As ever, I can only report what I say, and I try not to repeat what others have. Council members have 2mins only to speak on subjects. I do have problems with this; it’s not a good quality control measure. Additionally, council members are giving up their free time to attempt to help the college – thats a lot of time given up with very little actual opportunity for impact.

anyway

I spoke on 2 things.

1. The prevention paper. This was intended to set policy for what GPs should do for preventive healthcare (this will be available on the members part of the RCGP website, if you are a member). This is a hot topic because it has intersections with ‘lifestyle medicine’ (I have many issues with this. Most evidence based things to do with ‘lifestyle’ have been part of guidelines for decades. A ‘new’ speciality isn’t needed) and screening. I could not support this paper. I thought it needed rewritten pretty much from scratch. The references were often of poor quality and one paper didn’t seem to exist at all. Definitions of prevention were muddled into early diagnosis, which is different. The RCGP overdiagnosis group (which I co founded) hadn’t been asked for views but many others had – including many from the ‘lifestyle medicine’ movement (and including the British Society of Lifestyle Medicine) but there was little to no critical evaluation of some claims. The general premise seems to be that GPs can sort out preventative healthcare and should do so in each consultation. But the evidence for individual GPs making a difference in the medium or long term to individual patients in terms of ‘behaviour change’ (a term I hate) is unimpressive (smoking is probably the biggest). There was a real lack of public health involvement. But most missing of all was the need for government to make policies which have an evidence based, preventative agenda on the commercial determinants of health. GPs should not be claiming to be able to deliver most preventative medicine because i) most true prevention is political and ii) because we don’t have evidence that we can. I felt the calls to include ‘prevention’ in every consultation and have more ‘early diagnosis’ to be…. wild. I’ve written some things about this before with colleagues eg. Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement https://bjgp.org/content/71/706/229 and this piece by me about ‘prescribing parkrun’, correspondance and my reply https://www.bmj.com/content/389/bmj.r670 relates to it. I also said that I had asked for review of some of the resources on the RCGP website about lifestyle medicine, as they were, for a variety of reasons, poor quality (and were removed). I don’t think we are doing enough critical evaluation. Enthusiasm and good intentions aren’t enough, we waste time, money and morale otherwise.

2. sponsorship paper.

I was part of a short life working group on this but only got to one meeting. I was disappointed by the paper. It seemed to describe only the hazards (increased price of conference fees) if sponsorship stopped.

my points

• the whole reason for being concerned about sponsorship is because of patient safety (opioids, mesh) and healthcare sustainability (costs usually rise with COIs)
• telling ourselves that we are too smart to be influenced simply isn’t borne out by the evidence
• numerous issues have been caused by sponsors (Emmas’ Diary, Novo Nordisk, sponsorship conference by Babylon, PA locum agencies, Coppafeel)
• most of the membership don’t go to the conference caus it’s too expensive, and the last time I did a whole afternoon was sponsored symposia that I wouldn’t have gone to anyway. There are other cheaper better ways of having meetings to include more people
• professional independence is to be valued and treasured, and not being for sale might be good for our collective self esteem.