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Independents' Day

It's the workload, stupid

Editor’s blog

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The new GP contract has lived up to its billing as the profession’s biggest change in 15 years (although Scottish GPs may have something to say about that).

It’s radical and, as it was patently obvious that radical change was needed to address the crisis in general practice, that in itself should be applauded.

You can make your own mind up about whether the contract – and the move to primary care networks – is good for general practice, through our cover feature (page 6), our guide to all the key changes (page 14) and our interview with NHS England acting director of primary care Dr Nikita Kanani (page 26).

But for me, the real problem is what is not in the document. Because above all else, workload is the big, flashing neon sign hanging over the profession. I know the BMA and Dr Kanani understand this more than anyone. But I also know hands are tied. The new contract does little for workload; it may even pile on more through its organisational changes.

The contract does little for wokload, in fact it might even pile more on

As you may know, Pulse has just conducted a major workload survey. We will publish the results in April and May – and we will hold managers to account. But even the initial results point to real opportunities to use the contract to bring a swift cut in workload, such as:

No tight deadlines: Reverse the requirement for practices to decide on networks by May. GPs have enough on without such a deadline. That doesn’t mean you can’t give practices the funding now, however.

Implement a proper primary care support service: Capita has been a disaster. What about a support service that actually supports? One that eases headaches like transferring patient records, dealing with pensions or chasing claims, instead of making them worse. Maybe even one that offers support with other admin burdens, like GDPR and subject access requests.

Pretend the seven-day services pledge never happened: GPs don’t want it, patients don’t care.

Scrap CQC inspections: They are a sledgehammer to crack a nut. Most struggling practices fail due to lack of support. The tiny fraction that truly endanger patient safety are known by their neighbours and CCGs, so there’s no reason other practices should fret over soft toys and their curtains to identify them.

Scrap revalidation: See above.

Ditch the QOF: It has served its purpose. The good habits it promoted are embedded in practices and there are now diminishing returns. Put the money into the global sum.

In fact, end all these incentives once and for all: GPs do actually want to provide the best evidence-based treatment to their patients. What they don’t want is pots of funding that is tied to questionable screening or case-finding. Give the independent National Screening Committee absolute authority and put the funding for those unofficial programmes into the global sum. GPs will be happy and patients will receive evidence-based care.

Stop hospitals treating GPs as house officers: Yes, I know this has supposedly been done. But has it made any difference? Make sure the policy is enforced.

Some of these are doable, others a little more outlandish. But they all tackle the issue of workload. And they might actually take some weight off GPs’ shoulders – which has to be the priority right now.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at

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Readers' comments (6)

  • A lovely list.
    But what do you
    Really, Really Want???

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  • National Hopeless Service

    The problem is NHSE/CQC exists to 'control' General Practice. 'Managers' would be doing themselves out of some very lucrative jobs if most of this happened. I havent a clue what half the employees of my CCG do, I suspect very little thats actually useful.

    The internal market is also just rubbish. Its obstructive to patient care, has made secondary care doctors lazy and is pointlessly bureaucratic for GPs.Get rid of that too.

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  • Vinci Ho

    It is ultimately about whether you believe in this ‘new’ contract.
    But I will always say ,’ The truth cannot be condemned to be a lie and a lie can never be disguised as the truth.’
    For those up in the hierarchy, remember this :
    ‘’You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time. ‘’
    Abraham Lincoln

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  • Let common sense prevail

    Good article with some really simple 'quick wins'. Particularly scrapping CQC inspections and revalidation immediately.

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  • Lol, this list has been fobbed off for decades. Wishing for it is seriously as optimistic as winning the lottery. Do you seriously believe that the govt would provide more catch-free funding? That quangos like CQC/GMC/revalidation etc would be shut down? Politicking over the NHS e.g. 7 day service would stop? The bulk contract would be removed voluntarily? That you would get a quality support service without free market competition? Keep dreaming. All we can do is leave the NHS, en masse, if we can educate ourselves about the pros/cons, muster the courage to do so. And vote for a party that actually wants to downsize govt.

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  • What I really really want is a definition of safe workload.
    What exactly is this elusive creature?

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