This council was held online and was shorter than usual. Please note that there is no point in repeating what someone else has said; it was a shorter meeting than usual so this was especially important. This is just a record of what I said .

1) motion from North East London Faculty in support of Black Lives Matter, which I seconded. What we really need is a visible statement of support and a coherent plan to examine what the college response should be. There was already a statement online (https://www.rcgp.org.uk/about-us/news/2020/june/death-of-george-floyd-and-black-lives-matter.aspx) and two forums within the college with remits which would include addressing structural racism and inequalities (one of which I didn’t know about and was set up last year after Mayur Lakhani (then president) listening exercise.

Huge support from council.

2) paper on post covid 19 response.
this had lots in it that I fundamentally disagreed with, and then I panicked a bit trying to rush what I was saying (told had 75 seconds ! under time pressure) and left out some stuff. I added it to the chat facility where it will be stored as part of record, so all not quite lost. so:

1)
a) I am concerned that GPs are not being fully involved in the test/trace/isolate/support response. So we know from long history that large private companies who don’t understand healthcare cost a fortune and tend to leave large mess for primary care to sort out. My view is that the response to longer term covid-19 management should move into local public health and primary care – along with the resources. As time goes on, we will be managing small outbreaks and longer term consequences of covid-19. But tests are being organised without recording in GP records, often without GPs knowing, and remote from GP. Many people now with/potentially with covid-19 have morbidities and uncertain diagnoses / pathology. These people can’t be managed entirely remotely and need coherent holistic support. Also the government sites don’t collect important data eg on ethnic group. (This would be an example of where the college can show commitment to black lives matter)

b) total triage. Some practices are moving towards total triage now. It’s very different balance of risk to do triage for everyone in context pandemic and patients who you know , to move to system where everyone has to go through a phone triage first. It’s clear that some patients and some GPs love it. It’s also clear to me that it disadvantages some people and we do not have the evidence to say that it can provide as safe or as quality care. so: need to be v careful.

c) wearables for monitoring at home. BP monitors are about the only evidence based bit of tech for benefit. (also think good change o2 sats monitors could help with covid-19, current research underway). so don’t start thinking that tech can save us – it won’t

d) appraisal. move to make it more in a ‘wellbeing’ ‘health’ framework. This is just ridiculous. What even is ‘wellbeing’ – nebulous concept – and why on earth should the taxpayer fund this; appraisal relationship with appraiser is not confidential and is not as a doctor/patient .Yet this proposal is pushing into a quasi-medical role – completely inappropriate. This is an example of a power-grab via an appraisal system – a system that has the ability to stop you practicing as a doctor (it’s the only route to revalidation). Health care and support for doctors needs supplied via a different confidential route – not just once a year in a compulsory setting the appraisee cannot control. The potential for abuse is enormous. Am writing about this. More in due course.

e) This paper alluded to covid-19 being a ‘teachable moment’ for the population about healthcare/reducing their risks. I find this deeply patronising. Many people have been frightened and lonely, many people have been bereaved. The evidence on whether more people are exercising or not is not there. The only thing that might come of this is better active transport, but that needs systemic change (and is of course something the college should support but can’t supply beyond what any decent employer would do)

f) proposal that NHS bodies should train GPs to deliver coaching /motivational interviewing for patients. And the evidence is…..?

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4367-8