GP Frontline, Autumn 2022

MA GA ZI NE O F TH E R CGP  I SSU E 21  A U TU MN 2 0 22

CONTENTS 03 | NEWS IN BRIEF 04 | BIG INTERVIEW 04

Dame Jenny Harries on being a public face of the pandemic and her new role at UKHSA

07 | POLICY FOCUS 07

RCGP campaign to make general practice ‘fit for the future’

09

04 12

Q&A with Welsh Health Minister Eluned Morgan

10 | NEWS AND FEATURES 10

Meet next College Chair Kamila Hawthorne

12

‘Media GPs’ in the spotlight

14

Roundup from Wonca/RCGP Annual Conference 2022

15

10-minute consultation with Ursula Mason, incoming Chair of RCGPNI

Welcome to GP Frontline

by Professor Martin Marshall

I 14

17 | OPINION 17

Why general practice needs mental health practitioners

19 | GP LIVES

The medic working on the margins, the champion for women’s health, the Council activist, and the GP volunteering in war zones tell their stories

24 | BACK PAGE 24

Book now for RCGP virtual conference, October 2022

Editors: Daniel Openshaw, Gillian Watson

Reporters: Amy Boreham, Lucy Greenwood, Jonathan Blay, Cliona McCarney, Nicholas Webb Cover cartoon: Martin Rowson

Inside cartoon: Kipper Williams Design: Aura Creative Ltd

Feedback: can be emailed to gpfrontline@rcgp.org.uk or tweeted using #gpfrontline. You can also write to us at GP Frontline, 30 Euston Square, London, NW1 2FB

CONTENTS

| 02

22

t’s hard to believe that this will be my last GP Frontline column as your Chair. With November fast approaching, I will soon be passing over to my successor, the brilliant Kamila Hawthorne (see her first interview as Chair-elect on p10).

I was clear what I wanted to achieve for the College when I took on the role in November 2019, with my priorities of making the job of a GP ‘do-able’ again, highlighting the importance of having time to build trusting relationships with our patients, and supporting practices to adapt to new ways of working.

We all know what happened next and we have worked and lived through the toughest time in general practice and the wider health service since the NHS was established in 1948.

Escalating workload and GP shortages were taking their toll even before the pandemic, and these pressures have only worsened. We are now grappling with additional responsibilities resulting from Covid, including managing ‘long Covid’ cases in the community and the care of those patients who are bearing the brunt of NHS backlogs, with long waiting times for operations and specialist treatments.

Patients are also increasingly turning to us for support with the cost of living crisis, so there are even bigger challenges ahead.

In spite of everything, you and your teams continue to give your very best in the most difficult of circumstances – and even in the face of the totally unacceptable media and political criticism that’s been levelled at us so frequently of late.

I’ll say yet again that the way in which you adapted to new ways of

working, in particular maximising the potential of new technologies, right from the start of the pandemic was remarkable – as is the care that you deliver to millions of patients, day in and day out.

There is still so much to be proud of as our specialty evolves and adapts to working at larger scale and with multidisciplinary teams, and we must never lose sight of this.

Ever the optimist, I’m confident that common sense has to prevail and that the true value of general practice will be recognised – by politicians and policy-makers, and, most importantly, by our patients and the public who remain our most powerful advocates.

GPs deserve to work in a service that is appropriately funded and supported and your College will continue to fight for this (see p7).

I know I’m biased but it’s my view that GPs are the NHS’s biggest asset and being your Chair for the past three years has been the most enormous privilege.

Thank you for allowing me that privilege, and for the work you do for patients, our College, and our profession.

Goodbye, good luck and take care.

Martin Marshall

MINISTER VISITS VETERAN FRIENDLY ACCREDITED PRACTICE The College’s innovative Veteran Friendly Accredited Scheme had a boost in July when Minister for Veterans’ Affairs at the time, and a veteran himself, Johnny Mercer MP, visited the Atlantic Medical Group in Penzance, hosted by College Member and champion of the project, Matthew Boulter (pictured: Mercer, centre; Boulter, far right).

The College is stepping up its efforts in lobbying the Home Office and others for GP trainees from overseas to be given indefinite leave to remain on completion of their GP training in the UK. At the very least, it is calling for overseas GPs to be given a three-month visa extension after CCT to allow them to secure sponsorship for employment in UK general practice.

College Chair Martin Marshall wrote to the former Home Secretary about this, and Vice Chair for Professional Development Margaret Ikpoh gave powerful evidence to the Health Select Committee on the issue and the consequences both for the trainees affected and general practice. The issue was widely covered in the national media.

Giving GP trainees from overseas

indefinite leave to remain would bring general practice in line with other medical specialties that have training programmes five years or longer. It would also remove a barrier to IMG trainees, who have trained in the UK, leaving NHS general practice because of difficulties securing visa sponsorship.

This is a top priority for the College and Martin and Margaret have written another open letter to new Home Secretary, Suella Braverman, calling on the Home Office, calling on the Home Office to find a national solution to address this matter with urgency. At time of publication, more than 4,200 GPs, trainees and retired GP had signed the letter, to put further pressure on the Government to take action. 

Cabinet Office

LOBBYING EFFORTS TO SECURE IMG TRAINEES INDEFINITE LEAVE TO REMAIN Being ‘Veteran Friendly Accredited’ supports practices to deliver the care veterans need for their unique health needs. An evaluation by the University of Chester revealed that it leads to better healthcare for veterans and is recommended by 99% of practice staff.

What started out as a Midland Faculty project, now has more than 1,500 practices signed up. The scheme was conceived by Iraq veteran and GP Mike Brookes, taken forward by former College Hon Sec Jonathan Leach and Brigadier (Ret’d) Robin Simpson and is now being rolled out across England with support from NHS England. It’s designed with busy practice teams in mind and includes a simple process for coding veteran patients and information about supporting and referring veterans to specialist services.

Find out more about how your practice can become Veteran Friendly Accredited. 

NEW COLLEGE WEBSITE GOES LIVE We hope you’re noticing improvements to the RCGP website. The re-design reflects the views of College members across the UK. As well as being more user-friendly and easier to navigate, it showcases the ‘stories’ of individual members at all career stages.

It is also compatible with phones, iPads and other mobile devices and there are significant improvements in digital accessibility.

Over the coming months we will continue to improve the site, expanding the content and functionality. 

NEWS IN BRIEF

| 03

B IG I N T ER VI EW

PUBLIC HEALTH IN THE PUBLIC EYE

A

s inaugural Chief Executive of the UK Health Security Agency (UKHSA), Professor Dame Jenny Harries now oversees some of the labs where her father, a virologist, once worked visualising coronaviruses using electron microscopy.

At a recent event at Oxford University on pandemic preparedness, she describes seeing her father, who passed away at the start of the Covid-19 pandemic, staring back at her from a photo on one of the slides. ”It's gone full cycle in the family, which was completely unintentional but quite satisfying,” she says.

Dame Jenny wants to make one thing very clear: we are still in a pandemic. It's something that comes up three times in the first five minutes of our conversation – and continuing to manage it, albeit in a more proactive way, is her top priority as head of the UKHSA. Arguably best known as Deputy Chief Medical Officer for England during the Covid-19 pandemic, Dame Jenny was a very public face of the crisis, regularly appearing at the Government’s daily press conferences alongside Chief Medical Officer for England, Chris Whitty, former Deputy Chief Medical Officer for England, Jonathan Van Tam, and others. ”Between us, we had probably all the right skills and experience across completely different settings,” she says, keen to emphasise that leading the vaccination response was very much a team effort.

Now at the helm of the UKHSA, Dame Jenny stresses that whilst continuing to manage Covid is a big part of the role, significant other work is also ongoing. ”We've had Lassa fever. We've had monkeypox. We prevented children eating some potentially salmonella-infected chocolate just before Easter. ”We focus on health protection, protecting communities, preventing health threats and responding to those that arise. We do chemical, biological, radiation and nuclear response. We're using cutting edge data and analytics and scientific and genomic skills to have a really fast response.”

UKHSA replaced Public Health England last October, retaining its health protection and science elements along with the Joint Biosecurity Centre – the data and analytics element set up for the pandemic – and NHS Test and Trace. All of PHE's

BIG INTERVIEW

| 04

longstanding preventative work, including smoking cessation, nutrition and promotion of physical activity moved to the Office for Health Improvement and Disparities (OHID) in the Department of Health and Social Care.

On NHS Test and Trace, which has received widespread criticism due to its cost – 37bn between 2020-22 – and use of private companies, Dame Jenny is not in full agreement with all the points detractors have raised, highlighting the 'miraculous' scale, size, complexity, digitalisation and speed of the operation. ”We've gone a long way. We had one of the largest testing capabilities, certainly in Europe, by the end of last year, so when Omicron hit, testing capacity was not really an issue…We've gained lots of new learning,” she says, explaining how it has already been used successfully in the current monkeypox outbreak.

Learning is a theme of Dame Jenny’s overall experience of the pandemic: ”Every time you're asked to do something which stretches you or you didn't quite anticipate, the learning is enormous.

Assuming you come out of the other end in one piece, you've condensed years of learning into a very short time.”

It's also what will help achieve one of her big ambitions: to accomplish the 100 Day Mission to go from identification of a new variant to having a new vaccine available in 100 days. ”We got to about 352 days in the pandemic. Previously it might have been five to eight years,” she explains, ”with that learning and all the safeguards and governance in place, the 100 Day Mission is realisable.”

She describes being part of the top team leading the pandemic response as 'hugely responsible', 'quite demanding', needing 'strong resilience' and 'hugely privileged'.

It's also changed her view of public perceptions of health protection response activity. ”I used to think, if it was running quietly, that meant everything was smoothly going…Actually, now, I want us to be noisier.”

Nevertheless, she asserts it isn't UKHSA's job to tell people what to do but to 'give really clear information and the rationale for them to be able to make the decisions they feel are right for them.' ”We communicate the logic,” she says, ”and it's been very clear throughout the pandemic that

Grainge photography

Professor Dame Jenny Harries, Chief Executive of the UK Health Security Agency, and Deputy Chief Medical Officer during the Covid-19 pandemic, talks to GP Frontline about learning from crises – and being scrutinised in the public eye.

“GPs are our public health link to every single family across the country.” getting different pieces of information to different communities is critical.”

That's partly where she sees general practice having a role: ”GPs are our public health link to every single family across the country,” she says, ”the reality is, somebody like me or my staff are a very small component of interaction with the public.”

As one of the most recognisable faces of the pandemic, Dame Jenny has been at the receiving end of harsh criticism from some sections of the media, including a particularly personal attack questioning whether she should have been awarded her Damehood in the Queen's New Year Honours 2022.

It's something she plays down, particularly when asked to consider whether she thinks she received harsher criticism than her colleagues, and whether that was because she's a woman in a leadership role. ”I was so busy, I may well not have noticed, I was getting on with the job,” she says. ”Scrutiny is as you would expect…it's part of the job. That's good, you use it to improve. There's no point going into a senior post or public health role if you're not prepared to be scrutinised. The difficulty is where scrutiny turns into, let's just say less evidenced lines of enquiry… [that are] not productive and can be confusing to the public…and if comments and scrutiny move into abuse, that's something we need to move away from.”

She'd rather concentrate on the positives: ”There is actually both a responsibility and a great opportunity in being a woman leader out there.

It's undoubtedly been really positive for scientif-

ic colleagues and clinical colleagues. Many people have said how good it was to see a woman up there. So, it has its difficulties, but lots of positives too.”

And despite the media vitriol, Dame Jenny cites receiving her Damehood in July as a highlight of her career. ”If someone had suggested a few years ago that I'd end up walking into Buckingham Palace to collect a Damehood, I would not have believed it. It's a very humbling experience.

People say, 'it's for everybody around me' and you really feel that when you go and get it. I know exactly what they mean.”

Dame Jenny describes her career path to this point as 'slightly unintentional' and driven by 'a passion for taking evidence and information and turning it into something useful to improve people's health’. She completed her medical degree at Birmingham University, during which she also completed a degree in pharmacology, and then worked as a junior hospital doctor in a variety of specialist areas.

At this time, she was pre-occupied as to why so many people were coming through the doors of A&E with preventable conditions and what could be done to help prevent them doing so to free up capacity to treat those who could only be treated there. As she worked her way up in public health, she encountered 'a managerial element, a systems organisation element and a political one', the latter, she says, 'much to my amazement', she really enjoyed.

Having worked in health protection, working on responses to Ebola, Zika, MERS and the Novichok continues



BIG INTERVIEW

| 05

Provided by UKHSA

Grainge photography

“I don't think it's my job to relax, that would definitely be the wrong thing to do.”

attack in Salisbury amongst others, she applied for the Deputy CMO role which normally deals with prevention. ”You can have a bit too much excitement in health protection,” she laughs, ”so I thought I'd do some health improvement work.”

It didn't go to plan; mere months after starting the role, the pandemic hit.

And whilst Dame Jenny is very clear that Covid-19 continues to be a significant threat, she thinks the last couple of months have been indicative of the next major public health emergency: climate change. She estimates that over the three or four days in July when temperatures hit 40 degrees, there would have 'probably been a significant number of excess deaths’. ”It's a slower sort of incident response, perhaps, but very important,” she says.

General practice was a career option for her, having spent time working in the specialty during her medical training. She describes herself as 'a huge primary care fan' but that she doesn’t feel she's 'constructed the right way' to be a GP: ”GPs have to be generalists and be able to spot the anomaly in the hundreds of patients who come through their door. Their role is unique.

There are very few people who can hold the balance between the generalist and specialist bit. I admire that.”

It's not just the access GPs have to patients and the trust patients have in them that Dame Jenny says makes general practice so important to public health. She cites the potential of GP practices for data collection and research, giving a special mention to the RCGP's Research and Surveillance Centre, run in conjunction with Oxford University. ”It's really important and we're really grateful to practices that are signed up. It's been going for 50 years now, which is a sign of how important it is,

BIG INTERVIEW

| 06

and there are huge opportunities going forward.

It's gone well beyond monitoring respiratory disease and flu rates, which was predominantly the case before. ”There's a health inequalities angle too. Having GP practices signed up in areas of deprivation is really important for our understanding and to be able to plan public health interventions. The more practices signed up, the more community and geographical reach, and the more representative we can be.”

She describes the efforts of GPs and their teams during the pandemic as 'heroic'. ”They set up vaccination centres overnight, they completely moved forward in a week or two from the way they see patients,” she says. And whilst she recognises new ways of working in general practice have been controversial, she describes them as a lifeline for many patients who were clinically extremely vulnerable or found it difficult to travel.

On the scrutiny faced by those on the frontline of healthcare, she adds: ”None of it should move towards abuse, that's inappropriate and it just means none of us can do our jobs, including GPs. ”Many people don't understand quite how hard people have been working, because they don't understand the complexity of the roles they're carrying out,” she explains. ”We're all on a little bit of a journey, we need to learn from the pandemic and keep good bits and drop bits that didn't work so well.”

As to her approach to leading an organisation that by its very nature is relentless: does she see any downtime on the horizon? ”I don't think it's my job to relax,” she said, ”that would definitely be the wrong thing to do.” 

Campaigning to make general practice fit for the future Weather forecast

E

very year the RCGP carries out a ‘state of the nation’ survey of our members and your experiences of being on the frontline of patient care.

This year’s results show the starkest signs yet of a profession in crisis.

With 68% of GPs saying they don’t have enough time to adequately assess and treat patients during appointments, and 42% saying that they are planning to quit the profession in the next five years, the need for urgent action has never been clearer.

The RCGP wants the Government to commit to a bold new plan to provide GPs with the support that they need to do the job safely, for themselves and their teams as well as for their patients.

As such, it has launched a new Fit for the Future campaign calling for: •

A new recruitment and retention strategy to go beyond the target of 6,000 more GPs pledged by the Government in their election manifesto

•

An NHS-wide effort to free up GPs to spend more ti with patients by cutting unnecessary work oad and bureaucracy

•

Investment in IT products support for practices

and

• A return to 11% of total health spend for general practice, including £1 billion additional investment in GP premises.

To kickstart the campaign, the College asked GPs across England to add their name to a letter to the Health Secretary, then Sajid Javid. The response was unprecedented, with 4,620 GPs signing up.

In the letter, College Chair Martin Marshall, wrote: ”As GPs, retired GPs and GPs in training in England we are writing to ask you to take action in response to the RCGP's Fit for the Future campaign.

General practice is the cornerstone of the NHS. It helps more patients than the rest of the NHS put together. So, when GPs and their patients say that general

2

Daily Express Monday, July

”It’s clear that many practices are already in crisis, and without action things are likely to get worse.

LIVE That is why we LIVE are calling for a bold new plan to provide GPs and patients with the support that they need.”

Temperatures in Centigrade Glasgow/Argyll: Drizzle during the Caithness/N morning. A mainly dry afternoon.

Moderate with light rain,orth West: Wet and overcast westerly winds. High 16C becoming showery later.

(61F).

Fresh westerly winds. High Edinburgh: Dry with sunny 13C (55F). intervals Falkirk/Stirling: Mainly breaking through by the chance of scattered lightcloudy with a westerly winds. High 18Cafternoon. Fresh (64F). westerly winds. High 18Cshowers. Fresh Fife/Dundee: The odd shower (64F).

Central for a time, but sunny periods is possible as well. Fresh chance ofHighlands: Mostly cloudy with the westerly winds. High 19C showers, heavy (66F).

Moderate westerly winds. for a time.

The Borders: Drizzle High 13C (55F). the morning.

Moray A mainly dry afternoon.during Firth/Aberde en: Mostly cloudy with a scattering of light showers. winds. High 17C (63F). Brisk westerly westerly winds. High 16C Moderate SW Scotland: Overcast with (61F). drizzle in England, Wales and places during the morning.

Ireland: Largely dry and bright Northern westerly winds. High 16C Moderate with sunny spells (61F). through the day. High 24C Shetland/Orkney: Mostly (75F).

Sea: North Sea: Moderate. chance of a few scattered cloudy with the Irish Sea: Moderate. Channel: Moderate. westerly winds. High 12C showers. Fresh (54F).

UK OUTLOOK TOMORROW spells in the south, although : A largely dry and sunny day tomorrow, plenty rain will push eastwards over of bright Scotland later, some heavy.

Glasgow Aberdeen Belfast Cardiff Edinburgh Inverness London Manchester Newcastle

Aberdeen Aberporth Alnwick Belfast Birmingham B’mouth Bristol Cardiff Durham Edinburgh

Britain Extremes:

2.5 7.3 4.3 2.8 7.6 5.6 7.8 7.6 6.7 3.1

SIX-DAY FORECAST Temperatures in Centigrade TUE WED THU FRI SAT 14 16 13 17 14 17 13 21 13 18 13 17 13 23 13 18 14 18

0.07 0.00 0.00 0.01 0.01 0.00 0.01 0.00 0.12 0.00

14 16 14 19 14 18 14 23 14 19 14 18 15 24 14 18 14 20

12 17 12 18 13 19 13 25 12 20 12 19 14 26 13 20 11 20

Britain yesterday

SUN

13 17 13 19 14 20 15 24 13 20 13 19 15 27 13 21 12 20

13 18 13 19 14 20 15 25 13 19 13 20 16 27 14 22 13 22

Moon, sun and tides

10 17 Glasgow 2.0 0.00 11 16 MOON rises: 10.04am, sets: 12.02am 10 16 Hull 6.1 0.01 8 20 SUN rises London: 4.49am, sets: 9.19pm 12 19 Ipswich 7.2 0.02 12 20 Manchester rises: 4.46am, sets: 9.39pm 12 16 Leeds 8.1 0.00 7 18 First Quarter 8 18 Lincoln 07 July 7.4 0.03 11 19 9 20 London 6.7 12 19 Manchester 4.3 0.00 11 24 HIGH TIDE 0.02 8 19 London B’ge (5.46am), (5.59pm) 14 18 Oxford 5.8 0.00 8 20 Liverpool (2.50am), (3.17pm) 11 18 S’hampton 8.4 (4.03am), (4.53pm) 11 17 St Andrews 2.9 0.01 12 21 Greenock 0.00 10 19 Dover Warmest: London (2.46am),

22C (72F) Coldest: Shobdon 6C (43F) (24 hours Wettest: Kirkwall 0.37in. to 2pm yesterday) Sunniest: Shoeburyness 13.1hr.

Today

Amsterdam Brussels Dublin Frankfurt Geneva Lisbon Madrid Paris Rome

13 17 14 20 13 19 14 24 13 20 13 20 15 25 14 20 13 21

Sunny Fair Cloudy Sunny Thunder Fair Sunny Sunny Sunny

Lighting-up times

Belfast Birmingham Bristol

10.01pm-4.55am 9.32pm-4.52am 9.29pm-5.00am

Europe forecast 21C/70F 23C/73F 16C/61F 26C/79F 24C/75F 28C/82F 36C/97F 25C/77F 33C/91F

Amsterdam Brussels Dublin Frankfurt Geneva Lisbon Madrid Paris Rome

(3.07pm)

Glasgow London Manchester Newcastle

10.03pm-4.39am 9.19pm-4.50am 9.39pm-4.47am 9.46pm-4.35am

Tomorrow

Sunny Fair Cloudy Sunny Sunny Sunny Sunny Sunny Sunny

19C/66F 21C/70F 19C/66F 26C/79F 28C/82F 28C/82F 34C/93F 25C/77F 34C/93F

WEATHER SERVICE 0906 156 0206

CALL OUR WEATHER LINE WHERE YOU CAN SPEAK LIVE WITH OUR PLUS YOUR TELEPHONE COMPANY’S EXPERTS FOR UP-TO-DATE FORECASTS. NETWORK ACCESS CHARGE. SERVICE OPEN 8AM - 6PM DAILY. CALLS COST £1.50 PER MINUTE SP SPOKE: 0333 202 3390

Supplied by MeteoGroup

4, 2022

DX1ST

Weather forecast

Take GP servWe icath e er forecast off life support, medics tell Javid Weather forecast

exclusive

By Giles Sheldrick

Chief Reporter

Temperatures in Centigrade

North West: A lot of East Anglia: Dry and and remaining largelycloud but some sun but also patchy cloud. bright with sunshine winds. High 17C (63F).dry. Brisk westerly winds. High 21C (70F).Moderate westerly Northern Ireland: Early then London/South East: A bright largely dry, although lotshowers, of cloud. Fresh and dry day with good spells of sunshine. westerly winds. High a16C (61F). south-westerly winds. High Moderate Wales: Largely dry with a 22C (72F).

South: Dry and fine with sunny sunny spells, especially few bright or spells and variable cloud. Moderate westerly westerly winds. High 18Clater. Moderate (64F). winds.

High 20C (68F).

Midlands: Dry with bright especially later. Moderate or sunny periods, South West: Quite cloudy, westerly winds. particularly in the morning, but some sunshine High 20C (68F). too.

Moderate westerly winds. High 19C North East/Yorks: Largely (66F). cloudy but Channel Isles: Bright and staying dry with some sunshine dry with at times. some lengthy periods of sunshine.

Moderate westerly winds.

High 19C (66F). westerly winds. High 18C Moderate Scotland: Cloudy with heavy (64F).

Sea: North Sea: Moderate. northwestern areas, dry with rain in Irish bright periods Moderate. elsewhere. High 19C (66F).

Channel: Moderate. Sea: UK OUTLOOK TOMORROW spells in the south, although : A largely dry and sunny day tomorrow, plenty rain will push eastwards over of bright Scotland later, some heavy.

London Belfast Birmingham

SIX-DAY FORECAST Temperatures in Centigrade TUE WED THU FRI SAT

Cardiff Glasgow Manchester Newcastle Norwich Plymouth

Aberdeen Aberporth Alnwick Belfast Birmingham B’mouth Bristol Cardiff Durham Edinburgh

Britain Extremes:

2.5 7.3 4.3 2.8 7.6 5.6 7.8 7.6 6.7 3.1

13 23 14 17 13 19 13 21 14 16 13 18 14 18 12 20 12 20

15 25 13 19 14 22 14 24 13 17 14 20 13 21 14 21 14 22

14 26 13 19 13 23 13 25 12 17 13 20 11 20 13 22 14 22

Britain yesterday

0.07 0.00 0.00 0.01 0.01 0.00 0.01 0.00 0.12 0.00

15 27 14 20 14 23 15 24 13 17 13 21 12 20 13 21 14 22

16 27 14 20 14 24 15 25 13 18 14 22 13 22 14 23 15 22

Moon, sun and tides

10 17 Glasgow 2.0 0.00 11 16 MOON rises: 10.04am, sets: 12.02am 10 16 Hull 6.1 0.01 8 20 SUN rises London: 4.49am, sets: 9.19pm 12 19 Ipswich 7.2 0.02 12 20 Manchester rises: 4.46am, sets: 9.39pm 12 16 Leeds 8.1 0.00 7 18 First Quarter 8 18 Lincoln 07 July 7.4 0.03 11 19 9 20 London 6.7 12 19 Manchester 4.3 0.00 11 24 HIGH TIDE 0.02 8 19 London B’ge (5.46am), (5.59pm) 14 18 Oxford 5.8 0.00 8 20 Liverpool (2.50am), (3.17pm) 11 18 S’hampton 8.4 (4.03am), (4.53pm) 11 17 St Andrews 2.9 0.01 12 21 Greenock 0.00 10 19 Dover Warmest: London (2.46am),

22C (72F) Coldest: Shobdon 6C (43F)

(24 hours Wettest: Kirkwall 0.37in. to 2pm yesterday) Sunniest: Shoeburyness

Today

Amsterdam Brussels Dublin Frankfurt Geneva Lisbon Madrid Paris Rome

15 24 14 18 14 21 14 23 14 16 14 18 14 20 14 22 13 21

SUN

Sunny Fair Cloudy Sunny Thunder Fair Sunny Sunny Sunny

13.1hr.

Lighting-up times

Belfast Birmingham Bristol

10.01pm-4.55am 9.32pm-4.52am 9.29pm-5.00am

Europe forecast 21C/70F 23C/73F 16C/61F 26C/79F 24C/75F 28C/82F 36C/97F 25C/77F 33C/91F

Amsterdam Brussels Dublin Frankfurt Geneva Lisbon Madrid Paris Rome

(3.07pm)

Glasgow London Manchester Newcastle

10.03pm-4.39am 9.19pm-4.50am 9.39pm-4.47am 9.46pm-4.35am

Tomorrow Sunny Fair Cloudy Sunny Sunny Sunny Sunny Sunny Sunny

19C/66F 21C/70F 19C/66F 26C/79F 28C/82F 28C/82F 34C/93F 25C/77F 34C/93F

WEATHER SERVICE 0906 156 0206

CALL OUR WEATHER LINE WHERE YOU CAN SPEAK LIVE WITH OUR PLUS YOUR TELEPHONE COMPANY’S EXPERTS FOR UP-TO-DATE FORECASTS. NETWORK ACCESS CHARGE. SERVICE OPEN 8AM - 6PM DAILY. CALLS COST £1.50 PER MINUTE SP SPOKE: 0333 202 3390

Supplied by MeteoGroup

CORRECTIONS AND

COMPLAINTS

If we’ve published anything inaccurate, please contact factually the readers’ editor by email at expressletters @express.co.uk or write Readers’ Editor, Daily to One Canada Square, Express at London E14 5AP and, once verified, we’ll correct it as soon as possible. The Daily Express and Sunday Express are published

by Express Newspaper subsidiary company of s, a which is a member of Reach PLC, IPSO, the Independent Press Standards Organisation. We adhere Editors’ Code Of Practice to the enforced by IPSO, which as is

Prof Martin Marshall

practice is in crisis, we should all be concerned.

He added: ”We were amazed at the response, especially when our hardpressed members have so many other demands on their time. It shows the strength of feeling amongst GPs who are doing the very best they can to deliver high quality care to their patients but in the most difficult circumstances.”

What no one could have predicted was the Government’s own ‘crisis’, just as the campaign was launched. The Secretary of State quit in the week the letter was delivered, and a few hours before Prof Marshall was due to meet the Prime Minister's health team to discuss the campaign, Boris Johnson himself announced he was stepping down.

Despite the political turmoil, the College is keeping up the pressure on new Secretary of State for Health and Social Care Thérèse Coffey, as well as with new

contactable for advice at IPSO Gate House, 1 Farringdon Street, 7LG. Website www.ipso.c EC4M Telephone: 0300123 2220,o.uk email advice@ipso.co.uk. If complaint concerning you have a breach of the Code of a potential Practice, we will deal with your complaint directly or IPSO can refer your complaint to us. Please go to www.reachplc.com/how where you can view our -to-complain Policy and Procedure. Complaints Complain pack is also A How To writing to the Legal andavailable by Compliance Department, Reach PLC, Canada Square, London One E14 5AP.

Picture: Dominic LiPinski/PA

6,000 more

medics fROnTLInE doctors pledge... told Health Secretary have Sajid Temperatures in Centigrade Sajid Javid “everybody should Javid be Today’spractice worried” general summar isy: Cloudy but largely dry North West fighting It looks set to be forCoast: its life.

East mostly cloudy Coast: Isolated showers initially, with the risk of a shower Theythe have but then dry but with overcast during morning.written to Mr A light to moderate and grey cloudy skies. A gentle westerly breeze. north-wester Javid to lay ly wind. bareHigh the15C (59F). scale High 17C of a (63F). crisis South West theyCoast: say It puts is going patient to be but North Central Ireland: with overcast, cloudy skies during dry safety After a wet start, it in peril. day. will be cloudy with a small A moderate north-westerly breeze.the chance of a The letter, shower.

15C (59F). was signed High Light to moderate north-wester last ly wind. High 14C (57F). night by 3,810 South Central GPs, retired Ireland: It is set to be doctors Northern Ireland: It will be mostly cloudy andwith family the odd medics rather cloudy isolated shower in with the occasional outbreak later. A light to moderate training. westerly wind. of rain possible. A brisk westerly wind.

High 17C (63F).

High 16C Royal College of (61F).

GPs (RCGP) chairman Professor Outlook tomorrow: Martin Ireland Warmest: Oakpark 16C (61F) Marshall It will be largely revealed: cloudy but rather Extremes: Coldest: Knock/Connaught 9C (48F) dry “General practice tomorrow, with helps (24 hours Wettest: Ballypatrick Forest 0.30in. the odd risk more of light rain or patients to 2pm yesterday) drizzle at times. thanThethe odd rest bright spell of the can be expected nHS putintogether. the south-east.

First Quarter 07 July “So, when GPs and their patients say SIX-DAY that generalFORECA prac- ST Temperatures in Centigrade tice is in crisis, TUE we should WEDall THU FRI be concerned.

SAT SUN London 13 23 “Without 24 15 25 action, 14 26 things15 are 15 27 14 17 likely Belfast to get worse.”

Battles…Braverman

‘Remainer bias holds up Brexit Today’s forecast: prog ress’ Islands Spain, Portugal and the Balearic and Canary Wire

Temperatures in Centigrade

A largely clear day for Spain with bright with warm, sunny plenty of warm sunshine, By Martyn periods although Brown with through the odd light shower developing Senior the day. High 33C (91F).

Political It will at Correspond be a warm entday for times too. High 37C (99F). and dry Canaries, although with the early cloud, Portugal will After some CIVIL servants some patchy be dry and are cloud cover at times. High 24C (75F). resisting Brexit reforms

Outlook: as they still Sunny want and to be bright in the EU, the Attorney And back General in Britain has claimed. today

London/South East: A bright SuellaNorth: and dry day Braverma with good spells of sunshine.

A mainlyncloudy day but dry with a said shefew south-westerly winds. High Moderate sunnyher fights periods. Moderate westerly 22C (72F).

High 17C (63F). “biggestwinds. battles” Midlands: Dry with bright with Scotland: periods, especially later. or sunny Whitehal Cloudyswith heavy rain in l mandarin northwestern areas, winds. High 20C (68F). Moderate westerly insteadelsewhere. with bright periods of politician s, dry High 19C (66F).

Wales: Largely dry with a somethin g she “didn’t or Ireland: Cloudy sunny spells, especially few brightexpect” with a risk of light showers, afterdrythe turning westerly winds. High 18Clater. Moderate with2016 bright and clear spells (64F). referendu later. mHigh result.

18C (64F).

14 18 The former Brexit 16 27 13 19 13 19 UK outlook tomorro Birmingham 14 20 13 19 w: Largely minister 14 20 14 21 dry with bright spells said Britain 14 22 13 23 14 23 Cardiff 13 21 has an “opportunity to 14 23 14 24 SIX-DAY FORECAST 14 24 13 25 15 24 Glasgow INback BRITAIN peel 14 16 Temperatures in Centigrade onerous 15 25 14 16 13 17 12 17 TUE Manchester 13 17 Patients struggle WEDrulesTHU and bureaucr 13 18 to obtain FRI acy” 14 18 13 18 SAT 14 20 SUN 13 20 routine Newcastle 13 21 London and appointm Boris Johnson 13 23 14 18ents 14and 15 24 that 14 22 20 15 25 13 21 14 26 11 20 research Belfast has 12 20 made Norwich says four 16 27 cutting 14 17 red 15 27 12 20in 10 14GPs 14 18 13 22 13 19 14 21 13 19 are Plymouth 13 22 set to quit in five years. 22 tape through Birmingham 14 20 13 21 14 20 post13 19 12 20 14 Brexit 21 13 21 14 23 14 22 14 22 Doctors also complain 23 a 14 22 deregulat13ion 14 23 Cardiff 14 22 14 24 of a 13 21 14 Governm 23 15 22 14 ent daily lack of resources 24 priority.

13 25 Britain 15 24 Glasgow yesterd 15 25 and ay Moon, sun and tides 14 16 Aberdeen IT2.5 0.07 10 14 16 She said: reliable 13 17 “I think 17 Glasgow 12 17 we 13 17 Manchester 2.0 Aberporth 7.3systems.

0.00 rises: 10.04am, sets: 12.02am 11 16 –MOON ily 13 doctors 18 13 0.00 18 10 16 132 14 The Hull 18 fewer are flexing 14 20our muscles than 6.1 0.01 8 20 SUN rises London: Alnwick stress go private.

13 20 4.49am, their 4.3 has sets: 9.19pm own 7.2 0.00 hit Newcastle 13 21 12 19 It sickens14 me.” when Ipswich 14 22 Manchester pledge 18 mental rises:made.

Belfast health, 0.02 the was 4.46am, sets: 9.39pm 14 as 12 20 20 a new 2.8 0.01with 13 democrac 21 12 16 Doctors want anLeeds 11 20 y. alarm- 8.1 The 12 20 Norwich a bold recruitBirmingham 0.00 RCGP 7 18 saysFirst Quarter 13 22 7.6 0.01 8 18 Lincoln ing 12 20 since number 14 22 2015, ment and retention of 07 July 14 21 7.4 0.03 11 19 B’mouth 13 22 5.6 0.00 9newly-qu Plymouth 13 21 number of trained 20 Londonali- the0.00 14 23 fied doctors 12 20 Bristol full- a campaign to slash strategy, 11 24 HIGH TIDE 13 21 7.8 leaving.

0.01 12 19 Manchester 6.7 14 22 14 22 time red tape, 4.3 14 22 Cardiff 0.02 equivalen 8 19 London tB’ge GPs The Governm 15 22 7.6 0.00 ent (5.46am),has 14 has 18 (5.59pm) IT Oxford upgrades prom5.8 Durham 0.00 by and a £1billionBritain 8 1,516.

20 Liverpool 6.7 0.12 11 18 S’hampton fallen (2.50am), (3.17pm) ised to deliver “And, yesterd like someone 8.4 0.01 12 21 Greenock Edinburgh 6,000 programm ay Moon, sun and tides more 2.9 3.1 0.00 11 Aberdeen e to rebuild (4.03am), (4.53pm) But 17 St Andrews 2.5 0.07 crumbthe19 Dover 10 17 Glasgow British Medical GPs 0.00 10 getting but the 2.0 back Britain Aberporth 0.00 11into Warmest:RCGP (2.46am), (3.07pm) ing surgeries 16 MOON the rises: 10.04am, sets: 12.02am says itLighting-up London 22C (72F) . 7.3 0.00 10 16 Hull gym,6.1 Associati on claims must Alnwick 0.01 8 20 SUN rises London: 4.49am, sets: 9.19pm Extremes: times Coldest: Shobdon 6C (43F) act now.

4.3 0.00 12 19 Ipswich it takes true Glasgowthe 10.03pm-4.39am bitManchester The Belfast of rises: 4.46am, sets: 9.39pm Governm Belfast 7.2 0.02 12a20 (24 hours fall is 1,622.

10.01pm-4.55am Wettest: Kirkwall 0.37in.

2.8 ent 0.01 12 said 2015, 16 Leeds time8.1 and0.00maybe 9.19pm-4.50am Birmingham 9.32pm-4.52am London theShoeburyness toIn 2pm yesterday) £520mill then-hea Birmingham Sunniest: 7 18 a bit First Quarter ion was 7.6 earmarke 0.01 8 18 dLincoln One9.29pm-5.00am 13.1hr. lth GP said:Manchester secretary Jeremy “I had 9.39pm-4.47am 07 July 7.4 to B’mouth 0.03get two to improve 11 those 19 5.6 0.00 9 20 Londonof pain Hunt prom-Bristolpatients 9.46pm-4.35am Today5,000 6.7 0.00 11 24 HIGH in theirNewcastle Bristol GP capacity, ised 70s in tears muscles 7.8 0.01 12 plus TIDE back more GPs 19 Manchester Europe a into bid forecast to 4.3 by create Cardiff 0.02 because hospital clinics Tomorrow 8 19 London B’ge 7.6 50 0.00 million (5.46am), (5.59pm) 14 18 Oxford shape.

2020, Amsterdam but that Sunny have more appointm 5.8 Our Parliament target was21C/70F Durham 6.7 0.12 not closed (2.50am), (3.17pm) 11 18toS’hampton 8.4 0.00 8 20 Liverpool ents Brussels Amsterdam a year due to met.

Fair Sunny being Edinburgh 0.01 has Excludin 12 been over21 Greenock 19C/66Fclear the Covid 3.1 0.00 11 17 St Andrews 23C/73F gCloudy subjugate trainees, there (4.03am), (4.53pm) Dublin Brussels d 2.9 0.00 10 19 Dover Fair 16C/61F whelmed are Britain backlog. now 27,647Sunny for 40 Warmest: London 22C (72F) (2.46am), (3.07pm) thing21C/70F Frankfurt Dublin . The only years.”

I full-time famCloudy Lighting-up could 19C/66F 26C/79F Extremes: Coldest: Shobdon 6C (43F) times suggest wasSunny Geneva Frankfurt for them 26C/79F Glasgow She Thunder 10.03pm-4.39am to OPINION:(24PAGE Belfast went10.01pm-4.55am on: “There 24C/75F hours Lisbon Geneva 12Wettest: Kirkwall 0.37in.

London Fair Sunny 9.19pm-4.50am Birmingham to 2pm yesterday) 28C/82F 28C/82F thousand 9.32pm-4.52am Sunniest: Shoeburyness 13.1hr. are Madrid Lisbon s of civilManchester 9.39pm-4.47am Sunny Sunny Bristol In 30 years as 28C/82F 36C/97F 9.29pm-5.00am Newcastle a GP, I’ve Paris Madrid servants [and] 9.46pm-4.35am Sunny Sunny I’m 34C/93F 25C/77F Today never Rome Paris lost my sense of than we did before the Sunny Sunny supporte Europe d, in 25C/77F forecast Rome privilege and professio33C/91F Sunny Tomorrow pandemiAmsterdam Sunny 34C/93F particulaAmsterdam c – more than 21C/70F r, by a team of Brussels satisfaction in serving nal Fair27 Sunny million in 19C/66F 23C/73F my brilliantBrussels May, with more Dublin lawyers and Fair Cloudy community.

21C/70F 16C/61F than 44 Frankfurt Dublin per cent on the officials…

Sunny Cloudy 19C/66F 26C/79F But this is predicate Geneva Frankfurt same day Sunny of booking.Thunder 26C/79F 24C/75F “But what Lisbon Geneva I have Sunny being able to establishd on Fair A recent 28C/82F 28C/82F and RCGP pollSunny Madrid Lisbon seen time CALL OUR WEATHER LINE WHERE nurture and time Sunny YOU hips relations CAN SPEAK LIVE WITH OUR EXPERTS 28C/82F 36C/97F revealedParis PLUS YOUR TELEPHONE with Madrid FOR UP-TO-DATE FORECASTS. the crisis is Sunny COMPANY’S NETWORK Sunny again, both CALLS COST ACCESS CHARGE. SERVICE OPEN my patients.

34C/93F 25C/77F Rome Paris in 8AM - 6PM DAILY. SP SPOKE: £1.50 PER MINUTE Sunny Sunny 0333 202 3390 forcing experienced GPs 25C/77F 33C/91F policyma Supplied by MeteoGroupRoyal College of General practice is in Rome GPs to re-evalua king and in Sunny 34C/93F te their careers broader decisioncrisis. Our teams on the Supplied by MeteoGroup how to tackle the workload – with 42 per cent stating front line are understa making, [is] that there they are likely to quit in the and overworked. We ffed and staff shortage is a Remain bias. I’ll next five years. don’t problems to make have the time to deliver say it.

The Government must the services sustaina GP care patients need. ble for “I have seen go beyond the target nHS patients in the of This is why more than future. 6,000 more resistance to some GPs. It has to of We share our patients’ 3,500 GPs and GP trainees the measures that cut unnecessary workload frustrations when they in England have urged and bureaucracy, invest ministers have wanted the face long waits in Health Secretar y to for an back to bring forward. appointment – but actually IT and practice support, the RCGP’s campaig and restore funding n “Because there’s an we’re carrying out more for for the Future. It sets Fit general practice to 11 out inability to conceive of consultations every per month cent of total health spend. the possibility of life outside of the EU.”

Greek Is and brigh chance o the morn evening c occasiona Turkish R for the Tu

London/S with good south-wes

Midlands: periods, es winds. Hig Wales: Lar sunny spel westerly wi

Crumbling

Muscles

LIVE

cOMMeNT

WEATHER SERVICE marti n 6 0906 156 020

marshall

OPINION 12 TV 33 LETTERS 38 STaRS 40 CITY 43 SPORT 45 PLUS PuzzLES PuLLOuT Subscribe to the Daily Express and save 20%. Call 0345 1494848 or visit newspapersubs.co.uk

Prime Minister, Liz Truss, for solutions to the workload and workforce pressures affecting GPs at all career stages.

One issue of major concern is the difficulty trainees from outside the UK are experiencing with the visa system. The College is working with these doctors to see how it can influence the Home Office to simplify the system and ensure that their skills are not lost to the profession and patient care (see p3).

It is also working with the RCGP Faculties across England to help them engage with their local MPs and Integrated Care Systems leads.

Prof Marshall said: ”NHS pressures are not confined to hospitals and we’re making it very clear to Government what is needed to make general practice safe and sustainable, both for patients and GPs and our teams,t now and in the future. Our members have very real concerns and we need positive changes that will allow us to deliver the care our patients need, and the type of care that we want to deliver, without this affecting our own health and wellbeing.”

The next action from the campaign will be the launch of a new College report on GP retention. 

POLICY FOCUS

| 07

U

SIX-

Londo Belfas Birmingham

Cardif Glasgow Manchester Newcastle Norwich Plymouth Aberdeen Aberporth Alnwick Belfast Birmingham B’mouth Bristol Cardiff Durham Edinburgh

Britain Extremes:

2.5 7.3 4.3 2.8 7.6 5.6 7.8 7.6 6.7 3.1

War Cold

(24 hours Wet to 2pm yesterday) Sun

Today Amsterdam Brussels Dublin Frankfurt Geneva Lisbon Madrid Paris Rome

Update your clinical knowledge with One Day Essentials Online conferences providing expert specialist clinical training and essential information High quality clinical training Essential information for general practice Delivered by clinical experts and leaders Practical tips and take-home messages Plenty of time for Q&A with the experts

RCGP member discounts available

rcgp.org.uk/essentials WELCOME

|8

Q&A: Eluned Morgan

Member of the Senedd Eluned Morgan MS has been the Welsh Government's Health Minister since May 2021. She answers GP Frontline's questions...

How do you feel general practice has responded to Covid-19?

General practice has played an invaluable role and will remain at the heart of our NHS as we move beyond the emergency response into recovery.

For many people, general practice is their main – and perhaps only – interaction with the NHS and they value this service highly in Wales.

Everyone working in general practice has supported and delivered care across Wales during the most serious global health crisis in our lifetimes, while also playing a key role in delivering the Covid vaccination programme.

GPs have been working under sustained pressure and I have been impressed by their commitment to ensuring the continued delivery of safe and effective services.

There is significant learning to be taken from how GPs quickly adapted to new ways of working, including the introduction of virtual consultations. To date more than 300,000 such consultations have taken place across Wales and we want to embed this way of working to improve access as we address issues caused by the pandemic, including a backlog of care.

I know GPs have a heavy workload, but in some instances, it will be appropriate for them to review people who are waiting for treatment – they know their patients best. We are currently working with GPC Wales to agree how this approach could work to support patients and GPs.

How can Wales balance responding to the immediate pressures on general practice and tackle the broader determinants of poor health outcomes?

We have invested £1m to provide community health checks for chronic conditions. A further £4m has been made available from 1 April 2022, for three years, to support GP practices to increase their staffing capacity, to support changes to access.

Longer term, we have a longstanding 'health-in-all-policies' approach and we

use health impact assessments as part of our policy development processes.

Work is currently underway to deliver the Health Impact Assessment Regulations, which will help us to further embed this approach by mandating health impact assessments are carried out by certain public bodies in certain circumstances.

What are your ambitions for the digitisation of healthcare?

We continue to support people to make positive choices to live healthier lives and are focusing on specific issues to improve people’s overall health and help tackle deep-rooted health inequalities.

There’s so much more we can do to make our health service more efficient – if we can join our systems together to share data in an easier way, this will free up more time for clinicians to spend with patients.

I’ve spoken to doctors and staff who have shown me stacks of paper prescriptions that need to be signed every day – time that could be saved if that could be done electronically and those prescriptions were sent to a person’s pharmacy of choice directly.

We want to have the first adopters of e-prescribing in primary care by next year, with a rapid rollout shortly after. Our new NHS Wales App will give people access to more data about their health, giving them more control over their health and wellbeing. They will be able to see their own test results and scans; blood pressure will be able to be remotely monitored

What would you like general practice to look like in 10 years' time? and people will be able to see discharge and follow-up letters as soon as they are generated.

The Primary Care Model for Wales is about informing people to understand how to live longer, healthier, and happier lives and to remain independent and at home for as long as possible. Through this model, GPs, nurses, pharmacists, dentists, optometrists, physiotherapists, occupational therapists, social workers and people working in the voluntary sector work together in the local community to plan and provide people with a range of ways to access seamless care and support so they receive the right care at the right time from the right person and service, at or close to home. Information about individuals is shared appropriately to ensure services are joined-up and provided in a timely way across the community. Modern technology, local facilities and services are all used to help people lead healthy lives and to support those who need care.

To provide accessible and sustainable care now and in the future, we are developing and diversifying the workforce, changing ways of working, and better signposting people to a wider range of local services. Our aim is to deliver the right care, at the right time in the right place.

An example of this in practice is the recent change to fit notes – previously only doctors could legally certify fit notes but a change in the law means four other healthcare professions can now do this. 

POLICY FOCUS

| 09

BREAKING A NUMBER OF GLASS CEILINGS

Kamila Hawthorne was welcoming a Ukrainian refugee family to her home when she received the news that she had been elected as the next Chair of the RCGP. ”It really put things into perspective,” she says, describing the contrast between her professional joy and the sobering reality of listening to their experiences of fleeing a war-torn country.

Nevertheless, her achievement is historic as she will be the first South Asian woman, and first working GP in Wales to become Chair of Council, which she describes as ‘breaking a number of glass ceilings'. ”I am not here on a race or gender card, but I think it is important to recognise I am the first South Asian woman in this role. There is still an awful lot of work to be done to improve equality in medicine, particularly for women and international doctors. The saying that ‘you can't be it until you see it’, carries some weight, I hope my election will inspire other GPs.” she says.

”

There is still an awful lot of work to be done to improve equality in medicine, particularly for women and international doctors.

The saying that ‘you can't be it until you see it’, carries some weight. I hope my election will inspire other GPs.

students in her practice in Cardiff, she has gone on to leading roles at Cardiff University Medical School, and to the University of Surrey in 2015 to help develop a bid for a new medical school.

She is currently Head of Graduate Entry Medicine at Swansea University, where she has loved the opportunity to develop the curriculum, showcase general practice and influence cohorts of new graduates to medicine.

She is under no illusions about the challenges she faces over the next three

Grainge photography

COLLEGE UPDATES

Kamila came to Britain with her family from Tanzania in 1970, qualified from Somerville College, Oxford in 1984, and did her VTS training in Nottingham.

She has been a GP Principal in Nottingham, Manchester and Cardiff, and now works as a salaried GP in Mountain Ash, South Wales.

A Bevan Commissioner, she is currently Provost of the South East Wales Faculty and sits on the College’s Trustee Board and Ethics Committee. She was Vice Chair (Professional Development) of the College from 2015 to 2018, working closely with Professor Dame Helen Stokes-Lampard.

Yet things could have turned out very differently as she remembers leaving the RCGP's former headquarters at Princes Gate in 1988 after sitting her MRCGP viva exam, and thinking, 'I'm never going back there again!'.

Kamila started attending faculty board meetings, then applied successfully for an MIA/RCGP Research Training Fellowship in 1991 to work on culturally appropriate health education for British South Asian patients with Type 2 Diabetes, prompted by patients she was seeing in Nottingham at the time.

Looking for ways to get more for her membership of the College, and wanting to get more involved, she became an MRCGP examiner in 1997 which, in common with all College examiners, required her to sit the MRCGP written paper a second time, and which sparked her interest in medical education and assessment.

Over the years, from teaching medical

”

Professor Kamila Hawthorne wants to create a 'welcoming College with a voice for all' when she takes over as the RCGP's first-ever South Asian woman Chair this November.

Grainge photography

| 10

”

I've had loads of opportunities from the College to develop myself professionally and made many lasting friendships with GPs from all over the UK. I want the same, or better, for all our members.

”

years, leading the College as GPs struggle with arguably the toughest workforce and workload pressures in the history of the profession.

Building on current Chair Martin Marshall's work around relationship-based care, she wants to ‘keep alive the essence of the GP’. ”Patients refer to their GP as 'my doctor’, not 'the doctor’, and that is a very special professional relationship that would be tragic to lose,” she says. ”But there just aren’t enough of us, 6,000 GPs aren’t going to suddenly appear, so we have to find ways of doing things differently, and a one size solution won’t fit all.”

One of her solutions is to maximise the potential of the College membership, encouraging GPs to support and help each other. ”Our members are our biggest resource”, she says. ”I’m a collaborative worker and I think there’s a lot we could do for each other within the membership network. There are many practices out there that have found solutions to dealing with these pressures and it's important that we find a way to applaud, share and promote these to other practices,” she says.

Kamila is clear that more needs to be done to highlight to members the opportunities the College is offering.

Married to a gastroenterologist and with two grown-up children, one of whom is now a GP, she still recalls sitting in her kitchen, opening her College membership subscription renewal notice.

At that stage, she was a young parttime Cardiff GP with two children aged under five.

MORE CHANGE AT THE TOP ”I thought 'that's a lot of money, what do I get for that? Either I get involved, and make sure I get value for my subscription, or I leave…’, so I got stuck in,” she says. ”It has really paid off.” ”I've had loads of opportunities from the College to develop myself professionally and made many lasting friendships with GPs from all over the UK. I want the same, or better, for all our members. Now I know that I get more value from my membership than the money I actually pay.”

She wants to add further value to College membership by improving the CPD offer, exploring options for paying exam fees and looking at the RCGP's future relationship with allied health professionals.

She is determined to improve the experiences of International Medical Graduates and support them to reach their full potential, in general practice and within the structures of the College itself. ”I've noticed that what is happening centrally in the College doesn't always reflect what is going on at the grassroots.

I want the College to be a more inclusive and welcoming environment, we need to have a voice for all,” she says.

With her daughter, her sister and brother-in-law all working as GPs, she already has a valuable sounding board and plans to run monthly 'surgeries', initially for Faculty Chairs and board members, to give them an opportunity to ask questions and give their feedback. If successful, she is keen to roll these out to the wider membership.

Addressing health inequalities will also be a priority during her time as Chair. She was awarded an MBE in the Queen’s New Year Honours in 2017 for services to general practice and her work on culturally appropriate diabetes health education with Bangladeshi patients in Cardiff (26 years after getting that crucial Research Training Fellowship).

As November approaches, she is starting to scale back on her other commitments so she can focus fully on her responsibilities as Chair – and ‘doing everything I can’ to support GPs to have intellectually satisfying and fulfilling careers, despite the current pressures. ”The RCGP has been instrumental in my career, enhancing my professional, intellectual, and personal development in ways that I would have never predicted. I am committed to trying to make sure every member feels this way. I want all members to feel that this is their College,” she said. 

As well as welcoming a new Chair of Council this Autumn, the College will also see some other new faces join its Leadership team.

Dr Victoria Tzortziou-Brown will take up the post of Vice Chair for External Affairs, succeeding Dr Gary Howsam who comes to the end of his three-year term.

Victoria has been a GP in Tower Hamlets, east London, for almost 20 years and has a keen interest in health policy and research. Whilst joint-Honorary Secretary between 2017-2021 she led on the College`s primary care ethics guidance during the pandemic, put in place policies for improving transparency within the College and oversaw high profile College consultations on decriminalisation of abortion and assisted dying. She has served as London Faculties Chair and has most recently been co-chairing the RCGP's Health Inequalities standing group – addressing health inequalities being another passion of hers.

Victoria told GP Frontline she is 'thrilled' to have been elected to the role: ”It's a great honour and a huge responsibility. I'm looking forward to working with colleagues and wider stakeholders towards supporting general practice, our members and the patents they care for.”

Over in Northern Ireland, RCGPNI Chair Dr Laurence Dorman is coming to the end of his term, making the way for Dr Ursula Mason, a GP in Carryduff, South Belfast, a GP trainer and Associate Director of GP Specialty Training at NIMDTA, Northern Ireland's medical training body.

Ursula told GP Frontline that the greatest challenge facing her leading the profession in NI is: ”No Government, no agreed budget and resultantly, no ability to deliver the change we need.” Read more about Ursula in our 10-minute consultation on p15.

Also new in post is Professor Mike Holmes, Chair of Trustee Board, which works to safeguard the charitable status and finances of the RCGP. He took up his post in April, taking over from Dr John Chisolm who was serving as interim-Chair.

Mike is a GP partner at the Haxby Group, which provides care to more than 100,000 patients across York, Hull and Scarborough. He has a long history and understanding of the College having been Vice Chair for Membership and International from 2018-2021 and is heavily involved in his local Humber and Ridings Faculty. 

NEWS AND FEATURES

| 11

In the media spotlight

”You can talk about health whether you’re a doctor or not, so it’s important to have real doctors giving information in the media,” says Ellie Cannon, a GP in Camden, North London who has been the Mail on Sunday’s resident GP for the last 15 years as well as making regular appearances on BBC, ITV and Sky programmes. ”It’s often just normal GP stuff,” she says, ”similar to what I get in real life clinics.”

Likewise, Fari Ahmad, a GP in Wilmslow, Cheshire and one of BBC Breakfast’s regular GP voices for the last five years, says ‘you’re a trained clinician, that holds a lot of weight, and that’s why they have you on. The presenters probably know all the answers you’re giving them, but they want you to be the person who says it.

”It’s about handling whatever questions are thrown at you in a measured, sensible way, which as GPs we tend to do anyway,” says Fari. ”Often headlines are very black and white, so being given some time to discuss the context is useful, for example, explaining why patients can’t get an appointment quickly because there aren’t enough GPs but we’re working harder than ever. The skill is having very clear ways of putting a message across, you need to use simple language that people get.”

Fari was first approached by a producer looking for a Muslim woman to give medical advice. ”I was initially reluctant but they said it was good to have different types of people represented, so I agreed to do it,” she explains.

Ellie was also approached directly to provide a quote for a newspaper and things grew from there – while Phil Hammond’s media career came out of comedy. ”Edinburgh Fringe was how it all started. I was in a junior doctor double act as a GP trainee. We thought, rather naively, that we could get some sort of social and political change through stand-up comedy. We collected a selection of the most outrageous junior doctor stories of unsupervised training, making mistakes due to being tired, and performed this [show] in Edinburgh. It got picked up by the BBC and got record numbers of complaints to the broadcasting standards authority, but back in the day, Radio 4 rather liked that and they gave us a series.”

He then met Ian Hislop, editor of Private Eye, at a BBC Christmas party and asked him for a column. He’s written for the magazine under the pseudonym M.D. for more than 30 years, although he’s

”You can talk about health whether you're a doctor or not, so it's important to have real doctors giving information in the media.”

Dr Ellie Cannon

COLLEGE UPDATES

| 12

Anne-Marie Briscombe photography

GPs in the media – on TV and radio, in newspapers and magazines, on social channels – play an important role in communicating important health advice and public health messages to millions of people, as well as advocating for the profession. Here, three prominent ‘media GPs’ discuss the upsides and downsides of being in the public eye.

publicly open about his alter-ego.

Recently retired, Phil practised as a GP for 20 years before switching to sexual health and latterly specialising in paediatric chronic fatigue. ”In my heart, I’m still a GP, and I’ve remained a member of the RCGP, but I found the 10 minutes for patients really hard,” he explains.

As well as Private Eye, Phil has written books, fronted TV series and hosted a show on BBC Radio Bristol. He lists unsafe NHS staffing, lack of data transparency, and not listening to whistleblowers as the three key issues he has campaigned on during his career.

He still doesn’t think whistle-blowers can genuinely speak freely. ”I’ve broken some big stories, and then protected the whistle-blower, but we’re still a long way from people being able to speak up safely so in that sense I’ve failed,” he says.

He thinks it’s important that medical voices continue to enter social and political debate because ‘politics is about the compassionate and responsible use of power…it’s absolutely at the heart of medicine, particularly a service that’s tax-funded’. He also sees social media as an important medium, although ‘you have to be careful what you tweet.’

Ellie recognises her prominence in the media and on social media allows her the opportunity to ‘shout about the things I like to shout about, such as women’s health and highlighting the link between rising cost of living and health.’

She has also written and published two books: the first for new mothers; and the second on mental health in the workplace. ”It’s lovely to publish books,” she says, citing the control she has over them, ”I chose the topic, I wrote them myself,

Supplied by Phil Hammond

”When I look back on my career, I'm sure I did more good making people laugh than feeding them statins.”

Dr Phil Hammond at the Edinburgh Fringe 2022

Ellie says she’s always surprised by how confrontational and angry people can get about certain topics, particularly on social media. ”You have to develop a tough skin,” she says.

the trick is to forget the camera and the studio and just have a conversation on the sofa.”

It’s gone full circle for Phil, who has just completed a stint at the Edinburgh Fringe

BBC News

and it’s really nice to see your name in print in a bookshop.”

During the Covid-19 pandemic she was the first doctor to write about making her own face mask; and she used her platforms to encourage people to get involved in vaccine trials.

Whilst all three GPs advocate for doctors, Ellie and Phil have also found themselves speaking out against the profession. ”One of the first stories I broke in Private Eye was the Bristol heart scandal,” recalls Phil, referring to high numbers of babies dying after cardiac surgery at the Bristol Royal Infirmary in the 1990s. It led to what was, at the time, the biggest public health inquiry in British history and called out staff shortages, poor leadership, unsafe working practices and a culture of secrecy around doctors’ performance. ”That’s when the whole thing changed from defending doctors to protecting patients,” he says – something that didn’t make him ‘universally popular’.

Ellie too received criticism from GPs for using her Mail on Sunday column to call out, and call for, examples of GPs not seeing patients face to face during the pandemic when restrictions were being lifted – but she stands by this. ”If you stay true to yourself, you don’t have anything to be afraid of. I would never welcome attacks on the profession because that is an attack on me at the end of the day. I’m a patient and a carer, as well as a GP, and I was fully aware that the practice where I’m registered was not seeing patients face to face. The letters we got [at the MoS] and stories I heard from friends and family were real. ”It’s important to highlight the problems.

And of course, it wasn’t just GP-driven, it was pandemic-driven and resource-driven, and it’s shown that general practice needs big investment to keep going.”

Dr Fari Ahmed on BBC Breakfast

”It’s about handling whatever questions are thrown at you in a measured, sensible way, which as GPs we tend to do anyway” Fari recalls a time when someone called her practice to complain about something she had said on TV, and another where some comments on a particularly emotive issue led to a backlash on Twitter. ”Luckily I’m not a proficient tweeter, so didn’t realise until a week later,” she jokes.

She’s also taken part in debates with those who have completely different viewpoints. ”I suppose it’s great for viewing figures. You have to consider your demeanour, if you’re aggressive and defensive, you will lose the audience. You’ve got to come across as human and talk from a place people can understand.” ”I do enjoy it,” says Fari, ”it can be daunting when you think it’s live TV and millions of people are watching, but

where it started for him 30 years ago. He did two shows a night for two weeks, one on each of his current books: the first a collection of his Private Eye M.D. columns about the pandemic; the second on how patient expectations of the NHS have changed over recent years. ”It went well,” Phil says with relief, ”it was risky, I remember when I was young, I’d go there and see these old farts and now I’m one of the old farts, but it was a joyous and liberating as ever. You have complete freedom to say what you want – well nearly, one comedian got cancelled this year – and your only accountability is to your audience.

When I look back on my career, I’m sure I did more good making people laugh than feeding them statins.” 

COLLEGE UPDATES

| 13

College on the international stage

N

early 3,000 GPs from the UK and 179 different countries converged on London’s ExCel Centre for the College’s first-ever annual conference in partnership with the European branch of the World Association of Family Doctors, Wonca.

A stirring opening ceremony, including music from popular West End shows, launched a stimulating four days of plenaries, CPD, policy sessions, networking events and 1,200 individual abstracts and presentations.

Highlights included Professor Victoria Tkachenko, who joined remotely from Kyiv, to give a passionate, awe-inspiring and shocking account of trying to provide healthcare in the midst of the war on Ukraine – for which she received a well deserved standing ovation.

There were also keynote addresses from World Health Organization Director

General Dr Tedros Ghebreyesus, Wonca World President Dr Anna Stavdal, and Sir Michael Marmot with a European perspective on tackling health inequalities.

College Chair Martin Marshall used the real-life example of his patient ‘Mohammed’ to explore the theme of relationship based care, setting out a fivepoint plan to modernise and reinvigorate the concept and make it more attainably deliverable, while the profession battles on under immense and unsustainable pressure.

The Vibrant Faculties session led by College President Clare Gerada was standing room only, with a variety of contributions about the importance of belonging to your ‘local’ College.

The Ask the Chairs session – where Martin Marshall was joined by College leaders from Scotland, Wales and Northern Ireland – also drew a big crowd, with

members’ concerns over visas for International Medical Graduate trainees a recurring theme.

Despite the difficulties being faced by primary care teams throughout Europe, a real sense of optimism and energy prevailed throughout the conference. College Vice Chair Margaret Ikpoh summed up the atmosphere with her rendition of the song ‘Something inside so strong’ at the closing ceremony.

RCGP Honorary Treasurer Steve Mowle, who led the organising team, said: ”The conference exceeded our expectations on all levels. It was a brilliant opportunity to share experiences with so many international colleagues, as well as highlighting the achievements of UK general practice and the commitment of hardworking GPs to the care of their patients, wherever in the world we practice.” 

”A big thanks to all delegates who took part, whether in person or virtually.”

Dr Steve Mowle

NEWS AND FEATURES

| 14

I’ve had mine for nearly two years and would estimate I’ve used it for 80% of my clinics. It means I’m rarely sedentary at work, I feel more energetic, and my clinics become dynamic and engaging.

Research has shown – some based on NHS employees – that having a standing desk reduces sitting time and daily anxiety, and can increase job performance and quality of life. Some evidence shows standing can help with office-related back pains.

I have always felt frustrated with the amount of potential time we spend being sedentary as GPs, especially given this is an independent risk factor for cardiovascular disease, diabetes and allcase mortality.

With telemedicine, patients are often completely unaware that I’m standing – but being able to stand whilst on the phone really helps me engage, feel energetic and not feel like I’m in a glorified call centre.

With my face-to-face consultations, the experience is almost universally positive. I’ve had patients say, ‘I need one of those’, ‘that’s such a good idea’, ‘do you think that would help me too?’ They’re inquisitive – they start asking questions about the benefits of standing and walking, which opens up conversations about nutrition, weight and other lifestyle factors.

I still have seats in my room and sit opposite my patient to talk to them before standing to examine or check their notes. Because I’m not tied to my computer, I might examine whilst we speak and I don’t end up being tempted to type as we talk. Some patients even ask to stand, seeing that the option is there.

When it comes to prescribing, doing a fit note, or printing a patient leaflet I’ll stand up and start back on my computer – this is great for the flow of the consultation too, it’s a signal to the patient and myself that we’re coming to an end.

I couldn’t do without mine. For me, it’s similar to the difference between going for a walk with a friend versus sitting in their kitchen for three hours. From the personal benefits to health, and the increased enjoyment and energy I feel in my clinics, a standing desk certainly elevates my work satisfaction and I’d encourage anyone tempted to try to just go for it.  Read more about the RCGP’s Physical Activity and Lifestyle programme.

TE

NU

M N. I

Until recent years standing desks may have been synonymous with a quirky Silicon Valley start-up, but they’re becoming mainstream, including in general practice. Dr Toby Haseler, a GP ST3 in London and RCGP Clinical Support Fellow for Physical Activity and Lifestyle, explains why he’s introduced a standing desk in his consulting room.

10

T LTA IO

AN UPSTANDING IDEA

NS U O C

DR URSULA MASON RCGPNI Chair-Elect and a GP in Carryduff, South Belfast

WHY DID YOU CHOOSE TO BE A GP?

No two days are the same! I really value the variety and the relationship-based care we provide to patients.

WHAT’S THE BEST THING ABOUT BEING A GP?

The close relationship with patients and my fantastic practice team. I feel proud that we are able to provide a high-quality service in the local community.

WHAT’S THE MOST FRUSTRATING THING ABOUT BEING A GP?

The challenge of trying to meet rising demand with limited capacity and insufficient resources.

WHAT ARE YOU MOST PROUD ABOUT IN YOUR CAREER?

I am probably most proud of being able to build a portfolio career. In my role as Associate Director of GP Specialty Training at NIMDTA and as a GP trainer, I have had the pleasure of supporting many colleagues through their GP training and now watching them thrive in their career.

HOW CHALLENGING HAS THE PANDEMIC BEEN?

It has been a huge challenge for all of us. We did not enter the pandemic in a good place and were already battling rising demand and limited resource. Moving virtually overnight to a new model of care was extremely challenging. In Northern Ireland, we also rapidly set up primary care Covid centres, to keep our patients and staff safe.

WHAT HAS BEEN THE MOST IMPORTANT LESSON YOU’VE LEARNT DURING YOUR CAREER?

When an opportunity arises, look at it, sleep on it, trust your gut and if it feels right, go for it!

WHY DO YOU THINK IT’S IMPORTANT TO BE A COLLEGE MEMBER?

Professional connections and fantastic learning opportunities. With the huge challenges we face, having a collective voice is important.

WHAT WOULD YOU BE IF YOU WEREN’T A GP? Searching for the right career!

WHAT IS THE BIGGEST CHALLENGE FOR GPS IN NORTHERN IRELAND?

No Government, no agreed budget and resultantly, no ability to deliver the change we need.

COLLEGE UPDATES

| 15

You feel

so protected when you know your outgoings are covered.

2 YEARS

20% DISCOUNT* CODE: RCGP

Protecting your income should be an important consideration in your financial planning. Suppose you found yourself unable to practise due to an injury or illness, how would you keep up with your monthly commitments?

That’s where PG Mutual Income Protection Plus comes in. It could provide you with a regular replacement income so that your outgoings are covered until you sufficiently recover or reach age 65 (whichever comes first). Their policy allows you to tailor a plan to suit your needs as a GP. Choose from a range of claim deferment periods, type of cover, how much cover you need and more to build a plan that works just for you, whether you’re a salaried GP, a locum, a partner, or in private healthcare. The result being you get the cover you need without paying for the cover you don’t.

Visit pgmutual.co.uk today for an instant quote. *T&Cs apply.

The Royal College of General Practitioners are an Introducer Appointed Representative (FRN 610437) of PG Mutual, the trading name of Pharmaceutical & General Provident Society Ltd. PG Mutual’s registered office is 11 Parkway, Porters Wood, St Albans, Hertfordshire AL3 6PA. Incorporated in the United Kingdom under the Friendly Societies Act 1992, Registered Number 462F. PG Mutual is Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority, Firm Reference Number (FRN) 110023.

THE CASE FOR MENTAL HEALTH PRACTITIONERS IN GENERAL PRACTICE Dr Ardyn Ross

Mental Health team, Norfolk and Waveney ICB

I

n April 2021, the first mental health practitioners (MHPs) started working in GP practices across the 19 primary care networks covering Norfolk and Waveney. We’ve never looked back.

It was the first stage in implementing our plans to transform mental health care in primary care across the region. Our vision, informed by people with lived experience and experts from across health, social care and community sectors, was to use PCNs in the region to provide ‘wrap around’ mental health provision for all GP practices, and dramatically reduce the time people are waiting for mental health care.

The majority of our MHPs are Band 6 and 7 mental health nurses, with some from other backgrounds such as social work. We also recruited several Band 8 PCN service managers to oversee the teams – all practising clinicians with significant experience in mental health.

There was understandable hesitation on the part of the local Trust concerned about their own workforce shortages, so we started by piloting the scheme in five sites. The idea being that by placing these professionals upstream in general practice, at the front door of the NHS, they will ease pressures longer term.

Patient feedback has been excellent.

They’re getting direct contact with an MHP and the appropriate support they need from their own surgery, usually within a week or two. People only need to tell their story once because we use a single trusted assessment, and they are involved in monitoring their progress through a system called DIALOG+, which maps the patient’s own goals.

Having MHPs working in our practices is vital. This is why we’ve supported the No Time To Wait campaign, which has gained cross-party backing from MPs, calling for every GP practice to have a mental health nurse.

Alongside this, we invested in a mental health diploma for primary care clinicians.

This has created a really engaged group of clinicians with an interest and passion for mental health across the region. We hold a monthly ‘lunch and learn’ webinar and keep everyone informed of changes that are happening through a quarterly newsletter.

We invested in online counselling platforms, five mental health support hubs offering walk-in support in a café environment seven days a week with evening ‘sanctuaries’ until midnight, two short-stay crisis houses where people in distress who would have ended up in secondary care can stay for up to five days, and a ‘mental health’ car, jointly with the ambulance service, so mental health distress calls can be managed in patients’ own homes.

We’ve worked with Mind to recruit recovery workers to work alongside our MHPs as first point of contact for low level anxiety and depression. We’re investing in trauma therapies, and looking to further enhance primary care teams by employing psychologists, psychiatrists and peer support workers specialising in complex emotional needs. We're also supporting our fantastic Voluntary Community and Social Enterprise colleagues to provide joined-up holistic care with us long-term.

Two valid challenges have been levelled at us for our approach. Firstly, whether having MHPs working directly in practices is detracting from core GP work; and secondly whether supervision of the new roles will perversely increase GP workload. Neither has been the case

in our experience.

GPs remain the main point of contact for their patients’ care, with MHPs offering support and additional expertise for patients with more complex mental health needs. GPs are kept informed of their patients’ progress and those who want to be more involved can engage with our mental health champion network.

Workload hasn’t increased as MHPs are managed and supported by our PCN service managers.

We’re confident the interventions we’ve introduced will lead to reduced hospital admissions and A&E visits and are already noticing positive change.

They are helping to destigmatise mental health in the community: our ‘mental health cafes’ for example, are all situated on busy high streets. There are still long waits to access community specialist mental health teams, but addressing that is the next step: we want to unlock both the front door and the back door for people needing mental health care.

It might sound like a lot but it’s doable and it works. We’ve been smart about maximising our Mental Health Investment Standard, as well as the Additional Roles Reimbursement Scheme (ARRS) and successfully applying for community transformation funding. We also have people monitoring financial 'slippage', so money can be moved to ensure it is spent and not wasted.

I am part of a fantastic team of people (pictured), all passionate about mental health. Our goal is to create a mental health ecosystem. Having MHPs working in GP practices is key to this.  Dr Ardyn Ross is a GP in Norwich and clinical mental health lead for Norfolk and Waveney Integrated Care Board.

OPINION

| 17

Exclusive member offers from leading brands and retailers

Motoring Financial services Shopping Insurance Travel Cinema Gym Tech Days out And much more

rcgp.org.uk/plus

WELCOME

| 18

GP LIVES 20

22

21

23

20

EWEN STEWART

21

ANNE CONNOLLY

22

UWADIAE IMA-EDOMWONYI

23

HAREEN DE SILVA

GP LIVES

| 19

AN EMPATHETIC EAR John Need photography

Ewen Stewart has built his career on caring for people on the margins of society.

former GP partner now turned salaried GP in Glenrothes, Dr Ewen Stewart spent 17 years in Leith working with drug users. ”The practice cared for a lot of people who had problem drug use. It felt as if they were a group who were stigmatised and who didn’t always receive the best care, and that felt important to challenge. They are a group who can be hard to get to know, but when you do and you hear why they’re in the situation they are, you understand that it’s not just someone who has a problem but that their whole history has led them to that,” he explained. ”Listening to people’s stories is so important, and sometimes it’s hard to imagine how people have gone through those types of experiences. It can be troubling, but I think that the privilege of people sharing those stories with you is a kind of reward and helps you cope.”

Ewen became involved with the College through a group of GPs who shared the vision of improving sexual health, drug misuse and HIV care in general practice – that eventually became the Sex, Drugs and BBV Task Group. ”That task group was led by some inspirational women, in particular Dr Chris Ford. I really enjoyed working with that group of committed and enthusiastic GPs over many years, and eventually became Chair. I was involved with the College for a long time, but it was a little bit through the ‘back door’, I’ve never been involved in the official structures.”

He is proud to be the Clinical Lead for the RCGP Scotland Part One and Part Two Certificate in the Management of Problem Drug Use, which

A

GP LIVES

| 20

has been revised and revitalised over the last two years, and is available for anyone working in primary care in Scotland who has an interest in working with drug users. He is also Clinical Lead for the Lothian Viral Hepatitis Managed Care Network and has recently taken on a new role teaching the graduate entry medical course at the University of St Andrews.

”If we want to prevent ill health and to stop people becoming unwell then we can advocate, but we shouldn’t be picking up the pieces. The politicians should be trying to prevent people getting into these situations in the first place.” ”While I definitely see the management of problem drug use as a medical issue, I see the prevention of problem drug use as a social issue, rather than a law and order or policing issue,” he said. ”There’s absolutely no doubt that poverty, childhood trauma, poor social circumstances are important antecedents of people developing a problem, and if we want to try and prevent this, we need to look at these wider social

issues. When people do develop a problem, that’s when a medical intervention along with the social one is really important.”

Another ‘social’ concern, he said, is the rise in patients presenting with concerns about the rising cost of living. ”Mental health consultations have rocketed and we are increasingly seeing people whose problems are related to spiralling debts, but also people who are having trouble feeding their families and having to make decisions around heating and food. ”It is very difficult to help them, we can signpost to resources like the Citizens Advice Bureau that help with financial issues, but it feels like chipping away at the tip of an iceberg. The situation is not going to get any easier and we can listen and empathise with where they are, but the answer isn’t medical, it’s social. ”It’s important that medics have a voice in raising what’s happening in patients’ lives around their financial issues. If we want to prevent ill health and to stop people becoming unwell then we can advocate, but we shouldn’t be picking up the pieces.

The politicians should be trying to prevent people getting into these situations in the first place.”

While he acknowledges the toll that caring for patients in difficult situations can take on a GP’s own health – workforce shortages and workload led to him giving up his partnership – he has never lost the enjoyment of being a GP. ”The privilege of sharing people’s lives and being the holder of information that they share with you is such an honour. It’s great when we can do things that really make a difference to people’s lives,” he said. 

Grainge Photography

CHAMPIONING WOMEN’S HEALTH Anne Connolly is on a mission for parity for women's health. hortly after qualifying as a GP, Dr Anne Connolly and her GP husband spent a couple of years working in a hospital in rural Zimbabwe.

Today, as the RCGP rep for Women’s Health, she wants women’s health to have parity with conditions such as diabetes and respiratory disease – and for women to have an individualised, personalised ‘life course’ approach to their care. ”Women spend more than 30 years of their life either wanting to be pregnant or wanting not to be pregnant, but we tend to treat conditions like endometriosis, polycystic ovary syndrome and early menopause ‘on the day’ rather than as the long-term conditions they are and it’s easy to miss the bigger picture. Much of this is about earlier intervention and prevention and if we could spend more time with patients, we would reduce a lot of the consequences of unmanaged concerns and when things go wrong,” she says.

Anne was a key contributor to the College’s response to the Government’s new Women’s Health Strategy, overall based on 110,000 consultation responses. ”Apparently only 0.5% of respondents to the survey were from the north and Midlands and only 7% from nonwhite backgrounds. There has to be a real effort to make sure that, whatever the future expectations from the women’s health work, the focus is on making sure that all women are heard,” she says.

She strongly believes that the solutions to improving diagnosis, standards and availability of treatment for women’s gynaecological health lie in holistic primary care – but that frequent calls by charities for additional mandatory GP training in areas like menopause

S

are not the answer. ”Women’s health care is part of our initial and ongoing training as GPs and providing relevant education has been a priority for the RCGP,” she explains.

The key, she says, is getting the right funding in the right places so women aren’t pushed from pillar to post when seeking treatment: ”It used to be much easier for women to get quality holistic care from their local GP whereas now we’ve got to refer here or there, or they get bounced from the sexual health clinic to the hospital, dependent on whether the method requested is for contraceptive or gynaecological reasons. ”The care is very fragmented and women who can’t navigate the hurdles are hit hardest. If women have cultural or social issues, they don’t have the wherewithal to get around the system.”

Anne says her career has been based on seizing opportunities, rather than a grand plan.

While raising her four children, she and her husband job-shared a GP partnership in a large teaching practice in Bradford and as the daily parental needs changed, she started taking on more women’s health issues and contraception clinics.

She got involved with what was then the College’s Sex, Drugs and HIV group and this led to chairing the popular One Day Essentials courses on women’s health and sexual health.

After qualifying with a post-graduate diploma in GPSI gynaecology from Bradford University, she was one of the co-founders of the multi-disciplinary Primary Care Women’s Health Forum.

She was also Vice President (membership) of the Faculty of Sexual and Reproductive Health (FSRH) from 2017-19.

She is particularly proud of the col-

laborative work with the Royal College of Obstetricians and Gynaecologists, FSRH and others to create the ‘one stop’ Women’s Health Library resources.

In 2017 Anne left her GP partnership to take on a part-time salaried role in inner city Bradford and was awarded an MBE for her work in women’s health in 2021.

She has nothing but praise for the profession in the current debate around HRT. ”GPs have done brilliantly, even though we’re still getting slated for it.

GPs have been inundated with menopause requests and they are responding brilliantly. ”It’s good to see that women are more aware of their symptoms and talking openly about HRT or getting better support in the workplace, but unfortunately, some of the media expectations are unrealistic and some women think that HRT is a panacea for all their ills.”

The College is still in ongoing discussions about particular recommendations in the Women’s Health Strategy, but Anne is optimistic that things are going to improve. ”Women’s health is no longer sidelined. We’ve got the political will, we’ve got passion amongst clinicians, we’ve got recognition that there hasn’t been enough research done on women-specific issues – and we’ve got women themselves refusing to accept this anymore,” she says. ”All the ducks are lined up – this is the time and we can’t miss the opportunity.” To find out more about becoming a College rep, like Anne, and use your clinical experience to help shape the future of general practice email collegereps@rcgp.org.uk.

GP LIVES

| 21

HOUSE OF REPRESENTATIVES SiraStudio

Uwa Ima-Edomwonyi wants the voices of doctors from minority ethnic communities to be heard – so he decided to do something about it.

ollege Council member Dr Uwadiae Ima-Edomwonyi is not one to sit back and wait for things to happen.

During the first lockdown of the pandemic, he was struck by the disproportionate toll that Covid-19 was taking on minority ethnic communities – and became even more alert to the need for more GPs from ethnic minority communities to have a louder voice and greater representation in leadership roles, both within the profession and the RCGP itself.

At the same time, the College was developing its action plan to improve the experiences of black, Asian and minority ethnic GPs and patients in those communities. He took the opportunity to join the College groups working to put the plan together and also got involved in his local North West England Faculty. ”I was attending meetings regularly and it was a really enjoyable journey, so I decided to run for the national Council elections.”

Uwa, a Locum GP in NHS Tameside and Glossop Clinical Commissioning Group, was successful and became one of six nationally-elected members to join Council in 2021.

He also became vice chair of his faculty a few months later. ”Even before I ran for Council, I wanted to get involved with the College because it’s important that more people from black, Asian and minority ethnic communities are seen and heard,” he said. ”Also, as a sessional locum GP there are times when you feel as if you don’t have representation or that we’re not really counted as part of the flock, so to speak, so it’s important to be a voice for that group as well. Putting yourself forward can be daunting, but you have to seize opportunities when they arise in order to be part of making a difference. I’m very glad I did and I hope others will to.

C

GP LIVES

| 22

”There can be a disconnect between what the College does and what grassroots GPs do or believe is happening, but I am hoping there is a way we can bridge that gap between the College, the faculties and what grassroots GPs do and face on a day-to-day basis.”

RCGP Council is now ‘hybrid’ and Uwa has attended both in person at 30 Euston Square and remotely. His first meeting was in person and he describes being ‘really excited’ about attending, and that despite some ‘expected protocols and proceedings’, he ‘really enjoyed it’.

”Even before I ran for Council, I wanted to get involved with the College because it’s important that more people from black, Asian and minority ethnic communities are seen and heard” ”It was lovely to meet the College Officers and other Council members in person. You are expected to read and digest the Council papers prior to the meeting, which I did, and I contributed to the discussion of two papers at the meeting,” he said.

He attended his second meeting remotely and says that whilst you're still 'seen and heard', being given the opportunity to speak on items and vote if required, ‘there is nothing like actually being in the same room with colleagues.’

Uwa completed his medical degree in Nigeria and his experiences of being an International Medical Graduate GP have driven him to help other IMG doctors following the same path. ”One thing I have in mind is to continue to mentor and give back and support

GP trainees. I’m part of the organisation Nigerian GPs in the UK and am one of the GP mentors there, supporting GP trainees of Nigerian origin.”

Uwa draws on the advice he himself was given by former RCGP President, Professor Mayur Lakhani. ”Up until then I’d viewed being a GP as being my job, but he mentioned four areas that you should look to build on as you progress in your career as a GP. One is the clinical aspect, seeing patients and consultations; two is the academic educational side, so you can get into academia or teaching, or medical education; three is research as part of your career; and then the fourth is medical leadership, either in a primary care organisation or the College itself. It gives you a structure for your career and it’s important to take these opportunities,” he said. ”I’m hopeful that the College can connect more with its members and grassroots GPs as we carry on into the next really challenging few years. I want to be part of that and I hope that we can really bring about impactful influential change.” 

Moritz Matakas

WAR AND PEACE Working as a volunteer has opened up very different worlds for Hareen De Silva.

Hareen at a camp in rural Rukka, Syria

n the middle of the South Atlantic Ocean is Gough Island, a remote and uninhabited 35 square mile stretch of volcanic land. For the last six months of 2021, this was home for portfolio GP Dr Hareen De Silva, who was working as a team medic on an expedition organised by the Royal Society for the Protection of Birds.

It was a peaceful contrast to other locations where Hareen – former Chair of the College's South Yorkshire and North Trent Faculty – has worked in his career to date. Over the past two years he has been delivering vital medical aid to refugees in Greece, Iraq, and Syria.

In November 2020, he volunteered to work at Kara Tepe 2, a refugee camp in Greece for six weeks. ”Outside our medical tent, daily queues of 500-600 people emerged, all waiting for a GP appointment, with some people sleeping in the line or joining the queue as early as 1am to try and get a consultation,” he said.

With a maximum of only 100 appointments available per day, a GP, nurse, and translator moved down the queue triaging patients, and deciding who needed to be seen that day, and, with no forward booking system for appointments, who would need to queue again the next.

Many of the patients had conditions caused by poor sanitation and overcrowding in the camp such as scabies, while others had poorly controlled long term health conditions including diabetes and high blood pressure. Access to and supply of medications was also limited.

I

But the most difficult challenge, says Hareen, was 'overcoming the sense of guilt and mental drain of telling patients that they'd need to wait longer for medical care when they'd already waited so long, sometimes so long they'd missed their allocated slot to shower or collect food.'

Two months later, he arrived in Syria after securing a job for a small non-governmental organisation CADUS and found himself working in what was still a very active conflict zone.

The key to working in this environment is, he says, 'firstly assessing if it is within the limits of your personal risk tolerance, and if it is, accepting that you can't control what's going on around you, then working to develop a strong sense of trust in the people you work with, particularly the security team.'

For four months, Hareen was responsible for updating and delivering clinical education to nurses and doctors working at the hospital, while also educating patients about hygiene, and manually monitoring and reporting diseases in the camp to the World Health Organization.

At the beginning of this year, Hareen returned to Iraq and Syria to work for CADUS as the Medical Coordinator for the middle east, overseeing the medical aspects of CADUS projects in Iraq and Syria and helping to identify possible new projects.

In Syria he manages the field hospital including the staff and budget for equipment and pharmaceuticals, and in Iraq he helped create a pre-hospital care training programme for ambulance drivers.

Two weeks before his arrival at the CADUS office, ISIS had orchestrated an attack on the al-Sina prison, in the town where their office is located, breaking out ISIS prisoners leading to ‘fighting in the streets, suicide bombings, and people being killed.' ”It is my responsibility to protect the wellbeing of the doctors and nurses and keep up morale. There is nothing more disheartening for the medical team than being faced with a patient they can't treat. I've also had to make some tough calls on what we spend our limited budget on,” he explains.'

His contract at the Syrian hospital finishes in December 2022. After this, he's hoping to temporarily switch off and embark on another conservation expedition to Midway Island in the North Pacific Ocean.

He hopes to work in Ukraine in the future. ”My experiences working with vulnerable populations has made me very grounded. I appreciate the ease of day-to-day life in the UK, such as having electricity to charge your phone, after living in Syria where electricity was only available for six hours a day. ”It’s also made me feel even more privileged to be a GP working in the NHS and grateful for easy access to an abundance of resources.”

Hareen encourages all GPs to get involved in volunteering, if possible.

Having also worked at a Nightingale Hospital during the pandemic, he says: ”It doesn't have to be abroad or in some of the remotest locations in the world.

You can have just as much impact volunteering in your local community.” 

GP LIVES

| 23

MEMBERS ATTEND FREE REGISTER NOW