Dr Helen Stokes Lampard - The challenges facing GPs in the current Healthcare Environment - Wednesday 31 May 2017

“All of the royal colleges are about quality and standards,” chair of the Royal College of GPs (RCGP), Dr Helen Stokes-Lampard, told Care Conversation delegates. Representing 52,000 family doctors across the UK, the RCGP was the largest of all, however, with a vision of “excellence in general practice for patients worldwide”.

The organisation was committed to the delivery of high-quality healthcare for all, she said. “Primary care, secondary care, social care – you need them all or the system falls over. A strain on one is a strain on all of them – if GPs shut up shop tomorrow, it’s very likely that NHS hospitals would have to shut up shop 48 hours later.”

When GPs drew attention to problems in the system they were frequently accused of scaremongering, however, and the situation had been thrown into further disarray by the General Election. “We’re working on the assumption that it would be foolish to interfere with an existing plan, but obviously we can’t take anything for granted.” The RCGP had set out its case in 2016’s General Practice Forward View document, she said, which included calls for a minimum of 5,000 new GPs, guaranteeing the status of EU healthcare professionals, an extension of GP training and action to build the capacity of nurses in general practice.

“Three and a half years ago we headed a campaign called Put Patients First,” the organisation’s Executive Director of Policy and Engagement, Mark Thomas, told the seminar. “There was a growing sense of crisis about the strain on resources, we were getting reports of practices folding, and GPs were raising profound concerns about their ability to provide safe patient care when they were being so squeezed.”

The RCGP commissioned Deloitte to analyse the proportion of NHS spend going to general practice, he said, and found that it had fallen from 11% to 8.4% in the space of a decade. “That was completely different to the political rhetoric we were all hearing, and something that urgently needed to be addressed if we didn’t want a tsunami of people heading to A&E. And all of this was obviously against a backdrop of people experiencing one or more long-term conditions, whether physical or mental. We’ve got an NHS that was designed around a different model – a 20^th century model where life expectancy was lower and there were far fewer people with multiple conditions.”

The campaign goal was to restore the proportion of spend to 11%, he said, something that was achievable by 2020 if the recommendations of the GP Forward View were implemented in full. “However, the vision we set out isn’t one of just getting more money to do more of the same.” While there were key aspects of general practice that it was crucial to retain, such as a population-based approach with patients registered at a single practitioner and continuity of care, there were also elements that the RCGP “absolutely accepted” needed to change.

“We need to break down the barriers that still exist between GPs and other parts of primary and community care, as well as social care and the voluntary sector, and to significantly expand the role of social prescribing.” Another key challenge was IT, he told delegates. “We live in a digital age, and patients want to be able to communicate with their doctor in a whole range of ways.”

It was also vital to look at ways in which patients could be empowered to understand and take charge of their conditions to achieve a genuine partnership approach with joint decision-making, and general practice also needed to develop as a set of providers, he said. “The college sees the need to retain what’s good about general practice – the sense of community, the doctor/patient role – but we also need to develop larger-scale provision, although there’s clearly no one size fits all. We see the future as a mixed economy with lots of collaboration.” This would be vital to enable the necessary shift of care from hospitals into the community, he stressed. Investment was increasing, but so was demand, and the GP Forward View set out a credible plan to give general practice the lifeline it required.

Getting the relationship right between primary, secondary and social care was ultimately about trust and “having honest conversations behind closed doors”, Helen Stokes Lampard told the seminar. “At the moment we’re in a crisis. There’s too much work for everybody, and in every crisis situation cooperation becomes a lot more attractive. But the first thing we need to do is trust each other. It’s incredibly empowering when we do that.”