Chief inspector of GPs: ‘Most doctors don’t really know what bad practice can be like for patients’

The man charged with inspecting doctors explains why he may not be welcome in every surgery

As a general rule, inspectors are not popular – at least not among those who they are inspecting.

But then good inspectors know that their job is not always to win hearts and minds, but to call things as they find them in the wider public interest, even if they ruffle a few feathers in the process.

And that principle must certainly have been in the back of the mind of those on the selection panel when they appointed Steve Field to become England’s first chief inspector of GPs last year.

They needed someone tough enough to devise and implement the first comprehensive performance assessment and management regime for a notoriously independent and recalcitrant profession.

They needed someone who was part of the profession but not bound by its vested interests. And they needed someone who understood that – in politics rather than medicine – just because a doctor tells you something doesn’t always mean it is in your best interests.

And Dr Field, an engaging but undeniably tough Birmingham GP, fitted the bill rather well. The former chair of the Royal College of GPs had already survived a baptism by fire when he led the independent review into the Government’s highly controversial health reforms in 2011.

His NHS Future Forum proved to be admirably robust and did much to improve the mess that was the Health and Social Care Act. But along the way he faced professional (and sometimes personal) attacks from both sides that wanted to influence him by means fair and sometimes foul.

Looking back now he describes that time as “the hardest I’ve ever worked” before adding “since I came here”.  “It was the first time I’d done anything really political rather than clinical,” he says.

“I was independent and having to stand up to some of the politicians who wanted to do things one way or the other. But when the Prime Minister asks you to do something, that’s what you do.

“It doesn’t mean politically you are for or against anything. But people make assumptions.”

In his new job he is fully aware that when his new GP inspection regime goes live in October he could be in the firing line again. Teams of five people – including a GP, a practice manager or nurse and an “expert patient” – will visit every GP surgery in the country and for the first time rate them as outstanding, good, needs improvement or inadequate. Those judged inadequate will be placed in to special measures and will be shut down if things don’t improve. And that could prove very controversial – locally and even nationally.

Already, trial inspections have shown that a small, but significant, number of practices are under-performing.

“We are unfortunately seeing some very unacceptable practice,” Dr Field says. “There is also a big variation of care even though the majority is really good. But the poor care affects hundreds of thousands of patients. My aim is to ensure that the public have a really good service whoever they are and wherever they are.”

Dr Field says some of the problems they have been finding recently include out-of-date medicines, drugs not stored at the correct temperatures and some practices not having in place the multi-disciplinary teams needed to deliver proper care.

“The biggest problems we’re finding is medicines management,” he says. “We’re finding a lot of practices that have out of date drugs including emergency medications. Not having drugs is also a problem. If you take your child in for a vaccination you want to know it is being stored properly and know that you’re having the right vaccine.

“But if your child collapses because they are allergic to something in the vaccine you’d like to know that the surgery has got adrenaline to resuscitate you quickly and not wait for an ambulance.”

Dr Field admits that many GPs do not like this level of oversight or criticism of their professional conduct.

“A lot of people had a go at me personally because they thought I was having a go at GPs – but actually if your vaccines are out of the temperature range they might not work. If that’s the case you’re affecting hundreds of children and many adults.

He adds: “There are a fair number of GPs who are scared and there are some who don’t like the principle of being inspected because they’ve been inspected in the past by health authorities or PCTs and often those were not really professional encounters, so their experience is not good in some areas.” But he adds that he is hopeful that when the full inspection regime is up and running the profession will be won round.

“Part of what we’ve got to do is encourage improvement – it’s not just about the bottom 2 per cent. We are learning every day, and by the time we go live in October we will have got there.”

And, interestingly, unlike most chief inspectors, Dr Field will himself be inspected as he is still a partner in a GP practice in Birmingham and still see patients at least one morning a week. But he thinks that is a strength, as he hopes that his inspection regime will be regarded as a way of improving standards in the profession as a whole – of which he very much feels still apart.

“Most GPs probably don’t really know what really bad practice can be like for patients,” he says.

“And if we have got very poor practice – even in small numbers that is not good for the profession as a whole.”

It is too soon to say what new inspection regime will achieve or if – after the scandal of Mid Staff fades – there is the political will to sustain it given how expensive it will be.

But one thing is pretty clear: Steve Field looks resilient enough to call it as it is and is quite prepared not be to liked if that’s what is needed. 

One father who couldn't get One Direction tickets for his daughters phoned in a fake bomb threat and served eight months in a federal prison
people... (and one very unlucky giraffe)
Arts and Entertainment
Joel Edgerton, John Turturro and Christian Bale in Exodus: Gods and Kings
Arts and Entertainment
Brendan O'Carroll as Agnes Brown in the 2014 Mrs Brown's Boys Christmas special
tvCould Mrs Brown's Boys have taken lead for second year?
Life and Style
ebookNow available in paperback
ebookPart of The Independent’s new eBook series The Great Composers
Members and supporters of the lesbian, gay, bisexual, transgender (LGBT) community walk with a rainbow flag during a rally in July
Alexis Sanchez missed a penalty before scoring the opening goal with a header at the back post
footballLive! Sanchez makes up for penalty miss to put Arsenal ahead
Arts and Entertainment
Amy Adams and Christoph Waltz in Tim Burton's Big Eyes
film reviewThis is Tim Burton’s most intimate and subtle film for a decade
Arts and Entertainment
Jack O'Connell stars as Louis Zamperini in Angelina Jolie's Unbroken
film review... even if Jack O'Connell is excellent
Arts and Entertainment
Madonna is not in Twitter's good books after describing her album leak as 'artistic rape and terrorism'
music14 more 'Rebel Heart' tracks leaked including Pharrell Williams collaboration
Rooney celebrates with striker-partner Radamel Falcao after the pair combine to put United ahead
footballManchester United vs Newcastle match report
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Ashdown Group: Senior Marketing Executive- City of London, Old Street

    £40000 - £43000 per annum + benefits: Ashdown Group: Senior Marketing Executiv...

    Ashdown Group: Marketing Manager

    £40000 - £43000 per annum + benefits: Ashdown Group: An international organisa...

    Ashdown Group: Internal Recruiter -Rugby, Warwickshire

    £25000 - £30000 per annum: Ashdown Group: Internal Recruiter -Rugby, Warwicksh...

    Ashdown Group: Marketing Manager/Marketing Controller (Financial Services)

    £70000 - £75000 per annum + benefits: Ashdown Group: Marketing Manager/Marketi...

    Day In a Page

    A Christmas without hope: Fears grow in Gaza that the conflict with Israel will soon reignite

    Christmas without hope

    Gaza fears grow that conflict with Israel will soon reignite
    After 150 years, you can finally visit the grisliest museum in the country

    The 'Black Museum'

    After 150 years, you can finally visit Britain's grisliest museum
    No ho-ho-hos with Nick Frost's badass Santa

    No ho-ho-hos with Nick Frost's badass Santa

    Doctor Who Christmas Special TV review
    Chilly Christmas: Swimmers take festive dip for charity

    Chilly Christmas

    Swimmers dive into freezing British waters for charity
    Veterans' hostel 'overwhelmed by kindness' for festive dinner

    Homeless Veterans appeal

    In 2010, Sgt Gary Jamieson stepped on an IED in Afghanistan and lost his legs and an arm. He reveals what, and who, helped him to make a remarkable recovery
    Isis in Iraq: Yazidi girls killing themselves to escape rape and imprisonment by militants

    'Jilan killed herself in the bathroom. She cut her wrists and hanged herself'

    Yazidi girls killing themselves to escape rape and imprisonment
    Ed Balls interview: 'If I think about the deficit when I'm playing the piano, it all goes wrong'

    Ed Balls interview

    'If I think about the deficit when I'm playing the piano, it all goes wrong'
    He's behind you, dude!

    US stars in UK panto

    From David Hasselhoff to Jerry Hall
    Grace Dent's Christmas Quiz: What are you – a festive curmudgeon or top of the tree?

    Grace Dent's Christmas Quiz

    What are you – a festive curmudgeon or top of the tree?
    Nasa planning to build cloud cities in airships above Venus

    Nasa planning to build cloud cities in airships above Venus

    Planet’s surface is inhospitable to humans but 30 miles above it is almost perfect
    Surrounded by high-rise flats is a little house filled with Lebanon’s history - clocks, rifles, frogmen’s uniforms and colonial helmets

    Clocks, rifles, swords, frogmen’s uniforms

    Surrounded by high-rise flats is a little house filled with Lebanon’s history
    Return to Gaza: Four months on, the wounds left by Israel's bombardment have not yet healed

    Four months after the bombardment, Gaza’s wounds are yet to heal

    Kim Sengupta is reunited with a man whose plight mirrors the suffering of the Palestinian people
    Gastric surgery: Is it really the answer to the UK's obesity epidemic?

    Is gastric surgery really the answer to the UK's obesity epidemic?

    Critics argue that it’s crazy to operate on healthy people just to stop them eating
    Homeless Veterans appeal: Christmas charity auction Part 2 - now LIVE

    Homeless Veterans appeal: Christmas charity auction

    Bid on original art, or trips of a lifetime to Africa or the 'Corrie' set, and help Homeless Veterans
    Pantomime rings the changes to welcome autistic theatre-goers

    Autism-friendly theatre

    Pantomime leads the pack in quest to welcome all