This page shows a summary of the latest news from the Royal College of General Practitioners RSS News Feed.15-minute minimum consultations, continuity of care through 'micro-teams', and an end to isolated working: this is the future of general practice
It states that by 2030 face-to-face GP consultations will be at least 15 minutes, with longer for those patients who need it.
Recent research showed that the UK offers some of the shortest GP consultations amongst economically-advanced nations at 9.2 minutes – with another study finding that the average GP consultation involved discussion of two and a half health problems.
It's estimated that the number of people with a single chronic condition increased by 4%, and with multiple chronic conditions by 8% per year between 2003/4-2015/16 – and that patients with long-term conditions account for around 50% of all GP appointments.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "It is abundantly clear that the standard 10-minute appointment is unfit for purpose. It's increasingly rare for a patient to present with a just single health condition, and we cannot deal with this adequately in 10 minutes.
"GPs we want to deliver truly holistic care to our patients, considering all the physical, psychological and social factors potentially impacting on their health. But this depends on us having more time to spend with patients, and the resources and people to allow us to do this.
"NHS bodies across the UK do not stipulate how long GP appointments should be, but GP workload is soaring, GP numbers are falling, and patients are already waiting too long to secure an appointment as a result. Without more resources and an expanded workforce, longer consultations would simply mean increased waiting times, undermining patients' ability to access the care that they need."
Fit for the Future – the College's vision of what general practice will look like in 2030 - was informed through consultation with more than 3,000 GPs, other health professionals and patients, as well as research commissioned from The King's Fund. It also predicts:
- An overhaul of the GP-patient record into a personalised 'data dashboard', accessible by healthcare professionals across the NHS, and that will draw on data from the patient's genomic profile and wearable monitoring devices.
- Networks of GP practices will evolve into 'wellbeing hubs' with expanded teams offering a wider range of services, both clinical and non-clinical – and that access will increasingly be via digital and video channels.
- Continuity of care will be maintained and improved but delivered via 'micro-teams', so that alongside having a named GP, patients can build long-term relationships with several members of a multi-disciplinary team. The GP team will include established nursing and pharmacy roles, but also emerging roles, such as physiotherapists, occupational therapists, link workers, dieticians and health coaches.
- GPs will no longer work in isolation – practices will work in networks or clusters, allowing them to pool resources and people, but facilitating smaller practices to retain their independence and patient lists.
- A greater use of AI to improve triage systems that assess the severity of a patient’s health needs, enhance diagnosis, flag 'at risk' patients, and safely identify the most appropriate care pathway.
Professor Stokes-Lampard continued: "Much of what we envision for the future of our profession we are already embarking upon in some form or another – but we need to make sure that whatever we do is safe, evidence-based and ultimately works to make general practice and the wider NHS more sustainable. In many cases, we're simply not there, yet.
"Ours is an ambitious vision but it is not a pipe dream. Realising it will depend on having a sufficiently resourced service to keep people well and provide them with the care they need around the clock, and we have identified several key enablers to deliver this.
"With these building blocks in place we can not only deliver world class, patient-centred primary care, we can ensure that being a GP is the best job in the world."
The College's report states that realising the vision is predicated on six 'enablers', including that general practice receives at least 11% of the NHS budget in all four nations of the UK; the full-time equivalent GP workforce expands by thousands, as does the wider practice team workforce; and that GP specialty training is extended to at least four years to expose trainees to the full breadth of skills and conditions they are likely to need and see in general practice.
The RCGP will now develop four 'roadmaps' outlining in more detail what needs to be done to realise its vision and advocating to governments and decision-makers in England, Scotland, Wales and Northern Ireland how to deliver it.
Professor Stokes-Lampard added: "Across the UK, patients have consistently high levels of trust and satisfaction in their GP service – they value general practice, the continuity of care it delivers, and how GPs and our teams deliver care close to home, thereby alleviating pressures across the NHS. We must protect our profession, and nurture it, for the sake of our GP workforce, the wider NHS and our patients.
"Things are incredibly tough at the moment for many working in general practice, but we have had promises of more funding, resources and GPs across the UK, a new five-year GP contract in England promising to ensure money gets to the front line of patient care, new contracts in Wales and Scotland, and new state-backed indemnity schemes in England and Wales.
"The pieces of the jigsaw are fitting together, and our vision should be the final piece, showing what the end result should look like – a thriving general practice service, continuing to keep the rest of the NHS sustainable and our patients safe - and how to achieve it.
"If everything is implemented effectively, we are at the dawn of a new era and I'm optimistic that the future of our profession - of the NHS, and patient care - is a bright one."
The psychoanalysts worked with groups of pioneering GPs in the 1950s, holding teaching and research seminars to explore the dynamics of the doctor-patient relationships and its role in diagnosis and treatment.
Their insights proved so powerful that there are still Balint societies worldwide dedicated to the training of doctors and to a sensitive and humane understanding of the tasks of medicine.
A blue plaque in commemoration of the couple's life and work will be unveiled at their former home at 7 Park Square West on Thursday (16 May) during a special ceremony to be attended by the Lord Mayor of Westminster, Ruth Bush.
The commemoration is being made by the RCGP's Heritage Committee and the Balint Society - 50 years after the group was founded to continue their work.
This is the fifth blue plaque to be presented by the RCGP. Previous recipients are doctor turned novelist, Archibald Joseph Cronin; Fraser Rose, co-founder of the RCGP; RMS McConaghey, a member of the RCGP's Foundation Council and founding editor of the British Journal of General Practice; and Professor Richard Scott, the first professor of general practice in the world.
Michael Balint was born in Budapest on 3 December 1896. The son of a GP, he studied medicine at Semmelweiss University and later trained in psychoanalysis with Sandor Ferenczi.
He emigrated to the UK in 1938 following hostility towards psychoanalysis from the Hungarian Fascist Government. He began practising in Manchester before taking up a position at London's Tavistock Clinic.
It was there that he met his wife and collaborator, Enid Balint and became established an outstanding reputation in two distinct fields – as one of the foremost theorists in psychoanalysis, and a pioneer researcher into the doctor patient relationship.
Enid was born in London on 1 December 1903. After studying psychoanalysis, she began working at the Tavistock Institute of Human Relations and joined a group of social workers and psychologists committed to the idea of investigating marital problems.
Together, the pair developed Balint groups whereby physicians had means to share problems of general practice, specifically focused on responses of doctors to their patients.
The UK Balint Society was founded in 1969 to continue the work begun by Michael and Enid Balint in the 1950s. It is this year celebrating 50 years of helping health and social care professionals better understand the emotional content of their relationship with patients or clients as Balint groups now reach into hospitals, medical schools and community teams.
Michael Balint died on 31 December 1970 whilst serving as president of the British Psychoanalytical Society.
Dr Caroline Palmer, president of the Balint Society, said: "We are thrilled that the RCGP has publicly honoured Michael and Enid Balint and their work.
"The Balints had a profoundly positive effect on the development of general practice, and the Balint Society continues to foster links between psychoanalysis and general practice.
"All our GP members are also members or fellows of the RCGP and we are delighted that this occasion brings the College and the Society closer together – something especially exciting and significant as we celebrate the 50th anniversary of the founding of the Balint Society this year."
Professor Mayur Lakhani CBE, president of the RCGP, said: "I am pleased to be able to unveil this plaque as a legacy on the building where Michael and Enid Balint lived and where I am sure so many inspiring ideas were formed and which influenced generations of GPs.
"Their methods have helped us to better understand the holistic nature of general practice, offering insight about the relationships between patients and doctors that continues to be explored and which we still see having an impact on the profession and patient care today."
Thursday's celebration will take place at 7 Park Square West, Regents Park from 4.30pm. Special guests will include Caroline Palmer, president of the Balint Society; a former Balint student; the Lord Mayor of Westminster, Ruth Bush; and RCGP president, Mayur Lakhani, who will unveil the plaque.
She said: "Prescribing is a core skill for GPs and we will always aim to take into account the physical, psychological and social factors potentially affecting a patient before recommending any form of medication – as well as taking into account relevant clinical guidelines.
"Thyroid hormones are powerful drugs and GPs will only ever prescribe them if we think they are of genuine benefit to the person sitting in front of us, particularly as it usually means taking the tablets and being monitored in the long-term. If evidence shows that they are not going to be of benefit to our patients, it is important that we know this and that it is reflected in the clinical guidelines that inform our decision-making.
"The authors make a powerful case based on emerging evidence, and it is important that this new research is taken on board as clinical guidelines are updated and developed, in the best interests of our patients. It is also important that patients do not suddenly stop taking their thyroxine medication, but that they discuss this with their GP at their next routine medication review."
"Not every woman going through the menopause wants to be or needs to be on HRT, and clinical guidelines don't suggest they should be. However, the latest research does suggest that for many women, HRT can be a safe and effective intervention to alleviate menopausal symptoms.
"Evidence and myths around the use of HRT has been very confusing and contradictory – to patients and healthcare professionals - which is why it's important that clinical guidelines are updated regularly to take into account the latest clinical evidence, and that any changes filter down to doctors on the frontline of patient care.
"It is also vital that women have access to high-quality, evidence-based information so that they can make an informed decision based on their individual circumstances, in conversation with their GP, about the options available to them and the various risks and benefits of each.
"Women's Health is a clinical priority for the RCGP and we have worked with partners including the British Menopause Society, the Royal College of Obstetricians and Gynaecologists and Faculty of Sexual and Reproductive Health, to develop educational resources to support GPs and other healthcare professionals deliver the best possible care for women, based on the latest evidence."
More than 800 general practices have now signed up to be a 'parkrun practice'; linking with their local parkrun event to promote the health and wellbeing of patients and staff, and create entire communities centred on wellness.
parkruns are volunteer-led 5k events that take place each Saturday morning across the UK and are open to walkers, runners and volunteers of all ages and abilities. parkruns are socially-focussed with the emphasis on regular participation rather than performance.
To celebrate the first anniversary of the parkrun practice initiative launched by parkrun and the Royal College of General Practitioners in June last year, the two organisations have teamed up to hold a national GP parkrun pledge day. The aim is to get as many general practice staff as possible to pledge in advance, to join thousands of walkers, runners and volunteers at parkrun events across the UK on the same day.
The GP parkrun pledge day is the first event of its type, and builds on the success of last year's celebration across hundreds of parkruns to mark the NHS's 70th birthday. That day saw more than 146,000 people take part in parkrun, with a 14% increase in the number of participants who were inactive when they registered and 9,000 people participating for the very first time.
On 1 June, general practice staff across the country are being encouraged to pledge to participate in a parkrun event and also to bring their patients, family and friends along to walk, run, volunteer or spectate.
It is hoped that this special day will raise awareness of parkrun across the health sector and help promote sustained participation by those who are least active or have health conditions.
Inactivity is a leading cause of premature illness and death in the UK, and GPs and their teams play a key role in empowering their patients to get more active and improve their health. Thousands of GP practice staff up and down the country, including Dr Andrew Boyd, the RCGP Clinical Champion for Physical Activity and Lifestyle, are encouraging patients to take part in parkrun to help prevent, treat or improve common conditions such as anxiety, depression, diabetes, cancer, heart disease and high blood pressure. Andrew said: "parkrun provides an accessible, unintimidating local opportunity for patients and staff to increase their activity levels, and have fun doing it, all in the great outdoors – and for free."
Dr Rangan Chatterjee, Author, GP and star of BBC One's Dr in the House, said: "It is becoming more and more common for a patient's symptoms to be caused by our collective modern lifestyles. For many, it is a change in lifestyle that will address the root cause of the problem and have a lasting impact, rather than a pill that often will only suppress their symptoms. At a time when the NHS is under huge pressure – with prescriptions alone costing around £10 billion every year – equipping healthcare professionals to prescribe a lifestyle change, where appropriate, is extremely important. Nationwide initiatives such as parkrun that are accessible to everyone, free and socially-focussed have the potential to help people take their first steps to a healthier and happier lifestyle, and in doing so relieve some of the strain on our health service. I take part in parkrun with my family every weekend and have seen first hand the benefits it brings to individuals and whole communities. With 800 practices now signed up to be a 'parkrun practice' we are starting to embed the links between primary care and voluntary sector organisations, and build strong, supportive communities that are focused on health creation. The GP parkrun pledge day is a really important way of maintaining that momentum and celebrating the progress that has been made".
Dr Zoe Williams, RCGP Clinical Champion for Physical Activity & Lifestyle and TV Doctor said: "The parkrun practice initiative has been a huge success so far, with over 800 practices signing up in the first year. We've heard incredible stories from patients, their relatives and GP staff. From getting their smile back, to improving their physical health, to feeling a part of their community again, the benefits are wide and varied, and absolutely everyone is welcome. So please help us to spread the word and get as many GP practice staff as possible to pledge to walk, run or volunteer at a parkrun on 1st June."
Professor Helen Stokes Lampard, GP and Chair of RCGP said: "The RCGP partnership with parkrun has captured the imagination of GPs and their teams right around the UK. The walk or run approach makes exercise accessible and inclusive, and the pledge day on 1st June is a good way of encouraging more practices to sign up and take part."
"There is some excellent work ongoing to boost recruitment into general practice and as a result we have more GPs in training that ever before. But GPs cannot be trained overnight, and whilst we wait for the next generation of family doctors to enter the workforce, existing GPs and our teams are struggling to manage escalating workloads without enough time or the resources to deal with them.
"Demand for GP services is escalating both in terms of volume and complexity – and when this is compounded by falling GP numbers, it creates a perfect storm that is leading to GPs becoming stressed and burning out, and in many cases leaving NHS general practice far earlier than they might otherwise have done.
"More must be done to keep our hard-working, experienced GPs in the profession for longer – not only are they vital to delivering vital care to over a million patients a day, but they have a huge amount of wisdom to impart to new colleagues.
"We are optimistic about the future of general practice: the financial commitment to primary and community care in the NHS long-term plan in England; the new five-year GP contract which promises that money will get to the front line; and pledges to ensure greater investment in technology are all part of a jigsaw that should help keep the NHS sustainable for the future. But GP numbers, which as this research shows are still falling, cannot be ignored.
"We need see more measures implemented to genuinely tackle soaring workload as a matter of urgency and efforts redoubled to cut red tape that diverts time away from patients, and we need to make the working environment in general practice supportive and sustainable, so that family doctors aren’t forced out of the profession. This would not just be in the best interests of GPs, but the NHS as a whole, and most importantly, our patients."
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."