Monday, 21 October 2013
Open letter to Steve Field, inspector designate of General Practice
May I congratulate you on your new post of Chief Inspector of General Practice. You are certainly well qualified for the post, having been a GP, a Course Organiser, a Regional Director of GP Education, Chair of Council of the Royal College of GPs, and Chair of the Future Forum. You have also been made a Professor, and have received awards from the Government for your work. A stellar career, for sure.
Meanwhile, I stayed a course organiser and a full-time GP.
We now see things from different perspectives.
The NHS is lurching towards a crisis. All those who are working at the front-line state that the service is hugely overstretched, and nearing crisis point. I'm sure that you have received this message from many front-line workers. The Government's solution is to marketise the system, seek cuts to be made (variously called the 'Nicholson challenge' or 'efficiency savings') . As the Chief Inspector of General Practice - a new post - you will be able to see this first hand.
The profession is as demoralised as I have ever known it. The causes for this are complex, but are based around a number of factors: firstly, the constant and vindictive sniping from aspects of the media, and also the Department of Health; secondly, increasing control from the centre through perfomance-related pay initiatives and revalidation of doctors by the generally dysfunctional GMC; thirdly the lack of investment in General Practice; fourthly, the seeming impossibility of those in power to listen to anyone at the front-line (except a few hard-line supporters in leafy shires); fifthly, the increasing demands on the service from demographic changes, as well as increased general demand. I could go on (and some of my colleagues will point to areas in this list that I have not mentioned).
There are very few people with the power and influence to affect the way in which Government policy since 1990 has been leading us to this point. The NHS was the unique selling point of this country, and in England it is being destroyed at a rapid rate. We wish to save it if we can, and you are one of the people that Government listen to.
You can achieve a lot by focussing on the role that you want, rather than the brief you have been given. Inspection should be a neutral process, and should have people doing it who are fiercely independent and are willing to point out mistakes, not only in front-line services, but how policy has caused this.
There are two role models you can follow. The first is Chris Woodhead, the second is Stephen Tumim. They were both chief inspectors - one of Ofsted and one of Prisons.
Chris Woodhead was a zealous promulgator of Government policy, and was more extreme than most of the politicians he reported to. He was, in my view, overpromoted because he was willing to do the Government's dirty work, and say things that ministers were thinking, allowing them to distance themselves from the more bizarre elements of right-wing policy. He was loathed by teachers as a hatchet man.
Stephen Tumim inspected prisons and told Governments not only what the service could do to improve the system, but also castigated Government for decisions that made it more difficult to run the service. He was independent, widely-respected and a force for good in the system.
So, Steve, I want you to ask yourself if you will follow the Woodhead model or the Tumim model? The way your colleagues see you will be directly affected by what you make of this. You have an opportunity to make a big difference.
Can you do it?