Updated: 21/08/2019 12:17
The news comes as today marks 'Blue Monday' - widely recognised as the UK's most depressing day of the year after the indulgences of Christmas and the end of the festive holidays.
The three pieces, which are part of a wider College exhibition called What Once Was Imagined (WOWI), highlight the realities of living with mental health problems, such as depression and anxiety – two of the most common conditions currently being diagnosed in the UK.
The collection is the creation of textile artist Susie Freeman and her long-time friend, Dr Liz Lee, who have worked together for more than 20 years in a collaboration known as Pharmacopoeia.
Some pieces have been inspired by Freeman's own experiences, like Wave - a delicate stretch of blue fabric decorated with the emptied packets of the medication she took for depression.
"I have lived with intermittent bouts of depression for several years and for some people it presents itself as a 'black dog', but for me it was a deep blue," she said.
"I wanted to show this in the exhibition and for the work to not only create a discussion about the advancements of modern medicine, but also about how vitally important this medication is for some people, and why there should never be any shame or stigma attached to taking it."
Other key pieces include:
Miss Essex: a representation of a young woman with serious mental health problems - a large metal wire handbag covered in the hundreds of pills she hoarded while pretending to take the drugs.
Purple Haze: a collection of medication for agoraphobia – a smaller handbag dotted with the pills needed to manage fear and anxiety associated with open or public places.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, added: "With 90% of people with mental health problems cared for entirely within primary care, GPs are acutely aware of the prevalence of these conditions and the impacts they can have on our patients' lives.
"But no patient wants to be reliant on – and no GP wants to prescribe – any medication long-term unless completely necessary, and where possible we will explore alternatives, such as talking therapies and CBT.
"However, there is a severe lack of these services and choice of therapies in the community that could benefit our patients with mental health conditions, which needs to change.
"NHS England's GP Forward View pledged for every GP practice to have access to one of 3,000 new mental health therapists. We need this, and its other promises - including £2.4bn extra a year for general practice and 5,000 more GPs - to be delivered as a matter of urgency, so that we can continue to provide the best possible mental health care to our patients.
"There is still a long way to go, but we hope this exhibition helps break down the outdated stigmas around mental health, and educate the public about the very real impacts these conditions can have on some patients' lives."
The exhibition is free to visit at 30 Euston Square until May 2019.
She said: "We are currently seeing a steady increase in the overall number of flu presentations in general practices across the UK at present, which is the usual annual pattern, and our teams are operating under considerable pressure as we try to deal with this seasonal demand.
"While influenza for most patients is incredibly unpleasant, it is not generally serious and symptoms usually pass within a week or two. However, for some patients, it does have the potential to become much more serious, particularly those in vulnerable groups, such as the elderly, young children or pregnant women – or people are living with long-term conditions, like heart disease.
"It's encouraging to see confirmation that this year's vaccine is well-matched to the circulating strains of flu, so we're confident that those eligible for the jab are getting the protection they need, but there are still at-risk patients who haven't had it, and flu can sometimes spread until early spring.
"We would therefore, urge anyone in at-risk groups who has not yet had the vaccine to make sure they get it as a matter of urgency – it isn't too late, it only takes a few seconds and can protect against some really unpleasant symptoms.
"For people who do develop flu, the best thing to do is get lots of rest and stay hydrated. Where possible, we would also encourage patients not to mix with other people, particularly the elderly or other ‘at-risk’ people, such as pregnant women, to try to avoid spreading the virus further."
The data, which compared Office for National Statistics official population data with GP workforce numbers from NHS Digital*, shows that the ratio has fallen from 6.56 full-time equivalent GPs per 10,000 population in 2007 to 6.19 FTE GPs per 10,000 population in 2017. The ratio is the lowest it has been since 2004. ONS figures for 2018 are not yet available.
GPs and their teams are making an increasing number of patient consultations every year – and research has shown workload is increasing both in volume and complexity. Yet, the latest workforce data from NHS Digital shows that there are fewer FTE family doctors in the workforce than there were two years ago – and data published on Thursday showed that 3m patients waited more than three weeks for an appointment in December last year.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "Our patients are living longer – that's one of the great wonders of modern medicine – but as they do, they are increasingly living with multiple, chronic conditions, which has a massive impact on workload in general practice, both in terms of volume and complexity.
"Unfortunately, as this data shows, the GP workforce is not rising with demand - indeed, we have fewer full-time equivalent GPs delivering patient care than we had two years ago. As a result, each GP is responsible for more patients – and more elderly patients, who typically have greater and more complex health needs – every year.
"This increasing pressure without the sufficient resources or an increased workforce of fully-qualified GPs to cope with it is untenable. The fact that GP workload is escalating and set to continue to do so - particularly with the drive to deliver more care out of hospitals stated clearly in the NHS long-term plan - whilst the GP workforce is still falling runs the risk of a perfect storm.
"We know that GPs are already stressed and burning out, in many cases leaving the profession earlier than they planned to, and a shortage of GPs is the main reason why patients are waiting too long for an appointment.
"NHS England's long-term plan for the health service has some great aspirations that promise to benefit patients – and it recognises the importance of GPs and their wider team of healthcare professionals for the sustainability of the NHS. But the plan will need the comprehensive workforce challenges we currently face to be solved, if we are to be able to deliver the vision.
"The forthcoming workforce strategy must explore all possible options to both recruit more GPs to the profession – and there is some excellent work ongoing in this respect - but also to retain our existing, hard-working and experienced workforce, as well as looking to use the skills of other healthcare professionals to best support the delivery of general practice.
"Key to this will be looking at how to reduce escalating workload – particularly the bureaucracy and red tape that diverts GPs from patient care - to make working in general practice more sustainable and removing incentives to retire early for GPs who might not necessarily want to.
"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."
“This review is a vote of confidence in GP partnerships and shows that they are an important and viable option for GPs at all stages of their careers, now and in the future – but there are clear challenges that must be addressed, and this review confronts some of the key issues as to why we are currently finding it more difficult to recruit GP partners.
"We particularly welcome the focus on reducing unnecessary workload in general practice and increasing both the GP workforce, and the wider practice team.
"Workload in general practice has escalated in recent years both in terms of volume and complexity, and we are now making over a million patient consultations every day, yet we are doing this with a smaller share of the NHS budget than we had a decade ago, and fewer GPs than we did two years ago.
"Our members consistently tell us about the red tape they have to deal with daily that gets in the way of what matters – direct patient care. So, the report's recommendations to reduce the bureaucracy involved with CQC inspections, appraisal and revalidation and GDPR compliance - and to simplify and streamline the communication we have with colleagues across the NHS, must all be explored and implemented.
"Ultimately, no model of general practice will be sustainable without sufficient numbers of GPs and our teams, so the recommendations to implement fellowships for newly qualified GPs, extend and enhance the GP retention scheme, and ensure the GP training budget reflects the true cost of delivering placements in general practice, are all also welcome – as is the recommendation to ensure the status of general practice by formally recognising it as a specialty.
"This report is optimistic and pragmatic – and has benefitted from being GP-led and having such rich GP input – but implementing the recommendations effectively will depend on having the funding and workforce to do so and hope the forthcoming workforce strategy will address this.
"We urgently need the promises made in NHS England's GP Forward View, for £2.5bn extra a year for general practice and 5,000 more GPs – and a guarantee that our profession will receive a significant share of the funding outlined for primary and community care in the NHS long term plan – delivered in full and as a matter of urgency.
"We eagerly await the response of the Secretary of State and Simon Stevens to the review and detail about how they plan to take forward these recommendations."
"We also know how soul-destroying it can be for hard-working GPs and our teams – across the country making more than a million patients a day – to see newspaper headlines unfairly admonishing their clinical skill and expertise and undermining their remarkable dedication to patient care. This can definitely have a negative impact on morale in general practice, and poses a real challenge to efforts to recruit more GPs and retain our existing workforce.
"It's frustrating because being a GP can be the best job in the world; it is intellectually stimulating, full of variety and allows doctors to build relationships with patients that simply aren't possible in other medical specialties – we just need the time and resources to do it properly.
"Without GPs and their teams, millions of patients wouldn't be able to get the care they need, close to home where they want it, and hospitals and other secondary care services would simply implode under the pressure.
"That's why we need to continue to do everything we can to make general practice an attractive career path and boost recruitment, including calling on the government to make sure it is properly resourced and funded for the future.
"This means seeing NHS England's GP Forward View, which promises 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 funding for primary and community care outlined in the NHS Long-Term Plan."
View the BJGP article
"Professor Gardiner's report outlines the stark realities facing the medical workforce in Northern Ireland. GPs and colleagues from other professions have been facing workforce challenges for many years as a result of a lack of planning and the College urges the Department to heed these findings and act immediately.
"The GP workforce has been changing over time. There is an increasing preference for modern work patterns, involving more flexible working and portfolio careers that involve a mix of working across general practice, hospital settings and community care services. We need to ensure we can meet the needs of both patients and professionals and having a sufficient stream of medical students and trainees across the various primary care professions is a key component of delivering this.
"We know we currently do not have enough full-time equivalent GPs in NI working solely in primary care and that we will need even more GPs to meet patient need, as people live for longer with more chronic conditions. These complex conditions are best managed in primary care, providing general practice is properly resourced, staffed and supported and there is adequate space to host GP teams in fit-for-purpose buildings. Crucially, we need more medical students and need to ensure there is sufficient capacity to train and educate students, trainees and staff. We simply cannot transform our health services without these fundamental issues in primary care being addressed.
"Retention is a vital element of workforce stability; not only in doing more to decrease the number of students and trainees who leave NI to study, train and work elsewhere, but to retain the skills of our older colleagues who are considering retirement. Almost one quarter of GPs in NI are aged 55 and over, and we must do what we can to encourage them to stay within health and social care for as long as possible, so we do not lose their expertise.
"The figures in the medical school numbers report highlight the falling number of Foundation Doctors who enter directly into specialty training and this must be accounted for in workforce planning for the future. While RCGPNI welcomed the increase in GP training places to 111 per year, places are not being filled and recruiting into specialty training must remain a priority.
"We also know that increasing training places is not enough in isolation to address GP workforce needs and we are pleased to see local and overseas recruitment campaigns acknowledged as a part of this solution. The College has been urging the Department to invest in a programme to attract people to live, work and train in Northern Ireland and the value of this has been recognised. We urge the Department to expedite robust plans for this work urgently.
"The Department of Health's response to the review of medical school places once again highlights how the political stalemate continues to thwart some of the essential elements of healthcare transformation and it is clear that more must be done to prepare for the future and support the current struggling workforce. Last year, the HSC Workforce Strategy was published and the recommendations from today's report mainly lie within its remit. To date, there has been minimal transparency around the development of any action plans for taking this Strategy forward and we call on the Department to urgently put plans in place to address the serious challenges we are facing."
She said: "Patients with long-term conditions need regular monitoring and treatment and advice tailored to their unique health needs, so missing appointments and not being able to access that support has the potential to have a devastating impact on their wellbeing.
"People miss appointments for a range of reasons, but this study highlights why it's more important to show compassion to people who fail to attend, rather than punishing them - for some, life gets in the way and they forget, but others might not turn up precisely because of their health issue.
"As this research has demonstrated, this particularly applies to patients with mental health conditions.
"It can take a huge amount of courage to ask for help when living with a mental health problem, and for some people, social anxiety or simply not feeling strong enough to leave the house could be reasons why they then don't make it to their appointment.
"GPs try to be extremely sensitive to this and will attempt to chase up those they are particularly concerned about, but some patients will be living with a mental health issue that the GP is not aware of and so the risk heightens.
"We need systems in place to better accommodate for these situations and the starting point is having more mental health therapists based in primary care, where the majority of mental health issues are identified and managed.
"Ultimately, we need substantially more investment in general practice across the board. NHS England's GP Forward View promises an extra £2.5bn a year for general practice, and the NHS Long Term Plan announced this week guarantees that our profession will receive a significant share of the funding outlined for primary and community care. We need these pledges turned into a reality as a matter of urgency so that we have sufficient numbers of GPs and the wider practice team to give all our patients the care they need and deserve."
She said: "The menopause is a transition stage for every woman and can cause difficulties for many – and for some specific symptoms, such as hot flushes and night sweats, HRT is the only medical treatment that has good evidence of benefit.
"While this study is certainly interesting and important, as the authors themselves acknowledge, the findings do not prove that tablets cause more DVTs than patches, just that there is an association. As such, it is essential that more research is conducted in this area and taken into account as new clinical guidelines are updated and developed.
"Prescribing is a core skill for GPs and current best practice is to prescribe the lowest possible dose of HRT for the shortest possible time, and so specific products and formulations of HRT are only initiated after a comprehensive discussion between the GP and their patient, and are tailored to meet the best interests of that individual.
"It's important that patients don't panic or stop taking HRT as a result of reading about this study, but instead discuss their concerns at their next routine GP appointment, or seek advice from a reputable website like NHS Choices."
She said: "It's extremely useful for GPs and our teams to get feedback from patients about their experiences of general practice – good or bad, it is central to helping us improve the care we can deliver.
"One issue that both GPs and patients have been voicing for some time now, and which is reiterated in this report, is the need to invest in GP premises to ensure they are easily accessible for patients with all sorts of disability and limitations - and this has become increasingly apparent with our growing and ageing population as more and more people live with multiple, chronic conditions and rely on regular visits to their local surgery to receive the care they need.
"Some practices are able to work around or make modest changes to overcome issues with their premises, but often the severe lack of resources across primary care has meant that many are functioning without essential structural improvements that could positively impact patients' experiences of a practice.
"The same applies to concerns highlighted in the report about patient confidentiality at GP reception desks, which can sometimes become overcrowded due to waiting areas that are too small or have poor acoustics and don't lend themselves to the privacy that patients expect and deserve.
"We understand that for some patients, discussion of their appointment with anyone other than their GP can make them uncomfortable – but we would like to assure them that GP receptionists are highly-trained members of the practice team and any questions they do ask patients questions about their health will be to ensure their visit to the surgery runs as smoothly as possible, and they will always strive to treat patient data as sensitively as possible.
"It's essential, particularly as patient demand grows, that these issues are rectified with better investment in general practice; issues that can have almost as much impact on patient care as ensuring surgeries are equipped with the right clinicians, medicines, and follow-up services.
"That's why we need to see NHS England's GP Forward View, which promises 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 funding for primary and community care outlined in the NHS Long-Term Plan."
"We are pleased to see £4.5bn extra a year earmarked for primary and community care – significantly more than the Prime Minister announced last year, and the landmark commitment that these services will receive a growing share of the NHS budget. But it is not clear what precisely this means, and if we are to secure the long-term sustainability of the NHS, we need the share of funding actually going to general practices to also grow.
"Increased resource directly into general practice is necessary to allow us more time to care for those patients who need it right now. This is in addition to fulfilling the aspirations of the plan which include a larger general practice workforce leading a wider range of healthcare professionals so that we can deliver care better tailored to our patients' needs, and using enhanced technology to broaden the range of consultation options for patients, to enable seamless care throughout the NHS.
"GPs and our teams make the vast majority of patient contacts in the NHS, alleviating pressures across the rest of the service. Our workload has increased substantially over the last decade, yet the share of the NHS budget that general practice receives in England has fallen, and the GP workforce has been falling too. As a result, GPs are currently working far beyond what is safe or sensible, working ever-increasing hours due to the rising volume and complexity of patient demand.
"The promise of a new workforce plan later this year creates an opportunity for us to alleviate these pressures over the medium to long term, but means that we are still struggling in the short term. Our greatest concern is that we still don’t have a robust plan to increase the GP workforce by the numbers desperately needed to deliver the care our patients need right now.
"The focus on prevention in today's plan and the need for a greater emphasis on truly patient-centred care are both very welcome – but again, we need to know what these plans will mean for GPs on the ground, and reassurances that any planned increase in workload is matched with sufficient personnel and other resources upfront, to do this effectively and safely.
"GPs are open to working differently in the best interests of patient care, and we know that working in larger groupings can be beneficial in terms of increased peer support, building resilience in the system and working more collaboratively – and primary care networks (PCN) build on models that have been shown to be successful. However, it is vital that this is done in a way that minimises disruption for hard pressed GPs and their practices and enables progress to be made in a way that protects the ability of GPs to deliver care in the way that best meets the needs of their local communities. It is also vital that continuity of patient care is prioritised.
"The emphasis on widening choice for patients using digital means to consult with GPs is interesting and will be very attractive to some patient groups. However, the ‘three tests’ specified to ensure patient safety, NHS stability and fairness must be applied properly before new schemes are rolled out further.
"There are lots of good ideas for specific groups of vulnerable patients and the health service as a whole, and we all want this plan to be a success for the sake of the future NHS. However, without the details of implementation, we remain cautiously optimistic.
"These bold ideas need to be underpinned by a robust and comprehensive workforce strategy and a sustainable funding settlement for general practice through the GP contract. We will continue to work with NHS England to make these a reality for GP teams and their patients as soon as possible."
"We know that being physically active is a vital part of living a healthy lifestyle, which is good for everyone's long-term physical and mental health and wellbeing and in turn good for the NHS as a whole, so whatever can be done to encourage and inspire people to get up and move more should be done.
"Diseases and health conditions linked to a sedentary lifestyle cause millions of patients and their families untold misery, and they cost the NHS billions a year at a time when every penny really does count. It is a courageous move by NICE to challenge sectors outside of healthcare, but one that recognises the need for a society-wide approach to encouraging people to take steps to be more active and lead healthier lifestyles, and the notion of people from the health community working with those in other sectors is a good and important one.
"People are more likely to exercise - or simply choose to walk instead of drive - on roads that safe, convenient and clean.
"Physical activity and lifestyle is a clinical priority for the RCGP and we have appointed our own clinical champions to support GPs to encourage patients to make simple lifestyle changes that could have a positive impact on their health. As part of this work we have recently partnered with parkrun UK, and over 500 practices have already signed up to recommend local parkruns to patients to be more active."
"Diagnosing cancer at the earliest possible stage could make a huge impact and lead to better health outcomes for our patients for many cancers, so it's really exciting to hear about this research that is just starting and we look forward to seeing the results of the forthcoming trial.
"However, as this research is in its early stages it's important for patients to know that breath tests to detect cancer are unlikely to be commonplace at their GP practice anytime soon. Nevertheless, if following rigorous evaluation these trials are successful, and shown to have potential benefit for patients, then we would certainly welcome them as routine tests for patients at risk of cancer, and it would be important that GPs have easy, funded access to them once proven to be safe and effective.
"In the meantime, GPs need better access to established diagnostic tools, and the appropriate training to use them. We are already doing a very good job at appropriately referring patients we suspect of having cancer despite the pressures general practice is facing and given that we have some of the worst access to diagnostic tools in the community in Europe. Ultimately, we also need to see more resources and more GPs in the community, so that we can continue to deliver the best possible care to all our patients, including those with cancer, and those we suspect of having cancer."
"When patients miss appointments it can be a frustrating waste of resources for GPs and our teams, but also for other patients who are struggling to secure an appointment for themselves.
"There may be many reasons why a patient might miss an appointment, and in some cases it can be an indication that something serious is going on for that individual - but we would urge patients to let us know if they can't attend as soon as possible, so that we can offer that time to someone else who really needs it. To this end, practices are using electronic methods, such as SMS reminders, to encourage patients to keep their appointments, or cancel them in a timely manner.
"Many patients are waiting far too long for a GP appointment and we can all do our bit to help - but what we ultimately need is for general practice to receive 11% of the overall NHS England budget as part of the forthcoming NHS ten-year plan to allow us to deliver the care our patients need and deserve."
'Feast' is a jacket made entirely from the leftover packaging from an average family Christmas Day dinner.
The meal typically contains around 7,000 calories - more than double the recommended daily allowance for men and women.
With millions of families indulging this Christmas, the College hopes the exhibit will serve as a reminder of the importance of eating healthily in the New Year, particularly as obesity and it’s related health problems threaten to overwhelm an already over-stretched NHS.
Feast is accompanied in the exhibition by another piece, Steve's Scarf, which is made of thousands of pills used by a patient to help treat his multi-morbidities, some of them as a direct result of poor diet and overeating.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "Christmas is, of course, a very special time for celebration with our loved ones and a bit of indulgence every now and then is fine.
“GPs aren't killjoys but we do want our patients to live long, healthy lives and as a nation we're already eating more now than ever before, which is having a serious impact on the health and wellbeing of millions of people.
"GPs and our teams, and indeed the entire NHS, are seeing a dramatic increase in the number of patients presenting with complex conditions, including obesity, hypertension, and Type 2 diabetes, caused by lifestyle factors such as bad diet and lack of exercise.
"Small lifestyle changes can often have the biggest impact, and we know that introducing some gentle exercise into a patient’s routine, eliminating a few unhealthy foods, or just getting more sleep each night can make a massive difference."
The 'Feast' dress is part of the What Once Was Imagined (WOWI) collection created by textile artist Susie Freeman and her long-time friend GP Dr Liz Lee - together known as Pharmacopoeia.
Working for more than 20 years, the pair have collected thousands of pills, drugs and tablet packets to illustrate the advancements of modern medicine, as well as its pitfalls and society's over-reliance on medication. The exhibition is free to view and will run in the public areas of the headquarters of the RCGP, 30 Euston Square, until May 2019.
Professor Helen Stokes-Lampard, added: "It's a superb, thought-provoking exhibition, which explores several pertinent issues for general practice, one being the rising problem of multi-morbidity.
"It's so important that we continue to face these challenges head on as society, and realise the crucial part that each and every one of us plays in protecting and maintaining our health and wellbeing."
The full version is below.
Once again, it seems to be open season on GPs who, this time, stand accused of ‘fobbing off’ pregnant women with severe morning sickness. (Women palmed off by GPs call ambulances over morning sickness, December 18, page 10)
Today alone, over 1m patients will visit their GP surgery, and dedicated GPs and their teams are working harder than ever to try and keep up with inexorably rising patient demand at a time when we also have a severe shortage of family doctors. To charge us with not giving our patients the care they need is insulting and demoralising at a time when we need all the support we can get.
GPs are managing complex conditions in the community that even a decade ago would have been automatically referred to hospitals, thereby reducing pressures on the rest of the NHS.
GPs want to do the very best for all our patients and we are well aware of the impact that severe vomiting can have on the health of pregnant women at a time when they often feel anxious and vulnerable.
There remains only one licensed drug available to GPs to prescribe in primary care to pregnant women with vomiting, although several others are available on an unlicensed basis. Additionally, many pregnant women choose not to take any medication and will only consider it as a last resort when milder treatments have not worked, which is why some patients come back to see us several times.
The high quality care of pregnant women, and indeed all our patients, is an absolute priority. However, our family doctor service needs investment and support to keep it going, not inflammatory headlines and accusations that we are failing the very patients that we entered this profession to care for.