MAGAZINE OF THE RCGP ISSUE 21 AUTUMN 2022
Welcome to GP Frontline by Professor Martin Marshall
GP LIVES
future’ 09 Q&A
Kamila
I’ll say yet again that the way in which you adapted to new ways of
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 bril liant Kamila Hawthorne (see her first inter view as Chair-elect on p10).
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incoming Chair of RCGPNI 17 | OPINION 17 Why general practice needs mental health practitioners 19 |
I was clear what I wanted to achieve for the College when I took on the role in No vember 2019, with my priorities of making the job of a GP ‘do-able’ again, highlight ing the importance of having time to build trusting relationships with our patients, and supporting practices to adapt to new ways of working.
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 BIG INTERVIEW Jenny Harries POLICY FOCUS campaign to general practice for the with Welsh Health Minister Morgan NEWS AND FEATURES next College Chair Hawthorne GPs’ spotlight from Wonca/RCGP Conference consultation Mason,
14 Roundup
with Ursula
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on being a public face of the pandemic and her new role at UKHSA 07 |
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Cover cartoon: Martin Rowson
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Annual
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Eluned
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in the
CONTENTSEditors:
Reporters: Amy Boreham, Lucy Greenwood, Jonathan Blay, Cliona McCarney, Nicholas Webb
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.
Daniel Openshaw, Gillian Watson
10 Meet
The
Escalating workload and GP shortag es 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.
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 04 2212
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 unaccept able media and political criticism that’s been levelled at us so frequently of late.
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Inside cartoon: Kipper Williams
Design: Aura Creative Ltd
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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.
College Chair Martin Marshall wrote to the former Home Secretary about this, and Vice Chair for Professional De velopment Margaret Ikpoh gave pow erful evidence to the Health Select Committee on the issue and the con sequences both for the trainees affect ed and general practice. The issue was widely covered in the national media.
indefinite leave to remain would bring general practice in line with other med ical specialties that have training pro grammes 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.
Thank you for allowing me that privi lege, and for the work you do for patients, our College, and our profession.
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 recom mended by 99% of practice staff.
What started out as a Midland Fac ulty 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 Col lege Hon Sec Jonathan Leach and Brig adier (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 spe cialist services.
Martin Marshall
NEW WEBSITECOLLEGEGOES
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.
The College’s innovative Veteran Friend ly 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, cen tre; Boulter, far right).
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It is also compatible with phones, iPads and other mobile devices and there are significant improvements in digitalOveraccessibility.thecoming months we will con tinue to improve the site, expanding the content and functionality.
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.
GPs deserve to work in a service that is appropriately funded and supported and your College will continue to fight for this (see p7).
Goodbye, good luck and take care.
This is a top priority for the College and Martin and Margaret have written another open letter to new Home Sec retary, 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 publica tion, more than 4,200 GPs, trainees and retired GP had signed the letter, to put further pressure on the Government to take action.
There is still so much to be proud of as our specialty evolves and adapts to work ing at larger scale and with multidiscipli nary teams, and we must never lose sight of this.
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Giving GP trainees from overseas
Ever the optimist, I’m confident that common sense has to prevail and that the true value of general practice will be rec ognised – by politicians and policy-mak ers, and, most importantly, by our patients and the public who remain our most pow erful advocates.
MINISTER VISITS VETERAN PRACTICEACCREDITEDFRIENDLY
Find out more about how your practice can become Veteran Friendly Accredited.
I know I’m biased but it’s my view that GPs are the NHS’s biggest asset and be ing your Chair for the past three years has been the most enormous privilege.
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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.
It's also changed her view of public percep tions 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 Nevertheless,noisier.”sheasserts 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
At a recent event at Oxford University on pan demic preparedness, she describes seeing her fa ther, 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 sat isfying,” she says.
”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.”
longstanding preventative work, including smok ing cessation, nutrition and promotion of physical activity moved to the Office for Health Improve ment and Disparities (OHID) in the Department of Health and Social Care.
BIG INTERVIEW PUBLIC HEALTH IN THE PUBLIC EYE
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On NHS Test and Trace, which has received widespread criticism due to its cost – 37bn be tween 2020-22 – and use of private companies, Dame Jenny is not in full agreement with all the points detractors have raised, highlighting the 'mi raculous' scale, size, complexity, digitalisation and speed of the operation.
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 vis ualising coronaviruses using electron microscopy.
”Betweenothers. us, we had probably all the right skills and experience across completely different set tings,” 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 be fore”WeEaster.focus on health protection, protecting com munities, preventing health threats and respond ing to those that arise. We do chemical, biolog ical, radiation and nuclear response. We're using cutting edge data and analytics and scientific and genomic skills to have a really fast response.”
She describes being part of the top team lead ing the pandemic response as 'hugely responsible', 'quite demanding', needing 'strong resilience' and 'hugely privileged'.
UKHSA replaced Public Health England last Oc tober, retaining its health protection and science elements along with the Joint Biosecurity Cen tre – the data and analytics element set up for the pandemic – and NHS Test and Trace. All of PHE's
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 gov ernance in place, the 100 Day Mission is realisable.”
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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 ArguablyUKHSA.best known as Deputy Chief Medical Officer for England during the Covid-19 pandem ic, Dame Jenny was a very public face of the cri sis, 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
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
continues BIG INTERVIEW | 05
It's2022.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.
ic colleagues and clinical colleagues. Many peo ple have said how good it was to see a woman up there. So, it has its difficulties, but lots of pos itivesAndtoo.”despite the media vitriol, Dame Jenny cites receiving her Damehood in July as a high light of her career. ”If someone had suggested a few years ago that I'd end up walking into Buck ingham 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 ex actly what they mean.”
“GPs are our public health link to every single family across country.”the
getting different pieces of information to different communities is critical.”
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 reallyHavingenjoyed.worked in health protection, working on responses to Ebola, Zika, MERS and the Novichok
”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 diffi culty is where scrutiny turns into, let's just say less evidenced lines of enquiry… [that are] not pro ductive and can be confusing to the public…and if comments and scrutiny move into abuse, that's something we need to move away from.”
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.”Asone of the most recognisable faces of the pandemic, Dame Jenny has been at the receiv ing end of harsh criticism from some sections of the media, including a particularly personal attack questioning whether she should have been award ed her Damehood in the Queen's New Year Hon ours
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 peo ple'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.
photographyGrainge
”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 pan demic and keep good bits and drop bits that didn't work so well.”
UKHSAbyProvided
”I don't think it's my job to relax,” she said, ”that would definitely be the wrong thing to do.”
It didn't go to plan; mere months after starting the role, the pandemic hit.
and there are huge opportunities going forward. It's gone well beyond monitoring respiratory dis ease and flu rates, which was predominantly the case
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:
BIG INTERVIEW | 06
”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,
”There'sbefore.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 ge ographical reach, and the more representative we canShebe.”describes the efforts of GPs and their teams during the pandemic as 'heroic'. ”They set up vaccination centres overnight, they com pletely 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 prac tice have been controversial, she describes them as a lifeline for many patients who were clinically extremely vulnerable or found it difficult to travel.
”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 bal ance between the generalist and specialist bit. I admire that.”
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.”
“I don't think it's my job to relax, that would definitely be the wrong thing to do.”
”It's a slower sort of incident response, perhaps, but very important,” she says.
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.
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 pub lic 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.
As to her approach to leading an organisation that by its very nature is relentless: does she see any downtime on the horizon?
And whilst Dame Jenny is very clear that Cov id-19 continues to be a significant threat, she thinks the last couple of months have been indic ative of the next major public health emergency: climate change. She estimates that over the three or four days in July when temperatures hit 40 de grees, there would have 'probably been a signifi cant number of excess deaths’.
H i g h q u a l i t y c l i n i c a l t r a i n i n g E s s e n t i a l i n f o r m a t i o n f o r g e n e r a l p r a c t i c e D e l i v e r e d b y c l i n i c a l e x p e r t s a n d l e a d e r s P r a c t i c a l t i p s a n d t a k e - h o m e m e s s a g e s P l e n t y o f t i m e f o r Q & A w i t h t h e e x p e r t s U p d a t e y o u r c l i n i c a l k n o w l e d g e w i t h O n e D a y E s s e n t i a l s O n l i n e c o n f e r e n c e s p r o v i d i n g e x p e r t s p e c i a l i s t c l i n i c a l t r a i n i n g a n d e s s e n t i a l i n f o r m a t i o n R C G P m e m b e r d i s c o u n t s a v a i l a b l e r c g p . o r g . u k / e s s e n t i a l s
GPs have been working under sus tained pressure and I have been im pressed by their commitment to ensuring the continued delivery of safe and effec tiveThereservices.issignificant learning to be tak en from how GPs quickly adapted to new ways of working, including the introduc tion 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 ac cess as we address issues caused by the pandemic, including a backlog of care.
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
Q&A: Eluned Morgan
To provide accessible and sustainable care now and in the future, we are de veloping and diversifying the workforce, changing ways of working, and better signposting people to a wider range of lo cal services. Our aim is to deliver the right care, at the right time in the right place.
and people will be able to see discharge and follow-up letters as soon as they are Thegenerated.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. Informa tion about individuals is shared appropri ately to ensure services are joined-up and provided in a timely way across the com munity. Modern technology, local facilities and services are all used to help people lead healthy lives and to support those who need care.
What are your ambitions for the digitisation of healthcare?
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 – interac tion with the NHS and they value this ser vice highly in Wales.
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 as sessments are carried out by certain pub lic bodies in certain circumstances.
How can Wales balance responding to the immediate pressures on general practice and tackle the broader determinants of poor health outcomes?
Member of the Senedd Eluned Morgan MS has been the Welsh Government's Health Minister since May 2021. She answers GP Frontline's questions...
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.
What would you like general practice to look like in 10 years' time?
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.
An example of this in practice is the re cent change to fit notes – previously only doctors could legally certify fit notes but a change in the law means four other health care professions can now do this.
POLICY FOCUS | 09
We have invested £1m to provide com munity health checks for chronic condi tions. A further £4m has been made avail able 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
I know GPs have a heavy workload, but in some instances, it will be appropriate for them to review people who are wait ing for treatment – they know their pa tients best. We are currently working with GPC Wales to agree how this approach could work to support patients and GPs.
How do you feel general practice has responded to Covid-19?
COLLEGE UPDATES | 10
Nevertheless, her achievement is his toric 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'.”Iamnot 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, par ticularly for women and international doc tors. 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.
Over the years, from teaching medical
There is still an awful lot of work to be done to improve equality in medicine, particularly for women
A Bevan Commissioner, she is cur rently 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, work ing closely with Professor Dame Helen Stokes-Lampard.Yetthingscould 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 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”ItRCGP.really put things into perspective,” she says, describing the contrast be tween her professional joy and the so bering reality of listening to their experi ences of fleeing a war-torn country.
BREAKING A NUMBER OF GLASS CEILINGS
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Professor HawthorneKamilawants 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.
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 de velop 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 de velop the curriculum, showcase general practice and influence cohorts of new graduates to medicine.
Looking for ways to get more for her membership of the College, and want ing to get more involved, she became an MRCGP examiner in 1997 which, in com mon with all College examiners, required her to sit the MRCGP written paper a sec ond time, and which sparked her interest in medical education and assessment.
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She is under no illusions about the challenges she faces over the next three
”otherelectionweight.seecan'tTheinternationalanddoctors.sayingthat‘youbeituntilyouit’,carriessomeIhopemywillinspireGPs.”
Kamila started attending faculty board meetings, then applied successfully for an MIA/RCGP Research Training Fellow ship in 1991 to work on culturally appro priate health education for British South Asian patients with Type 2 Diabetes, prompted by patients she was seeing in Nottingham at the time.
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 Notting ham, Manchester and Cardiff, and now works as a salaried GP in Mountain Ash, South Wales.
”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.
”The RCGP has been instrumental in my career, enhancing my professional, intellectual, and personal development in ways that I would have never predict ed. I am committed to trying to make sure every member feels this way. I want all members to feel that this is their Col lege,” she said.
With her daughter, her sister and brother-in-law all working as GPs, she al ready 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 ques tions and give their feedback. If success ful, she is keen to roll these out to the widerAddressingmembership.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).
I've had loads of ”allsame,theGPsfriendshipsmadeprofessionallytofromopportunitiestheCollegedevelopmyselfandmanylastingwithfromalloverUK.Iwanttheorbetter,forourmembers.”
Married to a gastroenterologist and with two grown-up children, one of whom is now a GP, she still recalls sit ting 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.
One of her solutions is to maximise the potential of the College member ship, encouraging GPs to support and help each other.
Victoria told GP Frontline she is 'thrilled' to have been elected to the role: ”It's a great honour and a huge respon sibility. I'm looking forward to working with colleagues and wider stakeholders towards supporting general practice, our members and the patents they care for.”
As November approaches, she is starting to scale back on her other com mitments so she can focus fully on her responsibilities as Chair – and ‘doing everything I can’ to support GPs to have intellectually satisfying and fulfilling ca reers, despite the current pressures.
As well as welcoming a new Chair of Council this Autumn, the College will also see some other new faces join its Leadership team.
Also new in post is Professor Mike Holmes, Chair of Trustee Board, which works to safeguard the charitable sta tus and finances of the RCGP. He took up his post in April, taking over from Dr John Chisolm who was serving as inter im-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 hav ing been Vice Chair for Membership and International from 2018-2021 and is heavily involved in his local Humber and Ridings Faculty.
MORE CHANGE AT THE TOP
Dr Victoria Tzortziou-Brown will take up the post of Vice Chair for External Af fairs, succeeding Dr Gary Howsam who comes to the end of his three-year term.
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 Asso ciate Director of GP Specialty Training at NIMDTA, Northern Ireland's medical trainingUrsulabody.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 con sultation on p15.
years, leading the College as GPs strug gle with arguably the toughest workforce and workload pressures in the history of theBuildingprofession.on current Chair Martin Mar shall'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.
She is determined to improve the ex periences of International Medical Grad uates and support them to reach their full potential, in general practice and within the structures of the College itself.
”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 sub scription, or I leave…’, so I got stuck in,” she says. ”It has really paid off.”
She wants to add further value to Col lege membership by improving the CPD offer, exploring options for paying exam fees and looking at the RCGP's future re lationship with allied health professionals.
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Victoria has been a GP in Tower Ham lets, east London, for almost 20 years and has a keen interest in health policy and research. Whilst joint-Honorary Sec retary between 2017-2021 she led on the College`s primary care ethics guid ance during the pandemic, put in place policies for improving transparency with in the College and oversaw high profile College consultations on decriminalisa tion 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.
”Our members are our biggest re source”, 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 deal ing with these pressures and it's impor tant that we find a way to applaud, share and promote these to other practices,” sheKamilasays. is clear that more needs to be done to highlight to members the op portunities the College is offering.
”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.”
”But there just aren’t enough of us, 6,000 GPs aren’t going to suddenly ap pear, so we have to find ways of doing things differently, and a one size solution won’t fit all.”
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.’
He then met Ian Hislop, editor of Pri vate 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
He thinks it’s important that medical voices continue to enter social and po litical 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.’
Dr Ellie Cannon photographyBriscombeAnne-Marie
Likewise, Fari Ahmad, a GP in Wilmslow, Cheshire and one of BBC Breakfast’s reg ular 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.
Recently retired, Phil practised as a GP for 20 years before switching to sexual health and latterly specialising in paedi atric 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 pa tients really hard,” he explains.
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 safe ly so in that sense I’ve failed,” he says.
”It’s often just normal GP stuff,” she says, ”similar to what I get in real life clinics.”
Fari was first approached by a produc er looking for a Muslim woman to give medical advice. ”I was initially reluctant but they said it was good to have dif ferent types of people represented, so I agreed to do it,” she explains.
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”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.”
publicly open about his alter-ego.
In the media spotlight
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.
Ellie was also approached directly to provide a quote for a newspaper and things grew from there – while Phil Ham mond’s media career came out of comedy.
”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 appear ances on BBC, ITV and Sky programmes.
”Edinburgh Fringe was how it all start ed. 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 come dy. We collected a selection of the most outrageous junior doctor stories of unsu pervised 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.”
As well as Private Eye, Phil has written books, fronted TV series and hosted a show on BBC Radio Bristol. He lists un safe NHS staffing, lack of data transparen cy, and not listening to whistleblowers as the three key issues he has campaigned on during his career.
She has also written and published two books: the first for new mothers; and the second on mental health in the work place. ”It’s lovely to publish books,” she says, citing the control she has over them, ”I chose the topic, I wrote them myself,
”It’s about handling whatever questions are thrown at you in a measured, sensible way, which as GPs we tend to do anyway,” says”OftenFari. headlines are very black and white, so being given some time to discuss the context is useful, for example, explain ing 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 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 real ise until a week later,” she jokes.
”When I look back on my career, I'm sure I did more good making people laugh statins.”feedingthanthem
Dr Phil Hammond at the Edinburgh Fringe 2022
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.
Whilst all three GPs advocate for doc tors, Ellie and Phil have also found them selves speaking out against the profession.
HammondPhilbySupplied
”That’s when the whole thing changed from defending doctors to protecting pa tients,” he says – something that didn’t make him ‘universally popular’.
the trick is to forget the camera and the studio and just have a conversation on theIt’ssofa.”gone full circle for Phil, who has just completed a stint at the Edinburgh Fringe
”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.”
”It’s about handling whatever questions are thrown at you in a measured, sensible way, which as GPs we tend to do anyway”
Dr Fari Ahmed on BBC Breakfast
She’s also taken part in debates with those who have completely different view points. ”I suppose it’s great for viewing figures. You have to consider your de meanour, if you’re aggressive and defen sive, you will lose the audience. You’ve got to come across as human and talk from a place people can understand.”
and it’s really nice to see your name in print in a Duringbookshop.”theCovid-19 pandemic she was the first doctor to write about mak ing her own face mask; and she used her platforms to encourage people to get in volved in vaccine trials.
”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.
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.
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.
”I do enjoy it,” says Fari, ”it can be daunting when you think it’s live TV and millions of people are watching, but
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NewsBBC
”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.
”It’s important to highlight the problems. And of course, it wasn’t just GP-driven, it was pandemic-driven and resource-driv en, and it’s shown that general practice needs big investment to keep going.”
A stirring opening ceremony, includ ing music from popular West End shows, launched a stimulating four days of ple naries, CPD, policy sessions, networking events and 1,200 individual abstracts andHighlightspresentations.included Professor Victoria Tkachenko, who joined remotely from Kyiv, to give a passionate, awe-inspiring and shocking account of trying to pro vide healthcare in the midst of the war on Ukraine – for which she received a well deserved standing ovation.
NEWS AND FEATURES | 14
General Dr Tedros Ghebreyesus, Wonca World President Dr Anna Stavdal, and Sir Michael Marmot with a European per spective on tackling health inequalities.
members’ concerns over visas for Inter national Medical Graduate trainees a re curring theme.
College on internationalthestage
”A big thanks to all delegates who took part, whether in person or virtually.”
Dr Steve Mowle
College Chair Martin Marshall used the real-life example of his patient ‘Mo hammed’ to explore the theme of rela tionship 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.TheVibrant 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.
early 3,000 GPs from the UK and 179 different countries con verged on London’s ExCel Cen tre for the College’s first-ever annual con ference in partnership with the European branch of the World Association of Fam ily Doctors, Wonca.
RCGP Honorary Treasurer Ste ve Mowle, who led the organising team, said: ”The conference exceeded our expectations on all levels. It was a brilliant opportunity to share experienc es with so many international colleagues, as well as highlighting the achievements of UK general practice and the commit ment of hardworking GPs to the care of their patients, wherever in the world we practice.”
Despite the difficulties being faced by primary care teams throughout Europe, a real sense of optimism and energy pre vailed throughout the conference. Col lege Vice Chair Margaret Ikpoh summed up the atmosphere with her rendition of the song ‘Something inside so strong’ at the closing ceremony.
There were also keynote addresses from World Health Organization Director
N
The Ask the Chairs session – where Martin Marshall was joined by College leaders from Scotland, Wales and North ern Ireland – also drew a big crowd, with
I’ve had mine for nearly two years and would esti mate 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 andResearchengaging. has shown – some based on NHS employees – that having a standing desk reduces sitting time and daily anx iety, and can increase job performance and quality of life. Some evidence shows standing can help with of fice-related back pains.
The close relationship with patients and my fantastic practice team. I feel proud that we are able to pro vide a high-quality service in the local community.
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.
RCGPNI Chair-Elect and a GP in Carryduff, South Belfast
COLLEGE UPDATES | 15
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 Iend.couldn’t do without mine. For me, it’s similar to the difference be tween 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.
DRTUNIMECONSULTATION.10URSULAMASON
The challenge of trying to meet rising demand with limited capacity and insufficient resources.
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 conver sations 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.
WHAT WOULD YOU BE IF YOU WEREN’T A GP?
WHAT’S THE MOST FRUSTRATING THING ABOUT BEING A GP?
Professional connections and fantastic learning op portunities. With the huge challenges we face, having a collective voice is important.
WHAT ARE YOU MOST PROUD ABOUT IN YOUR CAREER?
WHY DID YOU CHOOSE TO BE A GP?
I have always felt frustrat ed with the amount of po tential time we spend being sedentary as GPs, especially given this is an independent risk factor for cardiovascular disease, diabetes and allcaseWithmortality.telemedicine, pa tients 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.
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?
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 ex tremely challenging. In Northern Ireland, we also rap idly 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?
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.
Searching for the right career!
HOW CHALLENGING HAS THE PANDEMIC BEEN?
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 train er, I have had the pleasure of supporting many col leagues through their GP training and now watching them thrive in their career.
WHY DO YOU THINK IT’S IMPORTANT TO BE A COLLEGE MEMBER?
When an opportunity arises, look at it, sleep on it, trust your gut and if it feels right, go for it!
AN IDEAUPSTANDING
Read more about the RCGP’s Physical Activity and Lifestyle programme.
the trading name
The Royal College of General Practitioners are an Introducer Appointed Representative (FRN Mutual, of General Provident Society Ltd PG Mutual’s registered office is 11 Parkway, Porters Wood, St Albans, Hertfordshire United Kingdom Friendly Societies Act 1992, Registered Number 462F PG Mutual is Authorised by the Prudential Regulation regulated by the Financial Conduct Authority and the Prudential Regulation Authority, Firm Reference Number (FRN) 110023
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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.
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OPINIONBoard. | 17
It might sound like a lot but it’s doa ble and it works. We’ve been smart about maximising our Mental Health Investment Standard, as well as the Additional Roles Reimbursement Scheme (ARRS) and suc cessfully applying for community trans formation funding. We also have people monitoring financial 'slippage', so money can be moved to ensure it is spent and not wasted.
Patient feedback has been excellent. They’re getting direct contact with an MHP and the appropriate support they need from their own surgery, usually with in 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.
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 ex perience 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 signif icant experience in mental health.
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.
Two valid challenges have been lev elled 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
THE CASE FOR MENTAL HEALTH PRACTITIONERS IN GENERAL PRACTICE
Dr Ardyn Ross
n April 2021, the first mental health practitioners (MHPs) started working in GP practices across the 19 prima ry care networks covering Norfolk and Waveney. We’ve never looked back.
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 employ ing 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.
We’remanagers.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 men tal 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 peo ple needing mental health care.
Mental Health team, Norfolk and Waveney ICB
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.Weinvested in online counselling plat forms, five mental health support hubs offering walk-in support in a café envi ronment 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 ser vice, so mental health distress calls can be managed in patients’ own homes.
in ourGPsexperience.remainthe main point of contact for their patients’ care, with MHPs of fering 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 ser vice
I am part of a fantastic team of peo ple (pictured), all passionate about men tal 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
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 gener al practice, at the front door of the NHS, they will ease pressures longer term.
M o t o r i n g F i n a n c i a l s e r v i c e s S h o p p i n g I n s u r a n c e T r a v e l C i n e m a G y m T e c h D a y s o u t A n d m u c h m o r e r c g p . o r g . u k / p l u s E x c l u s i v e m e m b e r o f f e r s f r o m l e a d i n g b r a n d s a n d r e t a i l e r s
22 20 GP LIVES HAREEN DE SILVA ANNEIMA-EDOMWONYIUWADIAECONNOLLY232221 EWEN STEWART20 21 23 GP LIVES | 19
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”It is very difficult to help them, we can signpost to resources like the Cit izens Advice Bureau that help with fi nancial issues, but it feels like chipping away at the tip of an iceberg. The sit uation 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.
”Mental health consultations have rocketed and we are increasingly see ing people whose problems are relat ed to spiralling debts, but also people who are having trouble feeding their families and having to make decisions around heating and food.
Ewen Stewart has built his career on caring for people on the margins of society.
”The privilege of sharing people’s lives and being the holder of informa tion 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.
”If we want to prevent ill health and to stop people becoming unwell then we advocate,canbut we shouldn’t be picking up the pieces. The politicians should be trying to prevent people getting into these situations in the first place.”
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photographyNeedJohn
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 work ing with drug users. He is also Clinical Lead for the Lothian Viral Hepatitis Managed Care Network and has re cently taken on a new role teaching the graduate entry medical course at the University of St Andrews.
”The practice cared for a lot of peo ple who had problem drug use. It felt as if they were a group who were stig matised 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 prob lem but that their whole history has led them to that,” he explained.
”It’s important that medics have a voice in raising what’s happening in patients’ lives around their finan cial 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 pre vent people getting into these situa tions in the first place.”
AN EMPATHETIC EAR
issues. When people do develop a problem, that’s when a medical inter vention along with the social one is reallyAnotherimportant.”‘social’ concern, he said, is the rise in patients presenting with concerns about the rising cost of living.
former GP partner now turned salaried GP in Glen rothes, Dr Ewen Stewart spent 17 years in Leith working with drug users.
”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 sto ries 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 eventu ally became the Sex, Drugs and BBV Task”ThatGroup.task group was led by some inspirational women, in particular Dr Chris Ford. I really enjoyed working with that group of committed and en thusiastic GPs over many years, and eventually became Chair. I was in volved 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 Manage ment of Problem Drug Use, which
”While I definitely see the manage ment of problem drug use as a medi cal issue, I see the prevention of prob lem drug use as a social issue, rather than a law and order or policing issue,” he”There’ssaid. absolutely no doubt that poverty, childhood trauma, poor social circumstances are important anteced ents of people developing a problem, and if we want to try and prevent this, we need to look at these wider social
While he acknowledges the toll that caring for patients in difficult situations can take on a GP’s own health – work force shortages and workload led to him giving up his partnership – he has never lost the enjoyment of being a GP.
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.
She strongly believes that the solu tions to improving diagnosis, standards and availability of treatment for wom en’s gynaecological health lie in holistic primary care – but that frequent calls by charities for additional mandatory GP training in areas like menopause
”The care is very fragmented and women who can’t navigate the hurdles are hit hardest. If women have cultur al or social issues, they don’t have the wherewithal to get around the system.”
laborative work with the Royal College of Obstetricians and Gynaecologists, FSRH and others to create the ‘one stop’ Women’s Health Library re sources.In2017
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.
Anne says her career has been based on seizing opportunities, rather than a grand plan.
After qualifying with a post-gradu ate 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 (member ship) of the Faculty of Sexual and Re productive Health (FSRH) from 2017-19.
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Today, as the RCGP rep for Wom en’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”Womencare. spend more than 30 years of their life either wanting to be preg nant or wanting not to be pregnant, but we tend to treat conditions like en dometriosis, polycystic ovary syndrome and early menopause ‘on the day’ rath er 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 conse quences 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”Apparentlyresponses.only0.5% of respond ents 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 wom en’s health work, the focus is on making sure that all women are heard,” she says.
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.
WOMEN’SCHAMPIONINGcollegereps@rcgp.org.ukHEALTHAnneConnollyisonamissionforparityforwomen'shealth.GPLIVES | 21
She is particularly proud of the col
While raising her four children, she and her husband job-shared a GP part nership in a large teaching practice in Bradford and as the daily parental needs changed, she started taking on more women’s health issues and con traception 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.
”GPs have done brilliantly, even though we’re still getting slated for it. GPs have been inundated with meno pause requests and they are respond ing”It’sbrilliantly.good to see that women are more aware of their symptoms and talk ing openly about HRT or getting better support in the workplace, but unfortu nately, some of the media expectations are unrealistic and some women think that HRT is a panacea for all their ills.”
”All the ducks are lined up – this is the time and we can’t miss the opportunity.”
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 re quested is for contraceptive or gynae cological reasons.
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
PhotographyGrainge
The College is still in ongoing dis cussions about particular recommen dations in the Women’s Health Strategy, but Anne is optimistic that things are going to ”Women’simprove.health is no longer side lined. 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.
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 fol lowing the same path.
”Even before I ran for Council, I want ed to get involved with the College because it’s important that more peo ple from black, Asian and minority eth nic communities are seen and heard,” he
ollege Council member Dr Uwadiae Ima-Edomwo nyi is not one to sit back and wait for things to happen.
”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”
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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 pro tocols and proceedings’, he ‘really en joyed it’.
”I’msaid.hopeful that the College can con nect more with its members and grass roots 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.”
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Uwa draws on the advice he himself was given by former RCGP President, Professor Mayur Lakhani.
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.”
HOUSE UwaREPRESENTATIVESOFIma-Edomwonyiwantsthevoices of doctors from minority ethnic communities to be heard – so he decided to do something about it.
During the first lockdown of the pan demic, he was struck by the dispropor tionate toll that Covid-19 was taking on minority ethnic communities – and became even more alert to the need for more GPs from ethnic minority commu nities to have a louder voice and greater representation in leadership roles, both within the profession and the RCGP itself.
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 facul ty a few months later.
”One thing I have in mind is to contin ue to mentor and give back and support
”There can be a disconnect between what the College does and what grass roots 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.”
”I was attending meetings regularly and it was a really enjoyable journey, so I decided to run for the national Council elections.”
”It was lovely to meet the College Of ficers and other Council members in per son. You are expected to read and digest the Council papers prior to the meeting, which I did, and I contributed to the dis cussion of two papers at the meeting,” he Hesaid.attended his second meeting re motely and says that whilst you're still 'seen and heard', being given the op portunity to speak on items and vote if required, ‘there is nothing like actually being in the same room with colleagues.’
”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 edu cation; three is research as part of your career; and then the fourth is medical leadership, either in a primary care or ganisation or the College itself. It gives you a structure for your career and it’s important to take these opportunities,” he
At the same time, the College was developing its action plan to improve the experiences of black, Asian and mi nority 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.
”Also,said. 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 for ward can be daunting, but you have to seize opportunities when they arise in or der to be part of making a difference. I’m very glad I did and I hope others will to.
At the beginning of this year, Ha reen returned to Iraq and Syria to work for CADUS as the Medical Coordina tor for the middle east, overseeing the medical aspects of CADUS projects in Iraq and Syria and helping to identify possible new projects.
He hopes to work in Ukraine in the”Myfuture.experiences
”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.
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.'
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 vol unteering in your local community.”
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 Syria he manages the field hospi tal including the staff and budget for equipment and pharmaceuticals, and in Iraq he helped create a pre-hospi tal care training programme for ambu lance drivers.
In November 2020, he volunteered to work at Kara Tepe 2, a refugee camp in Greece for six weeks.
The key to working in this environ ment 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 re sponsible for updating and delivering clinical education to nurses and doc tors working at the hospital, while also educating patients about hygiene, and manually monitoring and report ing diseases in the camp to the World Health Organization.
Hareen at a camp in rural Rukka, Syria
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Many of the patients had conditions caused by poor sanitation and over crowding in the camp such as scabies, while others had poorly controlled long term health conditions including diabetes and high blood pressure. Ac cess to and supply of medications was also limited.
”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.
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Working as a volunteer has opened up very HareenworldsdifferentforDeSilva.
”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.”
With a maximum of only 100 ap pointments 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 ap pointments, who would need to queue again the next.
Two months later, he arrived in Syria after securing a job for a small non-gov ernmental organisation CADUS and found himself working in what was still a very active conflict zone.
MatakasMoritz
WAR PEACEAND
working with vul nerable populations has made me very grounded. I appreciate the ease of day-to-day life in the UK, such as hav ing electricity to charge your phone, af ter living in Syria where electricity was only available for six hours a day.
Hareen encourages all GPs to get in volved in volunteering, if possible.
n the middle of the South Atlantic Ocean is Gough Island, a remote and un inhabited 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 ex pedition organised by the Royal Socie ty for the Protection of Birds.
But the most difficult challenge, says Hareen, was 'overcoming the sense of guilt and mental drain of telling pa tients 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.'
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