This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

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

  • Print
  • 72
  • Rate
  • Save

Great GP debate logo

Great GP debate logo

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

Rate this blog  (4.65 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (72)

  • Good to see you back. This article is oh so true!

    We need a tiny number of Morlocks - but it should be something that GPs do briefly 'just before they die'.

    No one should have any role that involves commenting on another doctor's work until they have done 20 to 25 years of full-time work at the coalface in a partnership. I emphasise the full-time as it would have effectively debarred all of the most irritating blighters that I have encountered in recent years.

    Unsuitable or offensive? Report this comment

  • @sceptic monkey
    Its great to have people like you to act as a collective sort of target for all our arses.
    Phil is not arguing to stand still, but there is often a much better argument for not breaking the bits that clearly were not broken.
    2.5 days work for 1 days pay. Jeremy must love you.

    Unsuitable or offensive? Report this comment

  • It would be nice to go back to the original ancient Athenian Greek democracy. At that time those that wanted power and great public position where denied it. Only those who did not wish this were allotted for short periods of time. There was a rapid rotation of ordinary people filling powerful positions. This allowed a true democracy and stopped the development of Morlocks. I am not saying that this would sort everything out as experience still counts, but it would stop professional politicisation and the development of dynasties, which ultimately normally eventually lead to oligarchies, as we have in the world today.

    Unsuitable or offensive? Report this comment

  • You are so welcome back. Are you working as a locum/ salaried or even better, have you become a Morlock ? At least that way we willhave your wisdom and humour for years, because Morlocks are actually very very clever. They do not get burn out, they suffer no anxieties, they do not have 40 patients and 200 lab results, 50 letters and 100 prescriptions to do.
    All they have to worry about is whether they will have sole or eye fillet for lunch.
    For your sake, I do hope you are now a proper Morlock.
    Please stay for years and years.

    Unsuitable or offensive? Report this comment

  • This is spot on . Hundreds of GPs avoiding difficult ,risky clinical work - leaving a dangerous shortage. Have an input by all means but stop inventing well paid ,useless ,money wasting non clinical roles for yourselves!

    Unsuitable or offensive? Report this comment

  • Post-of-the-year-so-far 2017

    Unsuitable or offensive? Report this comment

  • Tremendous, and so, so true. So glad to see you back. Welcome home.

    Unsuitable or offensive? Report this comment

  • Elephant in the room... you have been eloquently found out!

    Unsuitable or offensive? Report this comment

  • How can we share this article.?

    Unsuitable or offensive? Report this comment

  • Spuds

    We've missed you, Phil

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say

  • Print
  • 72
  • Rate
  • Save