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



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