New RCGP chairman on the fight ahead for GPs

Professor Steve Field wants GPs to be leaders, writes Prisca Middlemiss.

Professor Steve Field has taken over as chairman of the RCGP as the profession increasingly feels under attack from private providers, the media and the DoH. He tells GP how he is going to stand up for his fellow GPs.

Is the profession right to be nervous about what is seen as aggressive privatisation?

From the RCGP's point of view we stand for high quality patient care and the role of the generalist.

There are threats to general practice as we know it, but there should be opportunities as well and we will fight very hard to put forward the central role of the GP as a leader.

Personally I think the future is bright. But GPs locally, regionally and nationally need to engage and be assertive. We need to be more explicit about the high quality care we provide and the benefits of continuity of care.

The GP as a highly-skilled expert in managing complex long-term conditions hasn't come across effectively enough.

As a Birmingham GP, what do you think about Heart of Birmingham (HoB) PCT's plans to franchise out general practice?

The HoB plans are part of a bigger change which involves replacing the teaching hospital.

In Birmingham you have some of the best quality general practice in the country. The uproar has been about the way what they are trying to do is communicated.

Their use of English has not been good. Franchising is a word which in this context I don't understand. It's about the central role of the GP, the provision of high quality services to a deprived population. The PCT should have worked closely with local GPs.

So there is no huge difference between the RCGP's federated practice model, the Darzi polyclinic model and the HoB franchise model?

You can't remove all the GPs in HoB from their work. If they want the GPs to work together in centres they need to persuade them. Providing big new all-singing, all-dancing buildings might attract high quality GPs. I will never criticise investment in resources.

It's very pleasing that nationally the DoH is acknowledging that it needs strong GP leadership. There is evidence of listening and learning and Darzi personally has quoted the road map. That's reassuring.

Darzi has said that he would want me and the RCGP to take a lead in providing solutions. He is looking to us to provide evidence of high quality care. The DoH will also look to others and will reach a political decision.

But the Darzi review is based in the localities and SHAs. Locally, we have put people up for committees and been disappointed by the uptake. Many GPs have been taken from the professional executive committee chairman community and people they know.

What is the RCGP's attitude to GP-bashing?

We are fed up with what has happened over the past two years over deriding of GPs for earning large sums of money when we know that the reality is that most doctors coming out of training aren't earning vast sums and are working long hours providing high quality care. We will be increasingly assertive about the role of the GP.

What about the DoH's push for increased access?

If GPs are going to work later we need to acknowledge that there will need to be more GPs.

Sir Liam Donaldson acknowledged the other night that we still have too few doctors - and too few GPs.

You chaired the advisory board of the now-discredited Modernising Medical Careers (MMC).

Advisory is the key word. I don't believe I was closely identified with the MMC failure. The Tooke report makes the line of responsibility very clear. Our concerns were fed to the DoH, but I don't believe we were listened to.

One great success is that we made sure that (on MTAS) general practice was listened to. We have our own highly successful central recruitment system, the number and quality of applicants has gone up and the standards of doctors coming out are fantastic.

Professor Field is proud of the new curriculum. But it assumed 18 months in general practice training.

We've been assertive about the benefits of 18 months in general practice. When we move to a five-year curriculum, as suggested by the Tooke inquiry, GPs will be able to develop even more expertise.

What is happening with recertification?

We are currently working on updating Good Medical Practice for GPs. I think you will see piloting of recertification in 2008 and roll-out in 2009. We'd like the pilot GPs to be formally recertified.

Under your predecessor Professor Mayur Lakhani the curriculum and the road map came in. What mark will you leave?

These projects take years to reach fruition. In my time we'll see embedding and updating the curriculum. We have to make sure that the college is meaningful for all doctors.

How?

In some areas the faculties have been very successful. But we have got to get the faculties more engaged with the primary care organisations.

Are GPs right to view the RCGP's work on, for example, physicians' assistants as a threat?

Initially I felt that way, but the more I see of them, the more I see them as assistants who give more time to the GP to deal with complex problems.

Do you have time for a private life?

Being chairman is a seven-days-a-week job done in three days. For me, everything else pales into insignificance apart from seeing patients and my family.

Do you come from a medical family?

I was the first person in my family to go to university. I grew up on a council estate and my dad sold cotton cloth and played the piano in pubs in the evening. My role model was my local GP.

prisca.middlemiss@haymarket.com

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