Heather’s notes from RCGP Council 8 March 2024

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:

• RCGP opposes GMC regulation of PAs
• GPs must be able to choose if they supervise PAs
• The training of GPs must be prioritised over training of PAs
• PAs must be considered additional members of the team – not substitutes for GPs
• PAs do not replace GPs 
• RCGP will undertake a formal consultation of its members’ views on PAs, including scope of practice and supervision

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:

• I am pleased to see the call for targeted recruitment and retention schemes to support maintaining GP numbers in deprived areas
• In North West England we have several successful ‘deprivation’-focused GP training posts, plus local initiatives to ensure GP trainees gain some experience of working with disadvantaged communities – such as arranging for trainees to spend time with a homelessness outreach worker, and a scheme I have until recently facilitated in the mental health unit in which I work, where GPST3 trainees would spend an afternoon with me
• I am pleased to see that the paper discusses the difficulty that some patient groups can have in booking an appointment. Interestingly the paper doesn’t talk much about the challenges that older people can face when contacting their GP surgery. I do my private work in a very affluent area, yet many of the patients who consult me are wealthy, educated older patients who report that they have really struggled to access their NHS GP because they cannot, or do not want to, use eConsult. The word “elderly” only appeared once in this paper, and I would ask that the needs of older adults, who are at risk of digital exclusion regardless of their socioeconomic status, are not forgotten.

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!