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A faulty production line

Professor Thomas, GPs are a key part of the future NHS

A GP and two hospital doctors critique Professor Thomas’ latest article for the Mail

With an increasingly multi-morbid and ageing population, the demand on primary care is ever-increasing and access is often highlighted as a key problem.

Therefore Professor Meirion Thomas’ insinuation in his latest article for the Daily Mail, that a general practitioner’s role is superfluous and undemanding, shows little regard for his colleagues and undermines the public perception of their practice.

He asserts that more money has been poured in general practice is disputed by the fact that between 2008/09 and 2011/12, the total number of consultations in general practice is estimated to have risen from 300.4m to 340m.1

During this time, the proportion of the annual healthcare budget spending on primary care dropped from 10.95% in 2005/06 to 8.5% in 2011/12, despite GPs continuing to deliver over 90% of patient care contact.1,2

Professor Thomas fails to appreciate the GPs’ duty to keep up with developments in medicine, as evaluated through appraisal and revalidation, and demonstrates a serious lack of insight into the complexity of the generalist workload.

He additionally highlights the problems with the workforce and the growing need for change in the service. However, the models proposed by Professor Thomas to counter the growing workforce problem are neither new nor original.

Practices across the country already employ specialist nurses to help deliver care for long-term conditions. The Five Year Forward View highlighted that the salvation of primary care is not going to be delivered by doctors, but through a responsive, integrated service which maximises the skills of our healthcare colleagues, including nursing and allied healthcare professionals. If anything, his rhetoric only challenges academics to describe the workforce of the future, which needs to be fit to deliver sustainable primary care.

Bids for the Prime Minister’s Challenge Fund reveal that GPs, along with their hospital colleagues, are leading the way towards new models of care. For example, general practice is the only sector in healthcare that holds completely electronic patient records, as well as electronic prescribing and referrals.

The drive to reduce variability within practices across the country has been recognised by the Royal College, NHS England and the Care Quality Commission. The aim of the inspections process is not to castigate, but to improve consistency. Primary care is the bedrock for providing the care for long-term conditions, and it is recognised in the Five year Forward View that the improvement of integration of the patient care pathway is required.4

Past form

In a previous article for the Daily Mail, Professor Thomas lamented the presence of women within medicine. And yet the only sustained increase of doctors entering general practice has been female doctors, with 65% of GP trainees being female.3 Primary care or indeed any form of healthcare is not sustainable without these female doctors within the workforce.

Professor Thomas raises some key issues and highlights that changes needs to be made in order to deliver a highly effective system of out of hospital care. Changes are being made both at ground level and policy level to address these issues.

However, by unreasonably criticising his colleagues who provide the majority of care delivery is incendiary and unnecessary.

As a surgeon who works in tertiary care and also in the private sector perhaps Professor Thomas would like to visit a busy GP surgery to understand the increasingly complex nature of a GP’s workload, and the challenges involved in delivering high quality care on an increasingly constrained budget.

Dr Saira Ghafur (@sairaghafur) is a clinical fellow to the national medical director at NHS England and is a respiratory specialist registrar. Dr Roisin Finn (@Roisin_Finn) is a clinical fellow to the national medical director at NHS England and is a neurosurgical specialty registrar. Dr Nikki Kanani (@Nikki_KF) is a GP and CCG vice chair.


1 RCGP. 34m patients will fail to get appointment with a GP in 2014. 2014.

2 Health and Social Care Information Centre. Primary Care. 2014.

3 Securing the Future GP Workforce. Health Education England, March 2014.

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Readers' comments (11)

  • Look forward to comments - a reminder that this is a breech of GMC Duties of a Doctor (Domain 3, clauses 35-38) and as such he can be reported for not supporting effective working with colleagues.
    PS Not a registrar, haven't updated my profile!

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  • Absolutely idea about the real world of Primary Care. From his Ivory tower window, GPs probably ;look like little ants scurrying around. He thinks his grand experience of 1 year nearlt 4 decades ago gives him an insight into current primary care. I have a strange feeling that this has something to do with the planned dismembering of the Primary care turkey, for our US companies, but its only my opinion.

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  • This comment has been moderated.

  • Fabulous response and thank you !

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  • Has this article been sent to the daily fail also?
    Has anyone approached the Gmc with it?

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  • I won't worry about comments from people like these, as a friend of mine who is an excellent general surgeon once told me - "I never realised how difficult it is to be on-call as a GP (this was when most practices covered their patients in OOH, as pooled services in remote areas) till I did a few myself - I was scared - with chest pains, collapses, strokes going through my mind". The same holds true in an everyday surgery, and nobody can survive if they don't keep up with their CPD. So people like him should think first before..............

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  • Vinci Ho

    (1)The political mission started when CQC released the risk banding data. This had to be followed by some Agent H's subordinate(who obviously needs to know how to inflict trauma)to exploit these data ,twist the truth to condemn all GPs and threaten to wipe out all of us.
    (2) The message to us is 'stop moaning or face extinction , this is what you can get from government , take it or leave it.'
    (3) What do we call this , ladies and gentlemen ?
    (4) RULE BY FEAR. And one of the Four Freedoms identified by Franklin Roosevelt is exactly Freedom from fear, my comrades.
    (5) ''The Conservative Party has issued a voluntary code of conduct to all its MPs telling them not to "bully, abuse or harass" their employees.'' ''
    11/4/2014. BBC news

    I guess some habit is hard to rid as far as this party is concerned. Dr Sarah Wollaston, where are you these days?

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  • On the day of the article I had just returned from a 12 hour day having done 2 walk in surgeries seeing 53 pts 3 visits and a practice meeting reviewing our building expansion of our surgery. The walk in surgeries often see us seeing up to 30 pts per session. To read such an article was soul destroying and encouraging my retirement plans which is so sad at the age of 53.

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  • if GPs feel insulted please sign the below petition: copied from the comments made by Una Coales. Expressing your comments here isnt going to go far to stop this disrespectful so called colleague.

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  • Dear All
    I have signed the petition. This is the first and I hope the last I will have to sign.
    Paul C

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  • prof Thomas is a complete Jeremy

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