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Raising the bar of quality in general practice

1 September 2006

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Mayur Lakhani
Chairman, RCGP

The Chief Medical Officer’s report, Good Doctors, Safer Patients, published in the summer, has given us the rightful opportunity for a long and considered debate on how we strengthen systems to assure and improve the performance of doctors and protect the safety of patients.

The first proper review of medical regulation for more than 30 years, the report acknowledges that the majority of doctors provide good quality care for patients, and emphasises the need for clearer standards of professional practice.

The report contains 44 wide-ranging and significant recommendations. A major consultation is now underway with our members and fellows across the UK, in order for the Royal College of General Practitioners (RCGP) Council to give a considered, structured response to the proposals – particularly those relating to revalidation and the structure and function of the General Medical Council (GMC).

The College has always advocated the need for stronger patient and public involvement in healthcare – a major theme of the report – and the views of our Patient Partnership Group are key to this consultation and to the College response.

Naturally, we understand that some doctors will have concerns about workload. The emphasis must be on support, education and professional development. We will be working closely with our colleagues on the General Practitioners Committee (GPC) to ensure a workable and supportive programme to assist all GPs in securing relicensure and recertification.

The subject of revalidation turns my thoughts to the ever-changing role of the modern GP and to the many and diverse elements of modern general practice that should be celebrated.

When this College was founded in 1952, there was no training or professional development available for general practice – indeed the very idea that training was necessary was a minority view. Look how far we have come, with world-class formal education, training and assessment.

Let us dispel the image of the GP working from an end terrace in isolation, with poor communication skills, dispensing cough linctus. The modern GP now works as part of a highly trained, highly intuitive practice team. Together, we master undifferentiated presentations and conflicting conditions; we manage uncertainty and provide a safety net for our patients.
Take a typical surgery – the child with fever, the old lady with abdominal pain, the person who feels tired all the time, the teenager with depression – all real-life examples from my own surgery or my rounds as a GP appraiser and practice visitor. What would happen to these patients if we did not have good general practice in this country? They would end up in hospital and the system would collapse.

Now we must look to the future and drive up even higher standards through better, more accountable training and continuous professional development across practice teams.

General practice commands the support of patients and so we approach this from a position of strength – but we cannot take this for granted. The way forward is achieving even higher standards and promoting the quality and safety of patient care. Just as records are broken at the Olympics, so we have to raise the bar of quality in general practice. Central to achieving these goals – in supporting GPs’ secure revalidation and driving up standards – are good practice management and organisational quality.