GP Frontline - Spring 2022 by RCGP

M A GA ZI NE O F TH E R CGP  I SSU E 20  SPRIN G 2 0 2 2

FUTURE OF GENERAL PRACTICE?

1 | CONTENTS

CONTENTS 03 | NEWS 04

Big Interview – Former Health Secretary Jeremy Hunt on his latest role – and the need for more GPs

Scotland’s Cabinet Secretary Humza Yousaf in the hot seat

A consultation with Dr Emma Wong, Chair of First5 Committee

11 | COLLEGE UPDATES 11

In at the Deep End in Wales and conversations with patients in NI

The College at 70!

New Vice Chair Margaret Ikpoh on her plans for MRCGP

Welcome to GP Frontline by Professor Martin Marshall

17 | OPINION 17

The argument for ‘vaccinating the world’

19 | GP LIVES 20

The GP on the SAGE committee during COVID, the couch potato turned long-distance runner, and the GP coroner share their experiences

24 | BACK PAGE 24

Countdown to College/ Wonca conference 2022

17 22

Editors: Daniel Openshaw, Gillian Watson

Reporters: Amy Boreham, Paul Christian, Tanisha Dadar, Lizzie Edwards, Lucy Greenwood, Cliona McNulty, 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

02 | CONTENTS

hat a whirlwind the last few months – indeed two years – have been in general practice. It’s always been a varied and evolving career but the pandemic has tested our profession to its limits. We moved straight out of some of the worst media vilification I’ve seen in 30 years of practice and into Omicron where you all stepped up, once again, to ensure the pandemic response was successful. And you did in droves; it was outstanding to see, a testament to your professionalism. Then 2022 began and everyone has been talking about the future of general practice. It is, as the front cover of this edition of GP Frontline suggests, frustrating to see so many people coming up with ideas about the future of our specialty when they have so little understanding of what general practice does and apparently an unwillingness to listen to the profession. One idea that has been mooted several times is that of ‘nationalising’ general practice. What is meant by that is removing the independent contractor status that general practices have, and all GPs becoming directly employed by the NHS. If people are looking for a ‘radical’ solution, then this is certainly one. But there’s no point in making radical change for the sake of it. The partnership model of general practice is founded on GPs’ goodwill, their understanding of their communities and their instinct to innovate in the best interests of patients. Without it, would we have seen the truly remarkable efforts of GPs and their teams to roll out the Covid vaccination

scheme – and not to forget, two expanded flu vaccination schemes – with such efficiency, success and out-of-the-box thinking? I doubt it. General practice is the bedrock of the NHS, and the ‘partnership model’ is the bedrock of general practice. The salaried model complements the partnership model. When other models of care are introduced in the best interests of local populations – as many have been – that’s great and we should learn lessons where appropriate, and replicate successes where appropriate. We’re open to working differently. Being opposed to so called ‘nationalisation’ of the profession is not about being resistant to change, it’s questioning the change of a model that works well for patients and the NHS, just for the sake of ‘being radical’. Politicians and decision makers will, of course, talk to the College, the BMA and other bodies representing GPs and the wider NHS, as they decide what the future holds – you can read more about my appearance at the Health and Social Care Committee on p7. My plea to them is to listen. 

NEARLY 3,000 GPs TAKE COLLEGE E-ACTION

The College joined forces with more than 100 health organisations, including all medical royal colleges, two former NHS Chief Executives and a former Health Secretary to back an amendment to the Health and Care Bill that would force the Government to publish regular independent projections of how many doctors, nurses and other healthcare professionals are needed in the NHS. Nearly 3,000 GPs took our campaign action to write to their MP, urging them

to back the motion – and Martin Marshall was interviewed for the FT and wrote OpEds in the Independent and New Statesman outlining why it was so important. Despite the widespread support, the Government repeatedly tabled motions to reject the amendment, which was put forward in two iterations by the House of Lords, and the Health and Care Bill received Royal Assent, making it the Health and Care Act 2022 and therefore legislation. Martin Marshall called the decision ‘shameful’. He said: “One reason general practice, and the wider NHS, is working under so much pressure is a historic lack of workforce planning. This was an opportunity for the Government to address this and their decision not to was shameful. We need thousands more doctors and nurses across the NHS, and we need a comprehensive plan as to how to achieve that. The College won’t stop making that case – the care we’re able to deliver to patients depends on it.” 

THE COLLEGE SUCCESSFULLY LOBBIES FOR WOMEN’S RIGHTS

The College lobbied MPs to amend the Health and Care Bill to make telemedical abortion permanent. In March, MPs voted in a free vote to retain the policy so women requiring early medical abortion can now continue to choose how and where they receive such care. At the start of the pandemic, the Government removed the requirement for women to attend a clinic in person, allowing appointments to occur remotely. Despite evidence of telemedical appointments being safe and women being positive about the experience, as restrictions were lifted, Government originally said appointments would have to revert to face-to-face. The College welcomes this win for women’s rights. 

MAKING THE CASE FOR GENERAL PRACTICE An OpEd by Martin Marshall made the front page of the Daily Express earlier this month. It followed comment pieces published by the New Statesman, the Independent, Hacked Off and politics. co.uk., all highlighting the unsustainable pressures facing GPs and their teams, the impact this is having on patients, and what needs to be done about it. Since the beginning of the year, the RCGP has featured in the media more than 3,000 times, more than 250 in national outlets, including multiple appearances on Radio 4's Today Programme, World at One and Newsnight. There have also been pro-

active stories in the FT and Guardian, and letters to the editor published in The Times, the Telegraph and Guardian. This piece in the Express also featured Vice Chair Gary Howsam and GP Nick Brown explaining how great a career in general practice can be, but that the profession needs support. The Express editorial said: “Losing yet more burnt out GPs from the profession can only make a dire situation worse. This health emergency needs to be sorted out – and quickly – because GPs are suffering, and patients too.” 

NEWS

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B IG I N T ER VI EW

THE CONTINUITY CANDIDATE

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It was the wrong argument,” says Jeremy Hunt MP about the row over remote working that has plagued the GP profession over the last year. “We should have been having a discussion about continuity of care and stopping the ‘Uberisation’ of general practice than the much more mechanical issue of the nature of consultations.” Mr Hunt, 55, a former Health Secretary, Foreign Secretary and Prime Ministerial candidate, is on a mission to reinvigorate continuity of care in general practice, indeed across the NHS. Now Chair of the influential Health and Social Care Committee (HSCC), he continues: “We had a fake debate about face to face versus virtual meetings [but] if people were seeing a regular doctor that they knew, they’d be happy with a phone call or a text message, or an email. It’s when they think they’re seeing someone completely new they feel uneasy about not being able to see someone face to face.” “We know from last year’s Norway study,’ he continues, “that people are 30% less likely to go to hospital if they have a family doctor over a long period of time, and that’s the role we want GPs to be doing.” Hunt suggests a move back towards GPs having their own patient lists would both instil continuity of care and improve morale in general practice, though he’s realistic it couldn’t ‘happen overnight’. “GPs who remember the days when they had their own lists say that was the best bit about it,” he says, “knowing a patient as they grew older, knowing a patient’s family, having those links with generations, that’s what makes being a GP more rewarding than being a surgeon, because surgeons see someone once, GPs see someone over the course of their lives. “It’s relationship-based care,” he says coining the description used by College Chair Martin Marshall, “and I think that’s what patients want too, so I firmly believe that in terms of patient safety and restoring joy, if it’s not too inappropriate a word, in general practice, it’s what we need to work towards.” At this he rushes off to vote. We’re meeting on the afternoon that amendments to the Nationality and Borders Bill are being voted on in the House of Commons. Hunt has set up camp to take meetings in the bustling Pugin tea room

04 | BIG INTERVIEW

in the Palace of Westminster where he can disappear off down the corridor to the voting lobby as necessary. It’s a cacophony of clattering tea cups, high-spirited discussion and occasional voting bells. Familiar faces come and go and people stop to thank and congratulate Hunt for speeches and interventions he’s made. He’s clearly still at the centre of the action, despite not being in Government, and he relishes it. “On the backbenches you can say exactly what you think, you don’t have to follow the party line. I love that,” he says. Hunt, who was Health Secretary between 2012–2018 – the longest-serving in British political history – has been a prominent critic of Government in its handling of the pandemic. He’s on record as saying the country should have locked down earlier and elaborates: “With hindsight it is clear that we should have worked much more quickly to adopt a mass test, trace and isolate system to prevent the need for a full lockdown. Without that in place, we should have adopted a comprehensive lockdown much earlier which would have prevented virus spread and saved many lives even though that meant going against the scientific advice which was aimed at moderating the speed of infection.” Hunt has also spoken out against aspects of the Health and Care Bill, currently going through Parliament, defying the Tory Whip to support an amendment that would strengthen NHS workforce planning by forcing the Government to publish independently verified workforce projections every two years. He admits he ‘didn’t get everything right’ when he was Health Secretary and that he was ‘very disappointed’ at the progress he made in building the GP workforce, particularly as the 5,000 target – upped to 6,000 by Prime Minister Boris Johnson on his first day in office in 2019 – was one he had personally chosen to make. “We've been talking now for a decade about the principle that prevention is better than cure and GPs have a central role in the prevention agenda. The NHS will literally fall over if general practice isn't functioning and indeed it's starting to because we don't have the capacity in general practice that we need.” He says recruitment efforts were successful with 3,250, half of medical students, choosing

Grainge photography

Jeremy Hunt MP was Health Secretary for six years, now Chair of the influential Health and Social Care Committee, he speaks to Daniel Openshaw about his plans...

"On the backbenches you can say exactly what you think, you don’t have to follow the party line. I love that."

to specialise in general practice – a number that has continued to increase – but that officials hadn’t factored in working patterns such as ‘people choosing to go part-time or retire early’. “It [also] means dealing with the ridiculous anomalies in the pensions system, which I tried to change when I was Health Secretary, and made some progress, but is still a massive issue,” he says. This is why he’s very keen his successors ‘learn from the things where I wasn’t successful, because that’s the way you make progress’, and is frustrated that the Government rejected the workforce planning amendment. He puts the Government’s reticence to support the amendment down to Treasury concerns that it will ‘give the NHS a blank cheque for getting the numbers of doctors trained that it wants’ and therefore losing control of the costs of doctors’ training. It’s a concern he understands, given how much it costs to train a doctor, but argues ‘the reality is they have already lost control’. He explains: “We’re spending more than

£6bn a year on locum doctors and agency nurses because we have lost control of the workforce and I understand the need for locum doctors, but if you believe in continuity of care, they aren’t a long-term solution to our workforce problems, and it’s very expensive.” Despite his disappointment around failure to sufficiently build the GP workforce, he was proud that by the time he moved on from his role as Health Secretary the NHS had five new medical schools and an extra £20bn of the NHS budget. He also says that despite a public narrative to the contrary, he never saw himself as an ‘enemy’ of the medical profession. Admitting that at times he ‘had his battles’, particularly around pay negotiations, he’s adamant that he ‘worked extremely well’ with doctors and nurses due to their shared focus on patient safety, ‘something that every doctor and nurse I ever met was very passionate about.’ “I tried very hard with general practice… I sometimes felt that some GPs didn’t understand how hard I was genuinely trying to work to solve some of the issues that they faced. But I also continues

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BIG INTERVIEW

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understand it’s politics and as Health Secretary you’re always going to be on the receiving end of a lot of the frustration people understandably felt about things that were going wrong.” It’s one of the reasons why Hunt, as Chair of the HSCC, has launched an inquiry into the future of general practice (read about RCGP Chair Martin Marshall’s appearance in front of the Committee on p7). “The scale of the crisis in general practice is clear with an exhausted workforce and patients uncertain what to expect. GPs are the lifeblood of the NHS and making sure general practice is fit to face future demand presents a key challenge for the NHS. Our inquiry will make recommendations to Government on how to meet this challenge.” The HSCC isn’t the only body currently thinking about the future of general practice. It’s a hot topic, with think tank Policy Exchange publishing its own ideas, and rumours circulating that current Health Secretary Sajid Javid is considering commissioning his own inquiry. An idea that keeps being mooted is reform of the independent contractor status of general practice. It’s something the RCGP is strongly opposed to, but Hunt is somewhat on the fence, recognising the partnership model for its innovation, but questioning how it can be improved to make it more sustainable long term, particularly given the workforce challenges facing the profession. Away from the mechanics, Hunt thinks hope plays a part in making general practice sustainable for the future. “GPs need to know there is a long term plan in place to reduce the intensity of the workload so that even if it’s very hard work coming to work, people can feel, particularly younger GPs, that it’s not always going to be like this.” It’s his key message to GPs: “There can be no sustainable NHS without our army of brilliant and very hard working

and very exhausted GPs, so work with me and others to try and get reforms in place to mean that you really can recommend your profession to your children and grandchildren, because we need more GPs.” Whilst being Health Secretary was not Hunt’s ‘most enjoyable’ ministerial role – that goes to his stint as Foreign Secretary – he says the brief was his ‘most interesting and worthwhile, because it’s the NHS, it’s people’s health and you’re making an immediate difference to people’s lives.’ And he’s also shocked about how much he is enjoying being out of Government, on the backbenches, with his scrutiniser role as Chair of one of the most high-profile Select Committees. “When you’re Secretary of State you can change the things you really want to change but 90% of your time is taken up by firefighting, so only a very small proportion of your time is spent on focussing on the really big things you want to change. When you’re on the backbenches, you can spend 100% of your time focussing on the things you want to focus on and you can spend more time to really think things through and learn from what you got right and what you got wrong, so in that sense, it’s more rewarding,” he says. It has also given him the opportunity to spend more time with his wife Lucia Guo and their three children, aged 7, 10 and 11, and whilst he says his aspirations to be Prime Minister haven’t completely vanished – he was runner up to Boris Johnson in the 2019 Conservative Party leader contest – he describes them as being ‘dimmed'. Although, he quips that if he was Prime Minister, his main focus where the NHS is concerned would be restoring continuity of care. “That would be top of my list,” he says. 

parliamentlive.tv

" There can be no sustainable NHS without our army of brilliant and very hard working and very exhausted GPs." Jeremy Hunt chairs the Health and Social Care Committee inquiry into the future of general practice

06 | BIG INTERVIEW

parliamentlive.tv

SHAPING THE FUTURE OF GENERAL PRACTICE The RCGP is at the forefront of representing GPs to politicians and decision-makers, advocating in the best interests of general practice and patients. Read about Martin Marshall's latest appearance at the Health and Social Care Committee.

Martin Marshall gives evidence to the Health and Social Care Committee

ooking to the future of the profession is a recurring theme at present. The College was at the forefront of pushing back against media speculation about plans to ‘nationalise’ general practice – and we continued our defence of the partnership model in our response to similar suggestions by think tank Policy Exchange. RCGP Chair, Professor Martin Marshall said: “We are open to exploring new ideas about the future of general practice, but there has to be a very good reason for changing a model that works well for patients, the NHS and the tax payer.” Last month Martin gave evidence to the first of five sessions that the Health and Social Care Committee is planning to hold as part of its own inquiry into the future of general practice (read more in the Big Interview with Committee Chair Jeremy Hunt MP, p4-6). The College had already submitted wide-ranging written evidence to the inquiry, but the focus of this session was the need to retain trained, experienced GPs in the workforce. Jeremy Hunt asked Martin about recent BMA findings revealing that nearly half of GPs are planning to reduce their contracted hours and nearly a third are going to leave general practice altogether in the next year. He said: “Does that ring true with you? Is the profession in crisis?” Martin responded: “Yes, it does ring true and it is a massive concern. I have been a GP for just over 30 years. I have

seen ups and downs over that time in the status of general practice and general practice’s ability to do its job, but I have never seen things as low as they are now. “If we are not able to provide the majority of care in the NHS – 90% of patient contacts happen in general practice; if we are not able to serve our communities, and if we are not able to do the job we do in protecting the rest of the NHS so that services are used judiciously and when they are required, that is a really big crisis.” He added: “Our own College survey showed that 60% of GPs said that their mental health had suffered in the last year; 34% of GPs said that at least once a week they are fearful that they cannot do their job, not even providing safe care for their patients; and 34% of GPs said that they planned to retire in the next five years. That would mean 14,000 fewer GPs than we have at the moment. We are likely to be losing more GPs than we are recruiting at the moment, and that is a massive crisis. “Essentially, the demand and the need for general practice services is greater than the supply,” he said. In summing up his evidence Martin spoke about how vital general practice was to the overall success of the NHS. “There has to be hope for general practice, otherwise there is no hope for the NHS,” he said. “We need to be honest with ourselves and say that we have reached a state in this crisis where we need to be working

really hard on long-term solutions.” In concluding the session, Mr Hunt said: “We have heard loud and clear that unless we have a long-term plan to give hope that the capacity of the system starts to match the demand on GPs’ time... we are not going to give credible optimism for the future to the new generation of GPs. That is certainly something we want to think about as a committee.” The College will continue to campaign for solutions to the intense workload and workforce pressures facing GPs across the UK. 

"There has to be hope for general practice, otherwise there is no hope for the NHS."

Prof Martin Marshall

POLICY FOCUS

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IN AT THE DEEP END Humza Yousaf is Cabinet Secretary for Health and Social Care in Scotland and recently visited the Perth practice of RCGP Joint Chair David Shackles. As he approaches his first year in the role, here are his reflections – as told to Lizzie Edwards.

balanced over the course of the year. Key to that is ensuring there is a hybrid model in how patients are seen. Keeping face to face where needed, we've got to have telephone consultations and video consultations because a lot of people benefit from that, I know I prefer it because it takes less time out of my day, quite frankly. We also need to ensure medical graduates are coming through the training pipeline and view general practice as really attractive. We’ve done well, 98% of GP training posts were filled last year. We’ve met our commitment to increase training places and available medical school places.

WHAT HAVE BEEN YOUR BIGGEST REFLECTIONS FROM YOUR VISIT TODAY?

WHAT ARE YOUR REFLECTIONS ON HOW GENERAL PRACTICE HAS RESPONDED TO THE PANDEMIC?

General practice is undoubtedly under considerable pressure. I could see that as soon as I walked in, how many people were in the waiting room and how many people were coming in. I was struck by the collaborative, multidisciplinary team working, that clearly works really well.

HOW WILL THE NEW HEALTH AND SOCIAL CARE WORKFORCE STRATEGY BENEFIT GPs, THEIR TEAMS AND PATIENTS?

Every person working in a GP practice I’ve spoken to tells me that the last two years have been exhausting. The receptionist staff have told me that they’ve never received as much abuse as over the last two years. That’s unacceptable. A key focus of the strategy is looking after staff wellbeing. We’ve got ambitious targets to grow GP numbers over the next five years and this strategy cements that commitment, but also looks towards how we can deploy our staff even more effectively, so we’re investing in our allied health professional workforce too.

WHAT NEEDS TO HAPPEN TO ENSURE GPs FEEL ABLE TO REMAIN IN THEIR ROLES?

It’s not just about recruitment, which is important, it’s about retention. We have to ensure that being a GP remains a really attractive career choice. GPs I speak to tell me that the last two years have felt like the worst of the winter pressures, they’ve had no respite. There will always be busy periods, but we’ve got to ensure that workload is more evenly

08 | POLICY FOCUS

I’ve been doing this for 10 months and it’s really challenging. People on the frontline have been working day in day out with all the associated pressures and health impact for two years. Many have told me that they haven’t had a moment to breathe. That’s my first reflection – my genuine worry about the mental wellbeing of our NHS staff. My second is that I get quite upset if I get a hint of anybody trying to blame any part of the workforce and there’s been a temptation by some, in politics and the media, to point a finger at GPs. I think that’s deeply unfair, I’ve not met a GP who’s sitting on their hands or twiddling their thumbs. They are working absolutely flat out and it must be really demoralising to have the finger of blame pointed at you when all you’ve done is work exceptionally hard. We’ve got to guard against that blame culture. We’ve been hit by the biggest shock our NHS has faced in its 73 years. That’s not the fault of GPs, or any health worker – they are doing their best and I think we need to remember how valuable GPs and all general practice staff are to our communities.

WHAT ROLE DOES GENERAL PRACTICE HAVE IN NHS SCOTLAND'S DRIVE TOWARDS NET ZERO AND HOW DO YOU PLAN TO SUPPORT THE PROFESSION IN ACHIEVING THIS?

Our health service has significant footprint in terms of employment, estates and treatments.

I think about inhalers: how can we reduce, where clinically appropriate the use of reliever inhalers and switch to dry powder inhalers? It may seem small, but actually the accumulative impact will be significant. We want GPs to work closely with our pharmacists to reduce the environmental impact of other areas of prescribing and we’ll publish our Scottish Quality Respiratory Prescribing Guidance, hopefully this year, to help clinicians with this. Estates is important too. With new builds it’s relatively easy to make them more environmentally friendly, for estate that already exists, it’s more difficult, but

“People on the frontline have been working day in day out with all the associated pressures and health impact for two years. Many have told me that they haven’t had a moment to breathe. That’s my first reflection – my genuine worry about the mental wellbeing of our NHS staff.” there are things such as boiler schemes, or solar panelling we could look at, and there’s a whole host of possible initiatives that are focussed on GP practices. We’ll be publishing our NHS Climate Emergency and Sustainability plan in the Summer.

RCGP SCOTLAND HAS BEEN ACTIVELY INVOLVED IN FINDING SOLUTIONS TO THE APPALLINGLY HIGH LEVELS OF DRUG RELATED DEATHS IN SCOTLAND. WHAT PROGRESS IS BEING MADE IN REDUCING DRUG RELATED DEATHS AND WHAT MORE NEEDS TO BE DONE TO SUPPORT THOSE WHO ARE SUFFERING FROM DRUG RELATED HARMS?

I agree, it’s appalling but we are making progress. I think the MAT [Medication Assisted Treatment] standards are vital to that, so embedding and implementing

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DR EMMA WONG First5 Chair and GP partner in Sheffield

WHY DID YOU CHOOSE TO BE A GP? them will be key to ensuring that people who need it get treatment in a timely manner, and vitally get the wrap around support that is needed. There’s a critical role here for primary care.

WHAT DO YOU SEE AS THE ROLE OF GENERAL PRACTICE IN HELPING TO REDUCE HEALTH INEQUALITIES IN SCOTLAND, WHICH HAVE WORSENED OVER THE PANDEMIC?

I’m a great supporter of the work of the Deep End, they do an incredible amount of good work and are an important voice in the discussion about how we reduce health inequalities in Scotland. The Short Life Working Group looking at health inequalities in primary care published their findings recently and I’m very enthusiastic about a lot of their recommendations. Primary care has such an important role to play in reducing health inequalities. You are the front door, you will see whole families so you will understand them better than I think just about anyone else. But it’s not just GPs, it’s

Community Link Workers, I’ve got a fantastic one in my own constituency, it’s the thousand additional mental health and wellbeing workers that we committed to by 2026. All of these individuals working together are going to play a really important role in all of this.

FINALLY, DO YOU HAVE A MESSAGE FOR GPs AND THEIR TEAMS?

Genuinely, whole heartedly and sincerely: thank you. I don’t think we can truly repay those who have worked and continue to work in our health service for what they’ve done during Covid. I want GPs and their practice staff, everyone involved in a GP practice, to know that this Government really supports your efforts and are grateful for your efforts. Sometimes my conversations with the RCGP and the BMA can be quite robust but where we have disagreements we’ll be constructive about it. I’m committed to doing my best to ease the workload pressures you are facing. I can’t promise I’ll be able to do that overnight and I’ll be upfront and honest about that. 

As a med student in my first GP placement at a rural Derbyshire practice, I remember a patient coming in with her daughter and granddaughter. That GP had looked after three generations of the family. There was clearly great trust and understanding in the doctor-patient relationship. I love the opportunity to have that continuity of care with patients. I don’t think that’s always achieved in a secondary care setting.

WHAT’S THE BEST THING ABOUT BEING A GP?

The variety – it’s never a boring day in the surgery! There’s always something new to learn or see. I am also lucky enough to work with a fantastic team.

WHAT’S MOST FRUSTRATING?

Resources and infrastructure – in particular, the lack of IT support. We could be using technology to improve patient care in more ways that we currently have funding for. I also wish that we had a better national system to educate patients on improving their health in the community.

WHAT ARE YOU MOST PROUD OF?

Completing my MRCGP during the Covid pandemic and surviving my first year in independent practice!

WHAT HAS BEEN THE MOST IMPORTANT LESSON OF YOUR CAREER SO FAR?

To make some time daily for yourself, even if it’s only five minutes. It’s hard to look after other people if you’re not looking after yourself.

WHAT IS YOUR MESSAGE TO YOUR FELLOW FIRST5s?

Don’t be afraid to ask for help if there’s something you don’t know or if you’re struggling. The first few years are tough when you’re finding your feet. Use your First5 network and the RCGP forums. There are a lot of people in your area with a hugely diverse pool of knowledge – not only will you learn things you never knew, but you might make some good friends along the way.

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

The resources it provides. Apart from the excellent online learning there have been some fantastic webinars. I’ve learnt about everything from Covid rehab to how to make Bahn Mi (online cook-alongs highly recommended!). The College also links you with your local faculty. It’s great for getting to know the GPs in your region.

WHAT WOULD YOU BE IF YOU WEREN’T A GP?

Humza Yousaf visits David Shackles' practice in Perth, with practice manager Lynn Williamson

POLICY FOCUS

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A pilot – lots of opportunity to travel and meet people.

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SUPPORTING WELSH GPs AT THE DEEP END

50 years on from GP legend Dr Julian Tudor Hart’s seminal 1971 article on ‘the Inverse Care Law’ about health inequalities, his premise that “the availability of good medical care tends to vary inversely with the need for it in the population served” remains pertinent.

And RCGP Wales are now following RCGP Scotland in initiating the ‘Deep End’ model of general practice.

Calling for a common language Dr Laurence Dorman, RCGPNI Chair

The beauty of general practice is our diversity and flexibility. As GPs, we are at the heart of local communities, and this allows us to design our services based on the needs of our patients. But it’s been a difficult two years as the Covid-19 pandemic forced our colleagues across the UK to operate services differently, virtually overnight. This was necessary to protect patients and our practice staff, but this shift in care was not without its challenges. In Northern Ireland, it became clear to us that one of the reasons patients and the wider public struggled to understand the change in our GP services is that we were not using a common language to describe our remote offering. Terms such as 'triage' are difficult to understand for patients – and the media – and are often conflated with ‘remote consultations’, despite being different things. Inadvertently 'apologising' for not offering a faceto-face appointment in the first instance, or suggesting these service changes were temporary, has been confusing for patients. One consequence was a dilution in understanding of the challenges

In 2009, Professor Graham Watt and colleagues from Glasgow University joined with GPs in many of Scotland’s most economically deprived areas to tackle the underlying reasons for discrepancies in health outcomes, with general practice core to the project. The model has been replicated internationally, but not yet in Wales, until now. A project proposed by RCGP Cymru Wales and spearheaded by immediate past jointChairs Dr Mair Hopkin and Professor Peter Saul has been granted initial funding for 18 months by the Welsh Government. The 'Deep End' describes the additional needs for populations living in the most deprived areas and the impact this has on workload for the GP practices that support these communities. Evidence shows that deprivation means people get sicker younger and are far more likely to have multiple physical and mental health co-morbidities.

Difficulties with health literacy compound these challenges as many patients require additional support to benefit from healthcare advice. In turn, the need for primary healthcare increases in both volume and complexity, meaning that 'deep end’ GPs and their teams are struggling. “We were delighted to receive the go-ahead from Welsh Government for this pilot project,” says Mair Hopkin, “the College has played a key role in the development of ‘Deep End’ in Scotland and I’m pleased the College is leading the way in Wales”. Peter Saul added: “This will provide a framework for tackling entrenched structural inequalities.” Current Chair of RCGP Cymru Wales, Dr Rowena Christmas, said “I want to thank Mair, Peter and everyone else who have worked so hard to make this proposal a reality.” 

in general practice from policymakers and stakeholders. While respecting the autonomy of GP practices to deliver services in the best interests of their patient populations, we thought it was essential that on first point of contact with their practice, patients are greeted in a way that will allow them to firstly understand, and then value the service they are going to be receiving. This is why we developed our Common Language paper, which received endorsement from RCGPNI Council and subsequently at national level from UK Council. This paper was not intended to reopen the debate on the merits of face-to-face versus remote care, or to dictate how colleagues operate their service, but to help foster better understanding of the current remote service model which is likely to be with us, in some form, for many years to come – something my colleagues and I have been making clear in the NI media recently. Work is ongoing to develop some practical resources for GP practices and we are continuing to engage with patient representatives. If you are interested in our work to support a common language and better patient understanding in general practice, please get in touch: chairni@rcgp.org.uk 

COLLEGE UPDATES

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RCGP at 70 The College celebrates its 70th anniversary in November, and a range of national and local Faculty events are being planned throughout the year across the whole of the UK to mark the event – including the joint RCGP/ Wonca Europe conference in June.

While the RCGP in 2022 looks very different to how it did in 1952, our mission remains the same: Cum Scientia Caritas – to deliver compassionate care with knowledge. When the NHS was set up in 1948, general practice was in decline and struggling to cope. Matters came to a head following the publication of the critical Collings report in 1950, which highlighted the perilous state of British general practice, with demoralised doctors, hurried work, and poor facilities. It was against this background that a few influential GPs began to develop the idea of a college. These doctors shared a belief that what was needed was an academic body to support good standards of practice, education and research, such as already existed for other medical specialties. Such a college, they argued, could provide leadership for the many doctors who were passionate about working for better standards in general practice, and make it possible to attract young doctors of the highest quality.

”The College is its members and we are proud to be representing family doctors, both across the UK and internationally, 70 years on“ Dame Clare Gerada, RCGP President

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John Hunt (left), Fraser Rose (right), founding members of the RCGP

In 1951, Dr John Hunt and Dr Fraser Rose published a joint letter in the British Medical Journal and The Lancet seeking support. The response from grassroots GPs was overwhelmingly enthusiastic – but it was far from plain sailing, with a lot of resistance and hostility, including from other Royal Medical Colleges.

Original 1951 letter to The Lancet by Drs Hunt and Rose

Later that year Hunt, Rose and a small group of doctors met to form a Steering Committee. At its final session in November 1952, nine months after its inception, the College of General Practitioners was legally constituted. Its Foundation Council comprised just one woman, Annis Gillie, who went on to become the College’s first female Chair in 1959 and President in 1964. In 1972, we were granted our Royal Charter and became the Royal College of General Practitioners. Today, we are the UK’s largest Medical Royal College with a thriving community of over 54,000 members. As general practice has changed over the past 70 years, so the College membership has changed.

In 1952, under 10% of general practitioners were women – today there are more women GPs than men. A third of College members are women under the age of 45 and International Medical Graduates make up 29% of our membership. Unlike other medical Royal Colleges, the RCGP has a Chair and a President, and we have had six women Chairs so far, including three in succession – Clare Gerada, Maureen Baker and Helen Stokes-Lampard from 2010 to 2019 – meaning that the College had a female Chair for almost a decade, something no other medical Royal College has achieved. To mark the start of our 70th anniversary year, 30 Euston Square is hosting an exhibition – Women at the heart of general practice – exploring the roles that women have played in general practice through the College’s history and earlier. Dr Mayur Lakhani became the first Chair from an ethnic minority community in 2004 and President in 2017. Mayur is a British Indian whose family fled to the UK as refugees to escape Idi Amin’s brutal regime in Uganda, 50 years ago this year. We have also had a Royal President – our patron, the late Duke of Edinburgh became President for a year to mark our 50th anniversary in 2002. Prince Philip visited the College to formally open our new London headquarters at 30 Euston Square in 2014. 30 Euston Square has been our headquarters since 2012 and is our fourth headquarters. One of its former uses was as the Department of Health and Social Security. The College was based at 14 Princes Gate in Kensington for over 40 years – hence the naming of the Princes Gate room in 30 Euston Square. After the First World War, Princes Gate was offered to the American government as a home for their ambassadors. Eight ambassadors and their families lived there from 1921 to the mid-1950s,

The College had to be evacuated due to the Iranian Embassy siege next door. The SAS took over the College’s rooms to plot their movements to end the siege – including abseiling from the roof and forcing the windows. Courtesy of Combined Military Services Museum, Maldon Essex

including Joseph P Kennedy, father of future American President John F Kennedy. It then became the headquarters of the Independent Television Authority for six years until the College bought it in 1962. In April 1980, it inadvertently became the backdrop for one of the most defining moments in British history when the College had to be evacuated due to the Iranian Embassy siege next door. The SAS (Special Air Service) took over the College’s rooms to plot their movements to end the siege – including abseiling from the roof and forcing the windows. The siege lasted for six days and two hostages were killed, two wounded and one SAS soldier wounded (see above). Five of the gunmen were killed and one captured, going on to serve 27 years in prison. No College members or staff were harmed. Back to the present day and general practice is no longer the ‘cottage industry’ it was in 1952. Even before the pandemic, it was clear that the NHS cannot survive without thriving primary care provision. General practice is the bedrock of the NHS, easing the pressure on other parts of the service and delivering safe care to patients in their communities, close to home. It is also the most cost-effective arm of the NHS, delivering excel-

Mayur Lakhani, then RCGP President, at a New Members' Ceremony, 2018

lent value for money to the taxpayer and public purse. Just as John Hunt, Fraser Rose and their forward-thinking colleagues envisioned, the College continues to support GPs in their care of patients by offering lifelong learning and CPD courses and events, both locally through our Faculty network and nationally – and increasingly online to accommodate GPs’ busy lives. Unfortunately, general practice in 2022 is again under enormous strain due to a lack of investment by successive governments across the UK for over a decade. Therefore, a great deal of College time and effort is

spent on campaigning to get GPs the support they need, both financial and staffing, to do their jobs – and to protect our members’ own welfare and wellbeing to prevent them from burning out or leaving the profession. We set standards for general practice through our College exam, the MRCGP. First established in 1968 as a requirement for College membership, the MRCGP became the only route into general practice for trainee GPs in 2007. Without the College there would be no new GPs and the MRCGP guarantees that all new qualified GPs can deliver the same high quality of safe care to patients wherever they are trained, due to a universal GP curriculum developed by the College. On the research front, the College’s Research and Surveillance Centre is an internationally renowned network that collects and monitors data from more than 1700 GP practices across England and Wales. As well as its weekly report on flu prevalence and other illnesses such as chickenpox, it played a lead role in the Covid pandemic, rapidly evaluating different treatments to stem the progression of the virus, particularly in elderly and clinically vulnerable patients. College President Dame Clare Gerada, who is a GP in south London and who is leading the 70th anniversary plans, said: “Despite the pressures we’re all under, I hope that all our members will be able to celebrate what the College has achieved over the past 70 years and what hardworking GPs, past and present, have achieved in caring for generations of patients and in making general practice the speciality it is today.“ “The College is its members and we are proud to be representing family doctors, both across the UK and internationally, 70 years on.” 

RCGP Chairs 2010–2019: Clare Gerada, Maureen Baker, Helen Stokes-Lampard

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RCGP ANNUAL CONFERENCE IN CONJUNCTION WITH WONCA EUROPE

29 June - 1 July 2022 | ExCeL, London High quality content 97% of previous delegates rate our sessions good or excellent Oustanding speakers including Prof Sir Michael Marmot Essential CPD including safeguarding and basic life support Peer reviewed posters Vibrant general practice community connecting hundreds of GPs across the UK and overseas

Seizing the opportunity November 2021 saw some new appointments in the RCGP Officer team. Amongst them was Dr Margaret Ikpoh, new Vice-Chair for Professional Development. Amy Boreham caught up with her to see how the job is going so far. Margaret

Ikpoh was a recently-elected National Council Member when she responded to the advertised role of ViceChair. Initially, the thought of applying evoked feelings of ‘imposter-syndrome’, but she realised she was more than qualified for the role and put herself forward. “I have always been passionate about encouraging others to take up opportunities when they present themselves, and I really felt I had to practise what I was preaching,” she said. Her role covers three key areas: oversight of the College’s CPD offering; the MRCGP assessment, including development of a new exam module; and planning the RCGP's Annual Conference, which this year is in collaboration with WONCA Europe. Margaret says that so far, she's really enjoyed working on CPD, something she attributes to her former role as education lead for the RCGP White Rose Faculties, which she says was the 'ignition to the fuse' to be further involved with the College and develop CPD for GPs across the country. Developing the new exam module, drawing on the Clinical Skills Assessment (CSA) and the Recorded Consultation Assessment (RCA), is going to be one of Margaret’s major challenges. The RCA was introduced as a temporary substitute for the CSA at the start of the pandemic so that trainees could achieve CCT on schedule and safely. Margaret, who is also a GP trainer, says these changes were ‘vital’ in allowing around 6,000 AiTs to sit the exams they’d be working towards, and which are the requirement for entering the workforce as independent practitioners. But she acknowledges that trainees face some challenging factors including consulting in areas of high social deprivation which may impact on how some trainees could prepare for the RCA. “This is why the exams team are continuing to engage our GP educator and trainee community to deliver a new exam module,

taking in aspects of both the RCA and CSA, that is reflective of the communities of practice that we serve,” she said. Margaret hopes this new assessment module will be ready at some point next year. “I want to make sure all aspects of the RCGP exams reflect current general practice, including supporting GP trainees to consult confidently as independent practitioners in a post-pandemic era, whilst also maintaining and upholding professional standards,” she said. Addressing long-standing concerns about differential attainment in the MRCGP assessment – which is common to many other professional examinations – Margaret says she is committed to continuing the College’s work in this area. She’s keen to support the College's commitment to equality of opportunity and promoting diversity in the assessments of the MRCGP. These include a myriad of initiatives, such as the working group that was established to look at decolonising the curriculum, exploring action points identified by the former BAME education and

“Acknowledging and recognising the fact that trainees consult with patients from diverse populations will help to shape the future of the exam and how it will need to reflect modern day practice.” training task group focused on support for international medical graduates and continuing to provide support for those trainees who require reasonable adjustments to complete their assessments.

Margaret in the MRCGP exam centre, 30 Euston Square

“Acknowledging and recognising the fact that trainees consult with patients from diverse populations will help to shape the future of the exam and how it will need to reflect modern day practice,” she said. She also made clear that the key to “tackling the issue and eradicating differential attainment is a collective effort that needs to be addressed from medical school through to post-graduate training. Engagement with trainers, trainees, patients, researchers and key stakeholders such as Health Education England and its equivalents across the UK, and the GMC is so important to addressing it.” Another area of work for Margaret will be looking into the possibility of a Primary Care doctor role in general practice, as proposed for further discussion in a recent RCGP Council paper. “I want to explore how general practice could potentially embody this type of doctor. The general practice team is already made up of a host of healthcare professionals including nurse practitioners and physiotherapists. It’s important that we explore how such a role could support our current workforce, particularly given the current extreme staff shortages being faced by the profession.” Margaret is certainly set to have a busy tenure. She reflects upon the support and dedication of her team who have helped her settle into the role, so far, and will ‘give [her] the tools and platform to make impactful and positive change on the careers of College members, from GP trainees to experienced GPs who’ve been practising for years.’ 

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WHY WE NEED TO VACCINATE THE WORLD Dr Kath Brown

n the UK to date there have been 176,000 deaths of people within 28 days of a positive Covid test. At least 1.5m are estimated to be experiencing ‘long Covid’ symptoms. More than 39m people – over 58% of the population – have been fully vaccinated. Over the last two years, GP surgeries up and down the country have risen to the challenge of providing healthcare to our patients in entirely different ways, trying to protect our patients and staff from Covid whilst offering ongoing care, and leading the Covid vaccination programme (as well as two expanded flu drives) in a way that has been truly outstanding. We should be incredibly proud of what we achieved. Data from the National Audit Office showed that up to October 2021, 71% of vaccines were given in primary care with remarkable efficiency. Yet, despite excellent vaccination rates, wave after wave of infections are

hitting our surgeries, we’re still seeing patients dying of Covid and living with the long-term impact of the virus and the pandemic. The pandemic has certainly highlighted domestic inequalities. But viruses do not respect borders and Covid has highlighted worldwide inequalities in healthcare. Thousands are dying in silence in Africa. For them, there are no ICU beds, no lifesaving drugs and only limited supplies of oxygen. Millions are unvaccinated; 7.2% of Nigerians have had two doses compared with 86.5% in the UK. Healthcare workers risk their lives as they treat patients with Covid despite being unvaccinated and having no PPE. The world has sent millions of doses of vaccine that are of little use because of the lack of syringes, fridges, or healthcare workers to put jabs in arms. Struggling services are devastated as healthcare workers lose their lives to Covid. More lives are being lost to TB, HIV, malaria and malnutrition as healthcare workers are stretched beyond their limits. Lives are being lost to preventable diseases as vaccinations for measles and polio are missed. Children are orphaned and cannot attend school. Adults are sick, unable to work and provide for their families. The way out of the pandemic is through global vaccine equity. There is no end until we are all safe. In February, the Access to Covid 19 Tools Accelerator (ACT-A), a partnership of leading global agencies, including the World Health Organization and COVAX, revealed a costed business plan to achieve global vaccine equity based on fair share financing from rich countries.

This will enable them to support low to middle income countries to roll out their vaccination programmes and deliver tests, treatment and PPE to those who need it most. The ‘fair share’ requested from the UK is a mere £720m compared to the eye watering £370bn spent on our domestic response, or the £37bn spent on test and trace. £720m may sound like a large sum but represents just 0.036% of our annual GDP. Put another way, it represents for every fully vaccinated UK citizen, the cost of a single grape in a weekly grocery shop. Apart from our moral obligation, there are clear advantages to the UK funding ACT-A: we protect ourselves from the emergence of potentially more lethal variants; help end the pandemic sooner; and get our economy back on track. Failing to meet the WHO target could result in 5m more deaths worldwide. More lives lost and lives changed. We owe it to our future generations to grow and thrive in a better and safer world. Many of you will have heard of #VaccinateTheWorld, a UK based campaign that has the support of the RCGP and organisations including the BMA, other Royal Colleges and the Doctors Association. They have a simple call: to ask the Prime Minister to donate 0.036% of our annual GDP to pay our fair share and help vaccinate the world. 

To support this campaign please go to www.vtw.org.uk Dr Kath Brown is a GP in Newquay and a member of the VTW Board With thanks to Dr David Attwood, Dr Lucy Henshall, Dr Simon Hodes and Dr Sonali Kinra for their contributions. Statistics correct at time of publication (May 2022)

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Women at the heart of general practice

Exhibition until September 2022 30 Euston Square, London

rcgp.org.uk/women-in-gp

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KAMLESH KHUNTI

FRANCES CRANFIELD

HUSSAIN AL-ZUBAIDI

AISHA AWAN

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SAGE ADVICE

In early April 2020, Leicester GP Kamlesh Khunti was one of the first clinicians in the world to tweet about a possible disproportionate impact of Covid in ethnic minority populations. Since then, I've become busy with doing the research in that area. It became very apparent – in fact, the first lot of data came out three days after the tweet, which I then sent to the Chief Medical Officer for England Chris Whitty. I was so pleased that the Government’s SAGE committee (Scientific Advisory Group for Emergencies) set up an Ethnicity Subgroup which I was asked to chair,” he explained. Professor Khunti was the only GP on the committee and says “it was an honour being on SAGE and to see how the different scientists have worked together.” Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, his work has influenced national and international guidelines on the screening and management of people with diabetes. He is an advisor to the Department of Health and Social Care, and a Clinical Advisor to

NICE (National Institute for Health and Care Excellence). Making a difference and personal experience are key drivers for his work to improve the health and care of patients. “My whole family has diabetes, my uncle and aunt, my father had diabetes. And because of the strong presence in my family, I took a great interest in it. Most of my relatives, especially on the male side, died before the age of 55 of diabetes related complications,” he said. “My research interests are in both diabetes and cardiovascular medicine because they're very interlinked.” He was instrumental in the establishment of the Leicester Diabetes Centre, founded in 2012. “I’m very, very proud of the centre – it is the largest applied health research centre in the UK and probably the second largest in Europe – and [I’m] very proud of the team, who conduct really cutting-edge work, not only screening

"Because of the strong presence [of diabetes] in my family, I took a great interest in it." My 32 years at the same practice has been fantastic as I still enjoy seeing my patients, and am now seeing three generations of them.” As demonstrated by his role on the SAGE Committee, Prof Khunti is passionate about addressing health inequalities: “We know that there are certain communities, such as the deprived and ethnic minority populations who are disproportionately impacted by certain conditions including access to care. I was born in inner-city Leicester and went to a very inner-city school, so this was something I grew up with in terms of the inequalities within Leicester. And again, I think it's probably influenced my thinking and

“

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and epidemiological work, but interventional work, especially in diverse populations such as deprived and ethnic minority populations,” he said. Prof Khunti has worked at the same practice, Hockley Farm Medical Practice, for 32 years. “I started in general practice as a full-time GP. That was 32 years ago. It was a very inner-city practice which I then helped become a teaching practice, training practice and a research practice. A few years down the line, I went half time because I took an academic post at the University of Leicester. I was a partner until two years ago, when I resigned from the practice as a partner. I'm still a salaried doctor one day a week at the same practice.

Source: Diabetes Professional Care, organised by CloserStill Media

my research prioritisation as well.” His future plans include continuing to learn the lessons of the pandemic and putting them in place on a global level, “prioritising people at the highest risk”, he said, with a focus on India and Africa. He was awarded a CBE in the New Year’s Honours List, an achievement he feels is shared with his colleagues. “I am absolutely humbled and honoured getting it. And I always say it reflects the work that my team here at the Leicester Diabetes Centre has been doing for over 20 years now,” he said. 

IN THE LINE OF DUTY Dr Frances Cranfield describes her journey from GP to becoming an Assistant Coroner in 1999, as ‘a path with an unknown destination ̛. She explains all to Lucy Greenwood. certainly didn’t start with the belief that I wanted a medical -legal career, it was a case of seizing an opportunity that arose at the time,’ she says. Frances was introduced to the legal side of medicine during her vocational training – part of which was completed at Scotland Yard as her trainer was a coroner – and then at the practice she joined directly after qualification “All the partners there were police surgeons and so I was expected to do police surgeon work. I was mentored by some of the giants of the forensic world,” she explains. “I did quite a lot of work around sexual assault victims and police work at that time. And actually, it was a really exciting time to be doing that kind of work because there was no structure and systems like we have now.” Frances was a founding member of the Faculty of Forensic and Legal Medicine, and the Expert Witness Institute, among many other professional bodies. The role of coroner is an independent judicial officer, appointed by the Crown. “You investigate deaths where there has been any suspicion of a violent or unnatural death, the cause of death is unknown, or the person has died in custody,” she says. “You have to do all the enquiries necessary for that. Sometimes you have to order post-mortems, most of the time you are requesting statements and medical notes. Some of the time you are holding inquests, and that is a formal court procedure.” Nowadays, Frances says she wouldn’t be able to become a coroner. Since 2009, a change in the law means you need to have been a barrister or solicitor for at least five years. “But there is a new option, open to GPs, and that’s the new medical examiner system, which is open to all doctors,” Frances says. The ability to help bereaved families ‘find the answers and knowledge they need to have the best closure possible’,

and for society to learn lessons from people’s deaths and change for the better are both drivers for Frances’ work. There is a wider point about death. “I see huge distress often where people haven’t got wills. Death is one certainty in life but it is a Cinderella subject…people feel unable to discuss it or prepare for it. It’s part of life’s cycle and I would like to see people acknowledge that more,” she says. On the other end of the spectrum, Frances describes the role of a coroner as being ‘bathed in grief’, so the ability to step away is essential. “You listen sadly to tragic accounts... people are trying to come to terms with sometimes horrific things so it is absolutely vital that you can go home to a safe environment and a supportive family. Hobbies, Saturday night escapes to the cinema and travel have been a vital part of that for me. “To a large extent that is true of general practice as well,” Frances, who practises in Welwyn Garden City, muses, “we deal with life changing events with people, but we have known some of them for three generations. I have looked after three generations of families and you know some of them really well and you have to be able to step away from their problems and grief as well.” As well as balancing her two careers, Frances is heavily involved in College life, having joined her Beds and Herts

“Death is one certainty in life but it is a Cinderella subject.” Faculty Board soon after completing her GP training. She’s now the Faculty’s rep on UK Council, and has held a number of local and national roles within the College. She speaks about her involvement fondly: “It’s provided me with knowledge, friendship, opportunities, and I would say I have tried to do my best to give back to colleagues and the profession over the years. I think it has to be a two way process.” Her advice for other GPs considering a portfolio career is to "look at the possibilities and explore the opportunities available with an open mind. Some won’t be right for you and that is okay… but don’t look back with regrets for not giving something a go. Have the courage to step outside your comfort zone because that can help you grow." Next for herself: “My ambition is to continue to be part of the process of embedding medical examiners into the system, where I hope we can be learning from death in a supportive and no blame culture. “Life is to be lived to the full – that’s the way I look at it.” 

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RUN HUSSAIN RUN

is journey started as a GP trainee when hearing a GP partner encouraging staff and patients to participate in a local parkrun. Inspired, Hussain attended with his wife, already an avid runner. He described the 5k course as a 'real struggle', “200 meters in, elderly people and people pushing buggies were passing me. It was a wakeup call that I needed to improve my fitness,” he said. Hussain completed the run in just under 30 minutes but described himself as being ‘totally wasted' afterwards. He started joining his wife on runs and attended parkruns to build up endurance. He has since won nine official races and is now a ranked athlete with a personal best 5km time of 16 minutes, 31 seconds. His passion for running has infiltrated all aspects of his life. He signed his practice up to the Run Talk Run and Walk Talk Walk initiative, a programme that creates a safe space for participants to talk about mental health whilst simultaneously getting the benefits of exercise and community support. “It is as simple as having a chat and going for a run or walk, but the positive benefits have been enormous. It’s been easier than I thought to talk to patients about stresses outside of practice whilst maintaining professionalism.” Hussain says the programme has strengthened relationships between practice staff and patients, and that there is a greater appreciation of the pressures the team is working under. He attributes this to the high number of patients who volunteered to help the practice deliver the Covid-19 vaccination programme. He now wants to promote the Run Talk Run programme to other areas. Spurred on by the success of Run Talk Run, Hussain founded the Clarendon Lodge Medical Practice Fitness Club (CLMPFC) on social media, allowing participants to share their exercise activity and encourage others to achieve their goals. The practice also sets chal-

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Four years ago, Hussain Al-Zubaidi’s free time consisted of relaxing on the sofa and watching Netflix. Today, he fills much of his spare time with exercise, having trained to complete numerous events including the Great North Swim, 30 marathons, three ultra-marathons and an Ironman 140.4 mile triathlon race. His most recent adventure was in April, finishing the Eco Trail Morocco 70km desert race in second place. lenges for patients to complete, such as #pledge10000, encouraging them to collectively run, walk, cycle, or swim 10,000km. In September 2019 the club met in real life with a fitness day in the practice's car park, offering taster sessions with local fitness groups such as yoga, spin, salsa, taekwondo and a session by the local Wasps rugby team. Hussain has used his involvement in CLMPFC to tackle health inequalities by addressing factors that may make it more challenging for patients to exercise. He curated and linked with specialised activities to make exercise more accessible to these groups, for example Bhangra classes for Asian female’s over-50s, and walking groups tailored to people with mental health challenges, obesity and osteoporosis. In January, Hussain also started the Leamington Lifestyle Clinic through his primary care network, offering group sessions on nutrition and physical activity followed by entry into a fitness club. “It was really rewarding to see the positive effect the club and lifestyle clinic was having on patients, some have kicked unhealthy habits such as smoking, improved their self-esteem, social skills and reduced their painkillers or come off medication for anxiety and depression altogether,” he said. Hussain regularly features on Channel 4's Steph's Packed Lunch, extolling the importance of physical activity. He's on the Swim England board advising people with certain health conditions to swim safely. As a member of the College's Physical Activity and Lifestyle project, he encourages practices to sign up to the RCGP Active Practice Charter scheme promoting the health benefits of

physical activity for staff and patients. He's not finished running. “I've got the Edinburgh Marathon in May, Ironman Weymouth and Portugal in July and October respectively, and I’ve qualified to compete in the London Marathon based on my time rankings,” he says. His advice to other GPs who want to get fitter: “If you've got a big fitness goal you want to achieve, break it down into smaller steps, but make sure you celebrate the smaller successes along the way. Regardless of the activity, it's so important for your mental health and self-esteem to find something you enjoy outside of medicine.” 

OFFERING REFUGE AT REACHE NORTHWEST According to the UN Refugee Council, 84m people worldwide have been forcibly displaced due to war or fleeing persecution; 26.6m of them become refugees, and 4.4m become asylum seekers. or the last 18 months Dr Aisha Awan has led the Refugee and Asylum Seekers Centre for Healthcare Professionals Education (REACHE). Established in 2003 and funded by Health Education England, the organisation has helped over 300 doctors – and more than 250 other healthcare professionals – to gain substantive posts in the NHS through supporting them to pass their UK licensing exams and English language proficiency tests. Born in Manchester, Aisha’s family moved to Saudi Arabia for her father’s job when she was a child. Studying at international schools and living alongside families displaced by conflicts had an impact. When the first Gulf War broke out, Aisha remembers leaving her home, school and father behind. She recalls watching the news a week later and learning a scud missile had landed a few hundred metres from their compound and the horror of realising her father might have been home. “The desire to stand up for displaced people and others who don't have a voice was partly seeded in my childhood experiences,” she says. This drive has shaped Aisha’s GP career. She was the clinical lead at her GP practice, supporting patients from

“The work REACHE does to help medical colleagues regain their professional identity is incredible. But we recognise we are also part of our members’ trauma.”

homeless and refugee communities, as well as caring for those who might have been ‘off-listed’ from other practices. She was also on the governing body of Salford CCG, working to improve the health outcomes of people living in one of the most deprived local authorities in England. In 2020, she became the Director of REACHE. “The work REACHE does to help medical colleagues regain their professional identity is incredible. But we recognise we are also part of our members’ trauma. They are already highly-trained professionals, some leaders in their field but they often have to restart their UK medical practice at a more junior level,” Aisha explains. Originally, applicants would contact REACHE after hearing about the service locally – but Aisha describes how people are increasingly contacting them directly from the countries they are trying to flee. “We’ve had desperate messages from Afghanistan and Ukraine asking for help to escape. It’s heart-breaking because as a country we should be offering refuge in a timely manner, but frustratingly, the mechanisms are just not in place,” Aisha says. Once arriving in the UK, REACHE supports members to find housing, offers pastoral care, counselling services, clinical English tuition and medical training. “We teach members about all aspects of working in the NHS, including the culture and processes,” Aisha says. REACHE arranges three-month hospital placements for members at Salford Royal Hospital where the centre is hosted. The centre is also supported by academics from the University of Manchester.

Aisha describes the ‘difficult’ switch to online learning during the pandemic: “Some members and their families were living in one-bedroom flats, sharing a mobile phone between them and their children who had to do schoolwork remotely.” REACHE intervened, and with the help of the charity Computer Aid, sourced and delivered 100 refurbished laptops to members, allowing the continuation of their training. The work of REACHE is not only socially responsible, but Aisha advocates its benefits to the NHS: “It’s a hugely cost effective project and an immediate solution to the extreme workforce shortages, we’re feeling across the health service,” she says. REACHE has been contacted by those looking to deliver healthcare refugee training programmes both nationally and internationally. Aisha is only too happy to support this by sharing resources and experience with her counterparts. “Over 18 years, we've learnt the art of how to teach and re-establish healthcare professionals’ careers. It is only right that we share this, so we can support healthcare refugees across the globe,” she says. She attests that her work at REACHE has positively impacted her ability to deliver clinical care as a GP. “I used to feel very strained sticking to the standard 10-minute appointment time,” she says, “but now I've stopped putting myself under so much pressure. I understand more the value of not rushing important conversations and the power of active listening. It makes the patient feel more understood and ensures that as GPs, we’re delivering the right care. 

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LOOKING AHEAD TO THE RCGP ANNUAL CONFERENCE The RCGP Annual Conference is fast approaching and will be a bit different this year.

Not only will we be celebrating the College's 70th anniversary but we are also hosting the conference in conjunction with WONCA Europe, the World Organization of Family Doctors. The event will be the 27th WONCA Europe Conference and will take place from 28 June to 1 July at London's ExCeL. The joint conference will offer a truly global perspective to primary healthcare as we will be joined by family doctor colleagues and health care professionals from across Europe and the rest of the world. We are delighted that World Health Organization Director General Dr Tedros Adhanom Ghebreyesus will be sending a pre-recorded opening address. Confirmed keynote speakers include WONCA Europe President Dr Anna Stavdal, Professor Sir Michael Marmot, and members from the Vasco da Gama Movement of trainees and early career GPs across Europe, as well as College Chair Prof Martin Marshall. It promises to be the must-attend event of the year for GPs and practice team colleagues, showcasing the latest clinical and policy developments across the UK and connecting you with over

1,600 of your peers, enabling you to network, learn from and inspire one another. Delegates can expect high quality content rigorously reviewed by GPs, outstanding plenary speakers, essential CPD, excellent networking opportunities and a celebration of general practice, its history and the amazing contribution of GP teams to the NHS. RCGP Honorary Treasurer, and Chair of the organising Committee, Dr Steve Mowle said: “It is my pleasure to welcome you all to this exciting event which will be the first WONCA conference to be held face-to-face since the pandemic. The conference will give us all a chance to meet, discuss and implement positive change.” “By welcoming you and hundreds of incredible family doctors and healthcare professionals from around the world, we’ll really show that London is open to the very best scientific research, talent and creativity.” 

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