News and Views
General Practitioner and Associate Clinical Professor Warwick Medical School and Honorary Editor, RCGP Publications
E-mail: rodger.charlton{at}warwick.ac.uk
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RCGP Annual Primary Care Conference |
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 TOP RCGP Annual Primary Care... New members ceremony-...Welcome to the Conference--David...The John Hunt Lecture--an...The medical generalist--an...Bionic learningWhat is the College... |
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2–4 October, 2008, Bournemouth International Centre.
This section reports from the second successful annual conference of the Royal College of General Practitioners (RCGP) which I attended. There were approximately 1000 delegates and this conference followed the successful inaugural conference last year in Edinburgh. Many AiTs were present and it was great to see them.
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New members ceremony—‘generalists not partialists’ |
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TOPRCGP Annual Primary Care...New members ceremony-...Welcome to the Conference--David...The John Hunt Lecture--an...The medical generalist--an...Bionic learningWhat is the College... |
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The conference really started on the evening of 1 October with the new members ceremony, 45 of whom had come through the nMRCGP route. The ceremonies for new members started 18 months ago and the RCGP President, Professor David Haslam, emphasized the enormity of the exam and that it is a considerable achievement. He reminded the audience of new members and their families present that the College ‘is not a trade union and it is not an ivory tower’. He described that it is a ‘College for real GPs, that it is a public voice for high-quality standards, a charity to improve the quality of care for patients and that the College works in education, research and developing standards’. For me, David Haslam made a defining statement when he recalled how he was once asked: ‘Are you a specialist or just a GP?’ He replied that as a GP he deals with ‘everything and anything’ and most importantly that he is ‘a generalist not a partialist’. He identified how proud the doctors present were to become members and to get through the assessments as they are not easy—the College is ‘proud to have you’. The RCGP College Chairman, Professor Steve Field, recalled the privilege it was to be present that evening and that ‘new members are the future for this College and that you will take forward the College of the future’. He told the new members how general practice is ‘the most difficult of medical specialties and it is the lynch pin of health care in this country’. He described how ‘there is more care in primary care than ever before and at the start of your careers there is where the action is’.
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Welcome to the Conference—David Haslam |
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TOPRCGP Annual Primary Care...New members ceremony-...Welcome to the Conference--David...The John Hunt Lecture--an...The medical generalist--an...Bionic learningWhat is the College... |
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The next day, in his opening address, David Haslam, told the audience that ‘our College is the largest’ with over 36 060 members. He reminded us of its considerable influence and that it has many roles including being the licensing body for GPs, making recommendations for revalidation to the GMC, defining standards to give GP practice accreditation, focusing on health care moving out of hospitals and that the College is ‘responsive to change’. The GP has many roles but he recalled three important roles: providing quality of care, advocacy and trust. He said that we lived in a time of an intense undercurrent of anxiety and perceived threat and yet GPs continue to receive considerable esteem and positive feedback from their patients. For AiTs, he reminded them that GP specialist registrars have the shortest training (3 years) but have the biggest curriculum. He described the conference as providing support, education and information, together with inspiration and the opportunity to mix informally with fellow enthusiasts and to hear national and international speakers. He recalled the previous evening and how ‘it was good to witness the passion, enthusiasm and altruism of former trainees—new members at the members ceremony’.
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The John Hunt Lecture—an international perspective |
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TOPRCGP Annual Primary Care...New members ceremony-...Welcome to the Conference--David...The John Hunt Lecture--an...The medical generalist--an...Bionic learningWhat is the College... |
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This year's lecture was given by Don Berwick, a Paediatrician, President and CEO, Institute for Health Care Improvement, Cambridge, USA. This lecture is given once every 3 years after John Hunt a co-founder of the College and was first given by the Prince of Wales in 1992. The lecture was inspiring and full of wisdom regarding general practice, relevant to international audience where he made an analogy to the life of his father, a GP, near the small town on Conneticut in the 1900s. During this incredible oration, there was complete silence as the development of our specialty and its very future was described. At the end, there was a standing ovation and acknowledgement of a superb lecture that set the scene for the rest of the conference. He described the GP as ‘royal person of privilege reaching the dark and tender places of peoples’ lives’. As a GP, his father knew their secrets, he helped and was trusted. What his father liked most about being a doctor was the mystery, the puzzles. He enjoyed solving the mysteries of people who put their lives in his hands. He had an inner professionalism or assumption of a personal mission of having technical knowledge, altruism and self-scrutiny. In the current health-care world, this has changed to being performance managed, accountable, ensuring patient safety and having defined standards. Things have changed, technology changes, there are new specialties and there are new institutions to house the technology. Outside the tiny kingdom of his father's consulting room, new dynasties were ruling where power is shared. Somewhere along the way, the bond of public trust has been broken, for example through Shipman.
The tasks of healing were of one person, now the craft of care is the machinery of care and so the loss of control from his father's day as a doctor. He described his father as an epitaph to a profession. The control of devices comes from patients with their newfound knowledge, not doctors. Email replaces the touch on the arm. The profession is grieving for the control, professionalism and self-regulation of the past. There has been a reinvention of professionalism with new terms of engagement: complexity, interdependency and being stewards together. Doctors are no longer self-reliant, rather they may know, but if not they can find out. We should promise patients the knowledge from the world of science and not just rely that one's own knowledge is correct as it was in his father's day. He discussed the autonomy of patients and families and the amazing statement that ‘we are not partners in care, but guests’.
We need to be counselled in a time of loss and a time of great discovery and so daylight. We need to find joy and pride in the normality of teamwork that we are on an expedition together with its vast terrain of modern knowledge. The essentials of being a GP have not changed—the core mission is the duty to care and to bring comfort. Full text to appear in future issue of BJGP.
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The medical generalist—an outmoded concept? |
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TOPRCGP Annual Primary Care...New members ceremony-...Welcome to the Conference--David...The John Hunt Lecture--an...The medical generalist--an...Bionic learningWhat is the College... |
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London GP, Iona Heath, presented this paper at the conference. This was a paper regarding the philosophy of being a personal doctor and that there is much uncertainty whereby a treatment for the same problem may give different outcomes. The Reverend Thomas Bayes (early 18th century) was quoted for his recognition that the known past history associated with a partial observation (prior probabilities) effected the likelihood that a given partial observation actually was a correct inference. Prevalence effects probability. The importance of GPs is that they work in low-prevalence environments where few tests work, whereas specialists are given a high-prevalence environment/population via referral. In general practice, illness is more extensive than disease. And so the old adage: knowing the patient who has the disease is more important than the disease itself—prior probability tests do not work for GPs. Most specialists have little idea of the interface between illness and disease. For GPs, the anecdote is the randomized controlled trial of general practice. Many speakers quoted the USA public health physician Barbara Starfield as did Iona Heath and how enhancing primary care, particularly family medicine, even in states with high levels of income inequality, can lead to lower mortality. Iona suggested that fragmentation of the generalist would mean delegating to the less trained and reduce therapeutic efficacy which is correlated with continuity of care. General practice is about the synthesis of the science and caring remembering the College motto: ‘Cum scientia caritas’.
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Bionic learning |
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TOPRCGP Annual Primary Care...New members ceremony-...Welcome to the Conference--David...The John Hunt Lecture--an...The medical generalist--an...Bionic learningWhat is the College... |
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RCGP Curriculum Development and CPD Resources Fellow, Dr Ben Riley, presented this paper on ‘The bionic curriculum: blended eLearning for GP training and CPD’.
He is the e-GP project clinical lead (www.e-GP.org). The e-GP is an ambitious joint project between the RCGP and eLearning for Healthcare to develop a comprehensive programme of eLearning modules to support General Practice education. The eLearning in e-GP consists of a range of interactive eLearning sessions and ‘virtual consultations’, designed to underpin the RCGP curriculum. Access to e-GP will be rolled out to all GP Specialty Trainees in autumn 2008, and during 2009, will be extended to all NHS GPs to support continuing professional development. He started off by providing the amazing statistic that through Google alone there are 7.1 billion searches every month and this is more than one per person in the world, such is the quest for knowledge and so education and learning. The eLearning should be fun, but the learner has to adapt to artificial limitations, to simulate learning and to relate learning to everyday practice. Evolution is adaption to the environment and if something is unfit for purpose, it will die out. To be successful, eLearning needs to be simple to use like Google. The e-GP learning is designed for general practice. It is problem based, uses video clips, patient narratives, virtual consultations, has diversity of provision and is enjoyable in different formats. He made the point about sustainability and the need to keep eLearning updated and also the need to recycle learning resources—repurposing or enriching like the new edition of a book.
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What is the College up to? Making a difference. |
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TOPRCGP Annual Primary Care...New members ceremony-...Welcome to the Conference--David...The John Hunt Lecture--an...The medical generalist--an...Bionic learningWhat is the College... |
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Prior to AiT workshops in the afternoon, Professor Steve Field addressed the conference. Professor Field quoted the GP writer, Dr James Willis, on how general practice has not fundamentally changed and that it is open-ended, inclusive, based on evidence where GPs have privileged access to the deepest secrets in patients’ lives.
Reference was made to politics and its recent influence in general practice and Steve Field quoted Woody Allen: ‘More than any time in history mankind faces a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. Let us pray that we have the wisdom to choose correctly’. Steve Field said that it is important that we lead individually and collectively as a College. He recalled Charles Darwin and that survival happens to those who are most responsive to change. He described how 90% of health-care problems are managed in primary care and that there are over 1 million consultations every day with high patient satisfaction. A recent Healthcare Commission survey demonstrated that 75% of patients are completely satisfied. What an achievement! There were many more quotations and the conference finished on a very positive note that general practice through the RCGP is thriving. In relation to the NHS, although it has changed, the basic values remain the same. Steve Field quoted Walt Disney: ‘All our dreams can come true—if we have the courage to pursue them’.
Steve Field described the College as being in a powerful position to influence policy makers and that the College is the heart and voice of general practice. The plan is to improve general practice and the NHS and that patients have a greater say than PCTs. He described how in the middle of difficulty lies opportunity through: Primary care federations working with other GPs to improve quality of care, e-GP for general practice is about to be launched, Good Medical Practice for GPs as a platform for revalidation and a robust system of revalidation which will be smooth and should not interrupt work and so care with patients. The College will continue to listen to ideas and concerns and live up to expectations and make a difference.
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