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

This crisis offers the chance for a radical change of mindset


In our first issue after Covid-19 truly hit the UK, we labelled it ‘the virus that will change general practice forever’. Three months on, this view has not altered.

This change could be great. I’m not talking about remote consultations, effective triage or better infection control. I’m talking about a change in mindset that will liberate GPs to do what is best for their patients. The response to the pandemic has provided a blueprint for the future.

First, the death knell should sound for pointless bureaucracy. It was acknowledged early on by health managers that practices would need to be freed from bureaucratic shackles. CQC inspections were wound down, appraisals and revalidation were put on hold, the QOF and enhanced services were suspended. This allowed practices to reconfigure services. In other words, they were able to improve patient safety and care because they weren’t having to prepare to be assessed on patient safety and care.

NHS England has said bureaucracy that was a ‘poor use of time’ should not be reinstated. Let’s hope its definition of ‘poor’ is similar to GPs’.

The GP initiatives I have heard have been awe inspiring

Second, as our cover feature this month shows, the pandemic has demonstrated just how flexible the partnership model is and what happens when GPs are trusted to adapt their services to patient need. I remember former RCGP chair Professor Helen Stokes-Lampard saying: ‘If the light bulb in my practice needs changing, one of us just changes it, we don’t need a series of delegations or committees to tell us who can, what type or precisely how to change the bulb.’

GPs have been doing much more than changing lightbulbs in the past few months. The initiatives I have heard of have been awe inspiring: redesigning surgeries to make them safe; introducing drive-through vaccinations; devising risk matrices for staff; and providing real support for shielded patients. On top of these, we’ve been inundated with positive stories, from GPs like Dr Sharon Raymond.

Of course, many of these initiatives have been borne of necessity and a lack of central support and resources. GPs only needed to source their own PPE, for example, because health authorities failed to do so. But the innovation we’ve seen would not have been possible without the partnership model.

Finally, when practices are given resources to spend as they see fit, they tend to spend them well, reconfiguring their surgeries spending only a few thousand pounds. 

Such a change of mindset would be radical. It would mean the NHS stops dictating how GPs spend funding – eg, on pharmacists or social prescribers. It would mean the NHS stops telling GPs how to organise themselves – it may be they are best off within larger federations, but that would be for GPs to decide. And it would mean the NHS stops using myriad pots of funding to force practices to fulfil the latest political whims.

This pandemic has proved GPs know their patients better than anyone. So give them the freedom to provide the best possible care for those patients.

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

Pulse voluntary donation scheme

Since the outbreak of this pandemic, Pulse has strived to support you, whether it be through our resources page, our ‘Clinical Crises’ series, holding policymakers to account with exclusives such as practices being supplied with faulty masks, or GPs being told to stop routine services in the hardest hit areas.

However, good journalism cannot be done on the cheap and, like the whole publishing industry, we have been affected by the economic slowdown. We also strongly believe the content we produce should remain free as we feel it is essential for you. Because of this, we have set up a voluntary donation scheme. There is no compulsion whatsoever to donate. But if you feel we are helping you, and you would like to support us, anything you can spare would be greatly appreciated. Read more here.

Donate here

Rate this article  (4.75 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 (7)

  • ‘I remember former RCGP chair Professor Helen Stokes-Lampard saying: ‘If the light bulb in my practice needs changing, one of us just changes it,’ etc
    Hate to say it but HSL’s ‘lightbulb’ with regard to ‘appraisal’ didn’t seem to be enlightened from the start!

    Unsuitable or offensive? Report this comment

  • Never gonna happen!

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    ‘’NHS England has said bureaucracy that was a ‘poor use of time’ should not be reinstated. Let’s hope its definition of ‘poor’ is similar to GPs’.’’

    Unfortunately, that is the bottom line held by NHSE that we could not breach . Perhaps , the political narrative had been shifted slightly as we demonstrated flexibility , agility , innovation and pragmatism in crisis management last 13 weeks . Our bottom line , though , was we did not trust NHSE at all . And it was the ‘perfect’ occasion for us to improvise with freedom while the regulatory bodies had to shut up inevitably.
    But you know , I know , sooner or later ( as both Ministries of Love have just resumed businesses) , the obsession and trepidation of ‘something would go wrong’ in a public service , namely NHS GP services , will be conjured up in the air once more .
    May be , just may be , our presumably influential ‘bigwig’ colleagues have just waken up to the reality of the true nature of our enemies in the system . Bureaucracy and technocracy are the two words they must relearn in their dictionaries.
    Early signs from the latest NICE recommendations on new obesity and cancer QOFs ( supported by some ‘top’ colleagues) are not promising at all .
    As I always say , the old die hard habits are hard to rid ........

    Unsuitable or offensive? Report this comment

  • The mindset is: remove yourself from this perpetual involvement with 'patient care'. It is an unfounded, archaic and disrespected philosophy.

    Unsuitable or offensive? Report this comment

  • yep - mind set on leaving the NHS even sooner than planned.

    Unsuitable or offensive? Report this comment

  • I am no lefty, but The new normal in primary care is probably up to us to define: the best (and probably only) time to work to rule / set limits/ limit engagement. Will we ever press our advantage? Now or never, before all the bits in the air have actually landed!

    Unsuitable or offensive? Report this comment

  • radical would replacing Pretty Crap News (PCNs). any case they are only temporary stage on the way to big budget Integrated Care Systems. More jobs for managers!

    Unsuitable or offensive? Report this comment

Have your say