News
Make your views heard on the Health White Paper Be constructive and creative and we can lead the NHS of the future – that is the message from Chairman Professor Steve Field as the RCGP opens its consultation on the new Health White Paper, Equity and Excellence: Liberating the NHS New Health Secretary Andrew Lansley has put forward a package of proposals which could potentially lead to the most radical shift of power and accountability in England since the NHS was founded 62 years ago – with GPs centrestage in controlling budgets and commissioning and providing services in the community near to patients’ homes. The launch of the paper has attracted widespread media criticism of the ability of GPs to deliver, with many NHS managers dismissing the proposals as a return to the days of GP fundholding, introduced by the previous Conservative Government in the 1990s. Professor Field is keen to stabilise the debate and ensure that the important issues are not sidetracked. He said: “The White Paper is a con-
sultation document and it is our job as the College to ensure that as many grassroots GPs as possible have their say in what finally comes out of it. “The Paper and its accompanying documents are extremely complex, with far-reaching implications for the future of primary care and the quality of services we can provide for our patients. From reading and listening to the news, it seems that we are all quaking in our boots at the prospect of taking on extra responsibility when the truth is that it is already happening in certain areas of the country – with excellent results. “We acknowledge that most GPs will want to continue providing high quality care wherever they live, whilst some GPs will want to become more involved. Of course we will want and need to work with specialist medical colleagues, ■ For further information about the White Paper and how it links to RCGP policy, as well as details of the College’s forthcoming consultation, see www.rcgp.org.uk/liberatingthenhs And let us know your views at liberatingthenhs@rcgp.org.uk
College comes to the end of an era Professor Steve Field RCGP Chairman
And now the end is near and so we face the final curtain… It’s hard to believe that later this month, we depart Princes Gate for the final time, closing that impressive front door and another chapter of College history forever. Princes Gate has been a constant throughout my professional career. For me, like many others, it’s been a second home – in fact, I’ve probably spent more time here than I have at home, especially in the past three years. I can’t believe how quickly the time has flown since I first stepped through the door as a young and energetic nearly-GP for my exam. I enjoyed my viva and can also remember my first day as a a GP regional adviser sitting between Donald Irvine and Denis Pereira Gray and feeling completely out of my depth amongst all the gravitas and experience. I’ve been using Princes Gate as my London residence since 1986 and have had some lovely times walking through Hyde Park, going to concerts in the Park. It’s also brought many happy family memories. I remember staying in Room 2 with my wife Lynn and our two girls when they were very small. They’re now young adults with lives of their own but are still regular visitors – they think that everyone in London lives in a house like Princes Gate! The building has also been the backdrop for history in the making. At our last Council meeting we enjoyed a magnificent fly-past by the Red Arrows, though I think the spectacle was arranged for the Queen’s Birthday rather than a farewell to the College! I’ll never forget watching the snooker on TV in 1980 when I received a phone call from a
Steve Field: That was then, this is now friend at Imperial College to say the SAS were going into action at the back of the building. I also remember being in the Kennedy Library in Boston and seeing a huge photo of JFK and RFK looking out of the windows at Princes Gate. I’m sure the guide didn’t believe me when I said that it had been taken from my office. But all good things must come to an end and it’s time to move on to the next exciting stage of our history. Before we go, you can read a potted history of the many memorable events that this building has seen over the past 48 years, along with some happy (and sad) reminiscences of the huge part it’s played in all our lives. Enjoy – see you on the other side.
nurses – and supportive high quality managers – to make this happen. “As always, the devil is in the detail, which is why we have launched an RCGP-wide consultation on this. There are some areas that cause us concern – such as the ability of patients to choose GPs anywhere in England and having a geographical basis for commissioning. I also cannot understand why maternity services are not part of the commissioning budget. “But there are also positive areas including the opportunity to work more closely with Local Government to improve patients’ health and public health. “I hope that College Members and Fellows in their thousands will contribute to the consultation, either as individual GPs or as part of the College’s response. Please don’t sit on the sidelines and just allow things to happen. “Our future – and the future wellbeing of our patients – is at stake here. We cannot miss this opportunity to influence our own destiny.”
THe NeWSPaPer OF THe rOyal COlleGe OF GeNeral PraCTITIONerS
AUGUST 2010
Also in this issue... New Faces RCGP elects new Vice Chairs
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Spotting the signs GP research offers hope on ovarian cancer
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Princes Gate remembered RCGP members share their memories
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Historic highlights Memorable events that have shaped the College
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International matters Report from the second JIC meeting
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Impressive innovations Enterprising GPs win awards
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NEWS
Sheffield steel: College elects two new Vice Chairs Sheffield GPs Dr Janet Hall and Professor Nigel Mathers have been elected as the RCGP’s new Vice Chairs, to work alongside Chair-elect Dr Clare Gerada when she takes office in November 2010. It is the first time that the posts of Vice Chair have been decided by Council Election – the posts had previously been chosen by the incoming Chair. Dr Hall’s news responsibilities will include patient liaison and attending the Patient Partnership Group; taking the overall lead for the planning and staging of the RCGP Annual Conference; and leading the College Officer input into the digital strategy and website redevelopment. Professor Mathers will support effective policy and communications by working on behalf of the Chairman and Honorary Secretary to provide informed GP input to RCGP policy delivery and alignment, including RCGP responses to consultations. He will also assist with the review and development of College publishing activities. Both remits may be adapted according to the College’s changing priorities over their term of office which is three years. Dr Hall is a full-time GP and represents Sheffield Faculty on RCGP Council. She has a special interest in cardiology, diabetes, paediatrics and minor surgery, and has recently qualified as a GP trainer. In her manifesto, Dr Hall described the role
Dr Janet Hall: Responsibilities will include patient liaison, the annual Conference, digital strategy and website redevelopment
Professor Nigel Mathers: Will provide GP input to RCGP policy and alignment, and will help develop College publishing activities
of faculties and patients in sustaining the ongoing work and future development of the college as ‘vital’, citing the importance of local and national opinion and patient engagement to improve standards of care. She said: “These are exciting times, affording many opportunities and challenges for the College. I will work diligently to serve members, promote excellent patient care and further the
aims of the College, developing its outstanding reputation and extending its influence nationally and internationally.” Professor Mathers, who recently demitted office as Chair of the College’s Clinical Innovation and Research Centre (CIRC), is an academic GP and Professor of Primary Medical Care and Director of Academic Unit of Primary Medical Care at the School of Medicine and Bio-
medical Sciences at Sheffield University. He has continued to carry out three clinical sessions per week in the same practice for the past 21 years. Standing for election, he said that the discipline of general practice was facing “a threat as never before”, and that the College should be making the case to keep general practice at the heart of the NHS by providing the best clinical and cost-effective care to patients. He said: “We must do more to support our members in caring for patients by setting the policy agenda and by providing them with reliable, useful information and guidance as well as the clinical tools needed to do the job well. Our clinical and academic work to improve the care of our patients should be at the heart of all we do in the RCGP.” RCGP Chairman Professor Steve Field said: “I am absolutely delighted that Janet and Nigel have been elected. I am pleased that we had a good choice of candidates, and I know that their knowledge, skills and, importantly, their experience both within the College and as general practitioners – both are active clinicians – will add to those of Clare Gerada to produce a superb senior team that will take the College forward from strength to strength.” ■ The other candidates standing for election were: Dr Una Coales, National Council Representative for the South London Faculty; Dr Helena McKeown, Salisbury Representative for the Wessex Faculty; and Dr Steve Mowle, Chairman of the South London Faculty.
Debunking the myth of the ‘silent killer’ A groundbreaking study led by GPs has identified seven symptoms which could lead to earlier detection of ovarian cancer. The findings from the population-based case control study should prove a major step forward in helping GPs and practice nurses to diagnose what has previously been described as a ‘silent killer’. The study, led by Dr Willie Hamilton and a research team from the University of Bristol, has identified the following as key signs to look out for in patients: ● Abdominal distension ● Postmenopausal bleeding ● Loss of appetite ● Increased urinary frequency ● Abdominal pain ● Rectal bleeding ● Abdominal bloating It concluded: ‘Women with ovarian cancer usually have symptoms and report them to primary care, sometimes months before diagnosis. This study provides an evidence base for selection of patients for investigation, both for clinicians and for developers of guidelines.” Its findings have been welcomed by cancer experts at the Department of Health and rapidly picked up by several ovarian cancer awareness charities, including Ovarian Cancer Action, which highlighted the early indicators in its Remember the Symptoms campaign in March this year. Professor Sir Mike Richards, National Clinical Director for Cancer, said: “Dr Willie Hamilton’s research highlights the fact that ovarian cancer is not a ‘silent’ cancer, but can give rise to a wide range of symptoms. This research has helped the Department of Health and several cancer charities to raise awareness of the symptoms and will hopefully be useful to GPs.” Dr Willie Hamilton said: “We cannot afford
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to be complacent about a cancer with nearly 7,000 new cases a year and such a dismal prognosis. Women often have subtle symptoms. Ovarian cancer is not silent: it is noisy – even if the noise is rather indistinct. “Ovarian cancer will not always spring to a GP’s mind with the subtle symptoms listed. Understandably, some cancers are missed. If our research helps even one woman to have her diagnosis expedited, then we will be delighted.” The study has also been awarded the prestigious RCGP Research Paper of the Year Award 2009-2010. RCGP Chairman, Professor Steve Field, said: “I’ve followed Dr Hamilton’s research very closely in this area in recent years and I’m thrilled that the College is presenting him with this award. This is a brilliant academic paper. It shows academic general practice research at its best. Research carried out in general practice by GPs that will lead to important changes in clinical practice and ultimately will save lives – great stuff!” Dr Frank Sullivan, Chair of the Research Paper of the Year Award judging panel, said: “The panel are delighted that this study, based in general practice, has demonstrated some key findings which can be used by doctors everywhere to diagnose cancer earlier.” Peter Reynolds, Chief Executive at Ovarian Cancer Action, said: “Dr Hamilton’s research provided vital evidence that most women with ovarian cancer experience symptoms prior to diagnosis, helping to dispel the myth that ovarian cancer is a ‘silent’ disease. “This work, together with the development of key messages on ovarian cancer by the Department of Health, has played an important part in helping Ovarian Cancer Action and others raise awareness of the symptoms of the disease among women and healthcare professionals. It is vital that this work continues, so
Optimistic about ovarian outcomes: RCGP President Dr Iona Heath, Dr Clare Bankhead, Dr Willie Hamilton, Professor Tim Peters, Professor Frank Sullivan, Professor Deborah Sharp and RCGP Chairman Professor Steve Field that all GPs are aware of the potential symptoms that could indicate ovarian cancer.” The award-winning paper was first published in the British Medical Journal in 2009(1). Dr Hamilton has also recently been involved in writing a BMJ Learning online module on early symptoms of ovarian cancer, available free to health professionals at www.bmj.com The Research Paper of the Year Award is run by the RCGP each year to raise awareness of high quality studies taking place within general practice and to encourage more GPs to become actively involved in research. Previous winners have included papers on the effect of using ‘lung age’ to encourage patients to quit smoking and the treatment of Bell’s Palsy. The College also awards its Discovery Prize every three years in recognition of groundbreaking research that has transformed healthcare and improved the wellbeing of patients. Recipients include Dr Julian Tudor Hart, founder of the Inverse Care Law, and Dr Clifford Kay, for his lifetime’s work in women’s health, particularly the effects of combined oral contraception.
(1) Risk of ovarian cancer in women with symptoms in primary care: population based case-control study. William Hamilton, consultant senior lecturer; Tim J Peters, professor; Clare Bankhead, university research lecturer; and Deborah Sharp, professor. BMJ 2009; 339:b2998 doi:10.1136/bmj.b2998. It can be viewed online at: www.bmj.com/cgi/reprint/339/aug25_2/b2998
InnovaiT needs new columnist Are you an Associate in Training (AiT)? Do you enjoy writing? InnovAiT, the RCGP journal for GPs in training, is looking for an AiT to take over the role of our regular ‘From the AiT’ columnist. This involves writing a regular single page article every three months, in rotation with our ‘From the new GP’ and ‘From the Trainer’ writers. Articles are intended to be thought-provoking and to stimulate the interest of readers by raising common issues. An honorarium is available for the successful candidate. Please apply with a brief, single page CV (including the date you expect to complete your GP training) and a covering letter stating why you would like this role. Applications should be emailed to the InnovAiT Editorial Office (innovait.editorialoffice@oxfordjournals.org) before 1 September. Shortlisted candidates will be asked to perform a small writing task to demonstrate writing capability and ability to meet deadlines. RCGP NEWS • AUGUST 2010
VALEDICTION
We bid farewell to Princes Gate on the park, the grand hall with the staircase flowing down, wood panelling, ornate plasterwork with feathers and rams’ heads and the history (JP Morgan the great philanthropist, the Kennedys, the Iranian siege). Then I was seated in the Members room, with its history, the names of the founding council in gold on a fantastic wood panelled wall, then the names of the past and current Presidents, Chairmen, Honorary Treasurers and Honorary Secretaries. I was given tea while I waited for interview and I thought ‘how civilised...’ ‘Wow’ and ‘how civilised’ really sum up the main areas of Princes Gate and the College. Each room with its distinct character – I have often sat in meetings and, in the quieter moments, considered the people and the events that have taken place in each room. The contrast, of course, comes when you venture into the ‘other areas’ – the offices where staff graft away, cramped, hot, papers and files piled up and filling shelf after shelf... The staff are stoic of course – such a contrast to the rest of the building; it is no wonder the move is needed. I will miss Princes Gate – the Summer Reception on the terrace, the dinners in the Long Room – but the College is bigger than Princes Gate; it is time to move on and we are moving to a fantastic building!
JoHN HoRDeR I am very fond of Princes Gate: it’s a rare thing – a building with that history – with the garden behind and the park in the front. As a building – the only minus of Princes Gate is that it’s not big enough. I think it’s done a very important job, but of course you have to also remember the regional faculties and the important work they’ve done. On my second day as College President, I went to Inverness, because I’ve always realised that the faculties are in danger of feeling left out, simply because they’re not in London. I see that Princes Gate is now not adequate, and I will mourn for the attractiveness of the building and the garden, and the history and the park in front. But I do so knowing that these are not what make up the heart of the College. Those things do count, but I think function has to come first. The new building will have the advantages of being near the major stations – and I gather there is the possibility of a roof garden, which will I hope be small compensation for the loss of the park. But the College is more than the sum of its parts; the building is, in a sense, a detail. It stands for the whole, but the College exists all over the country. One thing in particular I remember from my time as President is the wonderful help I received from the College staff. The College Council created a prize in my name for the staff, and I couldn’t think of a prize that would give me more pleasure to have my name attached to than that. I have a tremendous amount of admiration for the College staff. It’s the same thing that drives the whole College; we’re doing a job that is helping other people, and it feels worthwhile.
ClARe GeRADA My memories of Princes Gate focus on drugs! I held, with my friend Dr Chris Ford, the first RCGP Substance Misuse Conference here. We were worried whether we would fill the Long Room, in fact it was standing room only. From there we went from strength to strength and the College hosted the Substance Misuse Unit for eight years. I loved Princes Gate. Its strange rooms and always getting lost added to the fun.
MAuReeN BAkeR I have spent probably 15 years working for the College in which time I have been in and out of Princes Gate very frequently, and as a result, I am very fond of Princes Gate. It’s a very special building in a special location and, although we will have huge advantages from the building in Euston, I think we will really miss both being in Hyde Park and our lovely garden at the back of the College. It really is a lovely building; it’s got an amazing history and I always really enjoyed the historical associations that come with being here. However, I do remember one time coming to Princes Gate in a taxi, and the driver told me a number of stories about Princes Gate, with one particular gem. He told me that the Native American heads adorning the front wall were due to a misunderstanding when JP Morgan asked for the façade to carry representations of ‘early Americans’. Morgan was apparently expecting George Washington and Benjamin Franklin, instead got Native Americans. I subsequently learned it was completely apocryphal, but I liked it anyway! I think that the way the building worked lent itself to the Collegiality feeling here – it’s been a really good building for holding College occasions that were formal yet, at the same time, had a lot of informality. We’ve had many high-level visitors and important meetings here, but I think most people who’ve visited here really liked it, and really enjoyed the opportunity to be here. Because I was honorary secretary when my family were growing up, my daughters would come to the building, for family trips or in the school holidays. There are real family associations with Princes Gate. I will definitely miss Princes Gate and I think as I drive past the building in the future I’ll always have a pang. There are so many happy memories for me here. RCGP NEWS • AUGUST 2010
DeNiS PeReiRA GRAy
As the College prepares to leave Princes Gate for the very last time, some of the names and faces who have passed through its doors over the past 48 years share their recollections of a unique and very special place… MARGAReT BuRTT When I came to the College in 1985, my first impression of Princes Gate, after seeing the ground floor rooms was that it was very grand – but when I came to the offices I found it to be rather different! It was a much smaller staff and nothing like as professionally varied as now – the PAs to the Officers doubled up as committee clerks, for instance, and we were mostly women. There weren’t very many male members of staff – apart from Paul Morris of PM Printers, who organised the College printing in what is now the Archives Department. However, then as now, the College staff worked hard and enthusiastically. On one occasion when we were about to send a mailshot to the membership about the coming Spring General Meeting, the mailing house went bust – so the mailing was brought back to the College and the entire staff had to down tools and gather in the Long Room and John Hunt Room to stuff envelopes. To help us in our work the College laid on music and plied us with cakes! Fortunately the membership was very much smaller then so it wasn’t quite as daunting a task as if something like that happened now! The memories I have of the place are all
of the people I’ve met here – colleagues and members – and my favourite memories of Princes Gate tend to be about the events we’ve held here. I love the events, and I think the place really comes into its own when there’s an event like the summer reception. Some of the presidents have held lovely parties here, and I’ve very much enjoyed organising these events. It’s been one of the highlights for me. I’ll miss the terrace – I think it’s gorgeous, and I like the location of the building, opposite Hyde Park. I won’t miss the building as such, because it’s not an easy place to work in, and I think it will be great when we move into purpose-built accommodation. I think it will be really nice for us to be together: in this office, in this set-up, we’re in our little boxes, and it will be nice for us to work together.
ANToNy CHuTeR The first time I came to Princes Gate was on a bitterly cold day in November 2006. It was for my interview to become a member of the Patient Partnership Group. My first impressions were ‘Wow!’ – the grandeur, the decoration with a North American twist; the Native Indian heads either side of the front door, the location
In August the College leaves Princes Gate, the headquarters building since 1963, a brilliant investment by far-sighted leaders and a symbol of quality and status. Ownership of this building has broadly coincided with general practice emerging into its leading position in British medicine. Notable events included RMS ‘Mac’ McConaghey, a Council Member, initiating the first scientific journal of record for general practice in the world in 1961; another Council member, Richard Scott, becoming the world’s first general practice professor in 1963; the development of the MRCGP in 1965; the campaign in 1976 to achieve vocational training for general practice – the only branch of the medical profession to introduce mandatory training and limited tenure for trainers; and UK-wide vocational training mandated by Parliament in 1981. Such training was planned late at night by a few Council members staying regularly in the top-floor bedrooms. The College has recently become the Medical Royal College in the British Isles with the highest annual income and also the one with the biggest membership in the world. Now the College has outgrown this beautiful building which has served it so well. The new home, scheduled to open in 2012, is well positioned in the heart of medical London. It will allow the integration of College departments now spread around London, providing four times the floor space of Princes Gate.
Continued on page 6
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looking back at Princes Gate William Hare, an Irish MP raised to the peerage in 1802 as Lord Ennismore (later Earl of Listowel) could little have known that a provision in his will of 1837 permitting his heir and trustees to grant long leases for building and improvement on the freehold part of his Knightsbridge estate would create a building so well known by thousands around the world as merely as ‘No. 14’ or ‘Princes Gate’. Not only the headquarters of the largest branch of medicine practising in the UK but also with a place in military annals through playing a vital part in a daring diplomatic rescue mission. Like another building a couple of miles away many members, visitors and dignitaries have posed for photos outside the iconic front door; there has in recent years also been a policeman stationed nearby! College Archivist Claire Jackson relives some of the highlights of the past 160 years
The building of Princes Gate
Entertaining
William Hare’s grandson, the new Earl Listowel, was approached by a John Elger, a Bedford carpenter’s son who had made his name in the 1820s and ’30s as a speculative builder in the South Street area of Mayfair, who wished to build on the land. These plans were delayed for some years because of proposals to run a railway line through the area. Listowel’s solicitor commented: ‘It would be impossible in the event of a Railway to build the class of Houses he had contemplated with any chance of success’. Eventually the railway plans were rerouted and work could get under way. Elger had at first intended to undertake the entire development himself, using designs by the architect Harvey Lonsdale Elmes. Unlike the neo-classical facades of his contemporaries, Elmes broke up the building’s facades by grouping the windows into blocks. Advantage was taken of the views towards Hyde Park and the gardens, with large reception rooms at the front and back of the buildings. In the event, Elmes relinquished parts of the ground to two other speculators, both of whom brought in their own architects. Elger himself was responsible for the western range of Princes Gate, originally Nos. 13–25 (Kingston House itself being No. 12), and the houses south of Mayhew’s, now Nos. 39–59 Ennismore Gardens. He began building there in October 1846 (but died not long after), and the last three houses were started in March 1849. Six were sufficiently advanced for the leases to be granted in 1848; the remaining houses were leased between December 1849 and November 1850. No. 14 – ‘Mr Pearce’s house’ – was the one most resembling Elger’s original plans.
Princes Gate was ideal for entertaining members and friends of the College. MID-SUMMER DAY PARTY On Thursday 24 July, 1965 at 5 p.m., a party will be given at the College, 14 Princes Gate, London S.W.7. Official guests will include friends and well-wishers of the College. The weather on mid-summer day may permit of the terrace and gardens being used as well as the house. Members may wish to take this opportunity to show the College to their families and friends. Summer parties became a College tradition. In 1978 a Christmas Fair, opened by Mrs David Owen, was held to raise funds to refurbish the building. Although the College already had formal Council dinners, other traditions grew up including photographs on the stairs of award winners and of Presidents at the award winner’s dinner the night before formal meetings. A formal picture of Council on the terrace was taken at every September meeting and often published in the annual report. A tea party for Foundation members during the 40th anniversary year was so successful that a Retired Members tea party hosted by the President became an annual event.
No 15 Princes Gate
The Morgans
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No. 13 Princes Gate was bought by a George Baker on completion in 1849. Junius Spencer Morgan rented it from him in 1854 and bought it around 1858. He continued to live there until his death in 1890. His son, John Pierpont Morgan, for tax reasons, kept his art collection (valued at $60,000,000) in London until a change in laws encouraged him to move it back to America in 1912. ‘It was this atmosphere of domesticity in the midst of the richest of treasures that made Prince’s Gate unique: everything in the house was part of the house, and the house was the home of its master.’ Extract from an account of the interior of 13 Princes Gate by Bishop William Lawrence of Massachusetts visiting JP Morgan, summer 1908. When in 1904, Pierpont Morgan had run out of space he bought the next door house, No. 14, from a Mr Schenley, but from the outside they still appeared two buildings. To complement his collection, Morgan purchased a series of 14 Fragonard pictures, The Progress of Love, for £62,000 in 1898, and built a special room to house them (part of what is now the Long Room). After his death in 1913 they were sold to Henry Frick in New York for $750,000.
Despite moving into Cadogan Gardens in 1958 (see the Headquarters timeline opposite), the College had run out of room and was looking for a long-term solution. By December 1960, an appeal had raised £350,000 for accommodation and other projects. The College had been looking at a joint building with other organisations in Lincoln’s Inn Fields for a while but the Surgeons were only offering leasehold rather than freehold, and the proposed costs were so high that the College worried that they could not afford something larger than their present premises. At the same Council meeting of 7 January 1962, Mrs Glyn Hughes, the wife of the treasurer, reported that she would be visiting a freehold house in Princes Gate the following day which seemed a suitable investment. The contract was signed on 26 July 1962 and the building was purchased for £175,000, the asking price. The BMJ reported: ‘One room on this floor still has the telephone apparatus which went directly through to the White House in Washington’.
New life as an ambassadorial residence
Moving in and expanding activities
John Pierpont Morgan Jr offered the house to the United States as the residence for the ambassador to the Court of St James on 24 May 1919. In the midst of disputes about the League of Nations, the American Government was cautious. After nearly a year with no reply to his offer, Morgan wrote again to the President saying that if he did not hear he would withdraw the offer. The ambassador at the time said that if he was choosing a house he would not purchase Princes Gate as it was ‘in a considerably travelled section of London’ but that as it was being offered gratis it should be accepted, especially as it would be very saleable in the future. President Harding eventually accepted on 18 March 1921. Thomas Hastings, architect of the New York Public Library, was employed to make alterations – primarily the outside of the two buildings, a new staircase and remodelling the first floors to make them suitable for state entertaining. Hastings wrote in a letter to a Mr Beal of Boston (17 September 1923): ‘I do not quite agree with you that London architecture is ugly. I am particularly fond of the… early 19th century so-called revival of Classicism, which is the period we are trying to keep in and the same time trying to harmonise with our next door neighbours, without making too great a shock.” The budget for renovations was cut from an estimate of £33,100 to £17,000. The US Speaker visited the works in 1923 and stressed how little money was available. “It would be very difficult to obtain a supplementary approbation from Congress even for furnishing the building… a request for more money for this purpose would not be favourably considered.” Hastings sold the ornate Louis IV panelling Morgan had in his parlour (Members Room) and replaced it with new deal wood painted to appear walnut.
The first event was a sherry party on 2 November 1962 to commemorate ten years of the College. The offices and staff moved in on 2 January 1963. A telegram was sent to the Queen on the occasion of the first Council meeting at Princes Gate on 13 January 1963. There was a general feeling of excitement that the College at last had a building with room for events. The hope was that the new College building could function as an educational centre for general practitioners. A Headquarters Courses Committee was set up to run experimental educational events in Princes Gate. Fortnightly evening discussion meetings started in October 1963. The programme included ‘Neurosis in New Housing Areas’, ‘The Scope of Minor Surgery in General Practice’ and ‘The Proper Usage of Hormones in Therapy’. Faculties helped to fund furniture and fittings for the building, ranging from stone owls for the terrace to tables for Council (West of Scotland); pictures for a bedroom (known as the Welsh Room). The Ugandan Faculty sent a lion skin! ºBy November 1963 the bedrooms were ready. These comprised four double and four single rooms on the fourth floor and two flats on the third floor of 14 Princes Gate. Rooms were between 25 and 30 shillings a night, including breakfast. A large flat was £25 a week and flatlets were £20. The Research Committee took advantage of these facilities to run a residential weekend course ‘Research Methods in General Practice’ on 7/8 December 1963. Over the years, other educational innovations were pioneered at Princes Gate including Christmas Lectures. These annual lectures for fifth and sixth formers (16- to 17-year-olds) were started in 1995 with a careers talk ‘Nice Work if You Can Get It’ by Iona Heath.
Princes Gate during Morgan’s time
A new headquarters for the College
The College had an opportunity to buy No. 15 Princes Gate in 1975 but could not afford the asking price of £500,000. The following year, the owner, Mr Senley, decided that he wished to sell but retain ground and first floor flats for his own use for 12 years. The College was able to negotiate a better price of £323,000. The agreement provided for the College to have a 950-year lease and occupation of the owner’s flat 12 years later. Problems arose in 1988, however. Mr Senley had left but his wife was still in residence in the flat, claiming that she was a protected tenant and could not be required to leave. The College took professional advice from lawyers and surveyors and were advised that the building was worth more than £1.5 million more to the College without a tenant than with one in situ. College officers sued both Mrs Senley for breach of agreement and the College’s lawyers, Linklaters & Paines, in 1976 for negligence. The College settled out of court with Mrs Senley, who vacated the building in June 1992. The College obtained the freehold and paid Mrs Senley £250,000 in return. Linklaters & Paines made a without prejudice donation to the College’s Development Fund of £25,000. In 1992, after 30 years, the College finally became owner of the entire freehold of Nos. 13/14 and 15 Princes Gate.
Making a mark on the building When President Kennedy was assassinated in 1963 the College sought to have a plaque put up. The Greater London Council, who ran the plaques scheme at the time, had a rule that no plaque could be installed within ten years of the death of the person being commemorated but gave the address of the official plaque maker so that the College could install its own plaque. The wording was agreed with the US embassy and the American ambassador, David Bruce, unveiled the plaque on 23 June 1967. Senator Teddy Kennedy visited 14 Princes Gate in September 1971 when he was in England as part of his chairmanship of a senate subcommittee studying health services (with John Stubbs, Lee Goldman, Jay Cutler, Benjamin Colombo and James King). He took time to reminisce about living in the building, particularly playing in the lifts. He signed the visitors book: ‘My thanks for your hospitality and instruction… a former resident’. As he left, he turned to the building and said: ‘It’s in good hands!’. The College briefly became the home of the ambassadors for a final time in 1982 when London Weekend Television filmed an
1964 The Geoffrey Evans Library RCGP NEWS • AUGUST 2010
VALEDICTION ChroNoloGy oF ThE BuildiNG
1925-26
1980 The SAS camp out in the Long Room during the embassy siege
Agatha Christie story with a scene of the American embassy garden party (see picture below right). In 1999, the Knightsbridge Association, with the support of JP Morgan and Company, applied to English Heritage for a blue plaque for John Pierpont and Junius Spencer Morgan. It was approved on 18 June 2003. The plaque was unveiled on 22 October 2004 in the presence of the Lloyd Grossman, Chairman of English Heritage.
1849
Nos. 13/14/15 Princes Gate were built by John Elger to designs by neoclassical architect Harvey Lonsdale Elmes
1851
Census shows Mr George Baker as resident of No. 13
1854
Junius Spencer Morgan rents No. 13 from George Baker
c.1858
J S Morgan purchases No. 13
1890
Morgan dies, leaving 13 Princes Gate to his son, John Pierpont Morgan
1904
JP Morgan purchases 14 Princes for £30,000 and unites both properties including removal of No. 14 staircase and creation of the rotunda
1913
Death of JP Morgan, Princes Gate bequeathed to his son
1914-18
14 Princes Gate lent to Professional Classes War Relief Council
1921
Accepted by the US Government as ambassadors’ residence
1925-26
Frontage remodelled by Thomas Hastings of New York firm Carrere and Hastings. Building work carried out by Cubbitts
1927
Ambassador Houghton takes up residence
1929
Charles Gates Dawes become ambassador
1932
Andre Mellon has a short stint as ambassador
1932
Robert Worth Bingham is appointed ambassador
1937
Joseph Kennedy takes up residence as ambassador
1937
A banquet is held for George VI and the Queen in what is now the Long Room
1938
Joseph Kennedy is recalled
1938-46
Princes Gate is empty
1947
Lewis Douglas becomes ambassador and takes up residence
1950
Walter Gifford succeeds as ambassador
1953
Winthrop Aldrich, the last ambassador to live in Princes Gate, arrives in time for the Coronation
1955
The Independent Television Authority purchase Princes Gate
1961
The ITA moves to Brompton Road
Siege, fire and other dramatic events “About an hour after Constable Locke was bundled into the Iranian embassy at 16 Princes Gate, with armed policemen on the terrace pointing their revolvers at the embassy windows and instructing those of us watching to keep well back, I received a phone call from Professor Jimmy Knox in Dundee,” recalls Alastair Donald. I said: “Wait a minute, Jimmy. I seem to be under fire.” “Oh, I know the feeling...” was the reply. The siege of the Iranian embassy at 16 Princes Gate took place between 30 April and 5 May 1980. Staff of the Iranian embassy and members of the public were held hostage by six Arab terrorists, who demanded autonomy for the Arab-speaking province of Khuzestan in Iran. Five hostages were released during the siege but 20 remained in captivity. After negotiations failed and one hostage was killed, the Special Air Service Regiment (SAS) raided the building. All 19 hostages were rescued and five terrorists killed. The College was evacuated at 5.30pm on 30 April, six hours after the embassy had been captured. It was used by police and SAS for 24 hour surveillance, to set up listening devices and to climb onto the roof of No. 16. James Wood, Administrative Secretary of Appeals Committee, and Dick Lloyd-Williams, the Administrative Secretary Designate, took it in turns to remain at Princes Gate throughout the siege to provide hospitality for police. There was only minor damage to the facade of the College but the basement was flooded as a fire at the embassy was extinguished. Following the siege, there was a long-term dispute between the College and the Iranian embassy over liability for damages, as well as access to and restoration of the party wall. Due to the loss of the roof through fire and general deterioration of the embassy building the flanking wall became exposed to the elements which resulted in uncontrolled water penetration and rotting of timbers of the College building. Some years later there was more damage to the building when fire started in the early hours of the morning of 12 August 1996 in the Finance department on the second floor, caused by an electrical fault. The building was open to the public on 24 September 2002 as part of the annual London Open House event which allows access to public and private buildings of architectural merit. Tea and tours were organised by the Heritage committee. However, it coincided with a huge Countryside Alliance demonstration in Hyde Park, resulting in hardly any members of the public being able to access the building and the majority of visitors being protestors wishing to use the facilities. The College has, like many of its previous owners, shared this building with many visitors and friends. It is hoped that the new owners will get as much pleasure out of it as we have.
1967
1982
hEAdquArTErS oF ThE rCGP 1952 1953 1955 1957
1962 Jan ‘63 Nov ‘64 23 June 1967 Sep ‘71 Nov ‘72 Dec ‘76 1980 1982 1989 1992
1992 Nov ‘92 Dec ‘92 1994
Early history of the building taken from ‘Princes Gate and Ennismore Gardens: The Kingston House Estate: Development by Elger, Kelk and Mayhew from 1845’, Survey of London: Volume 45: Knightsbridge (2000), pp160-170.
1996 1998 1998 1999 2001 2002 2004 Sep ‘05
1996
1999 The aftermath of the second floor fire
RCGP NEWS • AUGUST 2010
Sep ‘07 2010
The first official address of the College was care of the Society of Apothecaries in Blackfriars Lane. College based in rented rooms at 54 Sloane Street Proposed relocation of College to south side of Lincoln’s Inn Fields (planning permission received 1958) Lease taken on 41 Cadogan Gardens, Sloane Square. Room set aside to display plans of practice premises and articles of practice equipment. Purchase of 14 Princes Gate Headquarters moved to 14 Princes Gate Visit by Lady Churchill to Princes Gate Plaque unveiled to commemorate John F Kennedy living at Princes Gate when his father was American ambassador Visit by Senator Edward Kennedy ‘former resident’ Visit of HRH Prince Philip, President of the College Purchase of 15 Princes Gate Iranian embassy siege London Weekend Television film an Agatha Christie murder mystery at the College Kenneth Clarke makes controversial speech about proposed new contract whilst attending College biennial dinner. It included the reference to ‘general practitioners reaching nervously for their wallets’ when faced with change. Vacant possession of 15 Princes Gate Visit by HRH Princess Anne, who addresses Listening to Carers conference Visit by HRH Prince Charles, President of the College New meeting rooms opened in 15 Princes Gate, named in honour of John Fry, John Horder and Ekke Kuenssberg. Fire at Princes Gate Princes Gate rewired and new phone system means direct dialing from bedrooms for the first time Replacement of lift (original 1904) Visit by Prince Charles (Commission on Primary Care) Visit by Tony Blair, Prime Minister Library moves from Geoffrey Evans Room to Kuenssberg, the former room is renamed the Old Library. Blue plaque unveiled at Princes Gate to commemorate bankers Junius and J Pierpont Morgan's residence. College agrees to sell Princes Gate and build a new headquarters incorporating an assessment centre. Opening of CSA Centre in Croydon Sale of Princes Gate and purchase of 30 Euston Square
5
VALEDICTION DAViD HASlAM Where to begin? It’s only a building... but it has been part of my life for the whole of my professional career, from the sheer terror of facing my oral examiners in the Long Room back in 1976 right through to the astonishing privilege of being Chairman and then President. It’s only a building... but it houses so many remarkable memories. There were the countless working dinners in the Cleminson Room – though the one that sticks in my mind was a discussion on drug policy with David Blunkett when he was Home Secretary. Midway through the main course I realised that Sadie, his dog, was lying on my feet and hadn’t moved a muscle even when my napkin had slipped from my knee and was draped across her head. There were the countless meetings and committees and discussions and debates. There were the years I spent with the exam department, frequently buried in the bowels of the basement. There was the camaraderie of friends and colleagues. Of council and fellow officers. Of the wonderful staff who made my life and my work possible. Of people. It’s only a building... but the memories are all of people. Whilst the architecture was beautiful, and the public rooms were a joy, it was the people who made the difference. Naturally I will look back with wry affection to the original rattling lift, to the portraits and the grandeur, to the bedrooms and the flat which almost became my home for six fascinating years, to the terrace and the gardens – the terrace which made such a perfect venue for summer receptions. But without the people it would have been cold and silent, and with the people it lived and it breathed and it did us proud. If I had to choose one memory, just one memory, it would have been of my daughter’s wedding reception which was held in Princes Gate. That wooden floor outside the Long Room made a perfect dance area, and to hear the walls echoing to the sound of music and fun and joy is a memory that will live with me for ever. That’s a very personal memory – but that’s the way memories are. Goodbye, old friend. And thankyou.
JACky HAyDeN I remember first coming to the College for a meeting of honorary secretaries in about 1983. I was pregnant with my second child and Donald Irvine asked me where the next GP leaders were going to come from. I was astonished – first that he knew my name and that he was looking to me either as a leader or to identify other leaders. I remember Mike Pringle, Peter Hill and, I think, Roger Chapman being there and John Hasler taking me into his office for a phone call about leadership with Marshall Marinker who seemed terribly important and a big name in general practice. A lot of things spiralled from that day. The Council meetings were quite different. We always had a dinner the night before and often a study afternoon. The doors between the dining room and the common room were thrown open and we had a big formal dinner, with port passing to the left. Everyone then sat in clusters in the members’ room and when a few people dared to drift off at midnight, they were accused of having no stamina. At the time, I think Lottie Newman and a doctor from Wessex were the only women on the College Council so I was treated with a mixture of respect and endearment, a bit like a china doll, but I never felt patronised. Some people think the College is pompous but I’ve never found it that way. I just remember real laughs and moments when history was made. I recall David Metcalfe, who was a leader in medical education in the 1990s, coming into the common room with an early draft of the GMC’s Duties of a Doctor and saying to me: ‘This is really exciting, we are setting the standards which state what doctors should do not what they should not do’. As for the draw of Princes Gate, I recently cancelled a hotel booking at the other side of London for a room at the College with a bed and a washbasin – I think that just about sums it up. As you walk through the front door and the receptionists greet you it feels like home.
6
❛ It’s only a building... but the memories are all of people. Whilst the architecture was beautiful, and the public rooms were a joy, it was the people who made the difference
❜
David Haslam AMANDA Howe Four Fs – fear, fury, fun and family – best sum up my experiences of Princes Gate over the years. Fear – I remember first coming here as an AiT and examinee in the 1980s, being terribly nervous about my viva… putting on my tights and make up in the toilets (which were even worse then than they are now) before being grilled in the attic about my logbook. Fury – when I’ve felt that the College wasn’t what I wanted it to be. I remember coming to a course with two colleagues from Sheffield and sitting in the members’ room having a cup of tea when elder male members of the College at the time (and who shall remain nameless) came in. I thought they were going to ask us to leave, so I was ready to hit back that this wasn’t a gentlemen’s club and we were the modern face of general practice. Once they had adjusted to our presence, they were charming – but there is still something annoying about the College being so ‘establishment’ and all-powerful when it should be more inclusive and responsive to members. Fury also refers to the fantastic rows there have been at Princes Gate as we’ve debated issues that matter to the profession and our patients. Fun – the lovely garden parties, dinners, new members’ ceremonies and many happy times. Family – as I said in my William Pickles lecture, we are a family in which we squabble, challenge each other and have our differences but we also have shared experiences and values that we can rely on and develop. 14 Princes Gate itself has been the physical presence of the RCGP throughout my 30-year career in general practice. But for me, it’s what we do and achieve together that matters rather than the actual building – so time to say Farewell!
He invited me to a dinner at the College and sat me next to Jan de Maeseneer, a young GP from Belgium. We discovered that we had similar interests in social justice and in the challenges of providing healthcare in deprived urban settings. We also had young children of almost exactly the same ages. Today, we remain friends and we have grandchildren of the same age and Jan is not only the Professor of General Practice at the University of Ghent but probably the single most influential general practitioner in the world today. In 1989, I stood in the national ballot for Council in order to make a statement, but with no intention of getting elected. I had not realised that this was at all likely. I have been a member of Council ever since and have spent many hours sitting in the Long Room, admiring its proportions and its plasterwork and comparing the merits of the various presidential portraits. I have listened to endless debates – some of them tedious, but most of them compelling – and learned to appreciate a wide variety of effective rhetorical styles. I have made many good friends and, all in all, I have had more delight in Princes Gate than any one person has a right to expect.
ColiN HuNTeR
Home sweet home – there is nothing like it! For me Princes Gate has been nothing less than a home away from home. A place where one could find companionship and security, a place of warmth and hospitality. Yet, it was the people who made this wonderful building a home – the very heart of the GP community. Neal Maxwell once said: “Good homes are still the best source of good humans”. In my experience this has certainly been the case at Princes Gate. I would go as far as to say this ‘good home’ has provided me with a ‘good family’ - a link to the past and the bridge to future. Clearly Princes Gate was far more than just a building made of bricks and mortar. It was building made with hopes and dreams – the very embodiment of Cum Scientia Caritas.
The first thing I remember about coming to the College is my first Council meeting, in the Long Room, a good number of years ago. There were a number of senior Council members who always sat in the same seat and I – in my complete innocence – came and sat in the seat usually occupied for Sir Donald Irvine. Fortunately a nice Council member tipped me the wink and I moved, very quietly, to the back benches. It’s a very nice building for me, and it’s been fantastic having the overnight accommodation in the same place as the office; it’s made it possible to work until midnight or from six in the morning by only moving a few yards. It’s going to be a bit different for the next two years. My favourite spot in the College is actually one that most members don’t get to see – the sitting room at the very top of the building in the flat overlooking Hyde Park. It’s a beautiful spot, with a lovely view, and nice open windows, and on a summer’s day you can open the door and have the breeze flowing through and hear the Household Cavalry trot past, and it’s all very nice. But I think the best way to describe Princes Gate would be to call her a lovely old lady. The upstairs residential accommodation could be best described as quaint; trotting along the corridor after a shower has always been interesting. You never know who you’ll meet or how they’ll react… I’m very hopeful for the future, in particular for the staff and their working environment. There’s a lot of history associated with Euston Square and I think that the College will take its place in that history in a very short space of time.
ioNA HeATH
ClAiRe JACkSoN
I first came to Princes Gate as a trainee, so it must have been some time in 1976. Paul Freeling was running a course for trainers and I was being a sample trainee. It was my first experience of a consultation with a simulated patient and mine wanted plastic surgery for his perfectly normal nose – I did my best but I certainly struggled! My next visit was similarly stressful, when I came to take my viva for the Membership exam in 1981, but it must have gone well because I ended up with the Fraser Rose Medal. John Horder was President of the College at that time and he was still a partner in the practice with which our practice shared a building in Kentish Town in London.
I joined the College in 2001, from the Royal College of Surgeons, so I’d already been used to working in a historic building but I have found Princes Gate beautiful on a much more intimate scale. You can really see the architectural details and get a real sense of connection with what is going on day to day. Experiences, I will long recall include lying on the floor outside the Long Room, alongside chief curator of the Frick Gallery of New York, as we tried to work out the relative ceiling heights of the different rooms on that floor to see if they were the same as in JP Morgan’s day. As we’ve been packing up for the move, delving through cupboards, covered in dirt, I’ve
GReG iRViNG
been given some new gems for the archives such as the MRCGP ‘game’ featuring a wooden owl which tumbles through all the various stages of RCGP membership from the exam to Fellowship (denoted as a halo!). The noise from the school, the demonstrations outside the Iranian Embassy and seeing carriages taking members of the Royal Family to Kensington Palace have all added to the uniqueness and charm of the building and created an experience that you wouldn’t get anywhere else. I feel very lucky to have worked here.
keN lAwToN I’ve been coming to Princes Gate for over 20 years, when my hair was still dark! My first visit was to attend a Computers in General Practice training course and I remember being really impressed by this grand building in the West End of London and thinking that this was a good College to be a member of. I was very impressed, walking in through the front door – and less impressed when I got to the bedrooms! I think I’ve slept in every bedroom on the top floor, with and without ensuite facilities, and let’s just say they have certain charm. It‘s going to be a big wrench leaving Princes Gate. For my generation it represents the College, and I have wonderful memories, particularly of the past five years. It’s been a fantastic place with fantastic people and I’ve had the privilege of meeting many of my heroes from when I was a young GP. There’s a real sense of collegiality and I’ve loved working with people like David Haslam, Steve Field and Iona Heath. I have happy memories of happy times but we have to admit we’ve outgrown the building, as I am always reminded when I sit in the increasingly crowded Council chamber. We work in a beautiful building in Edinburgh and, when I look around my lovely spacious office, I’m often grateful I am not the UK Chair. Doctors and staff from RCGP Scotland always talk about the lovely welcome they receive at Princes Gate. The staff are fantastic, from the front desk onward; they really care about the College and the doctors. I’ll also remember the great breakfasts which, in any other part of Knightsbridge, would have cost about £15!
Mike PRiNGle For many years ‘Princes Gate’ embodied the fear of the membership exam. The Long Room always brought back memories of screens and small cells, with two tired examiners going through their set questions and my discomfort rising. Despite passing, I associated the College building with stress. When I became the Vale of Trent Faculty representative the building became both familiar and kinder. I grew to love the faded glory of the first floor rooms; the threadbare bedrooms; the medieval plumbing; and the small offices. Any shortcomings in the buildings facilities were overcome by two features – the appearance of the building and the staff within it. When I was chair of Council I got to know every nook and cranny. I stayed three nights most weeks in the building. I had my own office that was, in reality, a closed-off corridor. The great charm was the immediacy of access to everybody who worked there. Princes Gate supported team-working when the team was of a manageable size. It was about 2000 when we began to rent other London accommodation to supplement Princes Gate. The structure could no longer sustain all our ambitions and, with the benefit of hindsight, that was the moment when the future of Princes Gate was sealed. I took a lot of persuading that the best option was to move on – it felt like an act of disloyalty to an old friend. However, I am not completely convinced that moving is the old option, both financially and more important functionally. We have a wonderful replacement building which will allow us to be efficient and to grow. But 14 Princes Gate will always have a special meaning, a unique emotional resonance for me personally. ■ You can find more memories of Princes Gate on the RCGP website: www.rcgp.org.uk RCGP NEWS • AUGUST 2010
INTERNATIONAL
Insights and initiatives at JIC meeting ha-Neul Seo rue roy Soleman Begg luisa Pettigrew Members of RCGP Junior International Committee Fresh faces and curious enthusiasm marked the beginning of the second International Committee (JIC) meeting. RCGP President Dr Iona Heath opened the day by commending over 50 UK delegates for their interest in international primary care. She then led an open discussion on international health care systems, highlighting their salient features. The remainder of the morning was composed of a series of inspirational plenaries. Professor Val Wass, Chair of the RCGP International Committee, provided an overview of the activity of the Committee and progress of MRCGP[Int]. Dr Kim Rollison, London Deanery AiT, returned in February from a one year Out-ofProgramme-Training scheme in rural South Africa. Kim detailed her experience of working in a multidisciplinary environment within a hugely deprived society. While not quite left to fly solo, her skillset increased vastly from inserting chest drains and spinal taps, and becoming proficient in ventouse deliveries. The numerous primary care issues presented included: access problems for patients without funds to return for follow-up, HIV, remoteness and lack of resources. Dr Chris Smith presented an insight into his development work in Uganda and Cambodia, in collaboration with the NHS South Central SHA and the Maddox Jolie-Pitt Foundation. His work supported improving health care in developing countries in line with the Millennium Development Goals, and provided opportunities to implement leadership skills within the community. Specific challenges included dealing with malnutrition, cultural differences and patients from conflict zones. Proceedings were slightly thwarted by the Icelandic ash cloud which had prevented Dr Per Kallustrup, founder of the Hippokrates exchange programme, from attending the meeting. However, Dr Patrick Kiernan, London Deanery OOP Director, and Dr Simon Davies, JIC Exchange Lead, stepped in to provide overviews of Out of Programme experiences (OOP) and Hippokrates respectively. In the afternoon Dr Steve Mowle enthused delegates further with his ‘Ten reasons to get involved’. Each JIC sub-committee held their own workshop, where participants discussed key topics in their field of interest. It was an opportunity to learn about the JIC’s work over the past year, and lay the groundwork for projects for the upcoming year.
Exchange The topic of discussion was ‘Barriers, challenges, opportunities and solutions to recruiting new host practices to the Hippokrates Programme’. The Hippokrates Programme is a Europe-wide venture encouraging trainees to spend short observerships abroad learning about primary care in another country. Happily the group formulated a number of strategies to encourage more UK GPs to host
Conflict resolution: Helping GPs prevent family breakdown Miranda Wynne-Edwards RCGP CPD Resources Development Fellow Jan Mitcheson Centre for Development of Healthcare Policy and Practice, University of Leeds
Supporting Couple Relationships in General Practice is the latest module available on the RCGP online learning environment. Joining forces on international primary care: the second Junior International Committee gets underway at Princes Gate trainees from abroad in their practices, whilst acknowledging that there were still some barriers to overcome. Overall it was felt that practices would gain a valuable experience by hosting an international trainee for a short observership. Some potential benefits for host practices were identified as: an excellent learning opportunity for practice staff about international primary care; visiting doctors acting as ‘cultural’ translators; improving the practice ‘image’ in attracting trainees and patients. The Exchange committee is undergoing a period of restructuring and many participants expressed a wish to be involved. The group discussed the different roles that were needed within the Exchange committee as well as the need for regional faculty contacts to facilitate observerships.
research Participants were invited to discuss: ‘Why is research important to the development (and re-development) of fledgling and failing health care systems?’ After an introduction to the concepts of evaluating health systems by guest speaker Dr Joseph Ana, the group performed a SWOT analysis of the current situation of academic general practice in the UK. Comparison was drawn to the situation in low and middle income countries (LMICs). Subsequent discussions focused on the key stages of building research capacity in resourcepoor settings and ideas were sought on how the UK, specifically the RCGP JIC Research group, might be able to offer assistance and collaboration. Proposals included establishing networks between academic departments in the UK with those in LMICs, and developing research exchange programmes. Organisations could be canvassed to fund junior researchers from LMICs to attend research conferences. Suggestions were also made about developing e-learning resources to both teach on topics such reading and writing academic papers, research methods and getting published, as well as providing on-line mentorship.
ing the morning plenaries, his advice and experience remained invaluable throughout the discussion. Dr Pippa Farrugia opened the session with an inspiring talk on her work as an MSF doctor, encompassing three years and three countries: Angola, Malta and Pakistan. She illustrated some benefits and challenges of working with a large NGO such as MSF, and highlighted issues presented by working in difficult environments such as post-conflict regions and detention centres. Dr Helen Munro followed this with an equally exciting account of her work with a faithbased NGO in Namibia immediately post-CCT. Her experience included clinical, public health and fundraising components, stimulating a discussion about long-term international GP career pathways for UK doctors. The workshop moved on to a large group discussion about topics including: the practicalities of working with NGOs; deanery-managed OOPs; timing of international work; post-graduate qualifications that may be useful prior to undertaking work abroad; and ethical dilemmas presented during international field work.
Education and Training The first part of the workshop discussed the imminent implementation of the UK arm of a Europe-wide questionnaire, designed by the Vasco da Gama Movement to compare motivation and satisfaction with GP training across Europe. Strategies to improve the response rate were explored and participants shared their knowledge of local networks that could be utilised for this purpose. The second part of the workshop involved a group task to design an international conference exchange. Novel ideas for the programme of events were discussed, including the all-important social programme! Challenges in organising an exchange and strategies to overcome them were explored. The ideas will now be actioned by the JIC team planning the RCGP Annual Conference in Harrogate, 2010, where GP trainees from across Europe will be hosted at an international exchange.
Strategic Planning
image
This workshop further explored Out-Of-Programme activities and international work postCCT. Although special guest Dr Kiernan’s workshop presentation had been delivered dur-
For the purposes of this workshop the JIC Image team merged with the Finance and Recruitment teams to discuss key projects that the Image team has undertaken. These have included setting up a website and active Google group; promoting the JIC at international and national conferences and collaborating on the newsletter. There were in-depth discussions on the role a junior international committee could play in raising the profile of the profession and enthusing foundation doctors and medical students towards general practice. The group discussed the need to recruit JIC faculty representatives to feed back to faculty boards about JIC activities and co-ordinate regional work. It has been a remarkable 12 months for the JIC, with high-profile presences at WONCA Europe 2009 in Basel and the RCGP National Conference in Glasgow. The future holds more promise, with the award of European Union Leonardo funding to facilitate exchange of UK GP trainees with other European general practices. These achievements and the passion shown at this meeting signify an even more exciting JIC year to come.
In discussion: delegates share ideas in the Long Room at Princes Gate RCGP NEWS • AUGUST 2010
E-LEARNING
In the current economic climate, many of our patients will be suffering from relationship distress, and some will turn to their GP or primary healthcare team. Would you know how to pick up the signs of relationship distress or be able to offer help to someone who came with these difficulties? Produced in collaboration with leading relationship research organisation One Plus One, the module aims to give GPs the tools to recognise, assess and manage patients with relationship difficulties. It is made up of a team of researchers, practitioners and information specialists whose aim is to enhance understanding of how family relationships contribute to the well being of adults and children. It was founded by Dr Jack Dominian, a psychiatrist in the London borough of Brent in the 1970s – an area of great social deprivation – who realised that relationship discord and breakdown was at the heart of the distress he encountered daily in families. One Plus One was founded in order to understand more about the needs of such families and, with that evidence, to develop effective ways of providing support when it is first needed – to shift relationship support from crisis intervention to prevention. There is compelling evidence that the quality of couple relationships does affect health outcomes for both adults and children. For instance, it has been shown that mortality rates for single men aged 30-50 are about three times more than those for married men. Children who are exposed to destructive parental conflict are more likely to have poorer outcomes, including physical and psychological ill-health and lower educational achievement. Recent research by the University of Newcastle and the Family Parenting Institute found that most people who sought help from their GP had done so primarily because they had been worried or depressed and this had been affecting their health: 43 per cent of those in intact relationships and 30 per cent of those planning to separate had talked to their doctor about their relationship(1). During times of financial difficulty, unemployment and particularly in the transition to parenthood, relationship satisfaction declines and conflict rises. GPs and primary healthcare teams are ideally placed to pick up the signs, provide advice and sign post to other services such as thecoupleconnection.net. This can help couples prevent relationship difficulties from escalating and has the potential to build protective factors that strengthen their relationship. This module aims to provide GPs and frontline staff with a framework to help them intervene early – to pick up the signs, not just the pieces. The Brief Encounters® Model, based on One plus One’s well-evaluated training course, is the basis for this framework. This provides practitioners with the steps to recognise and assess relationship distress and respond effectively to their patients. Included are interactive tools that can be used in the consultation with patients to help explain the situation they find themselves in – and, crucially, to find a way out. ■ The Supporting Couple Relationships in General Practice online course is free to RCGP members, AiTs and other primary care professionals. To access it simply visit the RCGP’s Online Learning Environment www.elearning.rcgp.org.uk (1) Walker J Barrett H, Wilson G and Chang YS (2010) Relationships Matter: Understanding the needs of adults (particularly parents) regarding relationship support. Institute of Health and Society University of Newcastle.
7
AWARDS
enterprising GPs lead by example The winners of the 2010 RCGP GP Enterprise Awards have been announced. The awards – jointly organised by the College and GP newspaper – publicise and reward ideas from grassroots practices that can easily be replicated by other GPs elsewhere across the country to improve patient care, as well as making a difference to their own working lives. This year, the awards were broken down into five categories: ● Practice Team ● innovative Clinical Care (General) ● innovative Clinical Care (Specific) ● enterprising use of iT ● Primary Care Nursing
Judges for the awards included RCGP Vice Chair Dr Has Joshi, and Louise Cox of the RCGP Patient Partnership Group.
Joined-up thinking: Upton’s Dr Susanna Everitt, Jo Dodd and Philippa White
The upton Surgery in Worcestershire won the Practice Team Award for providing a joined-up approach to supporting patients with acute needs, which saved £148,000 in one year and is now being rolled out across Worcestershire. Gnosall Surgery in Staffordshire were awarded the innovative Clinical Care (General) Award for their development of a memory service that has reduced the diagnosis time for dementia from the national average of three years to four weeks. The award for innovative Clinical Care (Specific) went to the Churchill Medical Centre in Kingston, for its work in reducing the number of local A&E attendances of under-16s by 40 per cent. Dr Charles Alessi and his team improved access for the surgery’s 15,000 patients by offering extended weekday opening hours and weekend services.
a lot of these initiatives cost ❛ nothing: they’re more about General clinical excellence: Dr Ian Greaves of the Gnosall Surgery
Dr Sripat Pai won the enterprising use of iT Award for his use of IT to improve the care of students at the university and also around the world. Dr Pai used mobile phones and video as a way of reaching out to young people and getting important information to them 24 hours a day, seven days a week. His students have now created a a Facebook appreciation page in his honour.
❜ Dr Has Joshi
The Primary Care Nursing Award went to the district nursing team at the Drs Ross and Robinson Practice in Glasgow for their work in ensuring the post-care needs of local cancer sufferers were being met. The clinic was started as a result of local discussions with nurses, and reviewed patients who had completed, or nearly completed, cancer treatment, to ensure that their general health and welfare needs were addressed. Speaking about the award winners, RCGP Vice Chair Dr Joshi said: “We’ve had some truly outstanding entries this year – well done to our five category winners. A lot of these initiatives cost nothing: they’re more about changing the way practices do things and making services more accessible for patients. “All of these initiatives could be easily replicated and I would urge all GPs and their teams to take inspiration from them.”
changing the way practices do things and making services more accessible for patients. They could all be easily replicated and I would urge all GPs and their teams to take inspiration from them
Putting improved access together: Churchill’s Rebecca Stevens, Susie Puffett, Dr Charles Alessi, Dr Maggie Walker and Jane Kingwill
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Top of the Primary class: Sister Phyllis Hutchinson and Dr Samantha Ross
Innovative information: Dr Sripat Pai