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A letter to Professor Steve Field from Birmingham LMC

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