Daily Archives: March 31, 2014

RCGP National Council Elections

The Royal College of General Practitioners National Council Elections will take place in April, with 6 places on the council being up for election. John Cosgrove and Martin Brunet will be standing for the election and would be very glad of your vote! Here are their manifestos:


It has become increasingly apparent in recent years that the hallmark of General Practice –holistic, patient-centred care – is under serious threat. While policy makers play lip-service to the importance of the family doctor, their actions have led to a fragmentation of the NHS, loss of continuity in care and over-reliance on tick-boxes and targets rather than time spent listening to patients. For thirteen years I have fought this by small-scale disobedience in collaboration with my patients in the consulting room, but in the last three years I have felt the need to speak out, challenge the policies and try to help bring about change. The Royal College is one of the few bodies that seems to want to do the same, and were I to be elected to the Council I would work hard to help the College stand up for the principles of our profession, and the care of our patients.

I write regularly about issues in healthcare, both on my practice blog and a Pulse blog entitled Beyond the Headlines. Particular concerns are overdiagnosis, overtreatment and the need to reduce conflicts of interest within medicine. As part of a campaign to encourage the GMC to keep a register of doctors’ interests, I helped set up the website whopaysthisdoctor.org.

I am flabbergasted by how often a proposal will come from our leaders which will so obviously fail what could be called the ‘Sensible GP Test’ – that is: ‘If I asked an average group of sensible, coal-face GPs about this idea, what would they say?’ From the dementia DES, through GPPAQ, to removing practice boundaries via requiring practices to check the residency rights of immigrant patients, policy after policy has failed this test spectacularly and yet still seen the light of day. The dementia DES in particular, and the drive for early diagnosis without any proposal for extra support, has been ill-thought out both in terms of its practical application and its overall effect on patient care. I have been one of its most vocal critics, including writing in the BMJ and speaking at the RCGP annual conference last year. I have not always been in agreement with the College on this issue, and debated against the College dementia lead, Jill Rasmussen, at the National Dementia Congress last year; the large swing away from unquestioned early diagnosis among the conference delegates helped convince me that challenging these issues is important, and can bring about meaningful results. This is something I intend to keep on doing.


How can we free up time for ourselves and our patients?

GPs as a profession must define for ourselves what is and what should not be our responsibility. For too long, society and politicians have directed to us whatever issues they cannot solve and then blamed us for outcomes beyond our control, whether it be A&E attendances, failing hospitals, “benefits cheats”, infant mortality or “missed diagnoses”. The result is widespread overmedicalisation, which we must reverse.

GPs should be the last resort for self-limiting illnesses, employment, relationship and emotional difficulties or primary prevention, not the first. We must restore this balance to survive in the face of an ageing population desperately in need of our medical skills. Screening and case-finding are no substitute for caring medical generalists.

RCGP should define appropriate practice, not lawyers, to allow GPs to continue to absorb risk and spare patients and the NHS from the harms of over-investigation and over-treatment.

Council must be transparent. New policies should be published for appraisal by all members before approval. This is essential if College is to engage with members and capitalise on their expertise to develop optimal policies, responsive to the needs of hardworking GPs. This will also strengthen Faculties, the life-blood of College, by enabling them to facilitate debate at the local level.

These are the principles which will guide how I will represent you at Council.

@DrJohnCosgove www.DrCosgrove.net/RCGP