Field's Future Forum report to call for GPs to move into 'bigger organisations'

Dr Field is due to hand the findings of the Future Forum’s second stage review to the government over Christmas. Ministers will publish the review and their response early in the new year.

Dr Field, also the immediate past chair of the Royal College of GPs, said one of its recommendations would be for GPs to move towards working in federations – linked groups of smaller practices – or for larger practices or provider organisations.

Newly published figures analysed by HSJ this month confirm a strong link between deprived areas, poor access to GP services and high use of emergency hospital care in the NHS.

Dr Field told HSJ part of the reason was the difficulty attracting new and good GPs to small practices in poor, inner city areas which offer bad staff conditions and little training.

He said: “We need to look at innovative models of general practice - better career structures for young doctors coming out [of medical school], and GPs working together, either in federations or in bigger organisations. The day of the small practice working in splendid isolation is gone.” He said that change was among his Future Forum recommendations.

Dr Field said there also needed to be greater investment in GP and community services, and said poor performing GPs should be addressed. He said: “The future for the NHS has to be more work being done in general practice and the community and reducing unacceptable variation in access and quality of general practice.”

The Future Forum has been asked to look at integration in the NHS and its report is expected to put further focus on the subject.

Dr Field acknowledged some GPs are “not too fussed about being involved in commissioning” and said they should focus on improving services, whether as commissioners or providers.

He said: “For those who want to get involved in commissioning, we should support them [and] those who want to be involved in provision should be able to.

“We need to make sure some of the words coming out about commissioning groups encourage there to be more and more cooperation and integration between hospitals and general practice.

“What is really going to make a difference is local decision making and local service redesign. Commissioning is important if it is about planning services with managers and hospital doctors and GPs and other professions in the same room.”