Good afternoon conference,
My first conference as chair of the GP committee (GPC) England, what an incredible privilege it is to address you. I’ve been chair for just one week.
When I was growing up my mother gave me a piece of advice. ‘Keep your head down,’ she said. ‘Don’t speak up.’ Look where that got me.
My mother is an amazing woman. She raised me as a single parent in the United Arab Emirates. She saved to put me through medical school, despite there being days and weeks where we didn’t have the money to pay the bills, where sometimes we had no access to hot water or electricity.
But she is a quiet and timid lady, having lived a life in a country where those who are not of blue blood were often made to feel like second-rate citizens – where it was seemingly set in stone that the best jobs were for other people, the greatest opportunities were not accessible for everyone and people were turned away from hospitals because they didn’t have the money to pay for care.
I came to this country in 2007 in search of a health service, and a society, which matched my values and aspirations. Values of, and aspirations for, tolerance, fairness and equality. Here, I found a national health service which was the very best of those things – a national health service in which everyone, no matter their background, ethnicity or salary, could access care at the point of need. That is the health service I fell in love with. A health service which indiscriminately cares for people when they need it the most.
I have worked across the country – from Brighton to Hull, and from Scarborough to London. I have worked in urban and rural communities, single-handed and multi-site practices and I have consulted, dispensed and trained. In every community, in every locality, I have witnessed the same ceaseless dedication to patient safety and care, the same appetite for innovation and progression and the same powerful sense of our profession as being a compassionate calling as much as it is a career.
What I have found, which all of you know, is that general practice is the absolute bedrock of our health service. Those principles of the NHS echo through everything that we do. I am tremendously proud to represent a profession which truly lives the values that mean so much to me and to our society.
Conference, those principles are worth fighting for. And so, not keeping my head down, I will speak up. Conference, we must all speak up. The truth is that the principles I moved to this country for – the principles we all hold so dear in our NHS – are under threat.
The services our patients desperately need have been eroded and worn away by a decade of austerity – and the impact of the pandemic has both worsened and shone a spotlight on the inequalities that cause so much pain and unfairness in our communities. In a period when the existence of movements like Me Too and Black Lives Matter remind us all of the inequalities in pockets of society, general practice also needs to stand up for those whose voices and needs may be often be overlooked.
I’m sure many of you, like me, face daily dilemmas over how much time to give to patients who need mental health support, social care or the dedicated expertise of public health services but can only make an appointment with their GP. Often it feels like we are the only people, the only professionals, on hand to lend an ear, to have a conversation or to try to help. The pressure of feeling so needed but having countless consultations every day – each a human being with their own unique story – can be genuinely overwhelming.
The strain is far from just anecdotal. The evidence is that we are working harder than ever. Last month, you dealt with 34m appointments. You saw 3m more patients in October of this year than in pre-pandemic October 2019. 40% of these appointments were made on the same day. And despite all that we’ve been through during this pandemic, nearly 65% were held face-to-face. In a country still facing down the difficulties of COVID-19, with a massive shortage of GPs, that is nothing short of monumental.
Conference, I’m proud of you and your achievements. I am so proud to be a part of this profession.
Of course, it is not just in general practice where the burden is immense. Every part of the NHS faces genuine struggle every day. By the end of September, there were more than 5.8m people on a hospital waiting list, the backlog is mounting and many patients have stayed at home with symptoms or worries rather than add to the burden their local NHS faces.
Winter is here, unmet need in our communities grows daily and the threat of a spike in COVID and flu cases hangs over us all. Every system indicator is flashing red and we are already exhausted. It has become too much for many of us. I, like many, have had to reduce my sessions. I, like many, have faced abuse from patients and been left scared and disheartened. I, like many, have become overwhelmed with the complexity of need and isolation I see in my community. Every step of the way our desire to help, our energy to serve is hampered by the system we work in and dampened by the restraints of a lack of resources that we so desperately need in order to care for our communities.
Patients are angry, they feel let down. Health care professionals are exhausted, they feel unheard and they also feel let down, and universal healthcare is on its knees. Abuse, aggression and everyday acts of incivility are rising exponentially. Right here, right now is a defining moment for general practice in England. Today, we draw a line in the sand. Enough is enough.
Conference, we took the decision to survey the profession in the face of such extreme difficulty. We carried out an indicative ballot which gave one vote to each practice with a GP partner who is a BMA member. The window for this process gave practices a mere two weeks to respond and yet, we achieved a turnout of 35%. At face value, it may not sound like much, but let me tell you, to achieve this response rate in such a short space of time speaks volumes about the strength of feeling across the profession.
The results showed that GPs and practice staff are frustrated, struggling and are desperate to see change, it is an overwhelming expression of sentiment, a sentiment of discontent and disappointment. 84% of respondents said they would welcome non-compliance with COVID exemption certificate requests, 80% said they would change the way they reported appointment data, 58% said they would support withdrawal from the PCN DES at the next opt-out period and 39% said they would be willing to disengage from the PCN DES before the next opt out period.
Make no mistake. This is a profession on its knees, and continuing to fight for its existence. This hasn’t come out of the blue and this should not be a surprise to anybody, not least those in Whitehall.
At the beginning of this pandemic, general practice was under-resourced and unprepared for any surge in demand. We knew that the 5,000 extra GPs promised to us in 2015 were not coming, in fact we now have 1,700 fewer full-time equivalent, fully trained GPs since then. A decade of austerity left us feeling the strain and working at the limits of our capacity and our sanity. We have repeatedly warned those who hold so much sway over our working lives and the fortunes of the NHS that we were struggling.
Yet when this country and the world faced the biggest public health crisis of a generation, against all odds, we dug deep, we rose to the challenge, we stood up to be counted.
We responded to radical change in society – to the locking down of everything we hold dear – by mobilising to provide care in completely different ways overnight. Rather than abandon our patients we did all we could to continue to serve them. In a pre-pandemic February 2020, general practice delivered 3.3m remote consultations. 13 months later, in March 2021, we were delivering 11.5m remote consultations.
We have used all the tools at our disposal, many of which we hadn’t utilised in our daily work before, and responded to an unprecedented situation with vigour and with compassion and with care for our communities at the heart of everything we did. We showed we could transform ways of working and treating our communities, some of these new ways made possible through digital platforms will continue to enable us to deliver safe, timely, effective, high quality care.
Through the toughest period in many of our lives we have continued seeing the patients who needed us, putting ourselves at risk to see patients face-to-face and whilst managing risk for the entire NHS while capacity was increasingly outstripped by demand.
I want us to remember and recognise our GP colleagues and friends who have lost their lives to this pandemic so far, they dedicated their lives in the pursuit of helping people get better.
Dr Habib Zaidi, Dr Fayaz Ayache, Dr Syed Zishan Haider, Dr Kamlesh Kumar Masson, Dr Krishan Gopal Arora, Dr Yusuf Patel, Dr Craig Wakeham, Dr Karamat Ullah Mirza, Dr Saad Al-Dubbaisi, Dr Poornima Nair, Dr Abdorreza Sedghi, Dr Mohinder Dhatt, Dr David Wood, Dr Thomas Oelmann, Dr Augustine Obaro, Dr Abdul-Razaq Abdullah.
Despite all of this, we have been the vanguard of the biggest vaccination programme the world has ever known. Make no mistake, the successes of this programme are in large part down to the dedication and hard work of staff across general practice.
You saved lives, you saved this country. This government and this country owe you a debt of gratitude. You are all heroes.
And now, with 20 months of this gruelling pandemic behind us, we are demoralised, broken and exhausted. We have seen precious little tangible recognition of everything we have done. And every day we move from being applauded to being vilified, these sentiments stoked by biased media coverage, divisive policies and divisive politics.
The results of our indicative ballot show that we will not allow this to go on any longer. General practice is ready to break, and mark my words, without us the NHS will fail and the principles we all hold dear, the values of fairness and equality which make the NHS so revered and so admired, will all be lost.
Conference, my election as the new leader of GPC England represents an opportunity for a reset. It is, naturally, a fresh start for the committee but it also needs to be a fresh start for the profession. There is so much work to do immediately and longer term. We need to rebuild our workforce and firmly place wellbeing at the heart of our priorities.
We need to give GPs time to see the patients who need them the most, time to lead their teams, time to keep up to date with the revolution in healthcare, and time to look after themselves. We need to learn the lessons of the pandemic and work with patients and partner organisations to develop the models of consultation for the future based on a blend of traditional and cutting-edge technology.
Today, I offer the government and the media the opportunity to participate in this fresh start – to step back from the rhetoric of division, to reflect on the dedication that general practice has shown in the most difficult of circumstances and to demonstrate a willingness to work together to create solutions to this crisis. Let’s work together, let’s build general practice back better.
The results of the indicative ballot show that the profession has had enough. Relationships are broken and trust has been lost. Building relationships based on trust and shared values is the call to action. We need to honour the elements of agreements that were good and rewrite new ones.
Today we start a new chapter. Conference, let’s start writing that, today. Ultimately, we don’t want to have to take action – we want to see action. We want to be able to look to the future rather than feeling suffocated by the past. We want to work with the government, and not to have to try to force it to listen. We want to protect, and build on, the principles of the NHS which are there for the good of our patients and our profession.
Conference, we may have a lot of work to do but we also have so much to be proud of. You have shown extraordinary dedication to your patients, your communities, the public and I am beyond proud to represent this incredible community of leaders.
Thank you for everything that you do, you matter, what you do for your communities matters. Under my leadership the GPC will speak up for you. We will create better for the profession. And we will be relentless advocates for our patients and our NHS. We will listen, with the intention of understanding and then move forward together.
Today I invite the government and the media to match that resolve, to show the same commitment to patients and the public that we do every day of our working lives and to work with us rather than against us. We stand ready to work together to begin a new chapter and build a better future. Let’s build general practice back better.
And so, I come towards the end of my maiden speech, and I cast my mind back to when I was growing up, and the advice my mother gave me: ‘Keep your head down’. ‘Don’t speak up.’
When things matter, we need to find our voices and we need to speak up. Our patients, communities and our colleagues across the NHS need to know we stand shoulder to shoulder with them and that we will turn our intentions into actions. With empathy, with kindness, with humility, with courage but most importantly with the care our patients deserve at the heart of it all. Let’s write the future of NHS general practice together.
If I may, I would like to end with a quote from a plaque my father gave me when I was 17. ‘Do not follow where the path may lead. Go instead where there is no path and leave a trail.’
It has been my honour to address you today. Thank you for listening.