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Should I be 'ashamed' to be a GP? An open letter to Steve Field

The government's chief inspector of GPs told the Daily Mail this week that GPs have 'failed as a profession'. But who is helped by his morale-crushing and unjustified comments?

David Wrigley
16 December 2015
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Image: Flickr/ El Payo

Dear Professor Field

GPs arriving at work on a typically crushingly busy Monday may have noticed your comments printed in that day’s Daily Mail – headlined “GPs have failed as a profession”, and where you said that you were “ashamed to be a GP”. 

My jaw dropped when I read this. I just couldn’t believe someone who had once led the profession as Chair of the Royal College of General Practitioners, and is now the chief inspector of GPs at the Care Quality Commission, could say this. 

I am not sure if you work as a GP on a Monday but if you did you would see what pressure GPs and their staff work under due to the failings of those working from comfortable offices in London – politicians and senior managers like yourself. 

My fellow GPs will have read these comments and felt their already low morale sink to even more subterranean depths. As they battled with their 12-14 hour day seeing sixty to seventy patients or more they will have wondered why you were beating them with a stick again. 

General practice – the backbone of the NHS - is on the verge of collapse. Our workload is unsustainable and unsafe. We have seen politicians cut the funding to our once world renowned profession year on year. Once we had around 13% of the NHS pie, but it’s now dropped to around 7%. Meanwhile hospital beds are cut, and social care is cut to the bone, making it even harder for us to treat our patients effectively. Who knows where the money is going – but it’s not to the places it’s needed. 

GPs have had enough – and are leaving in their droves to retire early or work abroad. Young doctors are running a mile from GP training schemes. We’re seeing GP surgeries closing down across the UK – who would have thought we’d see the day – as GPs unable to recruit new partners are forced to lock up and close their surgeries for good. 

GPs are forced to choose between giving up and cracking up. The British Medical Association has already raised concerns about the level of depression and even suicide amongst doctors. The problem is an international one but it’s worsened in England by political cuts to services which impact on the care we provide.

The ever increasing burden of over-regulation and bureaucracy is also bringing General Practice to its knees. We’re not helped by micro management of our day to day work by the likes of the organisation you work for –the Care Quality Commission– who last year had to apologise for mistakenly labelling a clutch of practices as unsafe. We are one of the most regulated and monitored professions in the world. We spend weeks on end filling out forms and paperwork of dubious value when we could be seeing patients and dealing with ill people.

Of course UK general practice is not perfect. There are parts of it that need to dramatically improve their standards. All GPs wish to support and encourage colleagues to provide high quality care. But even you admit that 85% of practices were rated ‘good’ or ‘outstanding’ – and that of the remainder, most had already made substantial improvements. So do you have any idea of the damage you do when you label us all as failures?

Those sections of the media, political classes and think tanks who wish to see a privatised general practice service will lap up your comments because you are the Chief Inspector of General Practice - the man who should be listened to.

GPs who work such long hours they can hardly drive home safely will just wonder whether it is all worth it.

We’ve met a few times, and discussed general practice and GP training. You may remember that I (like many others) was openly critical when you accepted the role offered to you by former Conservative Health Secretary Andrew Lansley to chair his NHS Future Forum. This forum played a crucial role in lending legitimacy to the disastrously expensive and distracting Health and Social Care Bill and helping it become law. This was at a time when every part of the NHS – most notably, my own Royal College – were warning of the devastating impact it was going to have on patient care.

I remember, too, that you’ve reviewed the NHS constitution for government – twice, in fact – but you and your fellow government advisors rejected the key Francis recommendation to ‘put patients first’.

As a GP yourself I hope you will now do what all GPs should do – reflect on their actions and think whether you have done the right thing. The Daily Mail interview was not, I feel, your finest hour. I hope you will apologise to the tens of thousands of GPs and surgery staff who deal with a million patients a day under the most testing of circumstances. They don’t deserve being criticised yet again with your comments which too often are ill thought through and hugely damaging.

The Chair of the Royal College of GPs Dr Maureen Baker says she finds your comments “baffling and offensive”. I agree - like her, I am “in awe” of how well most of my colleagues “deal with patients in the current climate”.

Please don’t make any more comments to demoralise and depress my colleagues. We really don’t need it. We want to do our very best for our patients but you are making that really hard for us to do. Please direct your critical comments to those who deserve them and who are responsible for the mess the NHS is in - the politicians. They are the ones who have truly failed our profession, and patients.

Yours sincerely

Dr David Wrigley

GP, Carnforth, Lancashire

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