GP News

Latest News from the Royal College of General Practitioners
Updated: 21/08/2019 12:17

Physios welcome in general practice – but not as substitutes for GPs, says RCGP

"Physiotherapists are highly-skilled healthcare professionals who are expert at dealing with a multitude of musculoskeletal conditions that cause many patients a great deal of misery. This scheme has shown that having them working in GP practices is beneficial for both patients and general practice, and cost-effective for the NHS, and we welcome the further expansion of this initiative. "However, physiotherapists like any other member of the wider practice team, must not be seen as a substitute for GPs, and we must continue to do everything possible to build the GP workforce by the thousands we desperately need to ensure the long-term sustainability of the NHS and patient care."

RCGP to support decriminalisation of abortion

The decision was based on a poll of members and consultation with local Faculties. More than 4,400 members from across the UK responded to the consultation*. They were asked whether the RCGP should have a position on the decriminalisation of abortion and what position they thought the College should take: 62% said that the RCGP should support the decriminalisation of abortion; 19% said that the RCGP should oppose the decriminalisation of abortion; 15% said that the RCGP should have a neutral position on decriminalisation, and 4% abstained. Of the 21 College Faculties that responded to the consultation, none said that the RCGP should oppose the decriminalisation of abortion, 11 supported the motion for the RCGP to support the decriminalisation of abortion, two said that the College should be neutral on the issue, and eight abstained. The College did not ask members about the term limits on, or the morality of, abortion. The College will now work with partners across the health sector, including the BMA, the Royal College of Nursing, Faculty of Sexual and Reproductive Health, the Royal College of Midwives and others, to call for the decriminalisation of abortion across the UK. Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "This is an incredibly sensitive topic, but it's essential that we engage in debate and hear what our members have to say on all issues facing modern healthcare.  "It speaks to the strength of feeling of our members that we had such a good response rate to our consultation. The quality of the feedback has been hugely valuable in helping us form an official position on the decriminalisation of abortion. "Ultimately, this is about providing non-judgemental care to our patients so that women who face the difficult decision to proceed with an abortion are not disadvantaged by the legal system."

RCGP welcomes plans to roll out mental health support for NHS staff

"GPs understand as well as anyone how escalating workloads and unsafe stress levels can take their toll on our mental health – in some cases, leading to burn out and highly-trained, talented people leaving the NHS. The NHS GP health service has been an excellent resource for GPs with mental health problems, and it's great news to see similar services being rolled out to staff across the NHS. "The NHS would be nothing without the people who work in it, and it is imperative we look after them."

HRT can help many women, but isn't suitable for everyone, says RCGP

"Prescribing is a core skill for GPs, and we will of course take clinical guidelines into account, but they are guidelines to be applied bearing in mind the unique features of each patient, not tramlines to force us in one direction. What they do is provide some options for treatment, and they offer reassurance that HRT is a safe option for many women - but it is not suitable for everyone and even when it is prescribed, best practice is to prescribe the lowest possible dose of hormones, for the shortest possible time. "Far from 'forgetting' about middle-aged women, GPs are embedded in their communities, seeing over a million patients every day, and we are trained to treat the whole person, taking into account all the physical, psychological and social factors potentially impacting on their health when making a diagnosis. Any decision to prescribe will be made in discussion with the patient, based on their individual circumstances, and taking into account both their preferences and clinical guidelines, to achieve the best possible health outcome. "The RCGP takes women's health incredibly seriously – it is a clinical priority for the College and a key part of the GP curriculum that all GPs must demonstrate competence of in order to practise independently as a GP in the UK. We have also worked with partners, including the Royal College of Obstetricians and Gynaecologists and the Faculty of Sexual and Reproductive Health to develop resources to support GPs in this area of learning."

Daffodils set the standard for end of life care

The mark, synonymous with the charity, is based on a new set of criteria called the Daffodil Standards – a set of eight quality improvement statements designed to support primary care teams in delivering care to patients living with an advanced, serious illness or at the end of their lives, and their loved ones. By adopting the Standards, GP practices commit to making improvements in at least three of eight core aspects of care each year, with the aim of having reviewed all of them after three years. The eight Daffodil Standards are: Professional and competent staff Early identification of patients and carers Carer support - before and after death Seamless, planned, co-ordinated care Assessment of unique needs of the patient Quality care during the last days of life Care after death General practices being hubs within compassionate communities  To coincide with the launch, a new ComRes survey1 showed that 92% of GPs agree it is important for them to spend time caring for terminally ill or dying patients, and another 87% say that caring for terminally ill or dying patients is a rewarding part of their job. However, it also revealed that more than four in five (85%) GPs say that they do not have as much time as they would like to care for terminally ill or dying patients because of their workload. Three in five (62%) disagree that there are enough community resources to give families and carers of terminally ill or dying patients the emotional support that they need. The Standards fall back on the fundamental values of general practice being hubs within 'compassionate communities', which includes considering staff emotional support needs after their patients die. According to the survey, seven in ten (71%) GPs agree that there should be more resources available to help GPs and practice staff with the grief of losing patients, with just 2% saying their practice holds formal support sessions on dealing with grief and loss. And three in five (59%) say that their practice does not organise ways for the staff to share stories or get support for dealing with grief and loss. The Standards, which have already been recognised by the new Quality and Outcomes Framework (QOF)2 on end of life care and the CQC3, have been piloted by a number of surgeries across the UK, and each Standard comes with its own evidence-based tools, exercises and quality improvement steps. Dr Catherine Millington-Sanders, End of Life Care Lead at RCGP and Marie Curie, said: "GPs are central to providing excellent end of life care, and we know how much patients and their families value being able to have an open conversation with their doctor about what lies ahead. "Our colleagues are already working hard to provide this level of care, but pressures on our system and a lack of resources in the community can sometimes make going the extra mile that bit harder, which can be incredibly frustrating for us and our teams. "That's why the RCGP and Marie Curie have developed these Standards. Most importantly, they are there to ensure that when patients see the 'daffodil mark' in our window or on the wall in our waiting rooms, they know we are committed to providing the care and support they need and deserve." Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, added: "Making sure that patients and their families feel supported at the end of life is an essential part of what we do, and in many ways, one of the most privileged aspects of our role. "The demand on GPs and their teams to provide high-quality palliative care is only set to rise as our population continues to age and we begin to see more patients present with more complex, long-term conditions. "We're delighted to be able to launch these Standards with Marie Curie and hope they go a long way in supporting GPs, their teams, and, of course, our patients, but current pressures on our service and the effects they are having on our ability to consistently provide high-quality palliative care cannot be ignored. "That's why it's essential that the pledges for more investment for general practice and for more GPs and practice staff, made in NHS England's GP Forward View and the NHS long-term plan are delivered urgently and in full." Dr Jane Collins, Chief Executive of Marie Curie, said: "From talking to families we know that GPs and practice staff make such a difference to how patients and families experience end of life care.  Having someone they can go to who they know well, trust, and help them prepare for the future, is vitally important at such a difficult time. It is also clear from the survey findings that GPs recognise how important their role is and how rewarding they find this part of their work. "The new Standards will play a key role in excellent end of life care and ensure that busy GPs and practice staff have the support they need to improve the quality of care provided.  It has been a real privilege working with the RCGP on the development of the Daffodil Standards."

Better access to alternative mental health treatments for all patients urgently needed, says College

She said: "Regardless of a patient's age, depression can be incredibly distressing and debilitating, and research has shown that for many adult patients, antidepressants can be effective drugs at alleviating its symptoms. "GPs are highly-trained to prescribe and will only ever recommend antidepressants after a full and frank discussion with the patient sitting in front of us, based on their individual circumstances, and if we genuinely believe they will help them. "Whilst antidepressants can be effective drugs, we know that in general patients don't want to be on long-term medication – and GPs don't want that, either. We will always try to explore alternative therapies, such as CBT and talking therapies, but access to these therapies in the community is patchy across the country – and there is also a lack of variety, to allow us to match these services to the specific needs of our patients. "We do know that for many older patients, the underlying reasons for them visiting their GP might not be medical – they might be feeling lonely or be socially isolated. In these cases, it's important that we have access to 'social prescribing' schemes to link these patients with an appropriate class or group in the community, that can have a positive effect on their health and wellbeing, and we welcome the focus on this in the NHS long term plan. "It can take a lot of courage to seek help for depression and other mental health problems, no matter what age someone is, and patients who do so should be able to get the care they need and deserve, close to home, where they need it most. "NHS England has promised that every GP practice in England will have access to one of 3,000 new mental health therapists by 2021 – we need this, and the other pledges of more investment in general practice and more GPs made in the GP Forward View and NHS long term plan delivered as a matter of urgency."

Efforts to boost general practice workforce will be 'imperative' in forthcoming strategy, says RCGP

"It is really positive to see that strides are being made to increase the numbers of other members of the practice team, some more than others, and it remains concerning to see a continued decline in practice nurse numbers. Nurses, pharmacists, paramedics, physiotherapists and so on play an integral role in supporting GPs to make more than a million patient consultations a day across the country, and most practices would not be able to function without the hard work and dedication of our wider team. "What's important is that patients are clear about the role of each member of the practice team – including what care and services each can and can't deliver – and that there is no doubt that allied healthcare professionals will support GPs, not replace them. It takes at least ten years to train a GP and the level of skill it takes to deliver truly holistic care to patients, and manage immense amounts of risk, cannot be substituted. "We want to see efforts to continue to increase numbers of all members of the practice team. But we also need to see efforts re-doubled to recruit and retain more GPs, who will lead these teams. "The NHS long-term plan has some truly commendable aspirations that will benefit patients, and it also recognises the importance of a robust general practice service in keeping the NHS sustainable, but we need the workforce to be able to deliver it. It is imperative that the forthcoming NHS workforce strategy includes comprehensive plans to boost GP recruitment – and great work is already ongoing – but also to keep existing GPs in the profession longer, so that we can deliver the care our patients need and deserve."

RCGP welcomes CMO advice for parents on screen time for children

"These digital advancements can be of great benefit, connecting youngsters to new learning tool, for example, but they can also have a profoundly negative impact and GPs are regularly seeing the adverse effects these devices can have on our patients' health and wellbeing. "Most often this includes sleep deprivation and fatigue from using phones and tablets before going to bed, but being able to access social media, constantly, can also lead to more serious problems, such as creating anxiety and magnifying feelings of loneliness and poor self-esteem. "This is a society-wide issue, which we must all take responsibility for if we're to see a real change in how people interact with their phones and similar devices. "We hope the Chief Medical Officer's guide for parents is useful, and helps them to support their children in redressing the balance between screen time and time with each other."

New contract could help general practice 'finally turn a corner' but workforce plan still desperately needed

"We are particularly pleased at the news that a state-backed indemnity scheme will be introduced from April this year, providing all GPs in England with full insurance cover that is on a par with the arrangements already in place for our hospital colleagues. "Escalating indemnity costs have become a huge burden for GPs at all stages of their careers, and some GPs have even cited this as their reason for leaving the profession. The College has been campaigning for a state-backed scheme for a long time, and we are extremely pleased that the Government has kept the promise first made by former Health Secretary Jeremy Hunt at our annual conference in 2017. "While our prime objective must remain the recruitment and retention of thousands more GPs, we also welcome the focus on collaborative working with a range of highly-skilled members of the GP team, to support our work and free up our time to deliver care to patients who need our expertise – as well as with other practices in the same locality. "Primary Care Networks have been shown to be beneficial in terms of increased peer support, building resilience in the system and pooling resources. It is vital that these networks are GP-led, prioritise continuity of care for those patients who need it, and are implemented in a way that minimises disruption for hard-pressed GPs and our teams and protects the ability of GPs to deliver care in the way that best meets the needs of their local communities. "General practice has been at a crossroads for several years: workload in general practice has escalated both in volume and complexity recently, yet the share of the NHS budget our service receives is less than it was a decade ago, and we have fewer GPs than we did two years ago – as a result, GPs are working unsafe hours, and patients are waiting longer and longer for an appointment. The RCGP has been making the case for many years that if action isn't taken, general practice will crumble, and the rest of the NHS behind it. "We hope that today's announcement of the new contract will mean that we can finally turn a corner towards making general practice sustainable for the future. Our colleagues on the BMA's GP committee have done an excellent job of negotiating with NHS England to secure a deal that is in the best interests of our profession and our patients. "Now we need the forthcoming NHS England workforce strategy to deliver viable measures to continue recruitment efforts into general practice, and initiatives to keep more GPs working in it."

New study on effectiveness of statins 'reassuring', says RCGP

He said: "It's encouraging to see further research showing that statins are safe and effective drugs that can reduce risk of cardiovascular conditions when prescribed appropriately, as there remains a lot of controversy around their use. "It's particularly reassuring to see evidence of benefit in patients over the age of 75 - the age group most likely to need cholesterol medication, and who are at risk of heart attacks and strokes. "Like any medication, statins can have side effects – and some patients won't want to take long-term medication. But GPs are highly-trained to prescribe and will only recommend the drugs if they think they will genuinely help the person sitting in front of them, based on their individual circumstances – and after a frank conversation about the potential risks and benefits. We will also continue to encourage all patients to make lifestyle changes that can improve their long-term health and wellbeing. "As with any new research, it is now important that this study is taken on board as clinical guidelines are updated and developed, in the best interests of our patients."

RCGPNI Patient Group encourages patients to use health system wisely

General practice and other health care services are under immense strain, facing workforce and workload challenges while struggling to meet increasing demand from patients. Recognising this, the RCGPNI Patient Group were keen to play their part to help make sure that we can all access medical, mental health and social support when we need it. Launching the leaflet, RCGPNI Patient Group Chair Karen Mooney said: "Working with the College, we have become all too aware of the incredible pressures that GPs and their teams are facing. As patients, being able to access services when we need them is our top priority, but we know that people are not making the most from all the services and support available to them within the community. "Our leaflet aims to give fellow patients more information about how they can better care for themselves, where they can find reliable health information online and how they can get the most out of all of their interactions with healthcare professionals. "Not only do we hope that some patients will think about the alternatives available to them before making an appointment with their GP, we also hope that the information we are providing will encourage those who avoid engaging with healthcare professionals to go and see their family doctor when they need to. "There is a vast variety of healthcare professionals and staff available to us, each playing their part to keep our health service running; however, many of us do not make the most of their knowledge and expertise. One of the groups that often get overlooked are medical receptionists in our GP practices. Medical receptionists are trained by the GP and while they cannot diagnose or advise on medical conditions, they have a lot of information they can offer us. We want to remind people that the entire GP team is there to help us get the most suitable service and best experience when we go to our local GP surgery. "Our key message today is to remind everyone that our health service is our best asset. It is there when we need it most and we expect it to keep us healthy, but sometimes we forget that we have a responsibility to keep it healthy too." Reflecting on the work that has been taken forward by the Patient Group, RCGPNI Chair Dr Grainne Doran said: "Patients are often unclear about the services that are available to them and by the conflicting information available online. It is great to see the innovation that has been shown by our voluntary patient group to help support others in getting the best from our health services. "There are many healthcare professionals and sources of information available to patients within the community. Our community pharmacist colleagues are an underutilised resource who can provide advice and treatment for many minor ailments and conditions, saving many people from waiting to see their GP unnecessarily. Nidirect is also an incredibly valuable source of health and social care information that patients can use to search symptoms, learn about the services available to them locally and advise on over-the-counter treatments and home remedies that might be helpful in certain circumstances. "Our patient group is also reminding others about the value of GP appointments. Every day, people do not attend their booked appointments with their family doctor. There are many reasons for this and it is often unavoidable, but this information leaflet encourages people to cancel appointments where they can so that spaces can be offered to those who need them. "We all have an important part to play to protecting our health and social care services and I hope that this information will assist people in making the right decision for them, based on their needs."

College welcomes national action plan in the fight against antibiotic resistance

She said: "Antibiotic resistance is one of the biggest and most dangerous threats to modern healthcare, and the more high-level support we get to tackle this problem, the better. "GPs are already making excellent headway in reducing antibiotic use in the community and will only prescribe when they are absolutely necessary and the best course of action for the patient sitting in front of us. "However, as this national action plan highlights, this is a society-wide issue and not something GPs can be held responsible for tackling on their own. "We need to get to a stage where antibiotics are not seen by patients as a 'catch all' for every illness, but rather as a serious drug option, usually reserved for when all other treatment options have either failed or been deemed inappropriate. "Sore throats, for example, are usually caused by viral infections that antibiotics will not help, but they are also usually self-limiting and will get better on their own in a few days with the help of basic over-the-counter pain relief, such as paracetamol and ibuprofen. "It's crucial that we continue to get this message out, so that we can carry on delivering safe, effective care to our patients both now and in the future. "It's also astonishing that there hasn't been a new and approved class of antibiotics produced in over 30 years – there have recently been some promising signs, but it’s clear that more investment in the research and development of new drugs to tackle emerging diseases is desperately needed, and if offering appropriate incentives and NHS collaborations with pharmaceutical companies are demonstrated to safely support this, then they should be encouraged."

NHS App promises to be a constructive step forward - but safeguards needed, says College

She said: "Technology plays an increasingly important role in the NHS, and in our patients' lives. "The new NHS App promises to be a significant and constructive step forward in using technology to support patients to manage their own care and wellbeing. We hope it will make navigating primary care services easier for patients by making it possible for them to book appointments, order prescriptions, and check their medical records on their smartphone, if they wish to. "Many GP practices already offer patients a range of digital services, such as self-check-in desks and text message reminders for appointments, and electronic symptom checkers and email contact with their surgery. This app will certainly complement those initiatives, but we need to make sure that patients who do not have access to a smartphone – or are just not as tech-savvy - can continue to make bookings and access healthcare in more traditional ways. "For those that do use it, adequate safeguards must be in place to ensure the utmost protection of patients' personal data, especially as people's confidential medical records will now be accessible via their mobile phones if they choose this option and therefore, potentially more vulnerable to security breaches. "It's also essential that the app is thoroughly and independently evaluated to ensure it is safe and cost-effective, and ultimately, beneficial to both patients and GP practices without unnecessarily increasing our workload."

Management of asthma a 'priority' but more funding needed so that GPs can give patients more time, says RCGP

"Asthma must never be underestimated as it is a serious condition that can claim lives in any age group. "We really sympathise with our younger patients who are finding it hard to book a GP appointment, but we are working harder than ever and seeing more patients than ever. Unfortunately, we have a chronic shortage of family doctors right across the country because investment in our service has not kept pace with demand and there is a limit beyond which we can no longer guarantee safe care. "GPs and our teams are highly trained to manage asthma in partnership with our patients, including identifying symptoms, prescribing appropriately and monitoring treatment. "We encourage the use of personal asthma action plans for patients and we aim to work with all patients with high-risk conditions to ensure they are undergoing regular reviews. "It is also vitally important that patients understand their own treatment and how to properly use equipment, such as inhalers, spacer devices and peak flow meters, and GPs take every step to encourage patients of all ages to feel more confident about managing their condition effectively and appropriately. "Respiratory disease is a clinical priority for our College and all trainee GPs are required to develop skills in diagnosing and managing patients of all ages and backgrounds with asthma and other airways conditions, which are then tested in the professional examinations which every GP must pass before they can work in general practice. "We would like to devote more time to our patients with chronic diseases such as asthma, but we need more GPs, more members of our wider practice teams, and more funding in order to do this. "Ultimately, we need to see NHS England's GP Forward View, which promised an extra £2.5bn a year for general practice, delivered, in full, as soon as possible, along with guarantees that general practice will receive a significant share of the additional funding earmarked for primary and community care outlined in the NHS Long-Term Plan. "We also need better and faster information sharing between primary and secondary care to improve the outcomes of patients with asthma to ensure all our patients are receiving the best possible care."

Taking aspirin must be managed 'carefully and effectively', says College

She said: "Prescribing is a core skill for GPs and patients can be assured that their family doctor will only ever prescribe medication following a full and frank discussion, outlining the potential risks and side effects associated with the drugs, and considering their unique circumstances and medical history, as well as the medications they are already taking and how they will interact with each other. "Aspirin can be an inexpensive and effective drug for reducing risks of recurrence in patients who have suffered a stroke or heart attack, but we have known for many years that there are risks and side effects involved with its long-term use, and this study highlights the importance of managing its use carefully and effectively. "It is important that this research is considered as clinical guidelines are updated and developed, in the best interests of our patients. "Patients who regularly take aspirin – either as prescribed by their doctor or who have self-medicated – should not panic as a result of this research. But if they are concerned about taking the drug they should discuss it with their GP at their next routine appointment, or with their local pharmacist."