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On the morning of the final day of the RCGP conference, as a few rays of sunshine poked through the heavy cloud cover that has been a shadow hanging over Glasgow for the past few weeks, it became clear how much the weather echoed the message of the conference: Times are dark and challenging in primary care, but outlooks for the future are positive with more than a glimmer of hope.

Colin Hunter, Honorary Treasurer for the RCGP, and replacement for an unwell Iona Heath as speaker, began the final plenary session by stating that the RCGP has set always aimed to develop the UK premier conference for general practice, and strongly believed that this week this has been realised in a “church of general practice”.

Justin Hughes, Managing Director for Mission Excellence, former fighter pilot and Red Arrows team leader, gave an inspirational talk on excellence and professionalism, items of worth picking out from his speech that tie into the agenda of the conference were policies for producing excellence through teamwork. As with all teams, from fighter pilots to practice staff, you can only perform as well as your lowest performer. Shared learning and experience is key, without admitting mistakes, as those involved in healthcare are too aware of, people die. There needs to be trust, honesty and teamwork to continue to deliver excellence.

Drawing the last talk of the conference to a close, and before letting attendees back out onto the rain-soaked streets of Glasgow, Niall Dickson, Chief Executive of the King’s Fund, said:

“we all accept that the next period will be difficult and have many challenges, but these challenges will be met.

“If you can take away one practical thing to your place of work, then it is something I heard said in a concurrent stream by Clare Gerada [Vice-Chair of the RCGP]: ‘It is a good idea if you just went back through your list, identified every practicing doctor, and invite them in for a free health check.’

Look after yourselves and the rest will follow.

Dr Andrew Spooner headed this mornings session on innovation, maintaining one of the strong themes of the conference. He hoped to answer the question: What will be the results of this drive for innovation?

Areas of innovation outlined by the GP attendees were not cohesive in themes, ranging from web prescription to text messaging patients, fitness cards to international experiences. However, what was consistent throughout is the enthusiasm of GPs for the innovation schemes they are pushing and the sense of achievement for those have had success with.

The issues that GPs are encountering when pushing through such schemes are also common, they are being blocked either by a PCT or a figure. With practice partners there are issues with staff, finances, resistance to change, patients, time allocation with other duties involved in running a practice and even technological barriers.

Salaried GPs have the blessing of having no medical partners, are not bogged down by the business side of running a practice and have more time. But it is this lack of control to take things forward that pose the biggest threat.

So how do you get over a practice that doesn’t want to change, or how do you as a person change to facilitate innovation and make schemes work?

According to Dr Spooner GPs need to be clear over the problems they are trying to solve, run a pilot, and most of all it is easier to start small, prove success and proceed with further schemes taking on larger groups.

A suggestion from the attendees was to follow a cycle similar to an audit – Plan, Do, Study (PDS) – but is an innovative cycle that can be done quickly and easily. Inspiration seems to be a common theme for success, it is easy to get into a rut with one clinical leader so leadership should be shared, with all individuals engaged, their input valued, and all staff educated in methods and management of change.

The RCGP has promised to remedy the blocks all practices are facing by commissioning a funded figure to put together management and PCT practices to enable them to carry out projects as a single unit.

One consistent theme that has emerged from the sessions is the amount of preparation work within the organisations that are steadily allowing people to innovate. Enabling the practice to commit to community leadership through a combined unit consisting of the patient, the GP, and the PCT, providing the highest quality healthcare through fund-saving innovate.

Andy Burnham once more sent in his his video replacement, unable to attend yet another conference as he jets off to the states to meet the Obama team and welcome the positive findings mentioned yesterday of the Commonwealth Fund.

The projected Secretary for Health rained down praise onto GPs, and promised to give them a mention stateside. In particular he highlighted that Primary Care is one of the, if not the, best in the world and the RCGP can take a lot of the credit in its leadership role.

Professor Steve Field, his replacement, led with the statement, followed by a more positive response than yesterdays to Mike O’Brien, that the RCGP does not support abolition of practice list, and most definitely does not support the abolition of practice boundaries, countering Minister O’Briens comments that they are in cohorts over the planned change in 12 months. It appears the GPs will not only have problems with management, but governmental policy.

A theme that is continuously cropping up here is that the UKs healthcare will not, and should not, have the same problems as care in the US. The UK has high quality general practice, and to continue to provide excellence there Professor Field outlined three key themes: “leadership, leadership, leadership”.

Recession and national debt is always going to be on the agenda, and certainly wasn’t forgotten today, with Professor Field pointing out that 80% of Gross Domestic Product will need to be used to pay off debts over the next few years. The threat is very real but even more real is the danger that we may not do enough about it and the NHS will continue to be squeezed. To fulfil David Nicholson’s prediction of £15-20billion savings needed, innovation and savings are going to be very much in the forefront, with cutting waste of high importance.

Without practice boundaries community leadership will be difficult. The RCGP believes in a system of prevention, not patching up, and a community of patients need to be behind this for it to work. With strong general practice quality of life is better, patients have longer and healthier lives, and costs are reduced.

The College will be working with the BMA and the four Departments of Health in the home countries to strengthen unity and clinical leadership over the whole of the UK, but GPs will need to stand up and be assertive to deliver a more cost effective service based on strong practice and Primary Care. There also needs to be a halt to restructuring, GPs need to work with management cohesively to provide the highest quality, learn from what is going well and not spend critical resources on management consultants.

The days of the GP working single handedly are gone. The future is integrated care between GP and secondary care.

Climate change cropped up, it may have been a surprise but the RCGP ideas to battle climate change were sound. The financial crisis over the next three to five years may abate, but the global crisis will go on. The risks are hear now and through schemes close to home in the GP community such as active travel and better diet will have their impact on climate change.

If anything GPs can take away from the conference that, as Steve Fields states, they should be proud that GP research is the best in the world.

A collection of images from day one at the RCGP conference, if you haven’t visited us yet feel free to drop by OnMedica at stand 45.