She said: "Patients should be able to access safe, high-quality care whenever they need it through routine GP services and GP out of hours services - and these services should be well-resourced and staffed appropriately by both clinical and non-clinical workers, to meet demand. "GP services are operating under intense resource and workforce pressures across the board – but this investigation reveals just how much GP out of hours services in some areas are struggling, and it is particularly alarming that in some areas, shifts are being run without a GP. "This poses a real safety risk not only to our patients, but also to overworked staff who run the risk of becoming burnt-out as they struggle to cover empty shifts. It is also unacceptable that GPs and our teams working out of hours are undoubtedly being forced to make decisions about which seriously ill patients need their help the most. "We have welcomed the recent introduction of a state-backed indemnity scheme in England and Wales, as we know these costs were a barrier for GPs choosing to work out of hours. But it is clear from this report that we still need to see urgent investment in all GP out-of-hours services and for them to be better integrated with our routine services so that patients are confident they can receive the care they need, regardless of when they fall ill. "It is the responsibility of individual Clinical Commissioning Groups to procure the services to deliver out-of-hours GP care locally, and it is paramount that CCGs and health boards are confident the providers they commission can safely deliver the service they are contracted to do."

She said: "GPs are acutely aware of how important it is to spot symptoms of pancreatic cancer, but it is notoriously difficult to diagnose in primary care, particularly in its early stages, simply because there are often no symptoms, at all – and when symptoms do present they are often initially very vague, and could indicate many other, more common conditions. "The most appropriate intervention to address this paradox is to give primary care teams better access to the right diagnostic tools in the community - and the appropriate training to use them - and we welcome the recommendations set out in this report to do this. "GPs are already doing a good job of diagnosing most cancers in a timely way, and it's due to this hard work and vigilance that 75% of patients found to have some form of cancer are referred after only one or two consultations, and that since 2008 the proportion of cancers diagnosed as an emergency have dropped from 23% to less than 19%. "But it's unsurprising to hear that just one in ten GPs feel as though they have access to the tools needed to diagnose pancreatic cancer, as we are working under immense resource and workforce pressures, and our access to important diagnostic tests are amongst the lowest in Europe. "Cancer is an enduring priority for the RCGP, and we have worked with Cancer Research UK and others to develop resources for GPs and other healthcare professionals to support them in the timely diagnosis of cancer."

Contesting the seat are: Professor Rodger Charlton: Professor of Undergraduate Primary Care at the University of Leicester and GP partner and trainer in Solihull  Dr John Chisholm: RCGP nationally-elected Council Member, Deputy Chair of the RCGP Trustee Board and Vice President of the BMA Dr Sunil Gupta: RCGP Council Member, MRCGP examiner, GP trainer and GP in Essex Professor Amanda Howe: Immediate past-President of the World Organisation of Family Doctors (WONCA), Professor of Primary Care at the University of East Anglia and RCGP East Anglia Faculty Provost Professor Roger Jones: Editor of the British Journal of General Practice (BJGP) and Emeritus Professor of General Practice at Kings College London Dr Imran Rafi: former Medical Director of the RCGP's Clinical Innovation and Research Centre (CIRC), Senior Lecturer in Primary Care Education at St George's University of London and GP in Surrey Dr Carter Singh: GP partner in Nottinghamshire, RCGP Vale of Trent Faculty Board Member, Nottinghamshire Local Medical Committee member The RCGP President is the ceremonial head of the College, but without executive powers, whereas our Chair, currently Professor Helen Stokes-Lampard, leads on strategic direction and policy at the organisation. Voting is now open (Wednesday, 1 May) and will close at noon on Friday, 31 May. All Members and Fellows in good standing – including Associates in Training - are eligible to vote in the election, which will be conducted officially and independently by the Electoral Reform Services (ERS). The Presidential candidates' video election statements can be viewed at: www.ersvotes.com/rcgp19 Voting is also now open for six nationally-elected Council Member places, which will become vacant from November 2019. The six successful candidates will sit for three years. This year, 19 GPs have put themselves forward. They are Dr Kirsty Alexander, Dr Neil Bhadresha, Dr Richard Byng, Dr Kathryn Carey-Jones, Dr Hisham Haq, Dr Lucy Henshall, Dr Haider Hussain, Dr Abrar Ibrahim, Dr Chandra Kanneganti, Dr Margaret McCartney, Dr Sheila Pietersen, Dr Bashir Qureshi, Dr Imran Rafi, Dr Joanne Reeve, Dr Jonathan Serjeant, Dr Catherine Tichler, Dr Caroline Watson, Dr Jane Wilcock, & Dr Jill Wilson. Voting has also opened today and will close at 12 noon on Friday 31 May. Professor Helen Stokes-Lampard, Chair of RCGP, said: "Thank you to everyone who has put themselves forward for College Office. Our candidates are all respected GPs with a wide variety of skills, experience, and knowledge that will stand them in good stead for the roles, and I wish you all the very best of luck. "Getting involved in the College should be encouraged at every stage of a GP's career, and I'm thrilled to see so many colleagues wanting to take up what are challenging, but hugely satisfying roles. "Council comprises such a diverse, energetic group of GPs who are all determined to make our profession and working lives the best they can be. "All Members and Fellows in good standing have a vote, as do all Associates in Training, and I'd strongly urge them use it now that the ballot is open – and to take some time to watch the candidates'videos and read their statements. "It's essential that our College remains democratic and representative of our fantastic frontline GPs who go that extra mile every day on behalf of patients."

"We want the NHS to be a world leader in innovation in technology and GPs are ready to embrace AI, digital medicine and robotics, all of which have huge potential to revolutionise care – but any innovation must be proven to be safe for patients, and aim to alleviate pressures across our health service. "Our current technology systems are not where we need them to be and we need to concentrate on the basics first. Some GP practices are still reliant on old-fashioned fax machines, we hear repeated stories from members about GP IT systems crashing numerous times a day, and some estimates suggest that 80% of practices are currently using outdated IT systems that are not suitable for the demands of future care. "Our manifesto calls on the government to first help us get the basics right, and this promise for high quality broadband across all general practice is welcomed as the promising start of major change and innovation across the NHS. "These improvements will allow GPs faster access to test results and patient records and help connectivity with wider NHS systems. Improved broadband speeds will also allow for more streamlined email communication and video calls; and help patients make appointments quickly and easily – but delivering it will be a significant challenge, so we look forward to hearing about NHSX's plans as to how they will deliver this. "This announcement is great news for the profession and for patients as it will help us improve levels of care and offer family doctors more of the resources needed to help them do their jobs. As such, we will work with the Department of Health and Social Care to ensure full delivery of this broadband commitment in all areas where it is so desperately needed."

It is estimated that up to 80% of GP practices could soon be using outdated IT systems that are not suitable for the demands of future care - with some practices still reliant on old fashioned fax machines that Health and Social Care Secretary for England Matt Hancock has said he wants to outlaw. The manifesto recognises the exciting potential of genomics, AI, digital medicine and robotics to potentially revolutionise patient care and improve patient safety. But the College says that widespread improvement will only be possible once robust, secure IT systems are in place for all GP practices and all areas of the NHS have access to computer networks which seamlessly link up the patient journey. Today, the College will use the launch of its tech manifesto - attended by Matt Hancock at its headquarters in London - to call on the Health and Social Care Secretary to urgently ensure all practices are equipped with systems and facilities that are fit for the future. It wants all GP practices to have: modern, digitally-enabled premises with fully interoperable IT systems access to secure high-speed broadband facilities; and  access to a single shared electronic patient record which documents patient interactions throughout the NHS. The UK currently lags behind its European neighbours, such as Finland and Estonia, that have already implemented a shared electronic patient record in their health systems. The RCGP manifesto explores how innovation can benefit GPs and patients by helping to reduce the ever-escalating workload of family doctors across the UK, and demonstrates how GPs are ready to embrace the changes needed to be at the forefront of innovation. Matt Hancock, will speak at the launch at the RCGP's 30 Euston Square headquarters, followed by a panel discussion with RCGP Chair Professor Helen Stokes-Lampard, NHS Digital Chief Executive Sarah Wilkinson, Demos Chief Executive Polly Mackenzie, Association of British Health Tech Industries’ Director of Market Access, Andrew Davies, and patient representatives. Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "GPs have always embraced new technology. General practice was the first NHS sector to have electronic prescribing and electronic patient records so we know how beneficial new technology can be and we recognise its huge potential to help our patients. "GPs want the latest, cutting-edge tech at our disposal but we need the basics to work first. That means everything from making sure that our computers don't crash while issuing a prescription, to making sure our systems talk to those in all hospitals so that we can improve the care and experience that our patients receive throughout the NHS. "We want the NHS to be a world leader in technology, and we are ready for a new wave of exciting opportunities which have the potential to revolutionise patient care, but a lot of work is needed before that can happen, and we need to ensure sure that these opportunities are embraced safely and sustainably with GPs at the centre of changes." Read the Tech manifesto [PDF]

"Nobody wants to think of themselves or their child as overweight or unhealthy, but the stark truth is that overweight and obese children face numerous, serious health-related problems – both physical and mental – in the years ahead, if their weight is not addressed. "This study shows how underestimation is prevalent across the board – including among healthcare professionals – and highlights the importance of taking accurate measurements, so that appropriate and consistent interventions can be implemented to support a child to lose weight and live a healthier lifestyle. "It also emphasises how vital it is to be frank about weight from an early age as forging healthy behaviours in early life will have a very real impact on a patient's long-term health and wellbeing into adulthood. Childhood obesity is one of the most serious health challenges of our time and one that mustn't be swept under the carpet. "GPs and our teams will routinely talk to parents about simple lifestyle changes that can have a positive impact on their children's health but this is a society-wide responsibility and we need to work with parents, healthcare professionals, teachers, advertisers, food manufacturers, retailers, public health officials and others, in order to evoke genuine change. "Now that this finding has been observed, it would be useful to see some research into the reasons why people are more likely to underestimate children's weight, so that we can start properly and effectively addressing the problem. "Physical activity and lifestyle is a clinical priority for the College and we have developed resources to support GPs and healthcare professionals to have what can often be difficult conversations with patients about their weight, and the weight of their children. "We have also embarked on a partnership with parkrun UK, which has already seen thousands of patients – including children - take part in local running events in their communities, and we will soon be launching another scheme to support GP practices in encouraging patients to get more active."

"Despite this, GPs are doing a very good job of diagnosing cancers generally and it's credit to our colleagues’ hard work and vigilance that 75% of patients found to have cancer are referred after only one or two consultations, and that since 2008 the proportion of cancers diagnosed as an emergency have dropped from 23% to less than 19%. "GPs are always mindful of pressures across the NHS, so we will only refer if we genuinely suspect a patient has any form of cancer. One key way to further improve appropriate referrals is to make sure that GPs have better access to diagnostic tools in the community, and the appropriate training to use them. "Ultimately, we also need to see more resources in the community, including more GPs, so that we can continue to offer improved access and deliver the best possible care to all our patients, including those with cancer and those we suspect of having cancer. "Cancer is an enduring priority for the RCGP, and we have worked with Cancer Research UK and others to develop resources for GPs and other healthcare professionals to support them in the timely diagnosis of cancer."

Prof Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "This is excellent news that is testament to the hard work and dedication of GPs and their teams around the country – as well as being very reassuring for our patients. "GPs have long borne the brunt of criticism for late diagnosis, and today's figures help set the record straight and demonstrate the important contribution that GPs make to the overall picture of cancer referrals and treatment in the NHS. "GPs will always do their best for their patients and are well aware of the link between timely diagnosis and improved survival rates. "However, cancer can present itself in many non-specific and vague ways, and GPs need much easier access to the right diagnostics in the community – along with the appropriate training and time to use them - so that we can continue this good work and deliver the best possible care to all our patients."

The full version is below. Dear Sir, Blaming GPs for the recent drop in take-up of smear tests – and, worse still, for the unnecessary and untimely deaths of women – is grossly unfair, and blatant scaremongering that will only serve to deter yet more women from getting tested. (Almost half of women delay cervical cancer screenings as they can't get appointment, April 15, page 8, and Comment, page 16, 'Dying to see a doctor'). We understand that it can be difficult to get an appointment with a nurse or GP, but we have a severe shortage of family doctors and practice nurses in some areas and the dedicated staff we do have are going above and beyond to provide safe patient care to rising numbers of patients. The NHS screening letter gives women a number of options where they can have the test done. If they do choose their GP practice, it is not usually necessary to wait for a GP appointment as most practices offer cervical screening clinics with practice nurses at a range of times. Cervical screening really can save lives and we encourage all eligible women to take up the invitation to be screened. When you do try to book, please have a range of dates and times available to make booking easier at the first attempt. General practice and community sexual health services have borne the brunt of years of under-investment, and the promises of funding in the NHS Long-Term Plan must be ploughed into the frontline as matter of urgency so that we can give all our patients the care they deserve.

An extraordinary meeting of the College's Trustee Board voted unanimously to withdraw the 'Companion of the College' honour awarded in 2013. The decision also includes the removal of the word 'Brunei' from the name of the auditorium at the College's headquarters 30 Euston Square, with immediate effect. Professor Nigel Mathers, Chair of the Trustee Board, said: "The fact that we convened an extraordinary meeting of Trustees shows how seriously the College is taking this issue. "We can confirm that robust governance procedures have been followed and that the decision of the Trustee Board was unanimous on the withdrawal of the honour and on the decision over the name of the auditorium." College Chair, Prof Helen Stokes-Lampard, wrote to the Sultan of Brunei last week, urging him to reverse the laws that carry penalties including stoning and flogging to death on the grounds of sexuality. She said: "Persecuting or punishing people based on their sexuality is completely unacceptable, and completely contravenes everything that the College stands for. "This has been an incredibly upsetting time for everyone - not least for our wonderful LGBTQ+ community of doctors, staff, and patients. "Our College honour was given in good faith but the recent events in Brunei have left us with no choice but to take action. "I know it has been frustrating for many of our members while we worked to find a solution, so thank you for bearing with us while we went through our due processes. "The College is nothing without our dedicated and committed members and staff, and we are proud to be a diverse and inclusive College that believes in equality for all." A regular meeting of the Trustee Board will meet next week to discuss issues brought to the fore by the Brunei developments, including the donation given to the College by the Sultan of Brunei, and the College's future work in countries with repressive regimes and its support for international human rights.

She said: "GPs are highly-trained to prescribe and recommend drugs if they think they will genuinely help the individual patient, based on the specific circumstances affecting their health and their personal risk factors – and then after a frank conversation about the potential risks and benefits. "When we prescribe medication, we have to rely on patients to make sure that they take it, both at the recommended dose and for the duration of time that we think will benefit them most. "There is a substantial body of research showing that statins are safe and effective drugs for most people, and can reduce the risk of heart attacks and stroke, when prescribed appropriately – but controversy remains around their widespread use and their potential side-effects. "There are complex reasons why patients choose not to take their prescribed medication, and mixed messaging around statins could be one of these. "We would encourage anyone who is on regular medication to attend their scheduled medication reviews and to raise any queries or concerns they might have. But given the widespread GP shortages and intense workload pressures that we currently have in general practice, it’s hard to know what more we can do to encourage greater compliance with medications that have been recommended in good faith."

"However, most of our hard-working, hard-pressed GPs will still tell a different story of working longer and longer hours and seeing more patients per day to try and cope with demand, which continues to increase in both volume and complexity. "The impact of Time for Care has to be seen as just one part of a much bigger solution that is needed, in the overall context of GP shortages and long-term underfunding of primary care. The investment announced in the recent NHS Long-Term Plan and GP contract framework will take time to be felt on the ground. "We are pleased to have more trainees in general practice than ever before, but this trend must be sustained and built upon, as well as continued urgent action to boost the GP workforce in the short-term. It is essential that the forthcoming workforce implementation plan launches effective strategies to boost the pipeline of GPs, protects and supports those who are struggling, and has robust solutions to expand the wider practice team - and that all this is properly funded."

The Sultan was awarded a 'Companion of the College' honour in 2013 in recognition of his support of the RCGP's work to provide primary healthcare in Brunei. But in her letter, Prof Stokes Lampard says that the latest developments in Brunei 'contravene our values and everything that the College stands for'. "Laws that persecute and punish individuals on grounds of their sexuality, and which carry sentences such as flogging and death by stoning, are completely contrary to these principles and will create an environment that is inimical to the comprehensive provision of safe, person centred, patient care for all. For these reasons, we oppose such measures in the strongest possible terms," she says. "We are a diverse and inclusive international organisation that is proud of its strong LGBTQ+ community of doctors and staff. Promoting equality and valuing diversity are central to the professional values of general practice and to the RCGP’s work to encourage, foster and maintain the highest possible standards of patient care." She continues: "When the College bestowed the honour of Companion of the College in 2013, these laws were not in place and we acted in good faith in recognition of your Government's commendable commitment to developing primary care in your country. "Latest developments have jeopardised this good work and we implore you to revoke these measures as a matter of urgency, or the College will be forced to act on the recommendation of our Fellowship and Awards Committee to rescind our honour to you." The College's Trustee Board will be holding an extraordinary meeting on Wednesday 17 April to discuss this. Read the letter to the Sultan of Brunei [PDF]

The recommendation will now be discussed at an extraordinary meeting of the College's Trustee Board next Wednesday (17 April) and Council members will then be asked to confirm their support for the decision. RCGP Chair, Professor Helen Stokes-Lampard, said: "We fully understand that our members want rapid action and a clear decision on this and we are working as fast as we practically can to deliver this. "The fact that we are calling an extraordinary meeting of our Trustee Board shows the level of our concern on this issue. "We ask for our members' support and forbearance over the coming days and will of course keep everyone updated as we follow our processes. "Meanwhile, we reiterate that we categorically condemn the recent change in the laws in Brunei and are proud to be a diverse and inclusive College that values our large and vibrant LGBTQ+ community."

The recommendation will now be discussed at an extraordinary meeting of the College's Trustee Board next Wednesday (17 April) and Council members will then be asked to confirm their support for the decision. RCGP Chair, Professor Helen Stokes-Lampard, said: "We fully understand that our members want rapid action and a clear decision on this and we are working as fast as we practically can to deliver this. "The fact that we are calling an extraordinary meeting of our Trustee Board shows the level of our concern on this issue. "We ask for our members' support and forbearance over the coming days and will of course keep everyone updated as we follow our processes. "Meanwhile, we reiterate that we categorically condemn the recent change in the laws in Brunei and are proud to be a diverse and inclusive College that values our large and vibrant LGBTQ+ community."