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At the heart of general practice since 1960

Was Professor Steve Field right to say general practice has ‘failed’?

Dr Alistair Howitt argues that we should be ashamed of poorly performing practices whereas Dr David Wrigley argues that GPs need support, not blame

YES

In December, Professor Steve Field told the Daily Mail that general practice has ‘failed as a profession’ and he was ‘ashamed’ to be a GP because of the poor care he saw in certain practices. This provoked outrage in the profession, but instead of questioning why he spoke to a tabloid, we need to consider the underlying issues he was pointing to.

What seems to have caused most of the furore was the CQC chief inspector’s personal reaction to the finding that the worst 4% of practices were much worse than expected. These were the practices that apparently we all knew were bad, but remained untouchable until the CQC came along with its regulatory powers. He spoke of practices with poor or absent leadership, working in professional isolation without reflecting on or learning from their work, and failing their patients with poor practice over the years. 

Sadly, these practices exist. My work as a locum takes me to practices rated as ‘among the worst’ by NHS Choices. Try working in one and you will experience everything that Professor Field is unhappy with. Then think of an adjective to describe how you feel about being a GP in such an environment. 

I often feel like giving up after a day in one of these practices, and it’s easy to see why young doctors look to Australia or a career outside medicine. But it’s important not to blame those working in these practices. It’s the system that’s rotten.

And it’s not just these practices where there are problems. The recent Commonwealth Fund survey of GPs in 10 countries showed that we are the most likely to think our care system needs fundamentally to change and to report that our job is very or extremely stressful. 

We must unite as a profession and engage with the process of improving the quality and sustainability of general practice. This includes acknowledging the validity of the CQC’s findings in the poorest practices, whatever we feel about its methods, and work collectively to remedy them. Only then can we transform the service from one plagued by micromanagement, underfunding and a flawed regulatory system to one that is safe. We should try to transform failing primary care, not shoot the messenger.

Dr Alistair Howitt is a GP in Kent and East Sussex

NO

When I read Professor Steve Field’s comments, I had just finished a crushing 14-hour-day at the surgery, not stopping once, yet Professor Field seemed to think I was a failure. A failure working in a chronically-underfunded NHS. A failure for struggling to find a community placement for a patient where social services have seen a budget cut of 35%. A failure for working in general practice whose share of the NHS budget has fallen year on year for a decade. A failure where mental health services are in such a state that severely mentally ill patients are kept overnight in police cells as there are no mental health beds left.

Here was a man who has the grand title of chief inspector of general practice for the CQC. A distinguished professor of general practice from Birmingham who was once chair of the RCGP – he once led the profession at the RCGP upholding the standards of general practice and promoting all the superb work we do day in, day out.

Professor Field is angry that general practice doesn’t pass his latest employer’s overly-bureaucratic tick-box exercise. I accept some surgeries are in need of help and support to improve, but as a professor of general practice surely he knows that the way to improve quality is not to shout from the rooftops, at the top of his voice: ‘You’re rubbish’.

How did it come to pass that he trashes my profession in a very high-profile soundbite that the media lapped up and splashed all over the internet, newspapers and television? Shouldn’t Professor Field instead be speaking out about the failings of politicians who have mismanaged finances in the NHS and cut funding to general practice?

Surely general practice and the NHS is struggling because the NHS spends one of the lowest amounts as a proportion of GDP compared with many other countries,1 not because GPs are failing.

Why is he telling the media that GPs are failures when he could be supporting us in these difficult times? He could instead lobby politicians hard for a double-digit increase in funding for general practice. If he succeeded with this, it would start to solve a lot of our problems and then maybe he would be a little less ashamed of us. 

Dr David Wrigley is a GP in Carnforth, Lancashire, a GPC member and has co-written the book NHS for Sale

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Readers' comments (47)

  • This comment has been removed by the moderator

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  • The two speakers do not actually disagree.

    Dr Howitt says the content of the message should be explored seriously; Dr Wrigley says the mode of delivering the message was unacceptable.

    Seems clear to me that both are right.

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  • Steve Field has had enough time in high profile jobs to know the effects of talking to the media.
    This was a deliberate comment that he would have known will undermine and demoralise the one part of the NHS that never gets bail outs, and provides appointments and all the care that surrounds it for

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  • very well said Alistair - we know some practices are not good - a few are quite frankly shocking (others like Prof Fields clearly will be beyond reproach of any kind - but not what his patient say on line!) but we cant continue to shoulder the burden of the NHS with the relentless lack of real base line funding - not special funny political money - and the continued onslaught of abuse from government & media

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  • Is Dr Howitt saying that Steve Filed is right in claiming that general practice "has failed as a profession" because of the 4% of alleged bad practices? I say "alleged" because CQC inspectors are not exactly the epitome of objectivity and independence.
    If this is the case, then the consultants, NHS England managers, the teachers and public servants have all "failed as a profession."
    It is the Chief Inspector who has failed to do his job properly, and it is he who has let the profession down miserably, for reasons time will reveal.

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  • Some doctors are bad, as are politicians,priests,papers et al. that is inevitable.
    We may cut cut out the very worst, but some will always under perform.
    We can try and minimize it. But GPs deal with almost 90% of consultations on 8% of the budget.
    Will do admirably.
    I am ashamed of being a GP because, like Dr Wrigley, we GPs are doing 14 hour days routinely on 5 cups of coffee. I do not have time to speak to my colleagues. No time for my family. No time to relax. i am getting burnt out. No many of us are and we do nothing about.
    It should be like this, almost impossible.
    I am ashamed because we subject GPs to this almost impossible monster and we do othing about it.
    GPC, is a 14 hour day right, everyday?

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  • Because a tiny minority of practices fail we should not be ashamed of the profession. If Prof Fields statement was taken out of context can he please clarify it

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  • GPs have failed,Hospitals have failed, nursing homes have failed, CQC has failed, NHSE have failed, bla, bla bla

    Shall we all just pack up and go do something else?

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  • I knew I should have been an architect! Lots of drawing, building models & trips into the country! if only,,,,,.....

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  • PROFESSOR FIELD HAS FAILED, HE HAS REPEATEDLY DISGRACED HIMSELF. iF HE REALLY CARES ABOUT PATIENTS THEN HE WOULD BE CAMPAIGNING FOR FUNDING SUFFICIENT TO PROVIDE A SAFE SERVICE. BE THE MOUTHPIECE OF IMPROVING CARE RATHER THAN THE DAILY MAIL AND YOUR RIDICULOUS TORY CHUMS.

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