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Field: NHS has ‘lost the plot’ on primary care

Future Forum chair Professor Steve Field has launched a stinging attack on the quality of general practice in the UK, claiming the NHS has ‘lost the plot' on primary care provision.

In a debate at the NHS Alliance conference in Manchester, the former RCGP chair said there was too much variation in primary care and that levels of access were unacceptable in some parts of the country.

Professor Field said it was time to consider new innovative models for primary care, and also aimed a mischievous dig at current College chair Dr Clare Gerada, citing her Hurley Group as the embodiment of successful competition, despite her vocal opposition to the exposure of the NHS to market forces.

Professor Field said:  ‘The challenge is how to provide a nationwide health service whilst stimulating innovation. I believe we can have both. Barbara Hakin's emphasis is on commissioning. [But] I believe we've lost the plot on provision in primary care. You need to stand up and not tolerate poor access for the humans that live in England, you must not tolerate unacceptable variation in primary care.'

‘We have some fantastic general practice in this country, and we have some bad as well.

Professor Field explained that his vision for innovation in primary care would involve more practices working in federations, and said the model favoured by Dr Gerada's Hurley Group was one that more practices should consider in order to raise standards.

‘With my national inclusion hat on I go around and see there are large numbers of people who can't access a GP. But I'd just like to talk about one of my very good friends Clare Gerada. Clare and I wrote a paper with Mayur Lakhani and others on federations of practices. First of all, she is promoting a federated idea. I think we need to work in bigger organisations whether they merge or work in an integrated way, I think we can create new models of general practice.'

‘But I also admire what she's doing in her own practice, that is also a model we should think about. She is the biggest provider of general practice in London, she employs about 100 salaried doctors, provides fantastic care and has won more Darzi contracts in competition than anyone else. And so I think Clare is espousing all of the things I think should happen, with compettion, and working in deprived areas with fantastic care and a different model. ‘

In response to the comments, Dr Gerada told Pulse she was 'very proud' of her practice.

She said: ‘It's a model that works well in areas like inner cities where there might be problems with recruitment and access, but it's not the only model of general practice. I'm in rural Scotland right now where they have a different and successful approach.'

In a later discussion at the NHS Alliance conference on the state of CCGs, Dr Hugh Reeve, chair of Cumbria CCG, said a radical overhaul of primary care was one of the most pressing tasks facing CCGs, and predicted that more practices would work under joint contracts in the future.

He said: ‘General practice will look very different in four to five years time. I think it will still be small units but they will work together very differently. Otherwise someone will do it to us.

‘Some practices will work under joint contracts, a bit like some us did under PMS, with one contract under several partnerships.'

Dr Shane Gordon, chief executive of North Essex GP Commissioning Group and national co-led of the NHS Alliance GP commissioning  federation, lead, said: ‘At the moment it feels like we're in a bunker. It's got to feel like part of a bigger system.'

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