – Adopting the term GP Registrars
I had hoped to speak on this item, but time was limited – our PA debate earlier in the day had hugely overrun, so there was pressure for us to claw time back so people wouldn’t miss their trains – so I didn’t get chance. Happily, the motion passed with a resounding majority, and GP trainees will now be known as “GP registrars” rather than “Associates in Training” within RCGP. However, it is important to note that GP registrars will still be associate members, rather than full members, of the College. Anyway, I can’t wait to find out what “InnovAiT” journal ends up being renamed as – hopefully there’ll still be a pun in the title!
Conclusion
Due to efficient chairing from Kamila, we actually finished pretty much bang on time in the end! A few of us even had time for a post-Council drink before catching our trains home! Today was a wonderful day; I feel so privileged to have been in the room where such an important decision was made.
I remain, as ever, your faithful servant; keep in touch!
Many private GP services offer “health checks” and “MOTs”, in which you pay a fixed price and have a set panel of blood tests and other checks. Here at Formby GP, we don’t offer set “MOT” packages – why not?
The problem with one-size-fits-all “health checks” is that research evidence actually shows that they don’t work. There is actually a Cochrane Review – the highest-grade evidence there is – which shows that “health checks” do not reduce patients’ risk of death from all causes, do not reduce patients’ risk of dying from cancer, and have little to no effect on heart disease outcomes.
Furthermore, there is actually a risk that generic “health checks” can do more harm than good. Whenever we do tests, there is a risk of false positives or other “red herrings”, which can result in patients having unnecessary tests and treatment, as well as causing a lot of worry and stress. There is also the risk that a patient with symptoms may be falsely reassured by normal test results. This is why it is best practice only to do tests when they are needed – such as if a patient has symptoms of an illness, or certain risk factors, or a relevant family history.
That’s why, if you contact Formby GP requesting a health check, we will advise you to book a GP appointment first. Patients almost never request a health check for absolutely no reason – perhaps you’re feeling tired and run down, or you’ve gained some weight recently, or your brother had a heart attack last year and you’re worried it’ll be your turn next. In your GP appointment, we will discuss any symptoms you have, your family history, your risk factors for illness, and we can explore anything that is worrying you. Then we can agree together on a plan, including any tests you need.
This approach often saves our patients money, as you don’t get charged for lots of unnecessary tests. But more importantly, it means you get a better standard of care.
This is why we describe Formby GP as “ethical”; our top priority is doing the right thing for our patients, rather than doing what is easiest for us or makes us the most profit.
If you’re worried about your health and would like to talk to one of our friendly GPs, you can book an appointment online:
Reference:
https://www.cochrane.org/CD009009/EPOC_general-health-checks-reducing-illness-and-mortality
Another enjoyable Council meeting – my third as a Nationally Elected Council Member! This was probably the least eventful of the Council meetings I’ve attended, but I still have plenty to update you on.
Firstly, an apology: I realise I have been a little bit less responsive than usual of late. It probably isn’t wise for me to go into details at this stage, but essentially I have had a very unpleasant experience recently. I am being well supported by the police – and the BMA, who have been absolutely wonderful. My husband, and my parents, are being hugely supportive too. Please be kind if I am not quite my usual self for a while, or if I don’t respond immediately (or at all) when you contact me. I continue to do my best to represent you.
The Chair’s welcome – some highlights
C43 – Preventive Medicine
This paper asked Council to support the adoption of “preventive medicine” as RCGP’s clinical policy priority for the next three years. Essentially, the paper proposes that the College should lobby for GPs to take a more prominent role in promoting a population-level approach to proactive care, rather than reactively waiting for patients to become ill then treating them. The paper advocates a focus on lifestyle modification to delay or prevent the onset of disease.
The paper received a broadly positive reception, though several Council members argued that the College is likely to have a far greater impact if it lobbies for strategic political changes to address socioeconomic determinants of health, rather than focusing on lifestyle advice given by individual GPs to individual patients.
Although there was much in this paper I agreed with, whenever somebody talks about things that GPs are best placed to do, my inner sceptic always wonders what additional resource will be made available to us to facilitate that – or, if no funding is available, what GPs should stop doing to give them capacity to pick up this new work. I also had concerns about the risk of overdiagnosis. I spoke to the paper as follows:
Heather Ryan, Nationally Elected Member. Thank you for bringing this paper, Michael – I thought it was really thought-provoking. However I worry a little about how this will be received by the wider membership. This paper suggests that College should call for greater resourcing of General Practice, on the grounds that preventative work could be funded by this. I think we can only ask members to do more work if we get significant additional resource. At the moment, many of our members are struggling to meet the needs of patients who are already unwell, and if offered more funding, many would argue that it should be used to deal with patients presenting with illnesses. What work should we stop doing in order to make time for more preventive work? GP surgeries are pushed to the brink already – without significant additional funding and staffing, I cannot see how our members can make time to do yet more work, and I think they will feel we are out of touch if we say they should.
I was relieved to see the repeated references to “evidence-based” in this document, given that some aspects of primary prevention and early intervention are less well-evidenced than others. I do think it is vital that the College focus on high-value interventions, rather than interventions of dubious clinical impact. I raised an eyebrow at the mention of “aiming to slow down or eliminate the onset of conditions” – this is not always of clinical value, as some conditions have a long latent period, or may never cause clinically relevant disease. Has the overdiagnosis group had any input into this policy? If not, can this be added to the ‘internal activity’ planned for this policy? (As a declaration of interest, I subscribe to the overdiagnosis group mailing list.)
I note the British Society of Lifestyle Medicine is listed as a key stakeholder – although much of the BSLM’s approach is commendably evidence-based, some isn’t, such as their promotion of the UPF hypothesis, which most academic nutritionists agree is grossly oversimplified and not supported by the existing evidence. (As another declaration of interest, I sit on an advisory board for Nestle, but that does mean that I know what I am talking about.) I would respectfully ask that you engage with BSLM with caution and ensure that any policies that the College makes are supported by evidence rather than ideology.
C46 – Responding to the climate emergency
In many ways, papers C43 and C46 were diametrically opposed: while C43 seemed to be predicated on the assumption that more medicine is a good thing, C46 had a refreshing focus on the benefits of deprescribing.
The background to this paper is that the climate emergency is one of RCGP’s four strategic priorities for 2023-2026, and this topic was first discussed at the November 2023 Council meeting, when the Officers received robust feedback to the effect that encouraging GPs to look after the planet might be perceived as inflammatory when they don’t currently have the resources to look after themselves, let alone their patients. At that meeting I suggested that the College should focus on promoting “win-win” initiatives which save practices time and/or money as well as helping the environment.
It is a testament to the Officer team that they took this feedback on board and presented a fantastic, pragmatic paper this time around. Despite this, when we discussed the current paper at our Faculty Board meeting on Wednesday, further concerns were raised about the need for sensitive messaging about GP workload. I articulated those concerns today:
This is a fantastic paper, Victoria, thank you, and it is a great testament to your leadership that you have clearly taken heed of the feedback you got when this was last discussed at November Council. I was thrilled to see the focus on reducing overprescribing and prioritising high-value care. I was also pleased to see how pragmatic many of the suggestions are – many suggestions would also reduce either cost or GP workload, for example the suggestion that electronic prescribing should be rolled out in those areas of the UK that do not yet have it. I was shocked by the statistic in the paper that approximately 15% of hospital admissions in over-65s are caused by the adverse effects of medication, and I think that makes the case beautifully that too much medicine can be bad for patients as well as the planet.
I would just like to sound a note of caution about how this policy is communicated to our members. I’m a Nationally Elected Member, but I attend Faculty Board. When we discussed this paper at Faculty Board, it was suggested by others that debate about climate change risks alienating members and making us seem out of touch, given the more immediate crises facing General Practice. As I say, I think this is a very clever paper because most of the suggestions would reduce cost or workload or both – I think we just need to be careful about the messaging.
Other Council members articulated similar concerns about how GPs might respond to any suggestion that College cares more about the green agenda than it does about its members. The Officers’ closing remarks made it clear that, although Council was broadly supportive of this paper, they had heard and understood those concerns and would ensure that the excellent ideas in this paper are communicated sensitively to our membership.
Verbal update from the Chair on the PA policy statement and consultation
This was a fast-moving and complex discussion, so forgive me if any errors have crept into this account; if so, let me know and I will of course correct them.
If you’re politically active enough to be reading a blog about an RCGP Council meeting, you have no doubt already seen the results of the RCGP member consultation about Physician Associates in General Practice, following which the College called for a halt to the recruitment of PAs into Primary Care for the time being. There was widespread praise for our bold stance, and although a couple of Council members expressed a desire for a more conciliatory stance towards Physician Associates, the vast majority of Council members wholeheartedly endorsed the College’s current position.
The next step is that the Officers will engage with external stakeholders, including patient groups and indeed PAs themselves. They will also, of course, consult with College members. A further paper will be brought to Council in September 2024 concerning the scope of practice, induction, and supervision of PAs working in General Practice.
Some other notes:
I spoke on the PA discussion as follows:
Heather Ryan, nationally elected member. I am glad that the College has demonstrated leadership on this issue, and has showed real courage in taking on the political establishment in defence of patients. We have set a fantastic example to the other Medical Royal Colleges. However, in the 48 hours since our statement was released, I have been contacted by members asking why, given the damning findings of the consultation, we have not gone further. Given that we have called for a halt to the recruitment of new Physician Associates due to safety concerns, is the next step to think the unthinkable and call for the phasing out of all Physician Associates in Primary Care, given the inherent unsuitability of the PA role for the GP setting? And should the College call for a pause on the training of Physician Associate students full stop, given uncertainty on the future of the role? I am disappointed to hear you say just now that you do not plan to call for GPs to stop training PAs in primary care.
One RCGP member approached me while the survey was live to express their view that there was pro-PA bias in the survey design; they felt that the questions were asked from the starting point that PAs have a role to play in General Practice. This member felt that they had to heavily utilise the free-text boxes in order to express their view that PAs have no place at all in Primary Care. Who designed the survey and was the possibility of bias considered? You mentioned a Task and Finish group – who was on it and how were they chosen?
In terms of transparency, it is commendable that we have published a full report into the consultation findings, but many members have asked me for more detail about what the free text responses said – I understand that individual responses may need to be redacted for confidentiality reasons, but can we please publish more thematic analysis of the free text comments?
I agree that it is vital that this debate remains civil, but I do not feel we should be weaponising rhetoric about kindness in order to stifle debate about patient safety.
The response to my points was as follows:
C49 – Member motion
This was a motion advocating that the GP trainee representatives on Council should be able to vote at RCGP General Meetings, which currently they cannot. There was overwhelming support for this motion and it passed. However, due to the need for this to be officially approved by the Privy Council, it will apparently take 2-3 years to come into effect.
C50 – Governance Review Update
The paper itself is a bit dry (and I say this as a governance enthusiast!), but we were treated to a slideshow which explained the issues very well. We were told that this would be made more widely available, so watch this space. Essentially the issue is that our current structure is unwieldy, and it is sometimes unclear who is ultimately responsible for decision-making. There will be an all-member workshop on 11th September to discuss the Governance Review in more detail. I have to say how impressed I am by the reflection that is taking place within the College following the concerns raised at November’s AGM.
Conclusion
I think I’ve covered everything! If you have any questions or comments, please get in touch; as a Nationally Elected Council Member, my job is to represent the views of my electorate! If you’d be interested in attending a Council meeting as an observer, please let me know and I can put you in touch with the relevant people at the College. If you’re in Merseyside and Cheshire, I can arrange for you to observe a local Faculty Board meeting too! Have a lovely summer and stay in touch 🌞
Every Spring we see posts about the so-called “hayfever jab”. Unlike many of our competitors, we very deliberately DON’T offer Kenalog injections for hayfever. Why not?
Kenalog is an injection which was once approved to treat hayfever. The idea of just having one or two injections to keep hayfever at bay for months may seem appealing. However, the evidence shows that Kenalog, a long-acting steroid, is no more effective than safer treatments. For that reason, it is no longer approved for use in the UK (and most other countries) as a treatment for hayfever.
Most doctors no longer offer the treatment, and Allergy UK – a national charity supporting allergy sufferers – explicitly does not recommend its use for hayfever. International experts also warn against the use of steroid injections for hayfever. Yet despite this, many private medical clinics and aesthetic services offer the treatment. Many of those giving the treatment are beauty therapists rather than doctors or nurses.
Although steroid injections do usually help with hayfever symptoms, there is a real risk of side-effects, some of them serious – they can affect blood sugars, mental health, and bone health, and may make you more vulnerable to infections. So they are not routinely recommended because there are effective alternatives which are much safer. Alternatives include antihistamines – which can be given as a nasal spray, or as tablets – and nasal steroid sprays, which are much safer than Kenalog because much less of the steroid is absorbed into the bloodstream. Most of these options can be bought from your local chemist. If those don’t work, then your GP – either NHS or private – will be able to advise about prescription-only treatments.
If, despite those prescription-only treatments, your GP can’t get on top of your symptoms, then it may be appropriate for you to be referred to an allergy specialist. Specialists can sometimes offer options like immunotherapy treatment, though that isn’t an option for everyone.
Patients sometimes seek Kenalog because they have an important event coming up, but even then, we would not recommend it; there are other alternatives which are as effective but safer, such as a short course of oral steroid tablets.
At Formby GP, we want our patients to know that they can trust us. We will not try to sell you things which we believe would do you more harm than good. As doctors our duty is clear: to first do no harm.
References:
Wow! What a momentous day! You’ve no doubt already seen the news on Twitter: RCGP Council has voted to revise its position on Physician Associates! It was actually a fairly packed agenda, and we discussed a couple of other very interesting papers as well. I’ll run through it in order…
Physician Associates
The Council paper had been kept confidential until after the vote, but I am told it will shortly be uploaded to the members’ section of the website, so if you’re a member you will hopefully soon be able to find it on the Council page on MyRCGP.
Mindful that Physician Associates would be on the March Council agenda, and cognisant that this is a topic which has aroused strong feelings in many of our members, I felt that as a Nationally Elected Member of Council I should consult my electorate to inform my position. In January I created my own informal survey of RCGP members – if you haven’t seen it, my results are presented here. This proved to be tremendously useful, as it meant I could represent your views with confidence and authority, and the results seemed to be taken seriously within the Council chamber. (One Council member came up to me in the ladies’ loos to congratulate me on doing it!) I am so grateful to the 457 RCGP members who spent time filling out my survey. You have all helped to drive change within our College. Thank you!
Due to the intense (and appropriate) scrutiny of the management of conflicts of interests, Council members had to submit a written declaration of their interests in advance of the meeting, and then separately had to re-state relevant interests before speaking.
I spoke to the motion as follows:
I’m Heather Ryan, nationally elected member. When I joined my former partnership, there was a PA at the surgery, who left fairly shortly afterwards, and I didn’t have much involvement with them. I occasionally let PA students sit in with me in the Secure Unit. I’m a private GP and we don’t employ PAs. My husband was a Nationally Elected Council Member when Council voted on PAs last time.
As a Nationally Elected Member of Council, I was keen to ensure I was representing my electorate on this contentious issue. So I undertook my own survey of RCGP members, advertising on social media platforms. I got 457 responses, all of whom self-declared they were members of the College. Respondents were asked how well they felt that RCGP was currently representing their views on PAs, on a scale from 1 (not at all) to 5 (very well). The majority – 72.9% – felt that RCGP was not representing their views at all, and a further 69 respondents (15.1%) gave a less strong but still negative response. Only 5 of those 457 doctors felt that RCGP is currently representing their views on PAs very well.
So, our members are not happy. What can we do better?
95.2% of the doctors who responded to my survey felt that RCGP should undertake a formal consultation of its members’ views on PAs. Most respondents felt that RCGP’s position should be that any incorporation of PAs into Primary Care should not be at the detriment of GP trainees’ learning opportunities, and, sadly, several respondents gave me examples of how their own GP training had already been affected.
The view of my members is that GMC regulation of PAs will add to the confusion amongst patients and clinicians, so in vote 4 I will vote for option B despite the caveat that it is likely to delay the registration of PAs. It is better that we get it right, than that we get it wrong quickly*.
Council, at this critical time for our profession, we must ensure that we take our members with us in any decisions we make. For that reason, I beg you to please vote yes to the questions put to us today, and in particular, vote yes to a public consultation.
* My questionnaire didn’t ask about this specifically, but colleagues made their feelings clear via other channels!
Most Council members spoke, and those who didn’t speak nevertheless had to declare their conflicts of interest before we voted.
The outcome of our vote was, as summarised in the RCGP press release, that RCGP’s position on PAs is now as follows:
Most of the credit for today’s victory goes to the incredible Victoria Tzortziou-Brown, RCGP Vice Chair for External Affairs, who showed great leadership and courage in bringing this paper to Council in its current form.
Approval of Standing Orders
Fair play to the RCGP officer team: after the excitement of November’s AGM and Council meeting, I was really impressed by how they approached the revision of the Standing Orders. The concerns I raised about the process for bringing motions to Council were incorporated into the next draft of the Standing Orders; and then the Hon Sec hosted a webinar for Council members in which the proposed changes were discussed, following which further amendments were made. As a result, I was happy to support the new Standing Orders, and I spoke to commend the Officers for the way in which they had engaged Council members with the process.
There was also some discussion about how declarations of interest will be managed going forwards. In principle it was agreed that Council members’ declarations of interest should be made available to the wider RCGP membership, though there are some practical and governance questions about how this can be implemented, so it’s unclear exactly what form this will take or how quickly it will happen.
Health inequalities
This was a great paper which prompted a lot of thoughtful discussion. It was humbling to be reminded of the depth and variety of expertise we have on Council. Points raised included culturally competent care for patients with learning disability; and how GP surgeries should not make showing photo ID or proof of address a condition of registration, as this risks excluding the very patients who most need healthcare.
I spoke to make the following points:
GP retention
Council ended on a high note with an excellent paper which summarised the College’s recent policy work on GP retention. I was particularly pleased to see that RCGP is calling for all international medical graduates qualifying as GPs to have the right to apply for indefinite leave to remain in the UK. Such a scheme would address the ludicrous situation we currently have, in which newly-qualified GPs risk deportation if they can’t find a job quickly enough after they complete their training.
One Council member spoke very well about how one of the groups with the worst retention rate is female GPs aged between 30 and 45, and factors which may be contributing to this, including the cost and difficulty of arranging childcare; recent changes to the retained GP scheme; and the reduction in availability of locum work.
I said the following:
I think this is a great paper – thank you for bringing it, Kamila. I was particularly pleased to see the mention of flexible working and I would echo [other member’s] comments. I was a GP partner when I had my eldest child, and I found it really difficult to stay in a substantive GP role because core contracted hours are 8am to 6.30pm and in the remote ex-mining area I lived in, nurseries and childminders didn’t offer long enough opening hours. I was fortunate that my husband, also a GP, picked up the slack – but he once had to take our 8-month-old on an emergency home visit to a nursing home. Given that childcare options are often worse in deprived areas such as the one I worked in, support for flexible working may well help mitigate the impact of the inverse care law.
As a GP educator in Sefton, where a high proportion of our GP trainees are international medical graduates, I was also pleased to see the suggestions put forward about how we might tackle the visa trap which sees excellent newly-qualified GPs threatened with deportation if they can’t find a job quickly enough.
That said, when we discussed this paper at our Faculty Board meeting on Wednesday, one of our members drily said, “if you want to retain GPs, you need somewhere for them to work”. I think this superb paper would be even better if it were clearer about the fact that we will not be able to retain GPs unless General Practice as a whole is funded adequately, because at the moment, our very profession is fighting for its survival.
One GP also contacted me to point out that the Performers’ List puts barriers in the way of retention, especially for doctors in low volume or niche roles. I would urge RCGP to consider its position regarding the Performers’ List.
Conclusion
I remain, as ever, your humble and obedient servant: as a Nationally Elected Council Member, I am here to represent you, so please do keep your feedback and suggestions coming! The outcome of today’s Physician Associate paper feels like a big step forward, but our work isn’t over; keep your eyes peeled for the member consultation!
