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CAMHS won't see you now

Mr Hunt! I know where your 5,000 extra GPs are

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The Darwinian theory of evolution applies to general practice as much as it does to anything else. When an environment changes and a new niche appears, something will evolve to fill that niche. This has happened to us in primary care.

There used to be but one type of GP; he or she would work in a practice and see patients, because that’s all there was. But in the past couple of decades a new niche has appeared, an area that contains opportunities for bureaucracy, quangos, regulation and governance. And crucially, the chance to not see patients.

As a result, GPs have evolved into two tribes; let us call them, for the sake of argument, the Eloi and the Morlocks.

The Eloi tribe, of which I was a proud member, are those of us who do the clinical stuff. We like to see patients and make clinical decisions, we are available and accountable. We avoid politics and management. We are, in fact, what the public thinks of when they think of a GP.

The Morlocks are those of us who have missed our calling. They have found out, perhaps after some time of being exposed to it, that they don’t really like clinical practice, or patients, or working out complex problems on behalf of others. But hey! Nowadays, they don’t have to!

The Morlocks seek out committees. They go into management, medical politics and clinical governance, they spend their time devising ever more complicated protocols, they develop increasingly byzantine and infuriating regimes for appraisal and revalidation, they join CQC inspection teams and CCGs, they become clinical directors. They work for NHS England. They become MPs. They don’t see many patients. And they feed on the Eloi.

We could JUST practise medicine.

If they were left to themselves, as they are still just about in a minority, it would not matter so much. They weren’t usually good clinicians anyway. But no Morlock can justify their own clinical irrelevance without imposing their influence on the Eloi, which is having a serious and deleterious effect on the way we Eloi can do our jobs. Weeks and weeks every year are taken from us as we are forced to leap through Morlock hoops, collect nonsensical data for appraisals that are no benefit to anyone other than the Morlocks. We worry that a Morlock CQC inspection team will find something vanishingly unimportant in our practices that will absorb staff and clinician time (and they always do; every Morlock suffers from Witchfinder General Syndrome) and take us away from our true calling. And they are getting very good at doing just that.

One of the major problems in general practice today is access for patients. Waiting times to see a GP are becoming untenable and unsafe; practices are underfunded and understaffed. But I can solve this problem, ladies and gentlemen, in one fell swoop, at least temporarily.

I propose a complete moratorium, for the next full year, on every appraisal, revalidation, CQC inspection, meeting, new initiative, audit, everything that takes us away from the clinical coalface. We never used to have these distractions, so a further 12 months away from this nonsense will make no odds. We could JUST practise medicine.

In addition, all those Morlocks, deprived of their toys, could join us on the front line and do some bloody proper work for a change. They could go back to their own practices, or work as salaried GPs or locums, for exactly the same remuneration that they get for doing whatever it is they pretend to do now. Except, now they’d be doing something useful, in fact what the public is crying out for.

Waiting lists would drop, consultations could be longer, patient satisfaction would go up, health outcomes would improve, and those patients who say (justifiably, in my opinion) that they attend A&E because they can’t get a GP appointment would not be able to say that any more.

I can see no flaws in this. After a year, we could go back to the depressing system we’ve got now, where one part of the profession is doing its damnedest to demoralise the rest, but I suspect that enthusiasm for this would be low (unless you’re a Morlock). If we have to have appraisals and inspections, we could do them alternate years and halve the pain.

You see, Mr Hunt, I KNOW where the extra 5,000 GPs you have promised by 2020 actually are. They’re hiding in plain sight. They’re there, but not doing anything that a normal GP would construe as useful work. And they’re sitting on a committee near you.

Dr Phil Peverley is a recovering GP in Sunderland

This blog is part of our ‘Great GP Debate’ season. If you would like to write a blog on how you see the future of general practice, then please email the Editor at

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Readers' comments (72)

  • Delighted to see you back - Pulse will once again be something I turn to in search of being cheered up!

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  • Seems to me that the 'Morlocks' are the real smart ones. Paid well, no pt contact, no risk of litigation. No ones forcing you to be an 'Eloi'.

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  • Great to have you back Phil, stay well

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    ?? no ones forcing you to be an eloi ... They are certainly all forcing us to stop being eloi's..
    How many elois required to keep a morlock in position??

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  • Cheers Phil.
    You are still on good form. Welcome back.

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  • Welcome back Phil!!

    You've absolutely nailed it!! Brilliant!!

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  • My parents always taught me that if you don't like something, don't whinge about it, do something about it. Since the whole NHS seems to be going to hell in a hand cart should I sit on the sidelines wailing & nashing my teeth? No - I decided to use my "day off" (which as we all know doesn't really exist) to do a day at the CCG trying to steer the somewhat ruderless supertanker in a direction that might benefit our patients and the clinicians of the NHS. Does this make me a Morlock? I rather thought I was one of the oppressed coal-face workers who might have risen up to try to influence things for the better! I actually spend most of my time trying to thwart plans for labyrinthine over-regulation to ensure we can just get on with our clinical jobs whilst ensuring a sustainale future. Don't fall into the trap of "divide & rule" - there are still some well-intentioned people out there!
    PS - I still see just as many patients at the practice as my colleagues.

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  • In response to 1.00 pm,you are part of the problem not the answer and should consider ceasing your activities immedeatly.
    In 1066 when the Normans conquered England(in effect all Uk eventually)about 2,000 Norman administrators and knights subdued and controlled the remaking 4-6 million population.
    In effect this is what the 'Morlock's'are doing now.
    If there is a local plan to close a DGH and relocate maternity services 100 miles away that goes out to 'Consultation'what typically happens in our dystopian world in that 99 Gp's in the area are against but they are opposed but the local Morlocks'who supports it.This gives the 'fig leaf'that the administrators needed--Bye bye hospital,Hello long journeys for Mums in labour.
    Good Governance usually demands 'a separation of the powers'.I have known (and we have been complicit in letting this happen)local Morlocks'be a part time GP partner ,whist being Clinical director of the same health body.Concurrentley sitting on the LMC and the BMA GP committee.This is akin to the President of the USA also sitting as a Senator,whilst also chairing the Supreme Court!
    Perhaps Phil should have used the 'Morlocks's' real name-'Quislings'.

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  • brilliant article. thank you

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  • Made my day when I logged in and saw you were posting again. Hope you are well recovered.

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