In the latest issue of the RCP's membership magazine, Commentary, RCP president Professor Andrew Goddard interviews Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners.
Professor Stokes-Lampard will conclude her three-year term in November. Looking back on her time as chair of the RCGP, she and Professor Goddard discussed a range of topics.
Short excerpts are included here, or you can download the full version of the interview at the bottom of the page.
On the GP partnership model
Andrew Goddard: From my perspective outside, it seems that more and more GPs want to do salaried posts, work flexibly, and reclaim a work–life balance. The thought of taking on the business aspects of owning the equity and helping to run the business sounds rather daunting. It feels to me that the partnership model is on the wane. In Wolverhampton, for example, there’s a single health employer that looks after both primary and secondary care, and in some ways that helps facilitate integrated care systems. Do some people in general practice see that as a threat?
Helen Stokes-Lampard: There are some places where the partnership model has gone already — these tend to be the areas that are hit by the workforce crisis first. Several years ago in Brighton seven GP surgeries all handed back their contracts in quick succession, forcing the CCG to step in and make quite radical changes, and we’ve seen similar situations in Wales. When that happens, it costs an awful lot of money to fix it.
Once you start putting people on proper contracts — GPs particularly — a normal general practice day turns into three programmed activities, because we do paperwork, visits etc. and that makes it quite expensive. You then need more experienced nurses with a high level of competence who can function autonomously. These factors mean that the partnership model is actually the most efficient way of delivering care. That realisation dawned on senior policymakers a few years ago and we’ve seen a real shift in attitude from government and from NHS England towards the partnership model and a real desire to reinvigorate it.
There was a review of the partnership model undertaken last year by Nigel Watson from Wessex, looking at what it would take to bolster, boost and enhance partnership and make it more attractive to people. We never had a formal response from the Department of Health to that report’s recommendations, which were not radical, but very sensible, balanced and pragmatic.
We’re entering into a new era of politics and there may be an opportunity to reinvigorate the partnership model. Younger GPs tell me that although they’re not attracted to partnership right now because it’s stressful and not financially rewarding, they see the attractions of having more control and autonomy in future. They tell me ‘not yet’; they don’t tell me ‘not ever’.
On a no deal Brexit
Andrew Goddard: We live in very interesting times. Boris Johnson has just become prime minister, and Brexit remains the elephant in the room. As medical colleges, we are both membership organisations and charities who represent the profession, but also have a political influence. When it comes to Brexit, the RCP position is that we don’t oppose Brexit per se, but a ‘no deal’ Brexit would be a disaster for the health system. What’s the RCGP’s position and how did you reach it?
Helen Stokes-Lampard: We’re the only college to take a strong formal line on this. To begin with, our Council didn’t really want to have a discussion about it, but last summer the situation got really heated and members asked us to debate the issue and take a formal position. We did, and our formal position is that we are opposed to leaving the EU, which is quite controversial as some of our members will have voted to leave. Our council went further, not just opposing Brexit, but also calling for a ‘people’s vote’.
However, the exact question that vote should ask wasn’t specified, and this put me in a difficult position as leader of the organisation in terms of relaying our message to government. As the leader of the organisation, I have to balance representing what our 53,000 members want, and also work with politicians and policymakers, and provide a coherent form of dialogue between the two.
On GP appointment times
Andrew Goddard: You’ve called for consultations to last 15 minutes rather than ten. That’s a big ask, and would presumably need 50% more workforce. How long do you think it would take to introduce 15-minute consultations, and do you have to wait for the workforce to expand, or do you stop doing other things, because you’ve only got a certain number of hours in the day?
Helen Stokes-Lampard: We can’t work any longer than we are; people are already burning out. You don’t need 50% more consultations to deliver 15-minute consultations, because although the arithmetic suggests that, you can achieve a lot more within a 15-minute consultation.
Many surgeries now have a sign saying: ‘Remember your appointment is only 10 minutes. Only discuss one problem with the GP.’ That’s naive because the reality is that patients don’t know which of their problems are interrelated. It’s quite common for patients to come in with a list of six or seven discrete problems, because they haven’t been able to get an appointment so they’ve stored them up. So then suddenly in ten minutes we’re meant to charge through all this. Whenever I see a list in someone’s hand, I ask to see the list. Invariably, a new lump in the breast will be item six or seven, whereas a knee that’s been aching for months will be top of the list.
I’m not saying I can solve seven problems in 15 minutes, but if I can do four or five things instead of two or three, then I don’t need seven appointments. I might be able to get away with three or four appointments.
This is an excerpt from the interview in August's Commentary magazine.
