"Lifestyle changes should always be considered before prescribing medication to lower blood pressure, as well as in addition to it. "But no two patients are the same and blood pressure lowering drugs save lives so, as the author of the study highlights, it is vitally important that patients do not give up their medication without the advice of their GP who will work with them to come up with the best options for managing their condition."

She said: "We are pleased to hear that, following repeated calls by RCGP and the BMA, the Government plans to scrap the Tier 2 visa cap for skilled workers in any migration system post-Brexit, including doctors wishing to move here to meet the significant gaps in our NHS workforce. "The removal of the cap for doctors and nurses from non-EU countries earlier this year was vital and it is encouraging to see this will continue to be part of the Government's plans post-Brexit. "At a time when workload in general practice is escalating and our GP workforce is plummeting, despite a record number of GPs in training, we need to encourage as many highly-skilled, fully-qualified GPs to come to and then remain working in the UK as we possibly can. "However, while this is positive news for appropriately-trained doctors and other 'skilled workers' from overseas, we are concerned that there could be a £30,000 salary cap, which would prevent other vital healthcare staff and support workers from being employed as practice nurses and other members of our wider practice teams. "We will continue to seek clarification from the Government on this and several other aspects to the plan. We are also keen to see a reduction in the arbitrary bureaucratic barriers faced by practices and GPs within the current migration system. It is essential that Government makes the new system as straightforward and 'light touch' as possible, and we will be seeking assurances that this will be at minimal cost to GP practices. "General practice needs all the support it can get and we urgently need to boost our workforce with more highly-skilled GPs and other healthcare professionals so that we can continue to deliver the best care possible to all our patients."

The publication of 'Cannabis-based medicines: an interim desktop guide' follows a change in the laws governing access to cannabis for medicinal use earlier this year. Only doctors registered on the GMC's specialist register, and who have the relevant specialist knowledge and expertise can prescribe cannabis-based products to patients in situations where there is an unmet clinical need. Whilst GPs are not able to prescribe cannabis, the new guidance recognises that the recent legal change may lead to 'increased demand on GPs for information and referrals for a range of conditions'. It gives an overview of the current legal situation regarding medicinal cannabis, the different forms it is available in, the conditions for which there is some, if limited, clinical evidence of benefit, and the potential side-effects of taking cannabis. The guidance also includes signposting to further resources for GPs and patients, and some FAQs. Cannabis is a Class B drug under the Misuse of Drugs Act 2001. However, two forms of cannabis-based products - Sativex and Nabilone - can now be legally prescribed. Cannabidiol (CBD) is also legally available as herbal supplement and is not a prescription medicine. Professor Helen Stokes-Lampard, Chair of the RCGP, said: "The decision to legalise medicinal cannabis for some patients, where there is an evidence-base that it could benefit them, is welcome. "However, the treatments that have become legal are only able to be prescribed by specialist doctors if they have a patient with an unmet clinical need – and so it will affect a relatively small number of patients, many of whom will likely already be known by their specialist doctor. "GPs will not be able to prescribe patients medicinal cannabis, but as the first point of contact for the vast majority of patients in the NHS it is important that we are aware of the legal situation and current clinical evidence around medicinal cannabis. "This desktop guide aims to be a quick reference guide for GPs, providing them with the information they may need when having discussions with patients who as them about cannabis, and to make it clear to patients that GPs are not in a position to prescribe cannabis." View the Cannabis-based medicines: an interim desktop guide [PDF]

Responding to the election of Mark Drakeford AM as the new First Minister for Wales, RCGP Wales has called on him to 'move the dial of the health service in favour of general practice'. The First Minister previously made this statement in the Welsh Assembly. The College has said its recent 'Transforming general practice' report should form the basis of a "much-needed package of support for general practice". Dr Peter Saul, Royal College of General Practitioners Wales Joint Chair, said: "The new First Minister has previously spoken of the need to 'move the dial of the health service in favour of general practice'. We look forward to him setting a strong direction as First Minister to make this a reality. "Last week the College published 'Transforming general practice: Building a profession fit for the future'. This report was informed by our member's experiences and presents a snapshot of general practice in 2018, shining a spotlight on high levels of stress, concern about the future, and worry about financial sustainability within the profession. "We also made a number of recommendations, which should form the basis of a much-needed package of support for general practice. The College looks forward to working constructively with the First Minister and the Welsh Government to put general practice on a stable footing."

"This is simply not good enough. Less than a month since we initially heard about this cervical screening error, we are now hearing it is more serious, and has affected thousands more women. "Cervical screening is a successful national programme that has potentially saved thousands of lives, yet take up especially among younger women, is falling. We should be doing our utmost to encourage more to have smear tests but errors, such as this, will only serve to further damage women's confidence in the programme. "Again, it is important for women not to panic and await further information – and we know that NHS England are working to contact women who have been affected as a matter of urgency. We also welcome the forthcoming review into national cancer screening programmes by Professor Sir Mike Richards. "Capita has been shown time and time again to be unable to deliver on the work it has been contracted to do in the NHS. This is completely unacceptable - people working throughout the NHS have lost all confidence in Capita, and it really is time for NHS England to reconsider its contract with them."

"However, while fax machines may be terribly old-fashioned, they do work and remain a highly valued and reliable form of communication between many GP surgeries and their local hospitals, nursing homes and pharmacies. "A wholesale switchover to electronic communication seems like a brilliant idea but for some practices it would require significant financial investment in robust systems to ensure their reliability was at least as good as the trusty fax machine, as well as having the time to embed - neither of which we have at present as GP teams are already beyond capacity trying to cope with unprecedented patient demand. "GPs are tech fans, not technophobes, and we have been calling on the Government for significant investment in our core IT infrastructure, some of which is archaic, so that all GP practices have technology that improves communication, works for patients and makes the working lives of GPs easier."

She said: "Despite the best efforts of GPs and our teams, who are working incredibly hard to deliver more consultations than ever before, our patients are waiting too long to secure a GP appointment. We know this is frustrating for them and their families, and it's frustrating for GPs and our teams too. We want to deliver timely care to patients, in the early stages of illness, to avoid conditions getting worse, when they can be both more distressing for patients, and more costly for the NHS. "We also want the time to deliver care for patients - for many who are living with multiple, long term conditions, the standard 10-minute consultation is no longer fit for purpose - but offering longer consultations, means offering fewer, and as this data shows, patients are struggling to get an appointment as it is. "With this in mind, it's encouraging and a great testament to the hard work and dedication of GPs that more than 40% of GP appointments are made on the same day the patient is seen, so we are confident most of those who are acutely unwell are being provided for. "Today's data also shows that many patients are not attending appointments when they have made them. There can be a number of reasons for this, and in some cases a patient not attending an appointment can be an indication that something has gone wrong - but this waste of resources is frustrating, and 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. "Ultimately, we are calling for general practice to receive 11% of the overall NHS England budget as part of the forthcoming 10-year plan for the NHS, so that our service can continue to deliver the care our patients need and deserve, and keep the rest of the health service sustainable. "On a wider note, it is very welcome that NHS England has started collecting and analysing GP appointment data - this is something we have long called for. There is a long way to go to improve the quality of this data - and the College is working hard in this regard as our own Research Surveillance Centre has recently started collecting comprehensive data on workload in general practice - this will be invaluable for future planning of our services."

The survey of 1,094 GPs in England found: 31 percent of GPs said they are unlikely to be working in general practice in five years with stress and retirement cited as the main reasons for this. 5 percent of GPs* report that their practice is likely to close in the next year. These are not practices that are merging with others. 37 percent of GPs* said that in the practice where they work, there are GP vacancies that have been open for more than three months.  Efforts to retain the workforce need to replicate the 'excellent' work that has gone into increasing recruitment to general practice, which has seen more GPs in training than ever before, the College is saying. It has also analysed the latest provisional workforce data from NHS Digital for September 2018, published last month, which showed an increase of 41 from September 2017**. However, looking back to September 2015 – the last set of workforce data before NHS England's GP Forward View was announced, with a pledge of 5,000 more GPs by 2020 – the total number has dropped by 460. Taking the data at Clinical Commissioning Group-level, it has identified where in the country has seen the biggest increase in GP numbers – with one area seeing an extra 87 GPs since September 2015 – and where has seen the biggest decrease. Areas with biggest increases in GP numbers between Sept 2015-Sept 2018: NHS Liverpool CCG (87) NHS Northern, Eastern and Western Devon CCG (67) NHS Kernow CCG (54) NHS Lambeth CCG (45) NHS Gloucestershire CCG (41) Areas with biggest decreases in GP numbers between Sept 2015-Sept 2018: NHS Horsham and Mid Sussex CCG (-52) NHS Walsall CCG (-33) NHS Portsmouth CCG (-29) NHS Hull CCG (-22) NHS Thanet CCG (-19) The College says that a primary factor in GPs leaving the workforce prematurely is excessive workload, which has risen substantially in recent years both in volume and complexity, yet the share of the NHS England budget general practice receives is less than it was a decade ago, and GP numbers are lower than they were three years ago. Last month the College renewed its long-standing calls for general practice to receive 11% of the overall NHS budget as part of the forthcoming 10-year plan for the NHS. The recent announcement that £3.5bn of the promised £20.5bn NHS uplift would be allocated for primary and community care shows a commitment to supporting healthcare services closer to home for patients. However, general practice currently receives 9.5%*** of the NHS England budget, and the College has called for assurances that general practice, specifically, will be a key recipient of this new funding. It says 11% of the budget for general practice would enable: Larger practice teams, which would enable GPs to spend more time than the standard 10-minute consultation with patients who need it. A wider range of healthcare professionals to provide a wider range of clinical services in GP surgeries. IT systems allowing more surgeries to use video consultations as part of a standard range of consultation options, and to enable joined-up care across the NHS.  Modernised, fit-for-purpose surgeries as the 'hub' of the community A bigger workforce, where more healthcare professionals will choose general practice as a career and are supported by better-funded training placements in the community. Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "All GPs are overworked, many are stressed, and some are making themselves seriously ill working hours that are simply unsafe, for both themselves and their patients - it is making them want to leave the profession. It is forcing some GPs to hand back their keys and close their surgeries for good. "This is having a serious impact on many of our patients, who are waiting longer and longer to secure a GP appointment. But it also means we don't have the time we need with patients – particularly the growing number living with multiple, complex conditions – so the standard 10-minute appointment is simply unfit for purpose. GPs often find ourselves fire-fighting by prioritising the urgent cases, whereas the strength of general practice is to prevent disease and identify conditions in the early stages, to avoid them becoming more serious – and costlier to the health service. "About a third of the GPs we surveyed said they were unlikely to be working in general practice in five years' time. This is gravely concerning. We are talking about highly-trained, highly-skilled doctors, that the NHS is at risk of losing – some will retire, which is to be expected, but many are planning to leave earlier than they otherwise would have done because of stress and the intense pressures they face on a day to day basis, whilst simply trying to do their best for their patients. "These GPs are the ones we need to be focussing our energy on – to make their working situation safer and more sustainable. "NHS England and Health Education England have done excellent work, supported by the RCGP and others, to encourage more doctors to specialise in general practice and we now have more GPs in training than ever before. But GP specialty-training takes three years, and if as many GPs are leaving the profession as entering it, we are fighting an uphill battle, when realistically we need thousands more. "We need to see this level of effort replicated in initiatives to retain GPs already in the profession, to reduce our escalating and often unnecessary workload, and to support GPs and our teams' own health and wellbeing. "The RCGP is calling for general practice to receive 11% of the overall NHS budget as part of the forthcoming 10-year plan for the NHS. Investing in general practice is investing in the entire NHS. It is an investment in good patient care."

Sir, Her Majesty's Inspectorate for Constabulary Fire and Rescue Services really needs to check its facts (GPs dump mental health cases on us, complain police – November 27 2018). GPs and our teams have the greatest respect for our emergency services, and we collaborate with them on a daily basis, but to accuse hardworking family doctors of 'shunting' patients after closing our doors at 5pm is disgraceful, disappointing and demeaning. 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 rising patient demand at a time when we also have a severe shortage of family doctors. We are managing complex conditions in the community - including serious mental health issues - that even a decade ago would have been automatically referred to hospital consultants. My members routinely report working over 12 hours every  day – indeed at my own surgery in Lichfield on Monday, I had over 100 patient contacts - so to say we close our doors at 5pm is completely untrue and unfair. GP surgery core hours are 8.00-18:30 and all practices in England now offer extended routine services, whether in the evening until 20:00 or at weekends. Outside these hours, GP-led out of hours services will take responsibility for the care of our patients with urgent health needs. Even when our doors are 'closed', we are still working on referrals, following up test results and all the tasks that were once part of our working day but now have to be done in our own time because we are constantly running to catch up. Our emergency services are under enormous pressure, but so is general practice,  and we achieve more for our patients by supporting each other and working together, rather than using GPs as an easy target and apportioning inappropriate blame. Professor Helen Stokes-Lampard, Chair Royal College of General Practitioners 30 Euston Square London, NW1 2FB

She said: "GPs are in an incredibly difficult position when it comes to making referrals or ordering blood tests and other investigations, in that we get criticised when we do, and criticised when we don't. Ultimately, our priority is to our patients and we will work in their best interests. "This research looks at the increase of number of requests for tests GPs make, but not the reasons why and whether they were appropriate – and both of those must be key when making a judgement about whether an increase is positive, or not. "The fact that the last 15 years have seen more varied and more accurate diagnostic tests become available in the NHS is a good thing – but these do come at a cost. It's obviously important to consider NHS resources when deciding to make a request for a test, but GPs and their teams don't take the decision lightly, or if they don't think they will genuinely help in narrowing down what might be wrong with a patient. "We're now serving a growing and ageing population, and where many patients are living with multi-morbidities, so, as this report shows, there will be a completely appropriate increase in the number of tests being carried out in the community as these conditions and the medications used to treat them are monitored. We would argue that GPs and our teams need far better access to diagnostic tests in the community, so that we can make a more informed decision about requesting more specialised tests or making a referral to a hospital colleague."