News
Criteria, Standards and Evidence for revalidation: RCGP invites your views The RCGP is launching a major consultation on its proposals for the Criteria, Standards and Evidence that will be used in the revalidation of General Practitioners in active clinical practice General practitioners, other doctors, the NHS, other Royal medical Colleges, regulators, patients and the public will all be given the opportunity to express their views on the overall proposals, their balance and fitness for purpose, and specific sections of the evidence required. A letter has been sent to all practices in the UK notifying them of the consultation, which will be available online through the College website www.rcgp.org.uk The consultation will be officially launched first week in December and will close on Friday 9 January – longer than the normal three weeks to accommodate the Christmas and New Year break. A draft paper on the response will go to the next meeting of the RCGP Council Executive Committee on 22 January 2009, with the final paper due to be considered by full Council on 27 February. The College is also drawing up a model for the processes for revalidation – and a proposal for piloting the model – as part of a clearly defined work programme to achieve a successful launch of revalidation in 2010. The proposals outlined in the Criteria, Standards and Evidence document will at first relate only to general practitioners on the General Medical Council’s general practitioner register who are in active clinical practice. This includes GP principals, salaried GPs and locums. It will also describe how the stan-
dards and evidence can be applied in the introductory phase of revalidation when GPs being revalidated may not have had the full five years to prepare. In time, the College will be putting forward proposals for general practitioners who are not in active clinical practice – such as those working in deaneries, medical schools, management or other settings – and GPs on career breaks who will wish to return to active practice. Under the proposals outlined in Criteria, Standards and Evidence, the evidence required to be submitted by all general practitioners in clinical practice will be:
As background:
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Professor Steve Field y Self-accreditation of a minimum
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q A description of the general practitioners professional roles and demographic data w A statement of any exceptional circumstances
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To meet the evidence requirements in the document: e Evidence of active and effective participation in a cycle of five annual appraisals over the five year recertification cycle r A personal development plan for each year agreed in appraisal t A review of the previous year’s personal development plan with reflection on whether educational needs identified have been met and agreed in appraisal
o
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of 250 learning credits over the five year revalidation cycle, normally at least 50 credits each year, discussed and agreed at annual appraisal Results of at least two multisource feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal Results of at least two patient surveys of their consultations and care during the revalidation cycle, wih evidence of reflection, appropriate change and discussion in appraisal A review of all formal complaints directly involving the GP, with description of the circumstances, lessons learned and appropriate actions taken, and evidence of discussion in appraisal A minimum of five significant event audits involving the GP that demonstrate reflection and change, with evidence of discussion in appraisal
Osborne takes over at RCGP Wales Dr Bridget Osborne is the new Chair of RCGP Wales, succeeding Dr Helen Herbert who has stepped down after four years. Dr Osborne (pictured right) practises as a salaried GP in Conwy and is a Sessional Course Director and Clinical lead for the Retainer scheme for Cardiff University (PGMDE). She is also a GP advisor for the primar y care support ser vice; a medical examiner for the Driving Vehicle and Licensing Authority and has given medical advice on the popular Jamie and Louise programme on BBC Radio Wales. Dr Osborne is also an award-winning farmer and – with the help of her family’s flock of sheep – was Welsh runner-up in this year’s Nature of Farming awards, organised by the Royal Society for the Protection of Birds. Dr Herbert will continue to be involved with the College as Provost of the South West Faculty.
Revalidation will be a challenge but we must all sign up to that challenge as it will benefit doctors as well as patients
1! Audits of the care delivered by the GP in at least two significant clinical areas of their practice, with standards, re-audit and evidence of both appropriate improvement, compliance with best practice guidelines and discussion in appraisal 1@ Evidence of appropriate insurance or indemnity cover 1# Statements of probity, health and appropriate use of health care, including registration with an independent GP
Additional evidence required from some general practitioners: 1$ Evidence and supporting statements for their training, standards of care and competency in any extended clinical role (such as GP with Special Interests) performed 1% Evaluations of teaching and appraisals by students and appraisees 1^ Research governance sign-off All doctors in active practice will be issued by the General Medical Council with a licence to practise in 2009. (All general practitioners in independent general practice must already be on the general practitioner register of the General Medical Council.) In due course, like all doctors, GPs will need to be relicensed and recertificated (for the general practitioner register) at regular intervals. These two outcomes will be achieved through the one process of revalidation which will require evidence that they “keep up to date and are fit to practise”. The RCGP has the responsibility to propose the revalidation standards that will apply to general practitioners. The General Medical Council then has to be satisfied that the RCGP processes – including quality assur-
THE NEWSPAPER OF THE ROYAL COLLEGE OF GENERAL PRACTITIONERS
DECEMBER 2008
Inside... QUESTION TIME PART 2 Shadow Health Secretary Andrew Lansley answers your questions 3
ACADEMIC PRIMARY CARE Amanda Howe explains why it matters to all of us
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CLINICAL UPDATE Smoking and mental illness
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121 YEARS OF CARE Profile of a practice that has been going twice as long as the NHS 7
NEWS New clinical champions announced
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ance – are fit for purpose before revalidation can proceed. The RCGP is determined that the process of revalidation will be supportive of good GPs – not a punitive measure – and that GPs will have as much time as possible to prepare. Revalidation will be underpinned by the College’s CPD strategy and a UKwide appraisal system. A number of useful resources have already been published by the College, including the revised Good Medical Practice for General Practitioners which sets out the expectations of an exemplary and an unacceptable general practitioner. RCGP Chairman Professor Steve Field said: ”The best doctors want to develop their knowledge and skills in order to do the best for their patients. “Revalidation will be a challenge but we must all sign up to that challenge as it will benefit doctors as well as patients. “Our task as a College is to produce guidance and a workable system that can cover the breadth of the profession. Our thinking is informed by ongoing discussions with key parties such as the General Medical Council, the General Practitioners Committee of the BMA and the Academy of Medical Royal Colleges, as well as being consistent with the Chief Medical Officer’s proposals for revalidation. “Now is the time to take stock of what we have done so far and consider the next steps to ensure a smooth and successful introduction of revalidation in 2010 – for all parties.”
POSTBOX
NEWS
Letter from Save the date the Presidents for inequalities
conference
Communication breakdown A major impediment to good care in the National Health Service is the disappearance of easy communication between general practitioners and consultants via a good secretarial service.
The RCGP Health Inequalities Standing Group will be hosting a major conference on 5 Februar y 2009. The conference – Taking action through learning, planning and providing – will look at a wide range of issues including:
Previously, consultants’ secretaries could be phoned and they usually resolved communication problems. Nowadays, GPs are often discouraged from referring to named consultants. The cost in time, frustration, and loss of good will for GPs trying to reach a relevant secretary in hospitals is great and growing. For GPs, acting for patients, communications with hospitals have deteriorated.
● Integrated health and social care models of provision ● The opportunities presented by Practice-Based Commissioning (PBC) ● Setting up and running primary care provision for mixed deprived populations ● PCTs, public health and primary care working together to tackle health inequalities ● GP workforce: the potential for a GPwSI in social inclusion role ● The Quality and Outcomes Framework (QOF) and health inequalities ● Health Inequalities in the Undergraduate Curriculum
Consultants now often have less secretarial support than many GPs. Hospital managers should examine this urgently. Professor Sir Michael Drur y Professor Sir Denis Pereira Gray Dr Stuart Carne Dr John Horder Dr Roger Neighbour Dr Lotte Newman Professor Dame Lesley Southgate Past Presidents of the Royal College of General Practitioners
Speakers will include RCGP Chairman Professor Steve Field and Dr Steve Feast from the Department of Health. The RCGP publication Addressing Health Inequalities: A Guide for General Practitioners will also be officially launched at the event. GPs, primary and secondary health care professionals, social care professionals, trainees, commissioners, charities and policy makers are all invited to attend. ■ Please register your interest by emailing your contact details to healthinequalities@rcgp.org.uk
Win £4,000 in cash
Plus a celebratory dinner for your whole team
ENTERPRISE AWARDS
2009
There is a long tradition of innovation in grassroots general practice but rarely have GPs been able to quickly take on board and replicate the ideas of colleagues from around the UK. That’s why the Enterprise Awards have been seen as such an important initiative for primary care. GP newspaper and the RCGP wanted to create an awards scheme that would showcase new ways of working that were easily replicable by other practices. And these awards are not just for the privileged few. The only work involved is telling us, in less than 500 words, what you did, why you did it and what you achieved. So just ask yourself whether your ideas are replicable. If the answer is yes, then we want to hear from you. And so does the rest of the profession.
Entry forms Proudly supported by
You can download an entry form now from: www.healthcarerepublic.com/awards
International – and national – success story: Professor Val Wass receives her National Teaching Fellowship from representatives of the Higher Education Academy at an awards ceremony in London
RCGP international education expert receives top award Professor Val Wass has been honoured with a National Teaching Fellowship by the Higher Education Academy. This award recognises her commitment to improving medical education in Britain and worldwide over the past 20 years. Professor Wass, who is Professor of Community Based Medicine at Manchester University, has an international reputation for medical research and is a longstanding member of the RCGP International Committee. She has been central to the establishment and successful running of the MRCGP (INT) in South-east Asia. Her crusade to provide medical students with a more holistic approach to medical training is producing trainees with an increased focus on primary care, patient centred communication skills, professionalism and heightened cultural awareness. “Our doctors need to understand that the measure of a good physician is more than the
Do you want to take the lead in diabetes care? Diabetes UK is looking to appoint a clinical lead from the RCGP to shape the future of diabetes care and research with Government and healthcare professionals Responsibilities will include: ●
advising and supporting the CEO and Directors of Diabetes UK
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liaison with the senior figures amongst healthcare professionals working in diabetes and their professional bodies
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influencing and communicating with clinical leads across the UK in the prioritisation of diabetes services and how they are delivered as set out in our policy statements
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aligning research and care priorities
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attracting and retaining clinical academic researchers to diabetes and Diabetes UK
Award categories Practice team Innovative clinical care – general Innovative clinical care – specific Enterprising use of IT Primary care nursing Environmentally friendly practice Risk management
The MDU Enterprise Award
The role will require time commitment of approximately one day per week. Location is flexible and remuneration will be negotiable and based on loss of earnings. The appointment will initially be for one year.
Closing date: 26 January 2009
There are no line management responsibilities but the post holder will attend Board of Trustees, Professional Advisory Council and Executive Team meetings on an occasional basis in an advisory capacity, as well as occasionally representing the charity at conferences and in the media.
The readers of GP newspaper will be invited to vote for an overall winner from the successful entrants in the seven categories. The winner of the overall award will receive a prize of £4,000.
www.healthcarerepublic.com/awards
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sum of the books they’ve read or exams that they’ve sat. Good general practice is an art, and one that needs to be studied in its own environment – the community,” she said. Professor Wass completed an International Masters in Health Professional Education in Maastricht and her PhD on assessing clinical competence earned her the rare Dutch accolade of academic distinction with honour – ‘cum laude’. She received her latest award at a ceremony in London. The Fellowship includes £10,000 to support further research, which she intends to use to expand on the success in South-east Asia. Professor Wass said: “Accreditation drives improvements and the award of the MRCGP (INT) is hugely significant. Before 2003, there was no formal qualification for family practitioners in South-east Asia and cementing its success will help to raise standards in primary care even further and create lasting benefits for patients.”
Please e-mail Douglas Smallwood Chief Executive of Diabetes UK on Douglas.Smallwood@diabetes.org.uk for further information
RCGP News • December 2008
INTERVIEW What are your priorities for the NHS in the short and long term future? In the short-term, my priority is to free healthcare professionals to focus solely on the needs of patients by ending the target-driven ‘tick-box’ culture which ties the hands of doctors and nurses through an obsession with process, not outcomes. For too long, NHS staff have been faced with an unpalatable distortion of clinical priorities as targets bind them to ministerial command above patient need. My priority in the long-term is to deliver some of the best health outcomes in Europe for NHS patients. If we improve the NHS so it meets the international average, we could save almost 40,000 more lives each year. If we improve the NHS so our results are comparable to the best countries in the world, we could save over 100,000 lives a year. I believe that moving to a system where a focus on outcomes empowers professionals and patients control over their care, and provides a powerful incentive for providers to improve, will free the NHS to deliver world-class standards of care.
How do you think the RCGP federated model for improving care for patients will help you achieve these priorities? I believe the RCGP federated model is innovative and encouraging: in the past, many practices in the same area have been reluctant to talk to each other, let alone to share patients. But by getting together to minimise back-office tasks, as well as economic risks, this model works to ensure that they can carry on delivering what their patients have told them they want and need: a service in their community provided by family doctors they know and trust. This initiative is important because our plans to reform NHS care by making it responsive to the needs of patients through outcomes, not the whims of politicians through targets, will require GPs to be ready and able to take much greater responsibility for managing the care of their patients. Mechanisms by which they can share and better manage this responsibility will be helpful.
Many GPs are upset by the lack of consultation over the location of local Darzi health centres. Do you plan to continue with the centres and how would you ensure communication with doctors was improved in future? I know that there is a lot of anger over the Government’s plans to impose a polyclinic (or GPled health centre) in every health trust in England – rightly so. These premises are being built in places where there is no need for them and the whole consultation process for where they should go has been a sham. Neither GPs nor local people have been properly consulted and there’s been no assessment of whether the new centres will provide better care for patients. Clearly, we start with the situation we inherit. There will be circumstances where contracts have been agreed to, which we will have to honour, but if PCTs are in effect ‘pushing’ patients to be registered at ‘Darzi centres’, as opposed to being free to choose, then we’ll stop that. Wherever possible, we will ensure that the provision of primary care responds to local needs and circumstances, not a ‘one-size-fits-all’ political plan. There are many steps that we can take to improve communication with doctors. Firstly, when we undertake a consultation, we will ensure that there is sufficient time and scope for consultees to engage with the process that the outcome is not already predetermined. I hope that GPs know that the Conservative Party care and will listen to what they have to say because they know that we have taken the time and effort to listen to them whilst we are in opposition.
We’ve heard that the Conservative Party are looking at reintroducing fundholding in some form. Could you explain your plans? The GP fundholding model in the 1990s allowed GPs to manage patients in the community, rather than be bound by the contracts negotiated by NHS managers in Health Authorities which tended to entrench historical [and inefficient] activity patterns, and which restricted scope for innovative care. We support the return of powerful, clinician-led commissioning in primary care – like that engendered by GP fundholding in the 1990s. Unlike Practice-Based Commissioning, it should be real budgets, real opportunities to save and re-invest, and real control over contracts. RCGP News • December 2008
Right of reply When RCGP Chairman Steve Field invited Members and Fellows to submit questions for his interview with Shadow Health Secretary Andrew Lansley, he was bombarded with suggestions. Over 400 questions were received, but the same themes kept cropping up – the future of GP-led health centres and the registered list; what next for federated GP practices and would the Conservatives bring an end to GP bashing? Here Mr Lansley outlines his plans and potential policies for how general practice and the NHS would run under a Conservative government Clinician-led commissioning in primary care combines the decision-taking responsibility for where and how patients are treated with the finances which are necessary to support it. The clinician’s voice, on behalf of their patient, is strengthened because the clinician is responsible for the resources needed to support his or her judgement. There are, however, clear differences between our plans and fundholding. First, it must be for all primary care, not a two-tier system. Secondly, PCTs should be able to establish a contractual formula using the tariff – cutting down on the bureaucracy which slowed-up fundholding.
The Pharmacy White Paper has caused consternation among dispensing GPs, particularly in rural areas. What would a Conservative government do to prevent conflict between pharmacists and dispensing doctors? It is not at all clear to me what the benefit would be of changing the distance requirements for the establishment of dispensing practices: currently, it is the distance from a patient’s house to the surgery; in future, it would be the distance from the surgery to the nearest community pharmacy. This could result in the loss of many dispensing practices that provide a vital service in rural communities. If a patient receives a prescription from a dispensing GP now, they are able to choose to have it filled at a local pharmacy if they wish. If dispensing doctors are prohibited from dispensing if a pharmacy is close by, there is a risk that many patients from rural villages could lose access to the most convenient service for them, including arrangements in villages for local collection of prescriptions. Instead of the current ‘control of entry’ system, we propose PCT commissioning of services and an ‘any willing provider’ arrangement for dispensing all other essential services.
What is your view on the opening up of general practice to private providers and do you have any plans to stop the current trend for commercial involvement in GP care? I think that Labour have been blinded by the private sector – not just management consultants but private providers too. The result threatens to undermine GPs – the original independent contractors to the NHS. PCTs are taking back control from GPs, and shifting contracts to private providers under preferential terms. This is a flawed strategy. It didn’t work in secondary care when the Government paid for block contracts with independent sector treatment centres at 11 per cent more than the equivalent cost in the NHS. And it won’t work if executed in the same way in primary care. But I don’t think that it’s about being against the use of the private sector as such. We want to have a far more productive relationship with the private sector. Most GPs and private-sector providers tell me that they are prepared to compete on a level-playing field. What they object to is the constant tilting of the playing-field for political purposes. We will fashion a rules-based pro-competitive system, in which providers of healthcare can invest without being subject to pointless organisational upheavals, endless bureaucracy or arbitrary political risk.
How will your policies reduce health inequalities and what will you do to encourage GPs into difficult and deprived areas? The underpinnings of inequalities are down to standards of living, family structures and unemployment, not health services. Throwing money at this problem is a flawed strategy. I am not saying do not give people equal health services, but do not pretend that giving more money for diabetes or chronic diseases means you are going to deal with the origins of health inequalities.
We support the return of powerful, clinician-led commissioning in ❛primary care – like that engendered by GP fundholding in the 1990s. Unlike Practice-Based Commissioning, it should be real budgets, real opportunities to save and re-invest, and real control over contracts
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We are treating the consequences of health inequality. The NHS should be proactively using substantial resources across government to intervene and try to deliver positive improvements in people’s standards of living. That is why we will make the renamed Secretary of State for Public Health directly responsible for a cross-government strategy on reducing health inequalities, actively co-ordinated across departments and with a champion at Cabinet level. We will also implement a new structure for public health, which would enable local directors of public health – jointly appointed by PCTs and local authorities with the power to allocate independent, ring-fenced budgets – to determine how funding for preventative health services would be spent. GPs who choose to deliver services in deprived areas should be rewarded for doing so – both in terms of being paid more per patient through the weighted capitation formula, and in terms of being better rewarded through a revised Quality and Outcomes Framework (QOF), which takes full account of the baseline data on their patients and the relative circumstances of more deprived areas. I know that GPs now are in the third year of falling incomes. David Cameron and I have consistently refused to join in the Government’s GPbashing based on practice incomes in 2005-6. Our view is that GPs are serious professionals; they should be paid as such and carry commensurate responsibilities.
How would your party restore public confidence in GPs following the sustained and unjustified campaign of GP bashing which has led to us being portrayed as hungry fat cats rather than caring clinicians? It is fundamentally dishonest for the Government to blame GPs for agreeing to a contract that ministers negotiated and urged GPs to accept. Nor is it GPs’ fault that they are being paid far more than they or the Government intended – it’s the Government’s fault for miscalculating doctors’ workload. That is what happens when you organise the health service using top-down bureaucratic methods which take away responsibility from multi-professional teams and interfere with the relationship between patient and clinician. Continued overleaf ➧
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NEWS
Healthcare Commission health check: The real story behind the headlines Jamie Rentoul, Head of Strategy at the Healthcare Commission, says the messages from this annual health check must not be lost: the NHS needs to make further improvements to access to GPs The Healthcare Commission’s recent annual performance ratings highlighted significant improvements in both the quality of services and the way in which organisations manage finances. The ratings also highlighted a number of areas needing improvement, one of which was access to GPs. On this latter point there was some confusion after the Daily Telegraph reported that twothirds of patients could not see a GP within the government’s target of 48 hours. But the Healthcare Commission did not say this and the newspaper subsequently accepted its error and published a correction. We did, however, make the important point that two-thirds of primary care trusts (PCTs) had failed to meet the target. We were clear that we were talking about the organisations we regulate, not individual patients. We were able to show this important picture after the introduction of a new, more sophisticated system of measurement. The principal difference with previous years was that we incorporated the views of patients – a move that I believe GPs would be in favour of. It is important to understand why this was necessary. In previous years, compliance with the target has been measured using only the primary care access survey (PCAS). This survey involves PCTs contacting GP practices to enquire about availability of appointments. The results of this exercise have proved somewhat unsatisfactory for all concerned, a point illustrated by data from this year’s annual health check. In the 2007/08 primary care access survey, 88 out of 152 PCTs reported that 100% of patients could access a GP within 48 hours. Only 18 trusts reported performance below 98%. But a different picture emerged from the De-
partment of Health’s GP patient survey, which we used in the assessment for the first time. Looking at a sample of around a million people, the highest performing PCTs achieved just over 93% compliance, while 124 of the 152 PCTs (82%) achieved below 90%. True, the national average showed that 87% of patients could see a GP within 48 hours. But clearly there were many trusts having problems with meeting the target set by the government. Our approach to this year’s assessment – agreed with the government – was designed to tackle these issues. The factors used to measure performance against the government’s target were: ● a high proportion of patients reporting good access to a GP within 48 hours in the 2008 GP patient survey ● an improvement compared with 2007 in the proportion of patients reporting good access to a GP in the 2008 GP patient survey ● a close correlation between the results of the 2008 GP patient survey and the results of the primary care access survey. This last factor rewards similarity between the experience reported by patients and that reported by GP practices. Clearly, this was a tougher and more sophisticated assessment than hitherto of what is undoubtedly a stretching target. We make no apologies for that because change was needed to get a realistic picture of what is going on. It was a shame that the Daily Telegraph story trigged confusion about what we are saying and it is very important that the main message is not lost. We know from our own surveys that patients are extremely positive about the services that GPs provide. Nevertheless, the annual health check does show that for a minority of patients there are still problems with access that do need to be addressed. We are sure that all GPs would agree with our aspirations, even if there will continue to be debate and discussion as to how access might best be assessed.
Peer takes platform at sexual health conference Baroness Gould – Honorar y Fellow of the Faculty of Sexual & Reproductive Healthcare – will be keynote speaker at the annual Sexual Health in the Surger y (SHINS) conference organised by the RCGP Sex, Drugs and HIV Task Group. The conference – Not as hard as you think: Improving Pathways and Sharing Good Practice – is aimed at GPs, practice nurses and other health professionals who wish to improve sexual health services in primary care. The programme includes: ● Review of the National Strategy for Sexual Health ● New HIV testing guidelines ● Quality STI management in general practice ● Best practice in contraception.
Practical workshops will cover issues including sexual health for men, sex workers and trafficking, sexual assault and commissioning services for sexual health. Further information is available from the RCGP website. When: 27 February 2009 Where: Palace Hotel, Oxford Road, Manchester Cost: £140 for RCGP members and £170 for other delegates. Contact: Irene Heaton 01264 353618 iheaton@rcgp.org.uk
Dr Kassionos (centre foreground) and Heath Secretary Alan Johnson at the awards ceremony
Health Secretary praises practice for heart care RCGP Fellow George Kassianos was presented with a National QOF Award by Health Secretar y Alan Johnson for work in helping patients with coronar y heart and cardiovascular disease. Dr Kassianos and his colleagues at Ringmead Medical Practice in Bracknell, Berkshire, won the GP Practice Award for their impressive allround performance, low exception reporting and proactive chasing up of patients with evening telephone calls. ‘We were especially pleased to see the incentives you have in place for your other staff members in the practice as a team approach is
necessary and undoubtedly benefited your CHD patients,’ said the judging panel. On 3 December, Dr Kassianos has been invited to Parliament to give a special presentation about his work on CHD services and how his patients’ care has improved as a result to MPs and peers including Kevin Barron MP, Chair of the Health Select Committee. It will not be his first visit to the Palace of Westminster – he was recently called on to vaccinate MPs and peers eligible for flu vaccination under the NHS scheme. Another RCGP Member Dr Patrick McFeely from Salisbury picked up the QOF award on diabetes.
Meningitis alert for GPs The UK’s longest established meningitis charity, the Meningitis Trust, is asking GPs to be especially vigilant for signs and symptoms of the disease during the winter months when there is usually a significant increase in the number of cases. Last year more than 11,000 GP practices across the UK received information from the Trust after its survey indicated that there may be as many as 500,000 people living in the UK who have had meningitis (bacterial or viral) or associated septicaemia. The Meningitis Trust is dedicated to providing practical and emotional support for life to anyone affected by the disease. It has a range of free professional support services which provide a lifeline to those who are struggling to cope with the impact of meningitis. Last year it helped 20,000 people and gave out £140,000 in financial support grants. On 4 March 2009, it will be hosting an After Care & After-effects conference examining the wide range of outcomes of meningitis and meningococcal septicaemia, and highlighting the importance of specialist support in helping those affected to rebuild their lives. The Trust also produces a range of free awareness information materials including:
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A pocket sized signs and symptoms card A What is meningitis? leaflet An After meningitis leaflet A Home from hospital leaflet
The cards are available free by calling the Trust’s freephone 24-hour nurse-led helpline on 0800 028 18 28. There is also a dedicated resource section on the Meningitis Trust website, with educational products and teaching sessions. You can also download posters, symptoms cards and leaflets to display in your surgery. Meningitis remains the biggest killer of all infectious diseases in children under the age of five. It is especially important during the winter months as approximately 60 per cent of the most serious bacterial types of the disease will occur between now and March each year. While the individual directly affected by meningitis has to overcome the consequences of the disease, family and friends can also be left needing support emotionally, socially and financially which can have a negative impact on their health. This can result in thousands of people turning to their GP and other local health professionals for help. ■ www.meningitis-trust.org/
Lansley: “We will abolish targets which force decisions contrary to GPs’ clinical judgement” ➧ Continued from page 3
A Conservative Government will trust professionals and increase their accountability to patients. We will give GPs the best opportunity to deliver by abolishing targets which force decisions contrary to their clinical judgement and handing over responsibility for budget-holding and commissioning to allow them to respond directly to the interests and wishes of their patients.
Alcohol abuse in patients is a growing problem. Do you have any plans to restrict opening hours, impose stricter rules on licences and increase tax on alcohol? All the conversations I have had with police officers, supermarkets and those whose lives are
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made miserable by the behaviour of binge drinkers have convinced me that we need to take targeted action to discourage young bingedrinkers. We will target the irresponsible retailers of alcohol who sell to underage and drunk people, as well as looking at tackling the sale of recklessly cheap alcohol. We have proposed a revision of the law to ban loss-leader sales of alcohol, in order to prevent the sale of alcohol below cost price. The Conservative Party will make the alcohol duty system better targeted by increasing tax on drinks most associated with binge drinking – alcopops and super-strength beers and superstrength ciders. But binge drinking should not be used as an excuse for yet more stealth taxes. We will use all
additional revenues to reduce taxes on families, and cut tax on drinks with lower alcohol content. We would introduce changes to the licensing regime to introduce a ‘three strikes and you’re out’ policy for licensed premises found to be selling alcohol under-age. A third offence within three years would trigger automatic revocation of the licence and a fine.
How will you improve sexual health and prevent unwanted pregnancy in teenagers? A transformation in Britain’s approach to sexual health is needed in order to end the intolerable rates of unwanted teenage pregnancies and sexually-transmitted diseases. We need a government which provides the
right legislative and administrative framework for the delivery of public health services such as the prevention of STDs at grass roots level. Our new structure for public health, which I set out in an earlier answer, will see local directors of public health better placed to make effective interventions across the health, local government, education and social housing sectors to promote sexual health in individuals, families and communities. At the heart of this, however, as with other issues like substance abuse or obesity, is the need for a comprehensive effort to raise the self-esteem of young people. Lack of respect for themselves and others is the origin of so many problems. Challenging as it may be, we must aim to tackle the causes, not just the symptoms. RCGP News • December 2008
VIEWPOINT
Why academic primary care matters for general practice LET’S FIRST DECLARE biases and assumptions – I think academic primary care does matter. So why do some GPs still think academic is a dirty word? To be fair, the Oxford English Dictionary does offer one definition of academic as ‘hypothetical or theoretical – not expected to produce an immediate or practical result’: which, having been trained to deliver the whole world of healing in ten minute packages, is not what GPs expect. There continues to be some evidence that GPs perceive academics to be in cahoots with government, bureaucrats and those many ‘others’ who make their daily lives more difficult. Consider, for example, these quotes made by a GP participant in a recent project: “We need to be very careful that we don’t end up with some clever person deciding we need an algorithm.” And: “I have a horrible feeling that a few academics got together and said this is a good idea and someone at the Department of Health said, ‘oh yes, this is another hoop to make GPs jump through’”[1]. Academics are also often associated with assessment examinations, which in general are anxiety provoking and not pleasurable for anyone. There is the dim memory of struggles to memorise arteries, nerves and biochemical pathways; or the more recent trauma of audit projects, essays, EMQs and the empathy-freezing effects of the OSCE circuit. But some GPs are academics; most GPs have respect for their academic colleagues; and all of us need academic products for practice. Let’s argue this one through. ● Point one – you need research to look after patients Most professionals working in primary health care are driven by their interest and compassion for people, as well as a liking for a stimulating and varied worklife. They want to do the right thing in the right way at the best time for their patient to benefit. They learn the right way by practice, from colleagues and from reliable resources and information. Their trainers and colleagues learn the same way. The information sources are often a synthesis of evidence, and that comes from research, whether in the form of guidelines, BNF or a textbook. Imagine not having any new research: changing practice is hard work, but do you really wish we were still giving out cough linctus[2]? ● Point two – you need research carried out
They put knowledge into practice... What’s not to like about academics? asks Amanda Howe, MA MEd MD FRCGP, Professor of Primary Care at the School of Medicine, Health Policy and Practice, University of East Anglia Similarly in research, the university departments use primary care staff and their research programmes to provide research training at undergraduate and postgraduate levels – taught components, project supervision and translating findings into curriculum updates. The same is happening with nMRCGP – as new research comes available, the primary care ‘academics’ liaise with national groups such as NICE and the RCGP curriculum champions to make sure that relevant findings get linked into training, both at VTS and CPD levels. ● So what do you mean by ‘academics’? By ‘primary care academics’, we are referring here primarily to those who either hold a substantive university or deanery appointment, or who spend a substantial part of their working week on the provision and supervision of research and education in with primary care. This is different from simply taking an academic approach (thoughtful, reflective, evidence based, critical analytic) or doing something academic (reviewing literature, teaching students, hosting research). Primary care academics produce and transfer new knowledge to others, while all primary care practitioners need to have an academic skillset which enables them to use that knowledge intelligently in their practice. The academic skillset also contribute to the acquisition of effective management and leadership skills – getting all the relevant information, bringing together different databases and methods to apply these with thought and focus to an important question, and seeing it through to the end.
in primary care to look after your patients A lot of research has little ‘ecological validity’ for general practice patients, because it has been done in hospital referral populations. So relying on other disciplines to tell us what to do doesn’t work either. We need to produce our own research, and that means having researchers who understand general practice. Similarly, while a lot of primary care research is done by excellent nonclinical academics, statisticians and social scientists, find it difficult to design and evaluate useful studies with a clinical sharp end unless they have GP colleagues. Recent successes in primary care research recognised by the RCGP Research Paper of the Year awards include the evidence base for treating Bell’s Palsy[i] and the treatment of childhood conjunctivitis[ii]. Recent text books[iii] and NICE guidelines also draw on the increasing evidence base from primary care research. ● Point three – you may now be convinced
research matters, but perhaps you still don’t want to do it yourself Fair enough. There are only around 100 professors of general practice out of around 35,000 GPs working in the UK. But all GPs should be able to read research-based information, decide how (or whether) it applies to their services and patients, and be able to think logically and critically about difficult questions and how to answer them – whether that means commissioning a new service; spending money on additional reception time; or doing a health needs assessment on whether teenagers feel able to access your team for contraceptive advice. So the skillset which fulltime academics need has a ‘startup version’ in all health professional trainings. Having a rigorous and appropriate specialist training has made GP a respected discipline in the last 50 years, worthy of professional recognition and College membership status. So not everyone has to do research, but they do need to understand it, and their training needs in itself to be based on good evidence – why learn out of date or irrelevant material? ● Point four – you need academics
to guide and provide training Much of our learning is based in healthcare settings, whether GP or hospital (incidentally, GP now provides about 15 per cent of all undergraduate clinical contact). The work of medical schools is hugely influenced by GP academics: both fulltime academics, and GPs with a special interest in education who are bought out of practice sessions to assist in curriculum development and delivery, supervise clinical placements and skills sessions, and assist with assessment. RCGP News • December 2008
● What are the options for developing
an interest in academic primary care? Over the course of their careers, some GPs will want to have a special interest in teaching and research, and some will want to be fulltime academics. The concept of GPs with special interests formally acknowledges what has been the case for years: that over a lifetime, GPs often take up additional roles as well as core clinical general practice – medical politics, management, teaching, research, clinical specialties. Many people working towards their CCT will feel they have had their fill of academic business, but within a few years will be beginning to miss the buzz of learning, and soon will be enthusiastic GP teachers or trainers, leading RCGP Faculty CPD events, or dipping their toe in the research waters. Some, once caught up in academic life, relish the broad sphere of influence and the opportunity to develop the discipline; as well as loving thinking through data analysis, and being thrilled by seeing students become experts through their supervision and support. ● This all sounds too easy… Getting information about career options and support for the development of educational and research options is usually straightforward. Getting the time out of practice, the costs of extra training and the self-discipline of pursuing further training are more challenging. The timescale of research is much longer than either clinical practice or teaching – and the mental effort of research design and delivery is very different from both those – proactive, predominantly theoretical and sometimes quite an isolated task. Good thinking and writing are skills which have to be learned. If you are thinking of a future career in academic primary care, a taught Masters degree is one way of testing the water. The extension of GP vocational training to four or five years should allow more time for trainees to build on their undergraduate experiences to develop the skills needed to contribute to a high quality practice service, as well as offer a competent clinical service to individual patients. It should also allow more people to select additional modules to reflect interests they may want to test out as future career choices, whether minor surgery, sexual health counselling, educational supervision or practice-based research. ● Where do I go for more information? The RCGP has always championed the leadership of academic excellence, and at this time there are more members and Fellows active in academic roles than ever before. Hopefully, most of your regional RCGP, deanery and university colleagues will already be
With practitioner support and ❛ RCGP champions, we hope to continue to expand the academic prowess of UK general practice, which has some of the best primary care research and education in the world ❜ Amanda Howe
known to you – academics can no more do their job without support from colleagues in practice than you can do your jobs without us. If not, try any of the following: your local college faculty, the GP director at the deanery, your medical school’s Department of General Practice and Primary Care, the Society for Academic Primary Care (www.sapc.ac.uk) or the NHS Primary Care Research Networks. ● In conclusion... General practice has been a huge success, and now much is being asked of us for undergraduate and postgraduate teaching and in terms of research productivity, as well as expanding roles in clinical care. With practitioner support and RCGP champions, we hope to continue to expand the academic prowess of UK general practice, which has some of the best primary care research and education in the world. If you are an RCGP member for whom the quotes at the start of this piece rang true, try and think why. You may have had negative experiences yourself at some point (exam failures, wasted effort in a research project, colleagues running off to the Deanery and leaving you to deal with all the extras…). You may be misclassifying academics as being under the thumb of government – in truth, we lobby tirelessly on behalf of practitioners, and often tread as fine a line as other GPs between getting what we can out of a political trend and avoiding it causing damage to our work and products. If you are happy to support academic activity without doing it, that’s brilliant! We just need people to give academic options a chance: flag them to registrars; encourage colleagues who want to teach; let us through the door to recruit for studies or collect data; and use the evidence for patient care. If you want to go further, you can be assured of some hard work, some self challenge, some new options and some great colleagues. The core criteria are hard work, intelligence, some scepticism and a commitment for the long haul. Much like any other general practice job, really. Acknowledgements: I would like to thank Professor Paul Wallace for his advice on this article, and all academics in primary care for their contribution to GP training and clinical practice.
References/Footnotes 1) From data for a project on QoF and mental health, article in submission to BMJ 2) You are? Read Schroeder K, Fahey T. BMJ. 2002 February 9; 324(7333): 329 i) Sullivan F, Swan I, Donnan P, Morrison J, Smith B, McKinstry B et al. Early Treatment with Prednisolone or Acyclovir in Bell’s Palsy. New Engl J Med 2007;357:1598-1607 ii) Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebocontrolled trial. Rose PW, Harnden A, Brueggemann AB, Perera R, Sheikh A, Crook D, Mant D. Lancet. 2005; 366(9479):37-43 iii) Jones R et al. Oxford Textbook of Primary Care. Oxford: Oxford University Press: 2005.
✉ Amanda.howe@uea.ac.uk 5
CLINICAL UPDATE
PRACTICE PROFILE
Smoking cessation: how primary care can improve the health of people with mental illness DR JONATHAN CAMPION Consultant Psychiatrist on secondment to Department of Health
DR DAVID SHIERS GP Advisor and Joint National Lead on Early Intervention in Psychosis Programme to National Institute of Mental Health in England MORE THAN 100,000 people die from smoking in the UK each year. Smokers die an average of ten years earlier than non-smokers[1]. Those with mental ill-health smoke much more than the general population[2] and as a consequence experience significantly greater smoke-related ill-health and loss of life than smokers without mental disorders. The impact of smoking on people with mental disorder is large because they smoke such a large proportion of total tobacco consumed: ● 44 per cent of cigarettes smoked in a nationally representative sample of over 4,000 participants were by those with a mental disorder in the past month [3] ● 76 per cent of young people with an emerging psychosis were smokers [4] and a population survey revealed that 64 per cent of those with probable psychosis were smokers compared with 29 per cent without psychosis [5] ● 70 per cent of those living in the community with more established conditions such as schizophrenia smoke, half of these heavily [6] ● Those with schizophrenia have a ten-fold increased death rate from respiratory disease [7]
SMOKING AND MENTAL HEALTH ● Smoking is a major determinant of health
inequality for those with mental illness ● People with mental illness smoke significantly
more than the general population ● With appropriate support, those with mental
illness are able to stop smoking ● Smoking cessation for those with mental illness
significantly improves mental and physical health while reducing the risk of premature death ● Doses of some medication can be significantly
reduced following cessation
Could you be an Assessor?
iMAP
interim Membership by Assessment of Performance
The RCGP is recruiting GPs to become iMAP Assessors. GPs with some background in postgraduate education and appraisals, and those who currently work as trainers and CPD tutors are especially welcome. If you are interested and would like further information, please email the iMAP administration team: imap@rcgp.org.uk If you are looking to add to your personal development plan or expand your involvement in RCGP related activity you will find this work hugely rewarding. You can be as involved as you want to be. iMAP is a non-exam based route of membership to the College. The assessment consists of two components: a portfolio of evidence and an oral assessment. Assessors are required for assessment of both components. Full training is provided, as well as ongoing advice and guidance from our existing assessors. Please visit the iMAP website for further details: http://www.rcgp.org.uk/gp_training/imap.aspx 6
Furthermore, smokers also have 44 per cent increased risk of type 2 diabetes compared with non-smokers, with the risk increased to 61 per cent for those who smoked at least 20 cigarettes a day[8]. This has serious implications for those with psychosis where 15 per cent have co-existing diabetes[9]. Nor is the impact of smoking confined to physical ill health: it also increases the risk of first developing a mental disorder [10]; is associated with higher rates of all psychiatric disorder[11]; and is related to depressive and anxiety symptoms which reduce after smoking cessation[12]. The presence of mental disorder confers social disadvantage, measurable by lower socio-demographic status[13] [14]. However, smoking is responsible for half the difference in survival to 70 years of age between social class I and V [15]. An interplay occurs between mental health disorders, long term physical conditions and socio-economic disadvantage to generate a negative spiral in which smoking acts as one of the principal agents of health inequality. This aspect of the physical health of people with mental illness has often been overlooked, in part driven by mistaken beliefs that smoking is somehow helpful for mental disorder. Indeed the tobacco industry previously monitored and directly funded research supporting the idea that individuals with schizophrenia were less susceptible to the harms of tobacco and that they needed tobacco as self medication [16]. This causes a continuum of co-morbidity seen at its most extreme in those with severe
Following the recent position statement from the Faculty of Public Health, the Forum for Mental Health in Primary Care has launched practical guidance for those working in primary care to support smoking cessation for those with mental illness. ▼ A Primary Care Guidance on Smoking and ▼ Mental Health can be downloaded from: ▼ www.iris-initiative.org.uk/ ▼ provide-practitionerlearning/ ▼ practitioner-learning/primary-care-resources.html
mental disorders who may suffer a 20 per cent reduction in life expectancy [17], most of this excess mortality due to smoking[18]. People with mental illness experience significant health inequality [19] and there is a real risk that such inequality will widen further without effective action. Since increased smoking is responsible for a large proportion of the excess mortality of people with mental health problems [18], investment of higher levels of smoking cessation resources to this group compared to the general population will result in significant improvements in health. To be effective this must be part of a wider, coordinated strategy to help this group access such support. Primary Care practitioners and organisations are ideally placed to help with their knowledge of those at risk and their skills and capacity to offer such prevention and health promotion activity. Faculty of Public Health (2008) Mental health and smoking. A position statement summarises the current evidence of the health impact and provides a set of recommendations endorsed by the RCGP and other key organisations. (ISBN: 1-900273-34-9) ▼ It can be downloaded from: ▼ www.iris-initiative.org.uk/provide-practitioner▼ learning/smoking-and-mental-health.html
References 1) Doll, R., Peto, R., Boreham, J., Sutherland, I. (2004) Mortality in relation to smoking: 50 years’ observation on male British doctors. British Medical Journal, 328, 745. 2) Kumari V, Postma P (2005). Nicotine use in schizophrenia: the self medication hypothesis. Neuroscience and Biobehavioural Reviews, 29, 1021-34. 3) Lasser K, Wesley Boyd J, Woolhandler S et al (2000) Smoking and Mental Illness, A Population-Based Prevalence Study. JAMA, 284, 2606-2610. 4) Wade D, Harrigan S, Edwards J, B et al (2006) Course of substance misuse and daily tobacco use in first-episode psychosis. Schizophr Res. 81(2-3), 145-50. 5) Coultard, M., Farrell, M., Singleton, N., Meltzer, H. (2000) Tobacco, alcohol and drug use and mental health. Department of Health. London: Stationery Office. 6) McCreadie R. G. (2003) Diet, smoking and cardiovascular risk in people with schizophrenia. British Journal Psychiatry, 183, 534-539 7) Joukamaa M, Heliovaara M, Knekt P et al (2001) Mental disorders and cause-specific mortality. British Journal Psychiatry, 179, 498-502 8) Willi C, Bodenmann P, Ghali WA et al (2007) Active Smoking and the Risk of Type 2 Diabetes. A Systematic Review and Metaanalysis. JAMA, 298(22), 2654-2664. 9) Bushe C, Holt R, (2004) Prevalence of diabetes and impaired glucose tolerance in patients with schizophrenia. British Journal Psychiatry, 184, s67-S71 10) Cuijpers, P., Smit, F., ten Have, M., de Graaf, R. (2007) Smoking is associated with first-ever incidence of mental disorders: a prospective population-based study. Addiction, 102(8), 1303-9.
11) Farrell, M., Howes, S., Bebbington, P. et al (2001) Nicotine, alcohol and psychiatric morbidity. Results of a national household survey. British Journal Psychiatry, 179, 432-7. 12) Campion, J., Checinski, K., Nurse, J, McNeill, A. (2008) Smoking by people with mental illness and benefits of smoke-free mental health services. Advances in Psychiatric Treatment, 14, 217-228 13) Melzer D, Fryers T, Jenkins R: (2004) Social Inequalities and the Distribution of the Common Mental Disorders. Maudsley Monograph 44. Psychology Press, Hove & New York. 14) Acheson D (1998) Independent Inquiry into Inequalities in Health. The Stationery Office, London. 15) Wanless D (2004) Securing Good Health for the Whole Population. The Stationery Office, London 16) Prochalska J, Hall S, Bero L (2008) Tobacco use among individuals with schizophrenia: what role has the tobacco industry played? Schizophrenia Bulletin, doi 10.1093 schbul/sbm117 17) Hennekens AG, Hennekens AR, Hollar D et al, (2005) Schizophrenia and increased risks of cardiovascular disease. American Heart Journal, 150, 1115-1121 18) Brown, S., Barraclough, B., Inskip, H. (2000) Causes of the excess mortality of schizophrenia. British Journal of Psychiatry, 177, 212-17. 19) Disability Rights Commission (2006) Equal Treatment: Closing the Gap, Report into the inequalities in physical health experienced by people with mental health problems and people with learning disabilities.
121 years of patient care – and the practice is still going strong The NHS may be celebrating its 60th anniversary this year – but a general practice in North London has clocked up more than twice as many years of providing care and services to patients THE EPONYMOUS James Wigg practice in Kentish Town was established in 1887 at a time when doctors faced very different challenges from today. According to a published history of the practice, most families in the area were so poor that many children ran barefoot and died of malnutrition. The major health problems of the day were alcoholism, tuberculosis, venereal disease and syphilis. James’s son John joined the practice in 1930, working through the harrowing years of the depression and then serving in the Royal Army Medical Corps during WWII. In 1948 he was one of just 11 per cent of doctors surveyed in the UK who supported the establishment of the NHS, deciding that “all my training and experience led me to the conclusion that a free comprehensive health service was an absolute essential for the people for whom I worked”. One of the more well-known alumni of the practice is Dr John Horder OBE, former President of the RCGP and a pioneer of vocational training for GPs. Dr Horder served as a partner at the James Wigg Practice from the 1950s until 1983. Today the practice has over 16,000 patients and employs over 69 staff. According to Dr Roy Macgregor, a veteran of 30 years,
the practice is unique for the breadth of its primary care team. “We have 21 visiting session holders who work on counselling, psychotherapy, alcohol and drugs, finance and debt advice, welfare rights and employment help. This kind of support is a natural and important extension of what GPs do.” One of the biggest success stories to date is Tomorrow’s People, an initiative to help the longterm unemployed back into work. Since 2001 an employment adviser has been providing support and guidance for patients receiving the Incapacity Benefit and Disability Allowances who want to re-enter the workforce. The scheme has been an outstanding success for both patients and doctors, with over a third of participants finding work and enjoying better health as a result. It has now been expanded to over 200 clinics in the UK and resulted in the James Wigg Practice being awarded the Lord Mayor of London’s Dragon Award in 2005 and a Regeneration and Renewal magazine award this year. As for the next 121 years, the practice will soon relocate to new state of the art premises and is looking to create a GP federation with the neighbouring Caversham Practice so it can keep on improving the care and services for its local community, just as James Wigg did all those years ago. Continuity over 120 years – and counting... (top right) James Wigg’s degree certificate; his son John was one of the small minority of doctors who said ‘yes’ in 1948 (right) Left: The present premises and (below) an architect’s drawing of the new home of the Kentish Town Practice
Left: Dr John Horder OBE, former President of the RCGP, is just one of the many alumni of the James Wigg Practice; he was a partner from the ’50s to the ’80s
Bridging the gap between science and the public By Alice Tuff GPS ARE OFTEN telling us how much of their surgery time is taken up reassuring patients about something they’ve read in a newspaper and how their hearts sink when confronted with a printed dossier of misinformation collected from the internet. While many of the questions are valid, with a new health concern being promoted every day (Should I be worried about artificial flavourings and colours in my children’s food? Will this new wonder drug cure my father’s Alzheimer’s? Can frankincense ease my arthritis?) it can feel like you are chipping away at a very large mountain of misinformation. Sense About Science is a charity set up to help by promoting good science and evidence for the public. We work with scientists, medics and engineers to help counter misconceptions in controversial areas – from debates about the safety of household chemicals to how to make sense of weather and climate predictions – giving people the tools and insights to help them weigh up the different claims they encounter. Set up in 2003 when debates about GM, mobile phones and MMR were raging, we noticed the absence of input from early career researchers in these discussions. We conducted a survey to find out why they weren’t taking part and discovered that whilst many of them wanted to get involved and felt passionately about their subjects, they were worried that they were not qualified enough, that their peers would think badly of them, or that their views would be misrepresented. We decided to address these barriers through a workshop where we could get people at the start of their careers together to find out how the media really works, to hear directly from sci-
entists who’d been involved in controversial public debates and to give them the chance to butt heads with their antagonists – journalists – about why science gets sexed up and messed up by the media. The workshop was very lively, but what started as a clash of cultures ended with the realisation that working with the media can help cross the gulf between science and the public. We have now run 14 of these workshops and demand remains high showing the appetite that those at the start of their careers have for standing up for science in public. Participants go on to join the Voice of Young Science (VoYS) network, where their passion and enthusiasm for good science is shared and supported amongst many. Over the last few years members of the network have begun to not only engage with the media but also to work actively to fight pseudoscientific claims. Last year a group of VoYS supporters decided to hunt down the evidence behind product claims such as yoghurts that ‘optimise the release of energy from our diet’ and sandwiches that ‘shun the obscure chemicals’. They rang the companies to ask what scientific evidence they had to support the claims they were making and were surprised to find that not one was able to provide any, and that they seemed completely unprepared to be questioned. The dossier There Goes the Science Bit… describes their endeavours, which were also reported across both national and international media, raising awareness of the importance of asking these questions. As VoYS member Caroline Grainger said: “It is completely immoral to exploit people’s anxieties, especially when the causes of these concerns are entirely fabricated, or when these products are used instead of proven treatments. Those of us who have the ability to recognise mumbo-jumbo when we see it need to speak RCGP News • December 2008
out and set an example to others who just don’t know who to believe.” Standing up for good science does not have to be just about big actions. VoYS members have begun to dip their toes into a variety of activities. Frances Downey, a PhD student at King’s University, started a letter writing campaign to MPs about an Early Day Motion (EDM) they had signed supporting homeopathic hospitals in the NHS. She wanted to check that they were aware of the lack of scientific evidence behind homeopathy. Many of the MPs justified their signing of the EDM on the basis that their constituents were keen on this but as Frances said “early career scientists are their constituents too”. Writing letters can also be a chance to inject some good science into a debate, as often a letter will allow you to argue your point more fully than if you are quoted in an article. Another VoYS member, Debbie Wake, a clinician working in the field of diabetes, endocrinology and general medicine, went a step further and set up her own podcast where she regularly interviews colleagues and talks about the latest health news, research, gadgets and gizmos. To encourage more people to take up the mantle of standing up for science VoYS members are now writing a handbook on how to get involved, Standing up for Science II – The Nuts and Bolts, which will walk early career researchers through how to start discussing their research in a way that people will understand, combating bad science and promoting good science. We hope it will inspire others to follow in these footsteps and show that any step counteracting bad science, whether small or big, is a step in the right direction and it is never too late to start. RCGP News • December 2008
Two vacancies for Lay Members on the Patient Partnership Group The Royal College of General Practitioners (RCGP) is committed to raising standards in patient care – and committed to lay involvement informing College policy and practice. This is largely done through the RCGP Patient Partnership Group which currently has two vacancies for lay members. The Group consists of patients and GPs who meet four times a year to discuss patient issues relating to general practice and the wider NHS: e.g. patient records, long term conditions, appointments. Lay members are also expected to contribute to College committees and working groups and to comment on key healthcare issues. The PPG plays an important part in the annual RCGP Primary Care Conference. All costs associated with membership of the Group, including travel, accommodation and other expenses will be paid by the RCGP.
A breakout session at the Voice of Young Science Standing up for Science workshop It is easy to get frustrated when you see science being misreported but it is also very easy to do nothing about it. With more stories of new research and miracle cures being reported every day, the need for us to engage with the public and the media grows. As doctors you are in a unique position, as you not only have the knowledge to understand the scientific issues being discussed, but you are also directly in contact with people’s concerns and confusion. So next time you see science being misrepresented why not join the debate? ■ To find out more about VoYS and its activities, publications or workshops, please contact Alice Tuff on: voys@senseaboutscience.org
We welcome applicants from any region and from people with different backgrounds in order to represent the general population. For further information and an application form, please email: ppg@rcgp.org.uk or telephone 0207 344 3050 Further information and online application forms are available at: www.rcgp.org.uk/patient_information/ patient_partnership_group.aspx Closing date for applications is 5 December 2008. Interviews for the vacancies will be held in week commencing 15 December 2008.
7
NEWS
RCGP appoints new clinical champions Five new RCGP clinical champions will take up their roles in early 2009 to lead the College’s work in key priority areas. These key areas are: ● Ageing and older people’s health and well-being with a specific focus on comorbidity and promoting healthy ageing ● Headache and its association with co-morbid mental health problems such as anxiety and depression ● Musculoskeletal medicine – Osteoarthritis with a focus on shared decision making with patients ● Musculoskeletal – Osteoporosis with a focus on service development ● Respiratory disease with a specific focus on health promotion and an emphasis on shared decision making During their three-year appointment, each clinical champion will be supported by the College’s Clinical Innovation and Research Centre (CIRC). They will play a key role in providing leadership for the College on their priority area
Dr Louise Robinson
and pressing for changes where improvements in the care of patients are needed. CIRC Chair Professor Nigel Mathers said: “This is an exciting opportunity to lead on the development and delivery of key programmes of work on behalf of the College.” They will work alongside the College’s current clinical champions who are leading the College’s agenda for Mental Health, Palliative and End of Life Care, Prescribing and Urgent and Emergency Care. GPs interested in any of the clinical areas mentioned above are actively encouraged to register with CIRC as an Expert Resource. Expert Resources play a valuable role in supporting the Clinical Champions and other College department developing work in these key priority areas. ■ For more information on the Clinical Champions, Expert Resource database and other Clinical Innovation and Research Centre initiatives, please visit www.rcgp.org.uk/circ and follow the relevant links
Dr David Kernick
Clinical priority
Clinical champion
Ageing and older people’s health and well-being
Dr Louise Robinson is a GP and senior lecturer in the Institute of Health and Society at Newcastle University. She has a particular interest in the understanding of dementia care. Her particular area of interest relates to the management of wandering and the promotion of patient-centred care.
Headache
Dr David Kernick has been a GP in a research and development practice in Exeter for the past 25 years (having started life as a chemical engineer in Canada). He is the lead research GP in the practice whose interests include headache and chaos and complexity theory. A key stakeholder in this priority area is ‘Migraine in Primary Care Advisors`.
Musculoskeletal medicine – Osteoarthritis
Dr Mark Porcheret is a GP in North Staffordshire who has developed an interest in the management of osteoarthritis. He is Director of the Keele GP Research Partnership – a network of 30 research practices involved in research programme at Keele University. His main research interest is the investigation of the care of older adults with joint pain.
Musculoskeletal medicine – Osteoporosis
Dr Graham Davenport, a GP and principal in Cheshire since 1984, is a past President of the Primary Care Rheumatology Society. (The PCRS is also a key stakeholder in this project.) As a member of the British Society of Rheumatologists’ working group, he has recently been involved with the publication of a report on the management of early rheumatoid arthritis.
Respiratory disease
Dr Kevin Gruffydd-Jones is a GP trainer and principal in Wiltshire. As clinical policy lead of the General Practice Airways Group, he is working to improve respiratory management at the primary/secondary care interface. Key stakeholders supporting this area of work are the British Thoracic Society, the British Lung Foundation and Asthma UK.
Dr Mark Porcheret
Vacancy for Assistant Honorary Secretary of Council The College’s current Honorary Secretary, Dr Maureen Baker, is to stand down from the post of Honorary Secretary in November 2009. We now need to appoint an Assistant Honorary Secretary to serve from May 2009 until the November 2009 Annual General Meeting. The member serving as the Assistant Honorary Secretary will be proposed to succeed Dr Baker as Honorary Secretary in November 2009. The vacancy is open to any member of the College in good standing. Nominees must be nominated by two Council members. The closing date for receipt of the application for this position is Friday 19 December 2008.
THE NEW CLINICAL CHAMPIONS
Dr Graham Davenport
Dr Kevin Gruffydd-Jones
College Fellow takes charity Chair RCGP Fellow Professor Simon Smail CBE has been appointed Chairman of Leonard Cheshire Disability in Wales and the West Midlands. Professor Smail (pictured right) was Dean and Head of the School of Postgraduate Medical and Dental Education at Cardiff University from 2001 to 2006, following a distinguished career in clinical practice, health education and health promotion. In his new role he will help drive the charity’s policy formulation and strategic development. Leonard Cheshire Disability works in 52 countries and supports over 21,000 disabled people in the UK. It campaigns for change and provides innovative services that give disabled people the opportunity to live life their way.
Seriously challenging... I Don’t Know What It Is But I Don’t Think It’s Serious is the latest offering from the RCGP Bookshop and looks at the basic challenges facing a GP.
For further details of the responsibilities of this post and appointment process, please contact: Mike Whelan Head of Policy & Governance via email: mwhelan@rcgp.org.uk by phone: 0207 344 3193 or in writing to: RCGP 14 Princes Gate Hyde Park, London SW7 1PU
www.rcgp.org 8
Decision-making and problem-solving are addressed, along with improving communication skills; dealing with patient complaints; delegation and working with difficult colleagues. Written with the RCGP Curriculum for specialty training in general practice in mind, the book challenges all doctors in primary care, in training or established in practice, to understand and deal with the uncertainties they see every day. ■ Copies can be purchased from the RCGP Bookshop online or by calling 020 7344 3198. A 10 per cent discount is available for all members.
RCGP News invites your comments or letters... Please write to: The Editor, RCGP News Royal College of General Practitioners 14 Princes Gate, Hyde Park, London SW7 1PU email: rcgp news@rcgp.org.uk
ISSN 1755-7720 © Royal College of General Practitioners. All rights reserved. Published monthly by the Royal College of General Practitioners 14 Princes Gate, London SW7 1PU email: rcgp news@rcgp.org.uk website: www.rcgp.org.uk
RCGP News • December 2008