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A letter to Professor Steve Field from Birmingham LMC

Dr Bill Strange

Dear Professor Field,

I am writing to you in my capacity as chairman of Birmingham LMC. The committee met on Tuesday, 15 December 2015 and unanimously asked me to write to you in order to voice its concerns at your remarks reported in the Daily Mail and to make the points as set out below. 

You will understand I hope that we feel particularly hurt in Birmingham as of course you are yourself a Birmingham GP. Birmingham LMC is proud of the tremendous work that general practitioners and their teams perform day in and day out for their patients – often in the most challenging of circumstances, an unacceptable and inexorably rising workload and with inadequate funding. By far the majority of patients hold their individual family doctors in high regard and NHS general practice in the UK is admired internationally, and quite rightly so.

I appreciate that your remarks might have been taken out of context but you are used to working in the public arena and I would have thought that you would be aware of how the media would interpret what you were saying. It is noteworthy however that there has been no public correction of your comments by the CQC. The reports that you believe general practice has failed as a profession and that you are ashamed to be a GP caused distress, confusion and anger amongst committee members.

When GPs and practices are being assessed they want it to be done in a fair fashion – with the knowledge that the CQC is approaching an individual practice with an open mind and not some preconception. Your comments as reported would leave many GPs to question this. I do not think that this is a constructive way for the relationship between general practice and the CQC to evolve.

Then there is the question of trust between family doctors and their patients. Of course, we must always strive to improve and it is clear that a very tiny minority of practices may be delivering unacceptable standards of care and that should be tackled. However, any system of quality assessment will show a distribution of standards and there needs to be proportionality when applying comments to the system as a whole. We feel that the reporting of your comments has done harm to the very core of general practice services – that relationship between the doctor and the patient.

In particular the report that a third of practices are putting patients at risk is scaremongering which is likely to have significant detrimental consequences. The committee finds your reported comments particularly incredulous in view of the fact that the actual proportion of inadequate practices you have identified is just 4% and that it is clear that the majority of these practices actually score highly in the ’caring’ category and in other clinical areas- it is often just procedural and administrative issues, with no evidence that they have impinged directly on patient safety or the quality of care that have dragged their ratings down.

Finally, I’m sure you are aware of the tremendous problems we have with respect to recruitment and retention within the profession.  Your position comes with great responsibility to many different stakeholders but again there is this question of proportionality. I would imagine that many young doctors would be put off pursuing a career in general practice if they felt that they were entering a branch of medicine that they might need to be ashamed of, were failing the very people they were trying to help (the public) or if, despite doing their very best for their patients, they ended up being unfairly denigrated by those in positions of authority and influence.

Yours sincerely,

Dr Bill Strange FRCGP 

Chairman of Birmingham LMC


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Readers' comments (9)

  • You may be surprised - people are not stupid they are aware they get used in medico-politico makes no difference to the relationship with a known GP -if it is a good one

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  • Other healthcare professional18 Dec 2015 6:38pm

    A) - people are gullible and susceptible to fear.
    B) - we live in a mobile society and many practices have a high number of inter-TP transactions.

    Our practice actually monitors new arrivals and we try to have some decompression time for new patients to settle in. Part of this process is natural, but scaremongering in the papers plays a huge part and doesn't help.

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  • Vinci Ho

    It is imperative to have a reliable , transparent and credible system to identify the bad apples which are naturally occurring in all professions. The question is simply what is the majority and what is the minority?
    Take the point what the head of CQC said could have been taken out of context but( always a but):
    As the head of an official regulatory organisation , he has public authority and power, we haven't , fact. 'Rubblish' comments coming from a person like me can be ignored easily . His comments , on the contrary , can potentially influence different sections of the society , fact. Sensationalism can be something abused by any media , so called Fourth Estate or Fourth Power. But the head of CQC must know what he represents in front of the public and impartiality is the prime expectation as far as his/her quality and competence are concerned.
    And it is exactly a betrayal of impartiality when he dissipated his comments through a well known hating GP , government propaganda media(with a liking of sensationalism!).Combining his public authority and the Fourth Power to step on us to raise attention , is simply bullying. Yes , one can also accuse me of playing with sensationalism as well.

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  • Excellent sober response which is unarguable
    Well done

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  • Congratulations To Bill for producing a thoughtful, considered response!

    The vast majority of GP practices are providing an excellent standard of care, in the face of exponentially rising workload in view of an ageing population who present with complex co-morbidity; furthermore the asylum seeker population place additional demands due to the language barrier, the need for interpreter services, different psychosocial expectations and need to consider exotic pathology as a diagnostic consideration for their presenting symptoms; the inexorable transfer of secondary care work into primary care is adding to the stress if GP practice

    Inadequate funding means our income is falling disproportionately whilst our workload is escalating

    There is a challenging workforce crisis. we are currently a partner short, and as our senior partner is retiring at the end of this months, we face the prospect of attempting to recruit two GPs-and the chances of success do not look great!

    Despite all the pressures I continue to enjoy GP-the vast majority of patients, as ever, are a delight! But the price is having to work exceptionally long hours, and it is not uncommon for me to return to the practice at weekends to complete the paperwork

    The overwhelming majority of GPs continue to provide an exceptionally high standard of care in these testing times, and the PCHT is to be complimented on excellent provision of care.

    Professor Field should know better! To denigrate the whole profession for the failings of a few practices is utterly indefensible and he is to be condemned in the highest terms. He is in a position of power and as a GP and former member of the RCGP hierarchy his remarks should be considered and reflect the ground realities ; he certainly should refrain from sensationalism, especially in The Mail, a paper which is well known for its anti-doctor stance.

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  • This comment has been moderated

  • Please note I am currently a GP partner, not a sessional GP

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  • Has this man got anything to say for himself?
    I was going to write more but then realised ...who on earth cares what I think?
    Writing here just makes me more angry.
    Stuff him...he's not worth any more of my energy. He'll get what karma brings him.
    We all do one way or another.

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  • Great letter, well done. I do feel an apology (rather than resignation) should be requested.

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