Professor Dame Clare Gerada, who takes up the presidency in November, calls for increased support for GPs exhausted by work during the pandemic

GP

Professor Dame Clare Gerada has long been highly visible, vocal, and passionate about being a GP. She greets her appointment as President of the Royal College of General Practitioners (RCGP) with a mixture of disbelief and determination to use the opportunity to haul the profession she loves back from the brink.

Nigerian-born Professor Gerada will be the first woman for nearly 70 years, and the second in the College’s history, to have held the position of both Chair and President. She was College Chair between 2010 and 2013. The current RCGP Chair of Council is Professor Martin Marshall.

Professor Gerada, who takes up the presidency in November, quotes novelist Margaret Atwood: ‘We still think of a powerful man as a born leader, and a powerful women as an anomaly’.

‘Therefore I am an anomaly’, she says. ‘Not only have I achieved a position of power, but I have done it despite my background as a new immigrant, and from a troubled background.’

She views the role as a crucial part of the RCGP’s drive to support GPs suffering from disillusionment and mental and physical exhaustion following their pandemic work, against a background of political and media accusations that general practice shut its doors during the COVID-19 outbreak.

‘We have a crisis because we have GPs who are burned out, demoralised, and depressed; who have borne the brunt of complaints and assaults, who are just trying their best, and then leaving because they can’t cope. This is leaving more and more work on the people left behind so it is just piling pressure upon pressure.’

The RCGP is calling on the Government to introduce an emergency rescue package, including recruiting 6000 more GPs and 26,000 additional support staff such as nurses and receptionists, by 2024.

Professor Gerada is currently the longest-serving RCGP Council member, having been continuously on the Council since 1998. She trained in psychiatry and medicine before following her father into general practice.

She is also a member of the British Medical Association’s Council, Co-Chair of the NHS Assembly, and Founder and Medical Director of Practitioner Health, which provides mental health support to GPs—as well as being a practising GP in South London.

She is a partner in the Hurley Group, and spoke to Medscape UK from her consultation room at the Hurley Clinic in Lambeth, where she’s worked since February 1991. ‘Being less visible will be a challenge, but I will do it. I absolutely love general practice’, she says.

Q&A 

The Chair sets the strategic direction, so how will you as President of the RCGP be able to continue your battle to save general practice?

‘Being Chair is like being the Prime Minister, and the President is like the Queen. So I am the Queen. I no more expected to become President of the Royal College than I did the Queen of England. It feels extraordinary.

‘The presidency is a ceremonial position, so I will not be able to speak out publicly with the same freedom, but I will have a tremendous opportunity in the College to support its membership and to have a pivotal role with senior officers who bring together unbelievable experience, history, and wisdom.

‘My real challenge is that I have got to the position that I have at 61 because I have been me, so what I have done has obviously been in the main in the right ballpark. I have spoken truth to power and I have worked so hard for more than 30 years. So I hope that I can use that breadth of experience and depth of knowledge to bring about change.’

This summer you set out your solutions for saving general practice in your ‘Stop skinning the cat’ editorial.  How can you now start to make progress?

[As President] you are in the heart of the decision-making process. I will use my experience within the senior officer team to point out what has already been tried in the past, what worked, and what was suggested, rather than each generation reinventing the wheel. I want to bring a corporate memory to an area that I have been in consciously for 45 years (I started working for my GP father when I was 16).  In my head now is years of knowledge. We need to change and I can add perspective.

‘One of the points I made in the article is about the need for GPs to look after themselves, which will be easier because I can make sure people are properly directed, but I can also work behind the scenes to see we have an out-of-hospital strategy that sensibly defines the new world of “teams without walls” and support them.’

What is the new role for GPs post-COVID-19?

‘It is not about creating a new role, but about underlining and retaining those things that make general practice different from other medical specialties and special—the most important being continuity of care with patients. One of the nicest things you can say to a patient is “see you next week”. The second aspect that GPs must continue to do at all costs is to see undifferentiated problems. The third—which is very difficult to maintain—is to see the patient in the context of their families and their communities. Everything else can be built out from there.’

How do you balance your work as a national figurehead, with your day-to-day work as a GP in Lambeth?

‘I’m in a fortunate position in having a flexible clinical workload, made up of three parts: working with mentally ill NHS staff via Practitioner Health, running a service for gamblers, and then general practice. I’m stopping the Practitioner Health [role] in March, and scaling back the work with gamblers. General practice I will continue to do, as I did through the chairmanship (which is far harder). I have no intention of stopping—I love it; I love seeing patients, all clinical contact fills me up with such joy. It is the most regenerating job because each patient gives you new pleasure.’

What is the first thing you are going to do when you take up the presidency?

‘I want to get an induction. I’m now the longest Council member and I should know what the president does, but things change, so the first thing will be to get to know the job. But one of the first things I want to do is to check that the national team is alright. They have had a horrible time over COVID, working so hard, and now they are having to deal with issues about general practice not working, GPs not working. So my first role will be to provide support and love to the senior officer team.

‘The second thing I want to do is to start reaching out to the membership and maybe to have a plan to visit each faculty round the country, either remotely or face to face. I want to do a dipstick [test] on how they are and what I can do for them, and start to provide hope for the future because they are doing a fabulous job and hope is what they need.’

You have 2 years—what do you want to achieve? And how will you know you’re successful?

‘I will have succeeded if we get more engagement with the College for members and people like my father, who feel alienated and do not feel that it belongs to them. I also have unfinished business from my time as Chair to do with doctors (mainly from overseas) who repeatedly fail our exams. I want to see whether there is a way to find those doctors new roles in the NHS rather than turfing them out. It is about supporting our international medical graduates and making sure there is a fair process.’

You were unopposed—is that a vote of confidence by your colleagues?

‘It’s the first time that the presidency has been unopposed. The College made me go through a vote, so I could also have been the first person in history to have lost an unopposed selection; 84% voted “yes” for me—so I have a mandate—but it was a scary time for me.

‘I am deeply honoured that my profession has voted for me. I hope I can do it service. I love the College, and have been on the council since 1998 and have held most of the senior positions. I want members to feel loved, that I’m looking after them, and that they have a role. I also want non-members to feel that the College is important.’

What does it mean personally to you to be President of the RCGP?

‘It is an unbelievable honour—and I hope I can do the right thing for the College and the members.

‘It is not the same kind of “giving back” as knocking on the doors of politicians, but I cannot believe I am really President of the College. When I close my eyes and think of a president, I think of someone in a robe, with a big chain of office, much older and male—someone who is not me. I came here as a foreigner as a child. My father was very anxious about the RCGP and would not take anyone who was a member or had exams from there, because he felt so bothered by them. By the time I became Chair, my father was too demented to understand what I achieved. My parents would be astounded.

‘I want to use every skill and fibre in my body to help my profession to feel loved and wanted and to find solutions to the difficulties we are in at the moment.’

This article originally appeared on Medscape, part of the Medscape Professional Network.