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A better general practice in practice

A better general practice in practice

When I came up with the idea to formulate a better model for general practice, our clinical adviser looked at me like I was mad. Having spent most of the summer working on this, I now agree.

My fear from the start was that the quest could be a purely academic exercise. Interesting, yes, but ultimately inconclusive. But having finished, I feel it was essential. The set of principles we have devised could be the basis for a better general practice. 

At Pulse, we have long called for an end to CQC inspections, appraisal and revalidation, for more funding to be put into the global sum with fewer strings attached, for an end to secondary care workload dump, and so on. While there have been half-hearted attempts to address some of these (and Scotland seems to have had more success than the other nations), they’ve rarely led anywhere. 

To me, those changes have always seemed like a no-brainer. GPs are extremely busy, and these questionable exercises and diktats take up precious time. But I never thought about why they are so damaging beyond that waste of time. 

Now, I think I understand. What these policies have in common is they remove autonomy and trust from GPs. As our panel put it, they treat GPs as if they are naughty schoolchildren. 

This lack of respect for professionals is bad enough. What’s worse is that the approach undermines GPs’ unique skills. Every QOF point pursued takes GPs away from the patient with ambiguous but worrying symptoms; every minute spent satisfying arbitrary safety standards is one not spent checking patients the practice nurse has raised concerns about. And while the relationship with secondary care should be one of mutual respect, in reality GPs are often told to do blood tests yet cannot contact secondary care for an opinion when needed. 

It doesn’t have to be like this. The principles we have devised can quite easily be introduced via one overarching principle: trust in GPs. Trust, rather than policies based on weeding out the rare bad ones, will immediately improve healthcare for GPs and patients. 

What would this mean in practice? Giving GPs funding with no strings attached so they don’t waste time ticking boxes. Freeing them to choose the best professionals for their team. Allowing them to continue professional development (as they do, being professionals) without having to prove it. Ensuring they can work with secondary care as equals, in the best interests of patients. 

Because, believe it or not, GPs want the same as managers and patients. They understand the importance of the latest evidence-based clinical care, practising safely and keeping their skills honed. Support, rather than inspection, is what they need. 

Yes, of course there will be bad apples. But a focus on them is a greater threat to public health, especially when the methods used to find them are so inefficient. 

I see the irony of conducting a major campaign only to reach the same views we started with: abolish the CQC, transfer more money to the global sum and stop workload dump. But there is a positive message. 

Trusting GPs will bring about a better general practice for all of us.

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

Read the full analysis here

See the full list of principles here

Review all the survey results here



Please note, only GPs are permitted to add comments to articles

Vinci Ho 25 August, 2021 10:23 am

As always , many thanks to your effort , Jaimie and Pulse 😎
I would always quote my favourite line ,’ To strive, to seek, to find, and not to yield’.
Though I respect some would insist that we should all throw the towels away 😑
PS I think you sent me an invitation for an October conference , Jaimie ?? Will join you if that is the case 😃

Decorum Est 25 August, 2021 12:47 pm

Good article and totally agree.

‘Trusting GPs will bring about a better general practice for all of us.’

‘Trust, Tolerance & Reciprocity’ are stated by Social Anthropologists to be the cardinal features of a belief system (religious or civil or combination) in a functioning and developing society. Strangely, our society does not even Trust highly committed people like healthcare workers!

Sarah Annetts 25 August, 2021 1:48 pm

Another astute analysis, thank you Jaimie. I would add one more layer to it.
Not only does the current system treat GPs like naughty children: it assumes we should treat our patients like naughty children too. Rather than focus on responding to the patients who wish to consult us, we are obliged (by contracts, by funding and by cultural ‘mission creep’) to spend increasing time and effort chasing perfectly capacitous adults who ‘ought’ to be having blood tests, checking their BP or losing weight. Their life decisions and priorities (which may be entirely reasonable) impact primary care in an unhelpful way and we are incentivised to oppose them. A rethink of QoF to a more ‘adult’ system may be overdue.

Patrufini Duffy 25 August, 2021 3:35 pm

Less is more. Is not the plan for the NHS. It never will be, ever.