Modern NHS will need leadership from GPs

Professor Steve Field shares his vision of the NHS with Colin Cooper.

Steve Field: no to abolition of practic boundaries
Steve Field: no to abolition of practic boundaries

General practice can be the saviour of the NHS, according to RCGP chairman Professor Steve Field, but only if GPs grasp the opportunity to become leaders.

'General practice is the way forward,' he says. 'If you have strong general practice in the right place at the right time, the outcomes are better, more efficient and more effective.

'We need stronger commissioning, but more than anything we need more integrated working between primary and secondary care. What it all comes down to is stronger leadership from GPs.'

Strong GP leaders needed
At last week's RCGP annual conference, the college launched its General Practice Foundation to support managers, nurses and physician assistants. Professor Field backs the move because he feels strongly that primary care is a team activity. But he warns GPs still need to take a lead.

'Sadly, in some areas, GPs have not stepped up to the plate, and some primary care organisations have not been as helpful as they could have been. But the time has come for strong GP leadership.'

GPs should not feel paranoid about other professions usurping their traditional role, says Professor Field.

'As technology improves care can be much more rules-based and people without the knowledge and skills of doctors will be able to take on more tasks.

'But highly skilled GPs have a unique set of skills that will be needed at the centre to manage the complex cases that we increasingly face.'

Professor Field would also like to see more leadership from GPs in local communities, even if it means taking unpopular decisions such as rationalising hospitals or closing pathology units.

GPs should also be more involved in commissioning, he says, working in a more integrated way with other professions, input from specialists, and even private expertise.

He wants Payment by Results overhauled so hospitals are no longer incentivised to increase their own activity, and believes that federations of GP practices should take over the provision of community services.

At the same time, Professor Field recognises that not all GPs want to spend their time running the NHS. 'Some GPs will just want to get on with high-quality clinical care. And we want to see a world where GPs are lauded for their high-quality provision of generalist care.'

To achieve this, GPs need to embrace revalidation as a means of professional development to improve the quality of care.

Embrace revalidation
'Revalidation is solely about professional development,' says Professor Field, 'not weeding out bad doctors. That should be done by clinical governance and contracting. If it just ends up as a guillotine, then we will have lost the plot.'

One group that needs particular support as the system develops will be the GPs responsible for appraisals. Meanwhile, the precise role of responsible officers must also be clearer.

'We need to be very careful that appraisers and responsible officers are trained and supported,' says Professor Field. 'And we feel that the college has a role here.'

The RCGP's plans for revalidation are now with the GMC awaiting approval. But the funding to support revalidation, and in particular remediation, is still to be decided.

'I am absolutely determined,' says Professor Field, 'that we will not have a revalidation system that alienates GPs.

'But GPs have to recognise that we will need to demonstrate our quality through such systems. We need to stand up and show how good we are, and not tolerate poor practice.'

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